Patent Publication Number: US-11653818-B2

Title: Camera positioning system, method, and apparatus for capturing images during a medical procedure

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This application is a continuation of U.S. patent application Ser. No. 16/435,170, filed Jun. 7, 2019, which is a continuation of U.S. patent application Ser. No. 16/156,625 now U.S. Pat. No. 10,398,287), filed on Oct. 10, 2018, entitled “CAMERA POSITIONING SYSTEM, METHOD, AND APPARATUS FOR CAPTURING IMAGES DURING A MEDICAL PROCEDURE,” the disclosure of each of which is hereby incorporated by reference in its entirety. 
    
    
     TECHNICAL FIELD 
     This disclosure relates generally to positioning a camera for imaging and more particularly to positioning a camera inside a body cavity of a patient for capturing images during a medical procedure. 
     DESCRIPTION OF RELATED ART 
     Miniaturized cameras are used during investigative medical procedures and surgical procedures, such as laparoscopic surgery and computer assisted robotic surgery, to produce images of a site of the procedure within a body cavity of the patient. A camera generally includes an illumination source for illuminating the site of the procedure and a lens for capturing images of the site. Known camera systems suffer from a variety of shortcomings, including large size, poor resolution, obstacles with being sterilized, lack of reliability, difficulties with being replaced during medical procedure, and the like. The present disclosure overcomes these and other problems associated with known camera systems, methods, and apparatuses. 
     SUMMARY 
     In some cases, a visualization device for a single port robotic surgery apparatus can include a housing configured to be positioned adjacent an insertion device of the robotic surgery apparatus and be attached to a mounting interface of the robotic surgery apparatus, the housing including an interior portion and a plurality of openings, at least some of the plurality of openings positioned on an exterior surface of the housing. The visualization device can also include a camera tube including a first end attached to the housing and a second end including at least one camera, the second end configured to be inserted through a first opening of the plurality of openings in the housing, pass through the interior portion of the housing, extend outside the housing through a second opening of the plurality of openings in the housing, and enter a channel in the insertion device, the insertion of the second end causing the camera tube to form a loop. The visualization device can also include a drive opening in the housing configured to receive a plurality of rollers configured to abut a portion of the camera tube that passes through the drive opening when the second end is inserted through the first opening, the plurality of rollers configured to move the portion of the camera tube through the drive opening and cause the second end of the camera tube to extend away from the housing through the second opening or retract back toward or inside the housing when the second end is inserted through the first opening. 
     The visualization device of any of preceding paragraphs and/or any of visualization devices described below can include one or more of the following features. The plurality of rollers can be configured to be rotated in first and second directions by a plurality of pins positioned on the exterior of the mounting interface of the robotic surgery apparatus, the plurality of pins can be configured to be actuated by at least one motor of the robotic surgery apparatus, the second direction opposite the first direction. Rotation of the plurality of rollers in the first direction can cause the second end of the camera tube to extend away from the housing through the second opening. Rotation of the plurality of rollers in the second direction can cause the second end of the camera tube to retract back toward or inside the housing. 
     The visualization device of any of preceding paragraphs and/or any of visualization devices described below can include one or more of the following features. The device can include a plurality of openings positioned on the exterior of the housing and configured to removably receive a plurality of supporting pins attached to the mounting interface of the robotic surgery apparatus. Rotation of the plurality of rollers can cause a diameter of the loop formed by the camera tube to change. Rotation of the plurality of rollers in the first direction can cause the diameter of the loop to decrease and rotation of the plurality of rollers in the second direction can cause the diameter of the loop to increase. 
     The visualization device of any of preceding paragraphs and/or any of visualization devices described below can include one or more of the following features. The camera tube can be substantially flexible, the second end can include an articulating portion terminating in a face including the at least one camera, the articulating portion can be configured to cause at least one of a pan or tilt of the face including the at least one camera, and the articulating portion can be substantially rigid to generally maintain orientation of the face including the at least one camera in a plane parallel to a plane of the channel of the insertion device when the articulating portion of the second end is passed through and exits the channel. 
     The visualization device of any of preceding paragraphs and/or any of visualization devices described below can include one or more of the following features. The visualization device can include at least one actuator positioned on the exterior of the housing and configured to be actuated by at least one motor of the robotic surgery apparatus when the housing is attached to the mounting interface of the robotic surgery apparatus, the at least one actuator configured to change a shape of the articulating portion to cause at least one of the pan or tilt of the face including the at least one camera. A change of the shape can include forming at least one bend in the articulating portion. The camera tube can enclose a plurality of links configured to be pushed or pulled to change the shape of the articulating portion to cause at least one of the pan or tilt of the face including the at least one camera, and actuation of the at least one actuator can cause at least one cable of the plurality of cables to be pushed or pulled. 
     The visualization device of any of preceding paragraphs and/or any of visualization devices described below can include one or more of the following features. At least one camera can include two cameras configured to provide a stereoscopic image of a region of interest in the body cavity, and the device further can include a light source configured to illuminate the region of interest. Plurality of rollers can include surfaces with a friction coefficient that allows the plurality of rollers to slip along the portion of the camera tube that passes through the drive opening of the housing to prevent movement of the portion of the camera tube. Plurality of rollers can provide a sterile barrier between a sterile camera tube and non-sterile mounting interface of the robotic surgery apparatus when the housing is attached to the mounting interface of the robotic surgery apparatus. 
     In some cases, a kit including the visualization device of any of preceding paragraphs and/or any of visualization devices described below and the plurality of rollers can be provided. The housing, camera tube, and the plurality of rollers can be sterile. 
     In some cases, visualization device for a single port robotic surgery apparatus can include a housing configured to be removably attached to a mounting interface of the robotic surgery apparatus and be positioned adjacent an insertion device of the robotic surgery apparatus, the housing including first and second openings positioned on an exterior of the housing. The visualization device can also include a substantially flexible camera tube including a first end attached to the housing and a second end including at least one camera, the second end configured to be inserted through the first opening in the housing, pass through an interior of the housing, and exit the housing through the second opening in the housing, the second end configured to extend away from the housing toward a region of interest outside the housing or retract away from the region of interest and back toward the housing. 
     The visualization device of any of preceding paragraphs and/or any of visualization devices described below can include one or more of the following features. The housing can be configured to receive at least one driver configured to cause movement of the camera tube away from the housing and/or toward the housing. The region of interest can include a body cavity into which an end effector is configured to be inserted. The first end of the camera tube can be removably attached to the housing. The camera tube can be configured to form a loop around at least a portion of the housing. 
     The visualization device of any of preceding paragraphs and/or any of visualization devices described below can include one or more of the following features. At least one driver can include a plurality of rollers configured to contact the camera tube and advance the camera tube toward the region of interest and retract the camera tube away from the region of interest. Rotation of the plurality of rollers in the first direction can cause the camera tube to advance and a diameter of the loop to decrease. Rotation of the plurality of rollers in the second direction opposite to the first direction can causes the camera tube to retract and diameter of the loop to increase. 
     In some cases, a robotic surgery apparatus including a mounting interface configured to support visualization device of any of preceding paragraphs or any of visualization devices described below can be provided. 
     In some cases, a kit including the visualization device of any of preceding paragraphs and/or any of visualization devices described below and the insertion device of any of preceding paragraphs and/or any of visualization devices described below can be provided. The insertion device can include a passage positioned in an interior volume of the insertion device. The passage can be configured to permit the second end of the camera tube to pass through and exit the insertion device. The insertion device can include at least one instrument channel configured to receive a surgical instrument. Central axis of at least a portion of the passage can be nonparallel with a central axis of the at least one instrument channel. At least one instrument channel can be substantially straight and at least a portion of the passage can be curved. The housing, camera tube, and the insertion device can be sterile. 
     Any of the visualization devices of any of preceding paragraphs and/or described below can be used with any of insertion devices and/or robotic surgery systems described herein. 
     In some cases, an insertion device for a single port robotic surgery apparatus can include a first portion including a plurality of instrument channels positioned in an interior of the first portion and extending along substantially an entire length of the first portion, the plurality of instrument channels configured to removably house a plurality of surgical instruments and first and second camera channels positioned in the interior of the first portion and extending along substantially the entire length of the first portion, the first camera channel configured to removably house a primary camera tube and the second camera channel comprising a secondary camera. The insertion device can also include a second portion including an insertion channel terminating at a first end with a first opening configured to permit the primary camera tube to pass through and terminating at a second end opposite the first end with a second opening aligned with the first camera channel of the first portion, the insertion channel configured to permit the primary camera tube to pass through the insertion channel and enter the first camera channel. The secondary camera facilitates insertion into a body cavity of at least one of the plurality of instruments or the primary camera tube. 
     The insertion device of any of preceding paragraphs and/or any of insertion devices described below can include one or more of the following features. The second portion can include at least one interface configured to engage and disengage at least one closure in order to attach and detach the second portion from the mounting interface of a robotic surgery apparatus. The second portion can include at least one opening configured to receive a pin positioned on the mounting interface of the robotic surgery apparatus, and wherein the at least one closure can be configured to engage and disengage the at least one pin. At least one closure can include a cam lock. 
