Patent Publication Number: US-2023135444-A1

Title: Instrument roll control

Description:
RELATED APPLICATION(S) 
     This application is a continuation of International Patent Application No. PCT/IB2022/051376, filed Feb. 16, 2022, entitled INSTRUMENT ROLL CONTROL, which claims priority to U.S. Provisional Application No. 63/150,318, filed Feb. 17, 2021, entitled INSTRUMENT ROLL CONTROL, the disclosures of which are hereby incorporated by reference in their entirety. 
    
    
     BACKGROUND 
     Certain robotic medical procedures can involve the use of shaft-type instruments, such as endoscopes, which may be inserted into a patient through an orifice (e.g., a natural orifice) and advanced to a target anatomical site. Such medical instruments can be manually rotatable, such that the shaft of the instrument rolls about an axis thereof. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       Various embodiments are depicted in the accompanying drawings for illustrative purposes and should in no way be interpreted as limiting the scope of the inventions. In addition, various features of different disclosed embodiments can be combined to form additional embodiments, which are part of this disclosure. Throughout the drawings, reference numbers may be reused to indicate correspondence between reference elements. 
         FIG.  1    illustrates an embodiment of a robotic medical system including a shaft-type instrument coupled to a robotic end effector in accordance with one or more embodiments. 
         FIG.  2    illustrates a robotic system arranged for diagnostic and/or therapeutic bronchoscopy in accordance with one or more embodiments. 
         FIG.  3    illustrates a table-based robotic system in accordance with one or more embodiments. 
         FIGS.  4 - 1  and  4 - 2    illustrate medical system components that may be implemented in any of the medical systems of  FIGS.  1 - 3    in accordance with one or more embodiments. 
         FIG.  5    illustrates a shaft-type instrument disposed in portions of the urinary system of a patient in accordance with one or more embodiments. 
         FIG.  6    shows an exploded view of an instrument manipulator assembly associated with a robotic arm in accordance with one or more embodiments. 
         FIGS.  7 A and  7 B  show cut-away perspective views of an instrument handle in accordance with one or more embodiments. 
         FIG.  8    shows a cut-away view of an instrument handle in accordance with one or more embodiments. 
         FIG.  9    shows a cut-away view of an instrument handle in accordance with one or more embodiments. 
         FIGS.  10 - 1 ,  10 - 2 , and  10 - 3    show perspective views of a roll axle assembly in accordance with one or more embodiments. 
         FIG.  10 - 4    shows an exploded view of the roll axle assembly shown in  FIGS.  10 - 1 ,  10 - 2 , and  10 - 3    according to one or more embodiments. 
         FIGS.  11 A,  11 B, and  11 C  show perspective views of certain instrument handle components, including an axle catch in a locked position, in accordance with one or more embodiments. 
         FIGS.  12 A,  12 B, and  12 C  show perspective views of certain instrument handle components, including an axle catch in an unlocked position, in accordance with one or more embodiments. 
         FIGS.  13 - 1  and  13 - 2    show perspective views of certain instrument handle components including an axle catch in accordance with one or more embodiments. 
         FIGS.  14 - 1  and  14 - 2    show a roll-lock feature for an instrument in unlocked and locked configurations/states, respectively, in accordance with one or more embodiments. 
         FIGS.  15 - 1 ,  15 - 2 , and  15 - 3    provide a flow diagram for a process for rolling an instrument shaft in accordance with one or more embodiments. 
         FIGS.  16 - 1 ,  16 - 2 , and  16 - 3    show certain images corresponding to various blocks, states, and/or operations associated with the process of  FIGS.  15 - 1 ,  15 - 2   , and  15 - 3 , respectively, in accordance with one or more embodiments. 