     The insertion device of any of preceding paragraphs and/or any of insertion devices described below can include one or more of the following features. The first opening can be configured to be aligned with an opening in a visualization device including the primary camera tube, the alignment permitting the primary camera tube to pass through the insertion channel and the first camera channel. The first opening can be positioned on an exterior surface of the second portion configured to face a housing of the visualization device. The exterior surface of the second portion can include top exterior surface. 
     The insertion device of any of preceding paragraphs and/or any of insertion devices described below can include one or more of the following features. The first and second camera channels can be positioned on opposite sides of the first portion. A diameter of the first camera channel can be larger than a diameter of the second camera channel. The secondary camera can include a face positioned at a distal end of the first portion. The secondary camera can include a two-dimensional imager. The secondary camera can include an illumination device. The secondary camera can include an optical prism configured to redirect a detected image of at least a portion of the body cavity on an image sensor positioned in a different plane than the at least the portion of the body cavity. The first and second portions of the housing and the secondary camera can be sterile. 
     The insertion device of any of preceding paragraphs and/or any of insertion devices described below can include one or more of the following features. The insertion channel can include a curved portion, and wherein the plurality of instrument channels are substantially straight. Central axis of the curved portion of the insertion channel may be nonparallel with a central axis of at least one instrument channel. 
     In some cases, a kit including the insertion device of any of preceding paragraphs and/or any of insertion devices described below and the visualization device with the primary camera tube of any of preceding paragraphs and/or described below can be provided. 
     In some cases, an insertion device for a robotic surgery apparatus can include a first portion including first and second camera channels positioned in an interior of the first portion and extending along at least a portion of the first housing, the first camera channel configured to removably enclose a primary camera tube and the second camera channel configured to enclose a secondary camera. The insertion device can include a second portion including a passage configured to permit the primary camera tube to pass through, the passage aligned with the first camera channel to permit at least a portion the primary camera tube to enter the first camera channel, pass through the first camera channel, and exit the first camera channel. 
     The insertion device of any of preceding paragraphs and/or any of insertion devices described below can include one or more of the following features. The secondary camera can be integral with the second camera channel. The first portion can include an instrument channel extending along at least the portion of the housing, the instrument channel configured to removably enclose a surgical instrument. 
     The insertion device of any of preceding paragraphs and/or any of insertion devices described below can include one or more of the following features. The instrument channel can extend between a first instrument opening at a proximal end of the first portion and a second instrument opening at a distal end of the first portion, the distal end opposite the proximal end. At least one of the passage or the first instrument opening can include a substantially fluid impermeable seal. The passage can be positioned in an interior volume of the housing. Central axis of at least a portion of the passage can be nonparallel with a central axis of the instrument channel. At least a portion of the passage can be curved, and the instrument channel can be substantially straight. The passage can be configured to be aligned with an opening in a visualization device can include the primary camera tube, the alignment permitting the primary camera tube to pass through the passage and enter the first camera channel. 
     In some cases, a kit including the insertion device of any of preceding paragraphs and/or any of insertion devices described below and the visualization device of any of preceding paragraphs and/or described below can be provided. The insertion device and visualization device can be sterile. 
     In some cases, a method of operating a robotic surgery apparatus can include attaching an insertion device to a mounting interface of a robotic surgery apparatus. The method can include attaching a visualization device that includes a primary camera to the mounting interface. The method can be at least partially performed by a user, such as a nurse, surgeon, or the like. The insertion device and/or visualization device can include any of the features described in any of preceding paragraphs or below. 
     The method of any of preceding paragraphs and/or any of the methods described below can include one or more of the following features. A distal end of the primary camera can be inserted through one or more openings in the visualization device (as described in any of preceding paragraphs or below). The distal end of the primary camera can be advanced through the visualization device and into the insertion device (as described in any of preceding paragraphs or below). This can be performed by actuating one or more first actuators. The distal end of the primary camera can be advanced through the insertion device and exit the insertion device (as described in any of preceding paragraphs or below). The distal end can be advanced adjacent to or into a site of interest to obtain one or more images of at least a portion of the site of interest. At least one surgical instrument can be advanced adjacent to or into a site of interest through a channel in the insertion device. In use, the distal end of the primary camera can be advanced or retracted. 
     The method of any of preceding paragraphs and/or any of the methods described below can include one or more of the following features. The distal end of the primary camera can be articulated, such as panned and/or tilted, by actuating one or more second actuators. Actuating the one or more second actuators can cause one or more flexible links of the primary camera to be manipulated, which can cause articulation of the distal end. The one or more flexible links can be pushed and/or pulled. The insertion device can include a secondary camera that can provide one or more images of at least a portion of the site of interest. 
     The method of any of preceding paragraphs and/or any of the methods described below can include one or more of the following features. At least one of the insertion device, visualization device, or the primary camera can be sterile. The mounting interface of the robotic surgery apparatus can be non-sterile. A sterile drape can be placed over the mounting interface to provide a sterile barrier. One or more holes can be made in the drape to permit mounting the insertion device and visualization device through the drape. One or more drivers, such as rollers, configured to advance and/or retract the primary camera can be inserted into an opening in the visualization device. The one or more drivers can be attached to and actuated by the one or more first actuators, which can be positioned on the mounting interface of the robotic surgery apparatus. The one or more drivers can provide a sterile barrier between the one or more first actuators, which can be non-sterile, and the visualization device and primary camera, which can be sterile. One or more sterile covers can be used to provide a sterile barrier between other components of the mounting interface (for example, one or more pins, one or more second actuators, or the like) and one or more of the insertion device or visualization device. 
     Any of the insertion devices of any of preceding paragraphs and/or described below can be used with any of visualization devices and/or robotic surgery systems described herein. 
     In some cases, a kit including the insertion device of any of preceding paragraphs and/or any of insertion devices described below and the visualization device of any of preceding paragraphs and/or described below can be provided. 
     In some cases, a robotic surgery apparatus as described and/or illustrated is provided. In some cases, a visualization device as described and/or illustrated is provided. In some cases, an insertion device as described and/or illustrated is provided. 
     In some cases, a method of using and/or operating a robotic surgery apparatus as described and/or illustrated is provided. In some cases, a method of using and/or operating a visualization device as described and/or illustrated is provided. In some cases, a method of using and/or operating an insertion device as described and/or illustrated is provided. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       Embodiments of the present disclosure will now be described hereinafter, by way of example only, with reference to the accompanying drawings in which: 
         FIG.  1    illustrates a robotic surgery system in accordance with some embodiments; 
         FIGS.  2 A- 2 B  illustrate insertion and visualization devices according to some embodiments; 
         FIGS.  3 A- 3 D  illustrate an insertion device according to some embodiments; 
         FIGS.  4 A- 4 C  illustrate a visualization device according to some embodiments; 
         FIGS.  5 A- 5 E  illustrate a mounting interface of a drive unit of a robotic surgery system according to some embodiments; 
         FIGS.  6 A- 6 I  illustrate attachment of insertion and visualization devices to a mounting interface of a drive unit of a robotic surgery system according to some embodiments; 
         FIGS.  7 A- 7 H and  8    illustrate visualization devices with imagers according to some embodiments; 
         FIGS.  9 A- 9 B and  10 A- 10 B  illustrate visualization and/or insertion devices according to some embodiments; 
         FIGS.  11  and  12 A- 12 D  illustrate drive units of a robotic surgery system according to some embodiments. 
     
    
    
     DETAILED DESCRIPTION 
     Overview 
     When performing medical procedures (for example, with assistance of surgery using a robotic surgical system) one or more instruments can be inserted into a body cavity of a patient. The insertion process has some risk since instruments may inadvertently damage organs or tissue while being inserted. Incorrect positioning of the one or more instruments in the body cavity may also result in a limited range of motion within the body cavity. 
     As an example, when performing abdominal surgery, at least one incision would be made in a body wall of the patient&#39;s abdomen. A trocar or other access port, may then be inserted through the incision. A camera can be first inserted through the access port and used by a surgeon to capture and relay stereoscopic images of a surgical site. One or more instruments can be inserted following the camera insertion. Views provided by the camera facilitate insertion of the one or more instruments and their manipulation of the surgical site. 
     Referring to  FIG.  1   , a robotic surgery system in accordance with some embodiments is shown generally at  100 . In some implementations, the robotic surgery system  100  can be configured to facilitate a medical procedure performed via a single incision. A single access port can be inserted into the incision to provide access for one or more instruments and cameras. 
     The system  100  can include a workstation  102  and a patient cart  104 . The patient cart  104  can include a central unit or drive unit  106  to which instrument insertion and visualization devices  108  can be attached or mounted. The workstation  102  can include an input device  112  that receives operator input and produces input signals and may also be configured to generate feedback to the operator. The feedback can be visual, auditory, haptic, or the like. The input device  112  can be implemented using a haptic interface available from Force Dimension, of Switzerland, for example. 
     The workstation  102  can further include a master processor circuit  114  in communication with the input device  112  for receiving the input signals and generating control signals for controlling the robotic surgery system, which can be transmitted to the patient cart  104  via an interface cable  116 . In some cases, transmission can be wireless and interface cable  116  may not be present. The input device  112  can include right and left hand controllers  122  and  124 , which are configured to be grasped by the operator&#39;s hands and moved to produce input signals at the input device  112 . The patient cart  104  can include a slave processor circuit  118  that receives and the control signals from the master processor circuit  114  and produces slave control signals operable to control the instrument insertion and visualization devices  108  and one or more instruments (and their respective end effectors) during a surgical procedure. The one or more instruments can include dexterous tools, such as grippers, needle drivers, staplers, dissectors, cutters, hooks, graspers, scissors, coagulators, irrigators, suction devices, that are used for performing a surgical procedure. While both master and slave processor circuits are illustrated, in other embodiments a single processor circuit may be used to perform both master and slave functions. The workstation  102  can also include a user interface, such as a display  120  in communication with the master processor circuit  114  for displaying information (such as, body cavity images) for a region or site of interest (for example, a surgical site, a body cavity, or the like) and other information to an operator. The workstation  102  can also include one or more controllers, such as one or more pedals  126 , for controlling the robotic surgery system. For example, one or more pedals  126  can include a clutch pedal that allows repositioning one or more controllers  122  or  124  without corresponding movement of the associated instrument. 
     Referring to  FIG.  2 A , in some embodiments, insertion and visualization devices  108  can include an insertion device  210  and a visualization device  220 . The insertion device  210  can include a housing  212  and a plurality of passages, lumens, or channels  214  for inserting and guiding one or more instruments. The plurality of channels  214  can be enclosed in another housing. The two housings can be connected. As is illustrated, the plurality of channels, such as radial channels, can be formed within a housing, which can be radially shaped. The plurality of channels  214  can also permit insertion of a camera lumen, cable, elongate shaft, or tube  224 . As is illustrated, a distal end  224 B of the camera tube can extend beyond the housing including the plurality of channels  214 . At least a portion of the distal end  224 B can be positioned near or in the site of interest. One or more cameras can be positioned at the distal end  224 B. The camera tube  224  can also include a proximal end  224 A as described herein. In some embodiments, a channel of the plurality of channels  214  can house or support a camera in addition to or instead of the one or more cameras of the camera tube  224 . 
     The visualization device can include a housing  222  to which the proximal end  224 A of the camera tube can be removably (or non-removably) attached. The housing  222  can include an opening in which a one or more drivers, such as at least one of  232 A or  232 B, can be positioned. As described herein, the one or more drivers can move the camera tube  224  through the opening in the housing  222  and a channel of the plurality of channels  214  so that the distal end  224 B extends away from one or more of the housings  212  or  222  or retracts back toward or into one or more of the housings  212  or  222 . The camera tube  224  can form a loop around at least a portion of the housing  222  as illustrated in  FIGS.  2 A- 2 B . The diameter of the loop can be increased when the distal end  224 B is retracted toward or into one or more of the housings  212  or  222  and be decreased when the distal end  224 B is extended away from one or more of the housings  212  or  222 . With reference to  FIG.  2 B , for example, when the distal end  224 B is substantially fully retracted, the loop can have a diameter  262  as shown. When the distal end  224 B is being extended away from the one or more of the housings  212  or  222 , the diameter  264  of the loop decreases as compared to the diameter  264  of the loop. When the distal end  224 B if fully extended away from the one or more of the housings  212  or  222 , the diameter  268  of the loop can be smaller than the diameters  262  and  264 . In some cases, extending the distal end  224 B away from the one or more of the housings  212  or  222  causes the length of the proximal end  224 A to decrease, which leads to a decrease in the diameter of the loop. 
     One or more cables  240  can be used to transmit control signals and data, such as analog or digital image data provided by the one or more cameras positioned at the distal end  224 B or in the insertion device  210 , to the patient cart  104 . In some cases, transmission can be wireless and one or more cables  240  may not be present. 
     At least a portion of the camera tube  224  can be flexible or substantially flexible in order to form a loop and/or be guided through the one or more openings and/or channels are described herein. In some cases, looping the camera tube  224  upward around at least the portion of the housing  222  as described can permit the camera tube to have sufficient length for reaching near and/or into the site of interest, while eliminating or reducing the risk of the camera tube  224  coming into contact with non-sterile object, such as the floor. 
     Insertion Device 
       FIG.  3 A  illustrates a front perspective view of the insertion device  210  according to some embodiments. The housing  212  of the insertion device can include an opening  330  configured (for example, sized and/or shaped) to permit the camera tube  224  to pass through the housing  212 . The opening  330  can include a seal, which may be covered by a closure (such as a latch), to prevent ingress of fluid, gas, or solids. Any of the seals described herein can include one or more valves, such as a duckbill valve. As illustrated in  FIG.  3 D  showing a cross-section view of the insertion device  210 , the housing  212  can include an interior passage  322  connecting the opening  330  to a channel  320  configured (for example, sized and/or shaped) to permit the camera tube  224  to pass through the channel. The interior passage  322  can be a channel positioned in an interior of the housing. The interior passage  322  can be bent or curved to facilitate various positional configurations of the visualization device  220  with respect to the insertion device  210  and in particular the housing  222  with respect to housing  212 . The interior passage  322  can include an opening that aligns with or includes the opening  300  and another opening that aligns with or includes opening of the channel  320 . In some cases, sealing material can be used on or around the interior passage  322  in addition to or instead of the seal in the opening  330 . As illustrated in  FIG.  2 A , the distal end  224 B of the camera tube  224  can exit the channel  320  and extend away from the insertion device  210  toward a site of interest, such as a surgical site, body cavity, wound, or the like. Also, the distal end  224 B of the camera tube  224  can retract toward or into the channel  320  toward the insertion device  210  and away from the site of interest. 
     The plurality of channels  214  can include one or more instrument channels  340  configured (for example, sized and/or shaped) to permit one or more instruments to pass through and extend away from the insertion device  210  toward the site of interest. As is illustrated, there can be two channels for left and right instruments. 
     In some cases, the interior passage  322  includes at least a portion with a central axis parallel to a central axis of the one or more instrument channels  340 . The interior passage  322  can include at least a portion (for example, the curved portion illustrated in  FIG.  3 D ) with a central axis not parallel to a central axis of the one or more instrument channels  340 . 
     The plurality of channels  214  can include a channel  310  for one or more cameras of the insertion device  210 . In some implementations, a camera can be positioned at a distal end of the plurality of channels (or at or near position of the arrow  310 ). Such one or more cameras (which can be referred to as a secondary camera) can facilitate positioning adjacent to or insertion into the site of interest of at least one of one or more instruments or at least one of the one or more cameras of the visualization device  220  (such cameras can be referred to as a primary camera). The secondary camera can include a substantially flexible or substantially rigid lumen, cable, or elongate shaft that is inserted into the channel  310 . The secondary camera can be integrated with the insertion device  210  or be removable. An opening of the channel  310  can include one or more seals, which may be covered by a closure (such as a latch), to prevent ingress of fluid, gas, or solids. In some cases, sealing material can be used on or around the opening of the channel  310  in addition to or instead of the seal(s) in the opening. 
     With reference to  FIG.  3 C , a secondary camera  324  can include a substantially flexible or rigid cable with a proximal end  324 A and a distal end  324 B. The distal end  324 B can include a protector  370  (such as glass or plastic). The protector  370  can protect an imager and/or other components of the secondary camera breaking or malfunctions due to, for example, coming into contact with fluid in the site of interest. In other embodiments, a protector may be included as part of the insertion device  210  at a distal end of the channel  310 , and accordingly the protector  370  may be optional. The secondary camera can include one or more lenses that focus light from and/or reflected by at least the portion of the site of interest on an image sensor  384 . The image sensor can be positioned at the proximal end  324 A and/or distal end  324 B. The one or more lenses can include concave and/or convex lenses. In some cases, one or more lenses can be moved to adjust the zoom (such as, an optical zoom). The image sensor  384  can detect the light and convert it to image information or data. For instance, the image sensor  384  can measure brightness at a plurality of points. The image sensor  384  can include at least one of charge-coupled devices (CCDs), complementary metal-oxide-semiconductor (CMOS) image sensors, or the like. The image sensor  384  can be a digital and/or analog image sensor. In some implementations, the secondary camera can include two or more cameras (for example, to produce a stereoscopic image). 
     In some cases, the secondary camera  324  can include an optical system  382  that redirects the detected light. For example, the optical system  382  can be a prism that redirects the detected light down onto the image sensor  384 . The image sensor  384  can be positioned in a different plane than a portion of the surgical site being imaged. The optical system  382  may be omitted in some implementations. For example, the optical system  382  may be omitted when the image sensor is positioned in the same plane as the surgical site being imaged. 
     The secondary camera  324  can be removable. For example, the secondary camera cable can be inserted into and/or removed from the channel  310 . When the secondary camera cable is removed, the channel  310  can be used for one or more of suction or irrigation of the site of interest. The channel  310  can alternatively or additionally be used to permit an instrument (such as, third instrument) to be inserted. The instrument can be controlled by the robotic surgery system or manually by a user. A protector would not be included at a distal end of the channel  310  or would otherwise be removable when the channel  310  is used for one or more of aspiration, irrigation, instrument manipulation, or the like. 