     
    
    
     DETAILED DESCRIPTION 
     The headings provided herein are for convenience only and do not necessarily affect the scope or meaning of the claimed invention. Although certain preferred embodiments and examples are disclosed below, inventive subject matter extends beyond the specifically disclosed embodiments to other alternative embodiments and/or uses and to modifications and equivalents thereof. Thus, the scope of the claims that may arise herefrom is not limited by any of the particular embodiments described below. For example, in any method or process disclosed herein, the acts or operations of the method or process may be performed in any suitable sequence and are not necessarily limited to any particular disclosed sequence. Various operations may be described as multiple discrete operations in turn, in a manner that may be helpful in understanding certain embodiments; however, the order of description should not be construed to imply that these operations are order dependent. Additionally, the structures, systems, and/or devices described herein may be embodied as integrated components or as separate components. For purposes of comparing various embodiments, certain aspects and advantages of these embodiments are described. Not necessarily all such aspects or advantages are achieved by any particular embodiment. Thus, for example, various embodiments may be carried out in a manner that achieves or optimizes one advantage or group of advantages as taught herein without necessarily achieving other aspects or advantages as may also be taught or suggested herein. 
     Although certain spatially relative terms, such as “outer,” “inner,” “upper,” “lower,” “below,” “above,” “vertical,” “horizontal,” “top,” “bottom,” “lateral,” and similar terms, are used herein to describe a spatial relationship of one device/element or anatomical structure to another device/element or anatomical structure, it is understood that these terms are used herein for ease of description to describe the positional relationship between element(s)/structures(s), such as with respect to the illustrated orientations of the drawings. It should be understood that spatially relative terms are intended to encompass different orientations of the element(s)/structures(s), in use or operation, in addition to the orientations depicted in the drawings. For example, an element/structure described as “above” another element/structure may represent a position that is below or beside such other element/structure with respect to alternate orientations of the subject patient or element/structure, and vice-versa. It should be understood that spatially relative terms, including those listed above, may be understood relative to a respective illustrated orientation of a referenced figure. 
     Certain reference numbers are re-used across different figures of the figure set of the present disclosure as a matter of convenience for devices, components, systems, features, and/or modules having features that may be similar in one or more respects. However, with respect to any of the embodiments disclosed herein, re-use of common reference numbers in the drawings does not necessarily indicate that such features, devices, components, or modules are identical or similar. Rather, one having ordinary skill in the art may be informed by context with respect to the degree to which usage of common reference numbers can imply similarity between referenced subject matter. Use of a particular reference number in the context of the description of a particular figure can be understood to relate to the identified device, component, aspect, feature, module, or system in that particular figure, and not necessarily to any devices, components, aspects, features, modules, or systems identified by the same reference number in another figure. Furthermore, aspects of separate figures identified with common reference numbers can be interpreted to share characteristics or to be entirely independent of one another. In some contexts features associated with separate figures that are identified by common reference numbers are not related and/or similar with respect to at least certain aspects. 
     The present disclosure provide systems, devices, and methods for implementing and controlling roll of an instrument shaft, such as a medical endoscope. With respect to medical instruments described in the present disclosure, the term “instrument” is used according to its broad and ordinary meaning and may refer to any type of tool, device, assembly, system, subsystem, apparatus, component, or the like. In some contexts herein, the term “device” may be used substantially interchangeably with the term “instrument.” Furthermore, the term “shaft” is used herein according to its broad and ordinary meaning and may refer to any type of elongate cylinder, tube, scope (e.g., endoscope), prism (e.g., rectangular, oval, elliptical, or oblong prism), wire, or similar, regardless of cross-sectional shape. It should be understood that any reference herein to a “shaft” or “instrument shaft” can be understood to possibly refer to an endoscope. 
     Medical Procedures 
     Although certain aspects of the present disclosure are described in detail herein in the context of renal, urological, and/or nephrological procedures, such as kidney stone removal/treatment procedures, it should be understood that such context is provided for convenience and clarity, and robotic and manual instrument shaft roll concepts disclosed herein are applicable to any suitable medical procedures, such as robotic bronchoscopy. However, as mentioned, description of the renal/urinary anatomy and associated medical issues and procedures is presented below to aid in the description of the inventive concepts disclosed herein. 
     In certain medical procedures, such as ureteroscopy procedures, elongate medical instruments that access the treatment site through an access sheath may be utilized to remove debris, such as kidney stones and stone fragments or other refuse or contaminant(s), from the treatment site. Kidney stone disease, also known as urolithiasis, is a medical condition that involves the formation in the urinary tract of a solid piece of material, referred to as “kidney stones,” “urinary stones,” “renal calculi,” “renal lithiasis,” or “nephrolithiasis.” Urinary stones may be formed and/or found in the kidneys, the ureters, and the bladder (referred to as “bladder stones”). Such urinary stones can form as a result of mineral concentration in urinary fluid and can cause significant abdominal pain once such stones reach a size sufficient to impede urine flow through the ureter or urethra. Urinary stones may be formed from calcium, magnesium, ammonia, uric acid, cystine, and/or other compounds or combinations thereof. 
     Several methods can be used for treating patients with kidney stones, including observation, medical treatments (such as expulsion therapy), non-invasive treatments (such as extracorporeal shock wave lithotripsy (ESWL)), minimally-invasive or surgical treatments (such as ureteroscopy and percutaneous nephrolithotomy (“PCNL”)), and so on. In some approaches (e.g., ureteroscopy and PCNL), the physician gains access to the stone, the stone is broken into smaller pieces or fragments, and the relatively small stone fragments/particulates are extracted from the kidney using a basketing device and/or aspiration. 
     In some procedures, surgeons may insert an endoscope (e.g., ureteroscope) into the urinary tract through the urethra to remove urinary stones from the bladder and ureter. Typically, a ureteroscope includes a camera at its distal end configured to enable visualization of the urinary tract. The ureteroscope can also include, or allow for placement in a working channel of the ureteroscope, a lithotripsy device configured to capture or break apart urinary stones. During a ureteroscopy procedure, one physician/technician may control the position of the ureteroscope, while another physician/technician may control the lithotripsy device(s). 
     In some procedures, such as procedures for removing relatively large stones/fragments, physicians may use a percutaneous nephrolithotomy (“PCNL”) technique that involves inserting a nephroscope through the skin (i.e., percutaneously) and intervening tissue to provide access to the treatment site for breaking-up and/or removing the stone(s). A percutaneous-access device (e.g., nephroscope, sheath, sheath assembly, and/or catheter) used to provide an access channel to the target anatomical site (and/or a direct-entry endoscope) may include one or more fluid channels for providing irrigation fluid flow to the target site and/or aspirating fluid from the target site (e.g., through passive outflow and/or active suction). 
     For ureteroscopic procedures, a physician may implement a procedure to break a relatively large kidney stone into a relatively smaller fragments to facilitate extraction thereof. For example, certain instruments may be utilized to break the stone into smaller fragments, such as by lasing, or through other application of cleaving force to the kidney stone. According to some procedures, a basketing device/system may be used to capture the relatively smaller stone fragment(s) and extract them from the treatment site out of the patient. Generally, when a stone is captured, the surgeon may wish to quickly extract the stone through the uretereral access sheath prior to opening the basket to deposit/drop the stone into a specimen collection structure or area, after which the basket may be closed and reinserted (e.g., within a working channel of an endoscope/ureteroscope) through the access sheath for the purpose of extracting remaining stones or stone fragments, should there be any. 
     Robotic-assisted ureteroscopic procedures can be implemented in connection with various medical procedures, such as kidney stone removal procedures, wherein robotic tools can enable a physician/urologist to perform endoscopic target access as well as percutaneous access/treatment. Advantageously, aspects of the present disclosure relate to systems, devices, and methods for robotically controlling axial rotation/rolling of endoscopes/ureteroscopes to improve procedural efficiency and efficacy. 
     Medical System 
       FIG.  1    illustrates an example medical system  100  for performing various medical procedures in accordance with aspects of the present disclosure. The medical system  100  may be used for, for example, endoscopic (e.g., ureteroscopic) procedures. As referenced and described above, certain ureteroscopic procedures involve the treatment/removal of kidney stones. In some implementations, kidney stone treatment can benefit from the assistance of certain robotic technologies/devices. Robotic medical solutions can provide relatively higher precision, superior control, and/or superior hand-eye coordination with respect to certain instruments compared to strictly-manual procedures. For example, robotic-assisted ureteroscopic access to the kidney in accordance with some procedures can advantageously enable a urologist to individually perform both endoscope control and basketing control. 