     In some cases, the primary camera can be a stereo or stereoscopic camera, which can produce three-dimensional representation of at least a portion of the site of interest, and the secondary camera can be a two-dimensional camera. The secondary camera can have lower resolution than the primary camera. For example, the secondary camera can have 1920×1080 pixels (or 1080p) resolution. The primary camera can have resolution of 1080p, 4K, 8K, or the like. The channel  310  for the secondary camera can be smaller in size (such as, narrower or having smaller diameter) than the channel  320  for the primary camera. The secondary camera may also include an illumination device for illuminating the site of interest. The illumination device can be incorporated as part of the secondary camera such that the illumination device and a lens system of the secondary camera all fit within the diameter of the channel  310 . In some cases, the illumination device may be an annular system with strands of fiber wrapping around a lens system for causing illumination to be provided to the site of interest using known means of fiber illumination. 
     In some cases, close proximity of the instrument channels  340  to one or more camera channels  310  or  320  can permit single port surgery. 
     The housing  212  can include one or more attachment mechanisms  360 . For example, the one or more attachment mechanisms  360  can be buttons positioned on opposite sides of the housing  212 . The buttons can be configured to removably attach the insertion device  210  to a mounting interface of the drive unit  106  (or, in some cases, additionally or alternatively to the housing  222  of the visualization device  220 ). Pushing the buttons can release the insertion device  210  from the mounting interface (and/or the housing  222  of the visualization device  220 ). The one or more attachment mechanisms  360  can permit attachment to and release of the insertion device  210  from supporting pins of the mounting interface (and/or the housing  222 ). 
       FIG.  3 B  illustrates a rear perspective view of the insertion device  210  according to some embodiments. Openings of the one or more instrument channels  340  can include one or more seals, which may be covered by a closure (such as a latch), to prevent ingress of fluid, gas, or solids. In some cases, sealing material can be used on or around at least one of the one or more openings of the one or more channels  340  in addition to or instead of the seal(s) in the one or more openings. The housing  212  can include one or more openings  350  for receiving one or more supporting rods of pins, which can be positioned on the mounting interface. The one or more attachment mechanisms  360  can permit attachment to and release of the insertion device  210  from the supporting pins (and/or from the visualization device  220 ). For example, the one or more attachment mechanisms  360  can activate or release a latch or lock, such as a cam lock, cam lock with a spring, or the like. 
     Visualization Device 
       FIG.  4 A  illustrates a front perspective view of the visualization device  220  according to some embodiments. The housing  222  of the visualization device can include openings  410  and  412  configured (for example, sized and/or shaped) to permit the camera tube  224  to pass through. As illustrated, the proximal end  224 A of the camera tube  224  (illustrated for convenience without a middle portion) can be attached to the housing. The camera tube  224  can loop around at least the portion of the housing  222  when the distal end  224 B is inserted through one or more of the openings  410  and  412  (see  FIG.  2 A ). The openings  410  and  412  can be aligned to permit the camera tube  224  to pass through. A bottom opening (not illustrated) aligned with the opening  412  can be positioned on the bottom of the housing  222  to permit the camera tube  224  to exit the housing  222  after passing through an interior portion of the housing (such as, the interior portion illustrated in  FIG.  4 C ). This bottom opening can be positioned adjacent to (such as over or on top of) the opening  330  in the housing of the insertion device  210  when the visualization device  220  is positioned adjacent to and/or attached to the insertion device. One or more of the openings  410 ,  412 , or the bottom opening can include a seal, which may be covered by a closure (such as a latch) as described herein. 
     The housing  222  can include a drive opening  414 . The drive opening can be positioned on a side of the housing  222  (for example, the back of the housing) that attaches to the mounting interface of the drive unit  106  as described herein. The drive opening  414  can be configured (for example, sized and/or shaped) to receive one or more drivers (at least one of  232 A or  232 B), such as a plurality of drive rollers as described herein (see, for example,  FIG.  2 A ). With reference to  FIG.  2 A , the plurality of drive rollers can include right drive roller  232 A and left drive roller  232 B (collectively, referred to as  232 ). When inserted through the opening  410 , the camera tube  224  is positioned between the right and left drive rollers  232 A and  232 B and contacts the drive rollers. The drive rollers  232  can contact, grip, or abut the camera tube  224 . The drive rollers can advance the camera tube  224  down or retract it up through the drive opening  414 . Movement of the drive rollers  232  in a first direction can advance the camera tube  224  forward or down through the drive opening  414  in order to advance the distal end  224 B toward the site of interest. For example, the right driver roller  232 A can spin counterclockwise and the left drive roller  232 B can spin clockwise in order to advance the camera tube  224  forward. Such combination of the counterclockwise and clockwise movement of the drive rollers can constitute the first direction. Movement of the drive rollers  232  in a second direction can retract the camera tube  224  backward or up through the drive opening  414  in order to retract the distal end  224 B away from the site of interest. For example, the right drive roller  232 A can spin clockwise and the left drive roller  232 B can spin counterclockwise in order to retract the camera tube  224  backward. Such combination of the clockwise and counterclockwise movement of the drive rollers can constitute the first direction. For each of the right and left drive rollers, movement in the second direction can be opposite to movement in the first direction even in cases where drive rollers spin in opposite directions during movement in the first and/or section direction. 
     Drive rollers  232  can have an external surface that is made out of and/or is covered by soft material, such as rubber, foam, or the like, that grips an external surface of the camera tube  224  in order to one or more of advance or retract the camera tube. In some embodiments, a portion of the camera tube  224  positioned between the drive rollers  232  can slip along the drive rollers, and as a result the camera tube would not be advanced or retracted. For example, slipping can be advantageous when a user&#39;s limb becomes caught in the loop formed by the camera tube  224  or in case of malfunction to prevent or lessen the risk of injury to the user or damage to one or more of the camera tube  224 , the visualization device  220 , the insertion device  210 , or any other part of the system  100 . At least one of one or more of the material on the external surface of the drive rollers  232  or on an external surface of the camera tube  224  or a surface pattern on the surface of one or more of the external surface of the drive rollers  232  or the external surface of the camera tube  224  can be selected to have a friction coefficient that results in slippage in case force on the camera tube exceeds a maximum force, such as, a maximum frictional force. The maximum frictional force can depend on one or more of the friction coefficient between the drive rollers  232  and camera tube  224  or a clamping force between the drive rollers  232  and camera tube  224 . In some cases, the maximum frictional force can be 5N or less or more, 7N or less or more, 10N or less or more, or the like. Surface pattern on the external surface of the drive rollers  232  (and/or the external surface of the camera tube  224 ) can affect the friction coefficient. For example, ribbed surface pattern, toothed surface pattern, or the like can increase the friction coefficient compared to a smooth or substantially smooth surface pattern. 
     At least a portion of the distal end  224 B of the camera tube  224  can articulate to permit viewing of at least a portion of the site of interest. The housing  222  can include one or more actuators  420  configured to control movement of the distal end  224 B of the camera tube  224 , which can include one or more cameras. In some cases, a first actuator can control pitch or tilt (up/down movement) of the distal end  224 B, and a second actuator can control yaw or pan (left/right movement) of the distal end  224 B. The first and second actuators can control movement of the distal end  224 B by manipulating links positioned in the interior of the camera tube  224  as described herein (for example, with reference to  FIGS.  4 B- 4 C ). 
     The housing  222  can include one or more attachment mechanisms  428 . For example, the one or more attachment mechanisms  428  can be buttons positioned on opposite sides of the housing  222 . The buttons can be configured to removably attach the visualization device  220  to the mounting interface of the drive unit  106  (or, in some cases, additionally or alternatively to the housing  212  of the insertion device  210 ). Pushing the buttons can release the insertion device  210  from the mounting interface (and/or the housing  212 ). The one or more attachment mechanisms  428  can permit attachment to and release of the visualization device  220  from one or more supporting rods or pins (and/or the housing  212 ). As described herein, the one or more attachment mechanisms  428  can activate or release a lock, such as a cam lock, cam lock with spring, or the like. The housing  222  can include one or more openings  424  for receiving one or more the supporting pins that can be positioned on the mounting interface. 
       FIG.  4 B  illustrates a perspective view of the distal end  224 B of the camera tube  224  according to some embodiments. An imager  430  (which can be the primary camera) with one or more cameras can be positioned at or near the tip of the distal end  224 B. The distal end  224 B can include a pitch or tilt segment or section  442  for controlling up/down movement of the distal end  224 B, and a yaw or pan segment section  444  for controlling left/right movement of the distal end  224 B. As illustrated, the tilt section  442  can be positioned adjacent the imager  430 , and the pan section  444  can be positioned adjacent to the tilt section. Pan section  444  can be positioned farther away from the tip of the distal end  224 B than the tilt section  442 . In some cases, positioning of the sections  442  and  444  relative to the tip can be reversed. In some cases, the sections  442  and  444  can be intermingled with respective couplings or guides (as described below) of the sections  442  and  444  alternating. 