     Although the system  100  of  FIG.  1    is presented in the context of a ureteroscopic procedure, it should be understood that the principles disclosed herein may be implemented in any type of endoscopic procedure. Furthermore, several of the examples described herein relate to object removal procedures involving the removal of kidney stones from a kidney. The present disclosure, however, is not limited only to kidney stone removal. For example, the following description is also applicable to other surgical or medical operations or medical procedures concerned with the removal of objects from a patient, including any object that can be removed from a treatment site or patient cavity (e.g., the esophagus, ureter, intestine, eye, etc.) via percutaneous and/or endoscopic access, such as, for example, gallbladder stone removal, lung (pulmonary/transthoracic) tumor biopsy, or cataract removal. 
     The medical system  100  includes a robotic system  10  (e.g., mobile robotic cart) configured to engage with and/or control a medical instrument  19  (e.g., ureteroscope) including a proximal handle  31  and a shaft  40  coupled to the handle  31  at a proximal portion thereof to perform a direct-entry procedure on a patient  7 . The term “direct-entry” is used herein according to its broad and ordinary meaning and may refer to any entry of instrumentation through a natural or artificial opening in a patient&#39;s body. For example, with reference to  FIG.  1   , the direct entry of the scope/shaft  40  into the urinary tract of the patient  7  may be made via the urethra  65 . 
     It should be understood that the direct-entry instrument  19  may be any type of shaft-based medical instrument, including an endoscope (such as a ureteroscope), catheter (such as a steerable or non-steerable catheter), nephroscope, laparoscope, or other type of medical instrument. Embodiments of the present disclosure relating to ureteroscopic procedures for removal of kidney stones through a ureteral access sheath (e.g., the ureteral access sheath  90 ) are also applicable to solutions for removal of objects through percutaneous access, such as through a percutaneous access sheath. For example, instrument(s) may access the kidney percutaneously through, for example, a percutaneous access sheath to capture and remove kidney stones. The term “percutaneous access” is used herein according to its broad and ordinary meaning and may refer to entry, such as by puncture and/or minor incision, of instrumentation through the skin of a patient and any other body layers necessary to reach a target anatomical location associated with a procedure (e.g., the calyx network of the kidney  70 ). 
     The medical system  100  includes a control system  50  configured to interface with the robotic system  10 , provide information regarding the procedure, and/or perform a variety of other operations. For example, the control system  50  can include one or more display(s)  56  configured to present certain information to assist the physician  5  and/or other technician(s) or individual(s). The medical system  100  can include a table  15  configured to hold the patient  7 . The system  100  may further include an electromagnetic (EM) field generator  18 , which may be held by one or more of the robotic arms  12  of the robotic system  10  or may be a stand-alone device. Although the various robotic arms  12  are shown in various positions and coupled to various tools/devices, it should be understood that such configurations are shown for convenience and illustration purposes, and such robotic arms may have different configurations over time and/or at different points during a medical procedure. Furthermore, the robotic arms  12  may be coupled to different devices/instruments than shown in  FIG.  1   , and in some cases or periods of time, one or more of the arms may not be utilized or coupled to a medical instrument (e.g., instrument manipulator/coupling). Roll of the shaft  40  may be controlled robotically and/or manually, such as through operation of an end effector associated with the robot arm  12   a , wherein such operation may be controlled by the control system  50  and/or robotic system  10 . The term “end effector” is used herein according to its broad and ordinary meaning and may refer to any type of robotic manipulator device, component, and/or assembly. Where an adapter, such as a sterile adapter, is coupled to a robotic end effector or other robotic manipulator, the term “end effector” may refer to the adapter (e.g., sterile adapter), or any other robotic manipulator device, component, or assembly associated with and/or coupled to the end effector. In some contexts, the combination of a robotic end effector and adapter may be referred to as an instrument manipulator assembly, wherein such assembly may or may not also include a medical instrument (or instrument handle/base) physically coupled to the adapter and/or end effector. The terms “robotic manipulator” and “robotic manipulator assembly are used according to their broad and ordinary meanings, and may refer to a robotic end effector and/or sterile adapter or other adapter component coupled to the end effector, either collectively or individually. For example, “robotic manipulator” or “robotic manipulator assembly” may refer to an instrument device manipulator (IDM) including one or more drive outputs, whether embodied in a robotic end effector, sterile adapter, and/or other component(s). 
     In an example use case, if the patient  7  has a kidney stone (or stone fragment)  180  located in a kidney  70 , the physician may execute a procedure to remove the stone  180  through the urinary tract ( 63 ,  60 ,  65 ). In some embodiments, the physician  5  can interact with the control system  50  and/or the robotic system  10  to cause/control the robotic system  10  to advance and navigate the medical instrument shaft  40  (e.g., a scope) from the urethra  65 , through the bladder  60 , up the ureter  63 , and into the renal pelvis  71  and/or calyx network of the kidney  70  where the stone  180  is located. The physician  5  can further interact with the control system  50  and/or the robotic system  10  to cause/control the advancement of a basketing device  30  through a working channel of the instrument shaft  40 , wherein the basketing device  30  is configured to facilitate capture and removal of a kidney stone or stone fragment. The control system  50  can provide information via the display(s)  56  that is associated with the medical instrument  40 , such as real-time endoscopic images captured therewith, and/or other instruments of the system  100 , to assist the physician  5  in navigating/controlling such instrumentation. 
     The renal anatomy is described herein for reference with respect to certain medical procedures relating to aspects of the present inventive concepts. The kidneys  70 , shown roughly in typical anatomical position in  FIG.  1   , generally comprise two bean-shaped organs located on the left and right sides, respectively, in the retroperitoneal space. In adult humans, the kidneys are generally about 11 cm in height/length. The kidneys receive blood from the paired renal arteries  69 ; blood exits the kidney via the paired renal veins  67 . Each kidney  70  is fluidly coupled with a respective ureter  63 , which generally comprises a tube that carries excreted urine from the kidney  70  to the bladder  60 . 
     The kidneys  70  are typically located relatively high in the abdominal cavity and lie in a retroperitoneal position at a slightly oblique angle. The asymmetry within the abdominal cavity, generally caused by the position of the liver, results in the right kidney (shown in detail in  FIG.  1   ) typically being slightly lower and smaller than the left, and being placed slightly more to the middle than the left kidney. On top of each kidney is an adrenal gland (not shown). The upper parts of the kidneys  70  are partially protected by the 11 th  and 12 th  ribs (not shown). Each kidney, with its adrenal gland, is generally surrounded by two layers of fat: the perirenal fat present between renal fascia and renal capsule and pararenal fat superior to the renal fascia. 
     The kidneys  70  participate in the control of the volumes of various body fluid compartments, fluid osmolality, acid-base balance, various electrolyte concentrations, and removal of toxins. The kidneys  70  provide filtration functionality by secreting certain substances and reabsorbing others. Examples of substances secreted into the urine are hydrogen, ammonium, potassium and uric acid. In addition, the kidneys also carry out various other functions, such as hormone synthesis, and others. 
     A recessed area on the concave border of the kidney  70  is the renal hilum  181 , where the renal artery  69  (not shown in the detailed view of the kidney  70 ) enters the kidney  70  and the renal vein  67  (not shown in detailed view) and ureter  63  leave. The kidney  70  is surrounded by tough fibrous tissue, the renal capsule  74 , which is itself surrounded by perirenal fat, renal fascia, and pararenal fat. The anterior (front) surface of these tissues is the peritoneum, while the posterior (rear) surface is the transversalis fascia. 
     The functional substance, or parenchyma, of the kidney  70  is divided into two major structures: the outer renal cortex  77  and the inner renal medulla  187 . These structures take the shape of a plurality of generally cone-shaped renal lobes, each containing renal cortex surrounding a portion of medulla called a renal pyramid  72 . Between the renal pyramids  72  are projections of cortex called renal columns  73 . Nephrons (not shown in detail in  FIG.  1   ), the urine-producing functional structures of the kidney, span the cortex  77  and medulla  187 . The initial filtering portion of a nephron is the renal corpuscle, which is located in the cortex and is followed by a renal tubule that passes from the cortex deep into the medullary pyramids. Part of the renal cortex, a medullary ray, is a collection of renal tubules that drain into a single collecting duct. 