     At least one of sections  442  or  444  can include one or more couplings or guides  434 . The one or more couplings  434  can be coupled to each other to allow bending of the distal end  224 B. The sections  442  and  444  can bend (as described herein) as a result of at least one of pulling or pushing one or more flexible or substantially flexible links  448  positioned in the interior of the camera tube  224  that control, for example, the bend, curvature, or another aspect of spatial orientation of one or more of sections  442  or  444 . One or more links  448  can include a wire, cable, or the like with elasticity that can support at least one of tension or compression without permanent deformation. One or more links  448  can be connected to the one or more guides  434  (for example, by being connected to the one or more guides in the interior of the camera tube  224 ). Movement, such as pulling and/or pushing, of the one or more links  448  can cause adjustment of the spatial orientation of the one or more guides  434  and, as a result, one or more sections  442  or  444 . 
     As described herein, one or more actuators  420  can pull and/or push the one or more links  448 , for example, via rotation in first and/or second directions. Pulling a link  448  can cause shortening its length, while pushing the link can cause lengthening the link (such as, returning the link substantially to its initial length). 
     Segment or section  446  can be positioned adjacent the pan section  444  at the distal end  224 B of the camera tube  224 . As described herein, section  446  can be flexible or substantially flexible. One or more of sections  442  or  444  can be rigid or substantially rigid to prevent at least the imager  430  of the distal end  224 B from drooping or sagging as the distal end  224 B exits the channel  320  of the insertion device. Drooping or sagging can undesirably lead to at least a temporary loss of vision of at least a part of the site of interest or inadvertent contact with tissue near or outside the site of interest. Rigidity of the one or more sections  442  or  444  can prevent movement of the distal end  224 B in a downward direction (for example, in the absence of actively tilting the camera tube  224  as described herein), while permitting movement in the opposite direction as the camera tube  224  is passed through one or more openings or channels, as described herein. Rigidity can help maintain orientation of at least the imager  430  in same plane of the channel  320  or in a plane above the plane of the channel  320  as the distal end  224 B of the camera tube  224  exits the channel  320 . The latter plane can be parallel or substantially parallel to the plane of the channel  320 . 
     In some cases, to increase the rigidity of the distal end  224 B, a supporting material or mechanism may be added to the distal end  224 B to help maintain orientation of at least the imager  430  in the same plane of the channel  320 . Such design can prevent the camera from drooping and/or contacting unwanted areas of the site of interest. The supporting material or mechanism can allow the distal end  224 B to flex (or curve) in one direction in a plane while preventing other flexing (or curving), thereby allowing the distal end  224 B to move through a curved portion of the interior passage  322  of the housing  212 . With reference to  FIG.  3 D , for instance, flexing in the direction of the bend or curve of the interior passage  322  can be permitted, while flexing in the other direction may not be permitted. 
       FIG.  4 C  illustrates a cross-sectional view of the housing  222  and camera tube  224  of the visualization device  220  according to some embodiments. The figure depicts view of an interior portion of the housing  222  looking up through the opening  412  in the housing  222 . Proximal end  224 A of the camera tube  224  can be attached to the housing  222  as described herein. As illustrated, interior of the proximal end  224 A can include one or more links  448  that extend along the length of the camera tube  224  to the distal end  224 B, as described herein. In use, the camera tube  224  passes through the interior portion illustrated in  FIG.  4 C . 
     The one or more actuators  420  can include first and second actuators that, respectively, control tilting or panning of the distal end  224 B of the camera tube  224 . For example, the first actuator can control pulling and/or pushing of one or more links  448  connected to a plurality of guides in the tilt section  442 . The first actuator can control tilting up/down of at least the imager  430 . The second actuator can control pulling and/or pushing of one or more links  448  connected to a plurality of guides in the pan section  444 . The second actuator can control left/right movement of at least one of the tilt section  442  and/or the imager  430 . 
     Pulling and/or pushing at least one link  448  can be performed via actuating the first and/or second actuator  420 . With reference to the first actuator, for instance, its exterior portion that protrudes from the housing  222  can serve as a shaft connected to a drum  450  located in the interior of the housing  222 . Rotation of the shaft and drum can cause a corresponding link pulley  460  to rotate, for example, in a plane perpendicular to the plan of rotation of the shaft and drum. The pulley  460  can be connected to the drum  450  such that rotation of the drum causes the pulley to rotate. The drum  450  can have threading on the surface that contact threading on the surface of the pulley  460  and transfers rotation to the pulley. The pulley  460  can be connected to at least one link  448 . For instance, the at least one link can be attached to the pulley. Rotation of the actuator  420  in a first direction (for example, clockwise) can cause rotation of the corresponding shaft (for example, in the same clockwise direction). This can cause the corresponding pulley  460  to rotate and, for instance, pull (or push) the associated at least one link, which can cause tilting of at least the imager  430 . In some cases, the pulley  460  can be connected to a pair of links  448  one of which is pulled while the other is pushed to control the tilting. Second actuator can operate similarly to control the panning. 
     Additional details of controlling one or more of the tilt or pan of the distal end  224 B of the camera tube are similar to those described in U.S. Patent Publication No. 2016/0143633 and U.S. Pat. No. 9,629,688, which are assigned to the assignee of the present application and the disclosure of each of which is incorporated by reference in its entirety. 
     Mounting Interface and Sterile Barrier 
       FIG.  5 A  illustrates the drive unit  106  of the robotic surgery system  100  according to some embodiments. The drive unit  106  can include a mounting interface  500  configured to support one or more of the insertion device  210  or visualization device  220 . The mounting interface can include an opening or slit  504  for receiving a looped portion of the camera tube  224  (see, for example,  FIG.  6 I ). 
       FIG.  5 B  illustrates a perspective view of the mounting interface  500  according to some embodiments. The mounting interface  500  can include one or more posts or pins  510  configured to actuate one or more drivers  232  for moving the camera tube  224  as described herein. As illustrated, the pins  510  can be provided to support the rollers  232 A and  232 B. The pins  510  can be configured (for example, sized and/or shaped) to attach to the rollers  232 A and  232 B. For example, the pins  510  can be hexagonal, and the rollers  232 A and  232 B can include hexagonal openings (see, for example,  FIG.  5 D ) configured (for example, sized and/or shaped) to be mounted on the hexagonal surface of the pins  510 . In some cases, one or more shapes such as square, round, triangular, or the like can be used in addition to or instead of hexagonal. 
     The mounting interface  500  can include one or more actuators  520  for causing movement of the one or more actuators  420  of the visualization device  220 . As illustrated, two actuators  520  can be provided, and they can include shafts or recesses configured (for example, sized and/or shaped) to receive protruding exterior portions of the actuators  420 . Within the recesses, the actuators  520  can include surfaces configured (for example, sized and/or shaped) to mate with the surfaces of the protruding exterior portions of the actuators  420 . The mating can provide attachment of the actuators  420  of the visualization device  220  to the actuators  520  of the mounting interface  500 . 
     As described herein, the mounting interface  500  can support one or more of the insertion device  210  or visualization device  220 . As illustrated in  FIG.  5 B , the visualization device  220  can be at least partially supported by the pins  510  supporting the drivers  232  that are placed in the recess  414  of the housing  222 . The mounting interface  500  can include one or more pins  530  configured to support the insertion device  210 . The one or more pins  530  can be configured (for example, sized and/or shaped) to be received in the one or more openings  350  of the insertion device  210 . The one or more pins can have size, shape, and/or surface pattern configured to be attached to insertion device  210 . For example, as is illustrated, a left pin  530  can have a groove, pattern, or indentation  552  at or near its tip. The indentation  552  can be configured (for example, sized and/or shaped) to mate with a surface in the interior of the left opening  350  (see, for example,  FIG.  3 B . This can provide attachment of the insertion device  210  to the mounting interface  500 . As described herein, one or more attachment mechanisms  360  can operate to disengage the visualization device  210  from the mounting interface  500 . For example, one or more attachment mechanisms  360  can be pressed to disengage mating of the surface in the interior of the left opening  350  with the indentation  552 . The right pin  530  can have a similar groove, pattern, or indentation  552  at its tip on the side facing the left pin. 
       FIG.  5 C  illustrates a rear view of the mounting interface  500  according to some embodiments. The mounting interface can include a first set of actuators  532 , a first set of gears  534  connected to or attached to the first set of actuators  532 , and a second set of gears  536  cooperating with the first set of gears  534 . These components can be collectively configured to actuate the one or more pins  510 . As illustrated, the first set of actuators  532  can include two actuators, the first set of gears  534  can include two gears, and the second set of gears  536  can include two gears. In some cases, the first set of actuators can be motors, for example, electric motors. 
     The first set of gears  534  can interlock with the second set of gears  536 . In some cases, the first set of actuators  532  can be configured to rotate the first set of gears  534  attached to the first set of actuators  532 . Rotation of the first set of gears  534  can cause the second set of gears  536  to rotate in a plane perpendicular to the plane of rotation of the first set of gears  534 . The one or more pins  510  can be connected or attached to the second set of gears  536 . Rotation of the second set of gears  536  can cause rotation of the one or more pins  510 . Rotation of the one or more pins  510  can cause rotation of the one or more drivers  232  and movement of the camera tube  224 , as described herein. Rotation of the one or more pins  510  and one or more drivers  232  can be in the first and/or second direction to advance and/or retract the camera tube  224 , as described herein. Rotation in the first and/or second direction can be caused by movement of the one or more actuators in at least two directions (for example, clockwise or counterclockwise). 
     The mounting interface  500  can include a second set of actuators  542 , a third set of gears  544  connected to or attached to the second set of actuators  542 , and a fourth set of gears  546  cooperating with the third set of gears  544 . Collectively these components can be configured to actuate the one or more actuators  520 . As illustrated, the second set of actuators  542  can include two actuators, the third set of gears  544  can include two gears, and the fourth set of gears  546  can include two gears. In some cases, the first set of actuators can be motors, for example, electric motors. 
     The second set of actuators  542 , third set of gears  544 , and fourth set of gears  546  can cooperate with each other and operate to actuate the one or more actuators  520  similarly to the foregoing description of actuating the one or more pins  510 . As described herein, movement of the actuators  520  and corresponding movement of the actuators  420  of the visualization device  220  can cause the camera tube  224  to tilt and/or pan. 
       FIG.  5 D  illustrates the mounting interface  500  prepared for supporting one or more of the insertion device  210  or visualization device  220  according to some embodiments. In some implementations, a sterile barrier may need to be provided between the mounting interface  500  of non-sterile drive unit  106  and the insertion device  210  and/or sterile visualization device  220 . The insertion and visualization devices,  210  and  220 , may be required to be sterile in order to protect the site of interest from infection in case of one or more of the insertion or visualization device coming into contact with the site of interest or with another sterile component of the system  100  (such as, an instrument) that may come into contact with the site of interest, with a user performing or assisting with the surgery. 
     One or more drivers  232  (for example, rollers) can be sterile and can be attached to or mounted on the one or more pins  510  of non-sterile mounting interface  500 . A sterile cover  550  can be attached to or mounted to cover the one or more pins  530 . With reference to  FIG.  5 B , the cover  550  can be mounted in a region  560  on a front surface of the mounting interface  500 . The cover  550  can be secured with one or more closures (not illustrated). For example, the one or more closures can be pins that are pushed in by the cover  550  when it is mounted in the region  560 . Pushing of the pins can cause a closure, such as a latch, to become closed. The cover  550  can be removed from the region  560 , for example, by pressing a button positioned on the bottom surface of the mounting interface  500  (not shown), which can push the pins against the cover  550  and dislodge the cover. 
     The cover  550  can include a bottom set of pin covers for covering the one or more pins  530 . The cover  550  can include a top set of pins  540  that can be configured to support the visualization device  220  when it is attached to the mounting interface  500 . The set of pins  540  can be sized and/or shaped to be received in the one or more openings  424  of the visualization device  220 . The set of pins  540  can have size, shape, and/or surface shape configured to be attached to the visualization device  220 , for example, as described herein in connection with the pins  530 . 
     With reference to  FIG.  5 E , in some implementations, the mounting interface  500  can include one or more pins  530 ′ configured (for example, sized and/or shaped) to support the visualization device  220 . For example, the one or more pins  530 ′ can function similar to the one or more pins  540 . One or more pins  530 ′ can be covered by the cover  550 , such as by pin covers  540 . In some cases, as illustrated in  FIG.  5 E , individual covers  550 ′ can be used to cover each of the one or more pins  530  and/or  430 ′. In some embodiments, two separate covers can be used to cover the one or more pins  530  and  430 ′ respectively. In some implementations, a single cover  550  (as illustrated in  FIG.  5 D ) but with pin covers replacing the top set of pins  540  can be used to cover the one or more pins  530  and  530 ′. 
     In some cases, a sterile barrier can be formed between one or more actuators  420  of the visualization device (see, for example,  FIG.  4 A ) and one or more actuators  520  of the mounting interface (see for example,  FIG.  5 B ) in one or more of the following ways. One or more actuators  420  can be covered by one or more sterile covers as described herein. A sterile drape can be placed over the drive unit  106  and the mounting interface. Drape material can flex and/or slip to provide the sterile barrier. Drape material can have appropriate thickness and/or other properties to allow for the flexing and/or slippage. The drape can include one or more sterile covers (which can function as actuators) that transfer motion between the one or more actuators  420  and one or more actuators  520 . The one or more sterile covers can be embedded or integrated into the drape. 
     The one or more drivers  232  and one or more covers  550  can serve as at least a partial sterile barrier between the mounting interface  500  and the insertion and visualization devices and the camera tube  224 . Any one or more of the drivers  232 , one or more of the covers  550 , or any other sterile barriers disclosed herein can be disposable or can be reused after being sterilized. For example, the one or more sterile covers  550  can be made out of plastic and be disposable. As another example, rollers  232 A and  232 B can be disposable. 
     Any of the sterile components described herein can be sterilized by fluid or gas (such as ethylene oxide (EtO)), heat (such as autoclaving), irradiation (such as gamma irradiation), or the like. For example, the one or more openings in the insertion device  210  and/or visualization device  220  can facilitate fluid or gas to contact exterior and interior surfaces during sterilization. 
     Docking the Insertion and Visualization Devices 
       FIG.  6 A  illustrates the insertion device  210 , visualization device  220 , one or more covers  550 , drivers (such as rollers)  232 A and  232 B, and the mounting interface  500  of the drive unit  106  according to some embodiments. As illustrated in  FIG.  6 B , a sterile drape  600  can be placed over drive unit  106  (and, in some cases, other parts of the robotic surgery system) to provide additional or alternative sterile barrier. For example, the drape  600  can act as a sterile barrier permitting a user performing or assisting with the surgery to touch the drive unit  106 . One or more holes  610  can be made in the drape  600  to permit one or more pins  510 ,  530 , and/or  540  or  530 ′ to be accessed. Positions and sizes of the one or more holes  610  can correspond to positions and sizes of the one or more pins. The drape  600  can be pulled tight around the drive unit  106  and other components of the system  100  as illustrated in  FIG.  6 C . The drape  600  can be held in place with one or more of ties, adhesive attachments, magnetic attachments, or the like. 
     The drivers  232 A and  232 B can be mounted on the one or more pins  510  as illustrated in  FIG.  6 D  and described herein. The one or more pins  510  can be exposed through corresponding one or more holes  610  in the drape  600 . One or more covers  550  can be mounted on one or more pins  530  and/or  530 ′ as illustrated in  FIG.  6 E  and described herein. The one or more pins  530  and/or  530 ′ can be exposed through corresponding one or more holes  610  in the drape  600 . 
     The visualization device  220  can be mounted on (or docked to) the mounting interface  500  as illustrated in  FIG.  6 F  and described herein. The camera tube  224  (which can be sterile) can be inserted into the visualization device  220  as described herein. At least a portion of the loop of the camera tube  224  can be positioned in the slit  504  as shown. The drape  600  can include enough slack to allow the camera tube  224  and surrounding drape material to be placed in the slit  504 . In some cases, the drape  600  can include a portion shaped to generally correspond with the slit  504  to facilitate positioning of the portion of the loop of the camera tube  224  in the slit  504 . 
     The insertion device  210  can be mounted on (or docked to) the mounting interface  500  as illustrated in  FIG.  6 G  and described herein. In some cases, the insertion device  210  may have already been placed near or into the site of interest prior to being mounted on the mounting interface  500 . In such cases, the drive unit  106  can be brought toward the insertion device  210  for docking the insertion device. The order of the mountings (or connections or dockings) can be interchanged. For example, the visualization device  220  can be mounted on the mounting interface  500  after the drive unit  106  has been docked with the insertion device  210 . The visualization device  220  and insertion device  210  can be independent from each other (for example, modular) so that the visualization device  220  can be changed during surgery if it breaks down or otherwise becomes unresponsive without the need to first undock the insertion device  210  (and any instruments which may have been placed through the insertion device). 
     Camera tube  224  can be advanced though the visualization device  220  and inserted into the interior of the insertion device  210  as illustrated in  FIG.  6 H  and described herein. Camera tube  224  can be further advanced through the interior of the insertion device  210  so that the distal end  224 B exits the insertion device  210  as illustrated in  FIG.  6 I  and described herein. The distal end  224 B of the camera tube  224  can be advanced near or into the site of interest. Then, one or more instruments (which can be sterile) can be inserted and advanced near or into the site of interest. 
     In some cases, a user, such as a nurse, can insert one or more instruments, dock one or more of the visualization device or insertion device on the mounting interface  500 , and advance and/or retract the camera tube  224 . A surgeon operating the robotic surgical system  100  can cause the camera tube  224  to be advanced and/or retracted. For example, the surgeon can operate the camera tube  224  once the distal end  224 B of the camera tube has been inserted into the opening  410  and past opening  412 . 
     Operation of a Visualization Device 
     As described herein, the visualization device  220  can include an imager, such as the imager  430  illustrated in  FIG.  4 B . The imager can be positioned at or near the tip of the distal end  224 B of the camera tube  224 . As described below, the imager can be oriented in various positions in the camera tube  224 . 