     The tip/apex, or papilla  79 , of each renal pyramid empties urine into a respective minor calyx  75 ; minor calyces  75  empty into major calyces  76 , and major calyces  76  empty into the renal pelvis  71 , which transitions to the ureter  63 . The manifold-type collection of minor and major calyces may be referred to herein as the “calyx network” of the kidney. At the hilum  181 , the ureter  63  and renal vein  67  exit the kidney and the renal artery  69  enters. Hilar fat and lymphatic tissue with lymph nodes surround these structures. The hilar fat is contiguous with a fat-filled cavity called the renal sinus. The renal sinus collectively contains the renal pelvis  71  and calyces  75 ,  76  and separates these structures from the renal medullary tissue. The funnel/tubular-shaped anatomy associated with the calyces can be referred to as the infundibulum/infundibula. That is, an infundibulum generally leads to the termination of a calyx where a papilla is exposed within the calyx. 
     With further reference to the medical system  100 , the medical instrument shaft  40  (e.g., scope, directly-entry instrument, etc.) can be advanced into the kidney  70  through the urinary tract. Specifically, a ureteral access sheath  190  may be disposed within the urinary tract to an area near the kidney  70 . The shaft  40  may be passed through the ureteral access sheath  190  to gain access to the internal anatomy of the kidney  70 , as shown. Once at the site of the kidney stone  180  (e.g., within a target calyx  75  of the kidney  70  through which the stone  180  is accessible), the medical instrument  19  and/or shaft  40  thereof can be used to channel/direct the basketing device  30  to the target location. Once the stone  180  has been captured in the distal basket portion  35  of the basketing device/assembly  30 , the utilized ureteral access path may be used to extract the kidney stone  180  from the patient  7 . 
     The various scope/shaft-type instruments disclosed herein, such as the shaft  40  of the system  100 , can be configured to navigate within the human anatomy, such as within a natural orifice or lumen of the human anatomy. The terms “scope” and “endoscope” are used herein according to their broad and ordinary meanings, and may refer to any type of elongate (e.g., shaft-type) medical instrument having image generating, viewing, and/or capturing functionality and being configured to be introduced into any type of organ, cavity, lumen, chamber, or space of a body. A scope can include, for example, a ureteroscope (e.g., for accessing the urinary tract), a laparoscope, a nephroscope (e.g., for accessing the kidneys), a bronchoscope (e.g., for accessing an airway, such as the bronchus), a colonoscope (e.g., for accessing the colon), an arthroscope (e.g., for accessing a joint), a cystoscope (e.g., for accessing the bladder), colonoscope (e.g., for accessing the colon and/or rectum), borescope, and so on. Scopes/endoscopes, in some instances, may comprise an at least partially rigid and/or flexible tube, and may be dimensioned to be passed within an outer sheath, catheter, introducer, or other lumen-type device, or may be used without such devices. 
       FIG.  2    illustrates a cart-based robotic system  101  arranged for diagnostic and/or therapeutic bronchoscopy in accordance with one or more embodiments. During a bronchoscopy, the arm(s)  12  of the robotic system  10  may be configured to drive a medical instrument shaft  52 , such as a steerable endoscope, which may be a procedure-specific bronchoscope for bronchoscopy, through a natural orifice access point (e.g., the mouth of the patient  7  positioned on a table  15  in the present example) to deliver diagnostic and/or therapeutic tools. As shown, the robotic system  10  (e.g., cart) may be positioned proximate to the patient&#39;s upper torso in order to provide access to the access point. Similarly, the robotic arms  12  may be actuated to position the bronchoscope/shaft  52  relative to the access point. The arrangement in  FIG.  2    may also be utilized when performing a gastro-intestinal (GI) procedure with a gastroscope, a specialized endoscope for GI procedures. 
     Once the robotic system  10  is properly positioned, the robotic arms  12  may insert the steerable endoscope  52  into the patient robotically, manually, or a combination thereof. The steerable endoscope  52  may comprise at least two telescoping parts, such as an inner leader portion and an outer sheath portion, each portion coupled to a separate instrument feeder from the set of instrument feeders and/or instrument handles  111 , each instrument feeder/handle being coupled to the distal end of a respective robotic arm  12 . This linear arrangement of the feeder(s)/handle(s)  111  can create a “virtual rail”  103  that may be repositioned in space by manipulating the one or more robotic arms  12  into different angles and/or positions. One or more of the instrument feeder(s)/handle(s)  111  can be configured to implement robotic roll of the shaft and may be configured according to one or more embodiments disclosed herein for such purpose. 