       FIG.  7 A  illustrates a combination  700 A of an image module or imager  702 , which can be similar to the imager  430 , and a distal end  750  of the insertion device  210 . The imager  702  can include one or more cameras  710  and one or more illumination channels  720  in which one or more illumination devices can be positioned. The one or more illumination devices can illuminate at least a portion of the site of interest to permit viewing of the at least one portion. The one or more illumination devices can include one or more light sources, such as light emitting diodes (LEDs), optical fibers, or the like. As illustrated, in some cases, two (or more) cameras  710  can be used in order for the imager  702  to operate as a stereoscopic imager, and to produce three-dimensional representation of at least a portion of the site of interest. Each of the cameras  710  can include one or more lenses  730  that focus light from and/or reflected by at least the portion of the site of interest on an image sensor  740 . The one or more lenses  730  can include concave and/or convex lenses. In some cases, one or more lenses  730  can be moved to adjust the zoom (such as, an optical zoom). The image sensor  740  can detect the light and convert it to image information or data. For instance, the image sensor  740  can measure brightness at a plurality of points. The image sensor  740  can include at least one of charge-coupled devices (CCDs), complementary metal-oxide-semiconductor (CMOS) image sensors, or the like. The image sensor  740  can be a digital and/or analog image sensor. In some implementations, one camera  710  can be used or more than two cameras can be used. 
     The imager  702  can be positioned in the camera tube  224 , such as at or near the tip of the distal end  224 B of the camera tube. For example, the imager  702  can be at least partially inserted into the camera tube  224 . As illustrated in  FIG.  7 A  and described herein, the camera tube  224  with the distal end  224 B can be inserted in a channel of the plurality of channels  214  of the insertion device  210 . As described herein, such channel can be the channel  320 . A protector  760  (such as glass or plastic) can be positioned in the camera tube  224  closer to the tip than the imager  702 . The protector  760  can protect the imager  702  from breaking or malfunctions due to, for example, coming into contact with fluid in the site of interest. The imager  702  can serve as the primary camera as described herein. A secondary camera can be positioned in the channel  310  as described herein. 
     In some cases, the imager  702  can be included inside an imaging module (not shown) that may be hermetically sealed and that is coupled or otherwise mounted to the distal end  224 B of the camera tube. The imaging module enclosing the imager  702  could be removably mounted and allow the ability to have the imaging module and camera tube  224  manufactured and/or packaged at separate locations. A variety of imaging modules (for example, with different orientations) can be provided as described herein. 
     Different orientations of the imager  702  in the camera tube  224  of the visualization device  220  can provide different advantages for exploring the site of interest. In some embodiments, the imager  702  can be positioned along or substantially along a central axis  792  of the distal end  224 B of the camera tube  224  as illustrated in an arrangement  700 B of  FIG.  7 B . In such orientation, the imager is not tilted down or up with respect to the distal end  224 B of the camera tube when the proximal end is extended away from the insertion device  210  toward the site of interest. A field of view  770  of the imager  702 , which can represent an area or region in which the imager obtains or captures image data, can be oriented along or substantially along the central axis  792 . The field of view  770  can encompass a region straight ahead of the distal end  224 B of the camera tube  224 . 
     Advantageously, in some cases, the imager  702  of the arrangement  700 B can provide image data of at least a portion of the site of interest when the site is positioned in front of the insertion device  210 . For example, the imager  702  can “look straight ahead” or provide image data of a region in front as the distal end  224 B of the camera tube  224  exits the channel of the insertion device  210 . When the insertion device  210  is positioned adjacent the site of interest, imager positioning in the arrangement  700 B can permit viewing the site of interest. This can be important, for example, to facilitate safe insertion of at least a portion of the distal end  224 B (along with, for example, the primary camera) into the site of interest. 
     In some cases, the one or more channels  340  are positioned below the channel  320  through which the distal end  224 B of the camera tube  224  is passed. With reference to  FIG.  7 C , when one or more instruments are inserted through one or more channels  340 , it may be desirable to orient the imager  702  of the arrangement  700 B to obtain a field of view oriented at least partially downward. For example, the imager  702  can be positioned to “look down” at the one or more instruments. Orienting the field of view  770  at least partially downward can advantageously permit viewing of the insertion of one or more instruments  758  into the site of interest. This can facilitate safe insertion of the one or more instruments into the site of interest. 
     As illustrated in  FIG.  7 C , in order to orient the field of view  770  at least partially downward, the distal end  224 B of the camera tube  224  may be bent along a plurality of segments or sections  762 B and  764 B. As described herein, section  764 B can correspond to the tilt section  442 , and section  762 B can correspond to the pan section  444 . Both sections  762 B and  764 B may be bent to orient the imager  702  to provide image data relating to the position of the one or more instruments  758 . 
       FIG.  7 D  illustrates an arrangement  700 D in which the imager  702  is tilted downward at an angle θ relative to the central axis  792 . The angle θ is formed between the central axis  792  and a central axis  794  of the imager  702 . The angle θ can be 10 degrees or less or more, 15 degrees or less or more, 20 degrees or less or more, or the like. Tilting the imager  702  downward can cause the field of view  770  to be oriented at least partially downward. Advantageously, the field of view  770  can capture at least a portion of the region in front (which, for example, can be the site of interest as described herein) as well as at least a portion of the region below the imager  702 . The arrangement  700 D can permit viewing of the position of the one or more instruments  758  as well as viewing of at least the portion of the site of interest. This can facilitate insertion of both the primary camera and the one or more instruments  758 . 
     As illustrated in  FIG.  7 E , the field of view  770  in the arrangement  700 D can be further oriented downward by bending the distal end  224 B of the camera tube  224  along a plurality of segments or sections  762 D and  764 D. These sections can be similar to sections  762 B and  764 B of the arrangement  700 B (shown in  FIG.  7 C ), respectively. The angle or curvature of the bend in at least one of the sections  762 D and  764 D can be smaller than in at least one of the sections  762 B and  764 B, respectively. This reduction can be due to initially tilting the imager  702  downward at the angle θ. 
       FIG.  7 F  illustrates an arrangement  700 F in which the imager  702  is positioned downward at approximately 90 degree angle relative to the central axis  792 . The field of view  770  captures a region below the imager  702 . This can be advantageous to facilitate insertion of the one or more instruments  758 . The field of view  770  may not capture or substantially not capture at least a portion of the region in front of the imager  702 . In order to capture at least the portion of this region, the distal end  224 B of the camera tube  224  can be bent along a segment or section  762 F as illustrated in  FIG.  7 G . This orientation can facilitate insertion of the primary camera. Comparing with the arrangements  700 B and  700 D, adjustment of the orientation of a single segment  762 F may be sufficient. 
     As illustrated in arrangement  700 H of  FIG.  7 H , in order to capture at least a portion of a region behind the imager  702 , the distal end  224 B of the camera tube  224  may be bent along a plurality of segments or sections  762 H and  764 H. These sections can similar to sections  762 B and  764 B of the arrangement  700 B, respectively. The field of view  770  of the arrangement  700 H can permit viewing of the one or more instruments  758  being advanced through the one or more channels in the insertion device  210 . 
     In some cases, a second or another imager can be provided in the arrangement  700 F, in which the imager  702  is positioned substantially downward. For example as illustrated in  FIG.  8   , such second imager  802  can be positioned along or substantially along the central axis of the distal end  224 B of the camera tube  224  similarly to the arrangement  700 B. The second imager  802  can provide an additional field of view  870  to the field of view  770  of the imager  702 . 
     The field of view  870  can capture at least a portion of the region in front of the second imager  802 . This can facilitate insertion of the primary camera, which can include both imagers  702  and  802 . 
     In some implementations, the imager  702  can be tilted up. For example, this can be advantageous when one or more channels through which one or more instruments are inserted are positioned above the channel  320  through which the distal end  224 B of the camera tube  224  is passed. 
     As described herein, the imager  702  can be oriented differently relative to the central axis  792  of the distal end  224 B of the camera tube  224 . The imager  702  can be positioned substantially along the central axis  792 , perpendicular to the central axis, or at any angle between 0 degrees and 90 degrees (facing up or down) relative to the central axis. Varying the orientation of the imager  702  can adjust the orientation of the field of view  770  of the imager. A suitable orientation of the imager  702  can be selected based on a desired field of view  770 . 
     In some cases, one or more actuators configured to adjust orientation of the imager  702  can be provided. For example, the one or more actuators can include one or more motors. Advantageously, orientation of the imager  702  can be adjusted in operation. 
     Movement of Primary Camera 
     Oher mechanisms for advancing and/or retracting a camera tube can be used. In some cases, a movement device can travel along with the camera tube. For example,  FIGS.  9 A- 9 B  illustrate an insertion and/or visualization device  920  with a movement device  930  configured to travel vertically (or, in some cases, horizontally) to advance and/or retract a camera tube  924 .  FIG.  9 A  illustrates a distal end  924 B of the camera tube  924  extending at a maximum distance toward the site of interest (such as, fully extended). In this position, the movement device  930  is moved downward, such as to the bottom position in a housing  922 , to advance the distal end  924 B.  FIG.  9 B  illustrates the distal end  924 B of the camera tube  924  extending at a maximum distance away from the site of interest (such as, fully retracted). In this position, the movement device  930  is moved upward, such as to the top position in the housing  922 , to retract the distal end  924 B. 
     The movement device  930  can include one or more actuators (for example, one or more motors) that move the movement device up and/or down (or, in some cases, left and/or right) within the housing  922 . For example, the movement device  930  can move along a rail or post  940 . In some cases, the rail  940  can include a chain for facilitating or guiding movement of the movement device. The movement device can include additional one or more actuators configured to tilt and/or pan one or more cameras positioned in the camera tube  924 . 
     As illustrated in  FIGS.  10 A- 10 B , a movement device  1030  may be positioned outside and/or away from a housing of an insertion and/or visualization device  1020 . The movement device  1030  can move downward to advance a distal end  1024 B of a camera tube toward the site of interest. The movement device  1030  can move upward to retract the distal end  1024 B. As illustrated, the movement device  1030  can downward and/or upward at an angle to the vertical axis. 
     In some cases, a movement device can be substantially stationary and the camera tube may not form a loop as described herein. For example,  FIG.  11    illustrates a drive unit  1106  supporting (for example, on top) a movement device  1130  configured to advance and/or retract a camera tube  1124  that includes a proximal end  1124 A and a distal end  1124 B. The movement device  1130  can advance and/or retract the distal end  1124 B of the camera tube  1124  along substantially horizontal direction (or, in some cases, a vertical direction). The proximal end  1124 A of the camera tube  1124  can provide “slack” or sufficient camera tube length to advance the distal end  1124 B to a maximum distance toward the site of interest (or away from the drive unit  1106 ). In some cases, the movement device  1130  can be positioned at another location on the drive unit  1106  or be supported by another component of a robotic surgery system. 
     In some cases, at least a portion of the camera tube can be substantially rigid. For example,  FIG.  12 A  illustrates perspective view of a movement device  1230  supported by a drive unit  1206 . The movement device  1230  can be positioned at the rear of the drive unit  1206 . The movement device  1230  can be configured to advance and/or retract a camera tube  1224  that includes a proximal end  1224 A and a distal end  1224 B.  FIG.  12 B  illustrates a bottom view showing one or more openings  1240  for one or more instruments (not shown). In operation, the one or more instruments can be positioned adjacent to the camera tube  1224 . In some cases, the movement device  1230  can be positioned at another location on the drive unit  1206  or be supported by another component of a robotic surgery system. 
       FIG.  12 C  illustrates the camera tube extending at maximum distance away from the site of interest (such as, fully retracted). In this position, a movement portion or mover  1232  can be fully retracted. For example, the mover  1232  can retracted backward and oriented outside an interior portion of the drive unit  1206 . Movement of the mover  1232  can cause the movement device  1230  to move in the same direction. The camera tube  1224  can be attached or connected to the movement device  1230 , and movement of the movement device  1230  can cause the camera tube  1224  to move in the same direction. Also illustrated are one or more actuators  1220  configured to control tilt and/or pan of one or more cameras positioned in the camera tube  1224 . 
       FIG.  12 D  illustrates the camera tube extending at maximum distance toward the site of interest (such as, fully extended). In this position, the mover  1232  can be fully extended. For example, the mover  1232  can be extended forward and oriented in the interior portion of the drive unit  1206 . As described, at least a portion of the camera tube  1224  can be substantially rigid at least because the proximal end  1224 A may be maintained as substantially straight. For instance, the proximal end  1224 A may not be bent in contrast with, for example, in  FIG.  11   ). The proximal end  1224 A can include the substantially rigid portion. Advantageously, having the substantially rigid portion may prevent the camera tube  1224  coming into contact with unsterile surface or object, such as the floor, because of the length of the slack. 
     Advantageously, using a visualization device configured to cause the camera tube to form a loop as described herein can reduce or eliminate the risk of a camera tube coming into contact with an unsterile surface or object. Advantageously, drivers configured to rotate (such as, rollers) to advance/retract the camera tube as described herein can facilitate reducing the size of a visualization device. 
     Other Variations 
     Those skilled in the art will appreciate that, in some embodiments, additional components and/or steps can be utilized, and disclosed components and/or steps can be combined or omitted. For example, although some embodiments are described in connection with a robotic surgery system, the disclosure is not so limited. Systems, devices, and methods described herein can be applicable to medical procedures in general, among other uses. As another example, certain components can be illustrated and/or described as being circular or cylindrical. In some implementations, the components can be additionally or alternatively include non-circular portions, such as portions having straight lines. As yet another example, any of the actuators described herein can include one or more motors, such as electrical motors. As yet another example, in addition to or instead of controlling tilt and/or pan of a camera, roll (or spin) can be controlled. For example, one or more actuators can be provided for controlling the spin. 
     The foregoing description details certain embodiments of the systems, devices, and methods disclosed herein. It will be appreciated, however, that no matter how detailed the foregoing appears in text, the systems, devices, and methods can be practiced in many ways. The use of particular terminology when describing certain features or aspects of the disclosure should not be taken to imply that the terminology is being redefined herein to be restricted to including any specific characteristics of the features or aspects of the technology with which that terminology is associated. 
     It will be appreciated by those skilled in the art that various modifications and changes can be made without departing from the scope of the described technology. Such modifications and changes are intended to fall within the scope of the embodiments. It will also be appreciated by those of skill in the art that parts included in one embodiment are interchangeable with other embodiments; one or more parts from a depicted embodiment can be included with other depicted embodiments in any combination. For example, any of the various components described herein and/or depicted in the figures can be combined, interchanged, or excluded from other embodiments. 
     With respect to the use of substantially any plural and/or singular terms herein, those having skill in the art can translate from the plural to the singular and/or from the singular to the plural as is appropriate to the context and/or application. The various singular/plural permutations can be expressly set forth herein for sake of clarity. 
     Directional terms used herein (for example, top, bottom, side, up, down, inward, outward, etc.) are generally used with reference to the orientation or perspective shown in the figures and are not intended to be limiting. For example, positioning “above” described herein can refer to positioning below or on one of sides. Thus, features described as being “above” may be included below, on one of sides, or the like. 
     It will be understood by those within the art that, in general, terms used herein are generally intended as “open” terms (for example, the term “including” should be interpreted as “including but not limited to,” the term “having” should be interpreted as “having at least,” the term “includes” should be interpreted as “includes but is not limited to,” etc.). It will be further understood by those within the art that if a specific number of an introduced claim recitation is intended, such an intent will be explicitly recited in the claim, and in the absence of such recitation no such intent is present. For example, as an aid to understanding, the following appended claims can contain usage of the introductory phrases “at least one” and “one or more” to introduce claim recitations. However, the use of such phrases should not be construed to imply that the introduction of a claim recitation by the indefinite articles “a” or “an” limits any particular claim containing such introduced claim recitation to embodiments containing only one such recitation, even when the same claim includes the introductory phrases “one or more” or “at least one” and indefinite articles such as “a” or “an” (for example, “a” and/or “an” should typically be interpreted to mean “at least one” or “one or more”); the same holds true for the use of definite articles used to introduce claim recitations. In addition, even if a specific number of an introduced claim recitation is explicitly recited, those skilled in the art will recognize that such recitation should typically be interpreted to mean at least the recited number (for example, the bare recitation of “two recitations,” without other modifiers, typically means at least two recitations, or two or more recitations). 
     The term “comprising” as used herein is synonymous with “including,” “containing,” or “characterized by,” and is inclusive or open-ended and does not exclude additional, unrecited elements or method steps. 
     Conditional language, such as “can,” “could,” “might,” or “may,” unless specifically stated otherwise, or otherwise understood within the context as used, is generally intended to convey that certain embodiments include, while other embodiments do not include, certain features, elements, and/or steps. Thus, such conditional language is not generally intended to imply that features, elements, and/or steps are in any way required for one or more embodiments or that one or more embodiments necessarily include logic for deciding, with or without user input or prompting, whether these features, elements, and/or steps are included or are to be performed in any particular embodiment. 
     Language of degree used herein, such as the terms “approximately,” “about,” “generally,” and “substantially” as used herein represent a value, amount, or characteristic close to the stated value, amount, or characteristic that still performs a desired function and/or achieves a desired result. For example, the terms “approximately”, “about”, “generally,” and “substantially” may refer to an amount that is within less than 10% of, within less than 5% of, within less than 1% of, within less than 0.1% of, and/or within less than 0.01% of the stated amount. 
     It will be further understood by those within the art that any disjunctive word and/or phrase presenting two or more alternative terms, whether in the description, claims, or drawings, can be understood to contemplate the possibilities of including one of the terms, either of the terms, or both terms. For example, the phrase “A or B” will be understood to include the possibilities of “A” or “B” or “A and B.” Further, the term “each,” as used herein, in addition to having its ordinary meaning, can mean any subset of a set of elements to which the term “each” is applied. 
     Conjunctive language such as the phrase “at least one of X, Y, and Z,” unless specifically stated otherwise, is otherwise understood with the context as used in general to convey that an item, term, etc. may be either X, Y, or Z. Thus, such conjunctive language is not generally intended to imply that certain embodiments require the presence of at least one of X, at least one of Y, and at least one of Z. 
     The above description discloses embodiments of systems, apparatuses, devices, methods, and materials of the present disclosure. This disclosure is susceptible to modifications in the components, parts, elements, steps, and materials, as well as alterations in the fabrication methods and equipment. Such modifications will become apparent to those skilled in the art from a consideration of this disclosure or practice of the disclosure. Consequently, it is not intended that the disclosure be limited to the specific embodiments disclosed herein, but that it cover all modifications and alternatives coming within the scope and spirit of the subject matter embodied in the following claims.