     The endoscope  52  may be directed down the patient&#39;s trachea and lungs after insertion using precise commands from the robotic system  10  until reaching the target operative site. For example, the endoscope  52  may be directed to deliver a biopsy needle to a target, such as, for example, a lesion or nodule within the lungs of a patient. The needle may be deployed down a working channel that runs the length of the endo scope to obtain a tissue sample to be analyzed by a pathologist. Depending on the pathology results, additional tools may be deployed down the working channel of the endoscope for additional biopsies. For example, when a nodule is identified as being malignant, the endoscope  52  may endoscopically deliver tools to resect the potentially cancerous tissue. In some instances, diagnostic and therapeutic treatments can be delivered in separate procedures. In those circumstances, the endoscope  52  may also be used to deliver a fiducial to “mark” the location of the target nodule as well. In other instances, diagnostic and therapeutic treatments may be delivered during the same procedure. 
     In the system  101 , a patient introducer  102  is attached to the patient  7  via a port (not shown; e.g., surgical tube). The curvature of the introducer  102  may enable the robotic system  10  to manipulate the instrument  52  from a position that is not in direct axial alignment with the patient-access port, thereby allowing for greater flexibility in the placement of the robotic system  10  within the room. Further, the curvature of the introducer  102  may allow the robotic arms  12  of the robotic system  10  to be substantially horizontally aligned with the patient introducer  102 , which may facilitate manual movement of the robotic arm(s)  12  if needed. The control system  50  and/or robotic cart  10  can include control circuitry configured to implement scope roll control as described herein. 
       FIG.  3    illustrates a table-based robotic system  104  in accordance with one or more embodiments of the present disclosure. The system  104  incorporates robotic components  105  with a table/platform  147 , thereby allowing for a reduced amount of capital equipment within the operating room compared to some cart-based robotic systems, which can allow greater access to the patient  7  in some instances. Much like in the cart-based systems, the instrument device manipulator assemblies associated with the robotic arms  212  of the system  104  may generally comprise instruments and/or instrument feeders that are designed to manipulate an elongated medical instrument/shaft, such as a catheter  48  or the like, along a virtual rail or path. 
     As shown, the robotic-enabled table system  104  can include a column  144  coupled to one or more carriages  141  (e.g., ring-shaped movable structures), from which the one or more robotic arms  212  may emanate. The carriage(s)  141  may translate along a vertical column interface that runs at least a portion of the length of the column  144  to provide different vantage points from which the robotic arms  212  may be positioned to reach the patient  7 . The carriage(s)  141  may rotate around the column  144  in some embodiments using a mechanical motor positioned within the column  144  to allow the robotic arms  212  to have access to multiples sides of the table  104 . Rotation and/or translation of the carriage(s)  141  can allow the system  104  to align the medical instruments, such as endoscopes and catheters, into different access points on the patient. By providing vertical adjustment, the robotic arms  212  can advantageously be configured to be stowed compactly beneath the platform  147  of the table system  104  and subsequently raised during a procedure. 
     The robotic arms  212  may be mounted on the carriage(s)  141  through one or more arm mounts  145 , which may comprise a series of joints that may individually rotate and/or telescopically extend to provide additional configurability to the robotic arms  212 . The column  144  structurally provides support for the table platform  147  and a path for vertical translation of the carriage(s)  141 . The column  144  may also convey power and control signals to the carriage(s)  141  and/or the robotic arms  212  mounted thereon. The system  104  can include certain control circuitry configured to control driving and/or roll of the instrument shaft  240  using the instrument feeder  211 , which may be coupled to an end effector of one of the arms  212 , wherein the instrument feeder  211  is controlled to automatically modify axial driving speed with respect to the elongate instrument (e.g., endoscope)  48  based on a determined position of a distal end of the instrument  48 . For example, when the distal end of the instrument  48  is positioned at a predetermined automatic pause location, the instrument feeder  211  can be controlled/driven to automatically pause/stop axial retraction to allow for specimen collection, as described in detail herein. 
     With reference to  FIGS.  1 - 3    and  FIG.  4 - 1   , which shows an example embodiment of the control systems of any of  FIGS.  1 - 3   , the relevant control system  50  can be configured to provide various functionality to assist in performing a medical procedure. In some embodiments, the control system  50  can be coupled to the robotic system  10  and operate in cooperation therewith to perform a medical procedure on the patient  7 . For example, the control system  50  can communicate with the robotic system  10  via a wireless or wired connection (e.g., to control the robotic system  10 ). Further, in some embodiments, the control system  50  can communicate with the robotic system  10  to receive position data therefrom relating to the position of the distal end of the scope  40 , access sheath  90 , or basketing device  30 . Such positional data relating to the position of the scope  40 , access sheath  90 , or basketing device  30  may be derived using one or more electromagnetic sensors associated with the respective components, scope image processing functionality, and/or based at least in part on robotic system data (e.g., arm position data, known parameters/dimensions of the various system components, etc.). Moreover, in some embodiments, the control system  50  can communicate with the table  15  to position the table  15  in a particular orientation or otherwise control the table  15 . In some embodiments, the control system  50  can communicate with the EM field generator  18  to control generation of an EM field in an area around the patient  7  and/or around the instrument feeder  11 . 
       FIG.  4 - 1    further shows an example embodiment of the robotic systems of any of  FIGS.  1 - 3   . The robotic system  10  can be configured to at least partly facilitate execution of a medical procedure. The robotic system  10  can be arranged in a variety of ways depending on the particular procedure. The robotic system  10  can include one or more robotic arms  12  configured to engage with and/or control, for example, the scope  40  and/or the basketing device/system  30  to perform one or more aspects of a procedure. As shown, each robotic arm  12  can include multiple arm segments  23  coupled to joints  24 , which can provide multiple degrees of movement/freedom. In the example of  FIG.  1   , the robotic system  10  is positioned proximate to the patient&#39;s legs and the robotic arms  12  are actuated to engage with and position the scope  40  for access into an access opening, such as the urethra  65  of the patient  7 . When the robotic system  10  is properly positioned, the scope  40  can be inserted into the patient  7  robotically using the robotic arms  12 , manually by the physician  5 , or a combination thereof. With reference to  FIG.  1   , a scope-driver/feeder instrument coupling  11  (i.e., instrument device manipulator (IDM)) can be attached to the distal end effector  22  of one of the arms  12   b  to facilitate robotic control/advancement of the scope  40 . Another  12   a  of the arms may have associated therewith an instrument coupling/manipulator  19  that is configured to facilitate advancement and operation of the basketing device  30 . The instrument coupling  19  may further provide a handle  31  for the scope  40 , wherein the scope  40  is physically coupled to the handle  31  at a proximal end of the scope  40 . The scope  40  may include one or more working channels through which additional tools, such as lithotripters, basketing devices, forceps, etc., can be introduced into the treatment site. 
     The robotic system  10  can be coupled to any component of the medical system  100 , such as to the control system  50 , the table  15 , the EM field generator  18 , the scope  40 , the basketing system  30 , and/or any type of percutaneous-access instrument (e.g., needle, catheter, nephroscope, etc.). In some embodiments, the robotic system  10  is communicatively coupled to the control system  50 . For example, the robotic system  10  may be configured to receive control signals from the control system  50  to perform certain operations, such as to position one or more of the robotic arms  12  in a particular manner, manipulate the scope  40 , manipulate the basketing system  30 , and so on. In response, the robotic system  10  can control, using certain control circuitry  211 , actuators  217 , and/or other components of the robotic system  10 , a component of the robotic system  10  to perform the operations. For example, the control circuitry  211  may control roll of the shaft/scope  40  by actuating drive output(s)  402  of the end effector  22  coupled to the instrument handle  31 . In some embodiments, the robotic system  10  and/or control system  50  is/are configured to receive images and/or image data from the scope  40  representing internal anatomy of the patient  7  and/or portions of the access sheath or other device components. 
     The robotic system  10  generally includes an elongated support structure  14  (also referred to as a “column”), a robotic system base  25 , and a console  13  at the top of the column  14 . The column  14  may include one or more arm supports  17  (also referred to as a “carriage”) for supporting the deployment of the one or more robotic arms  12  (three shown in  FIG.  1   ). The arm support  17  may include individually-configurable arm mounts that rotate along a perpendicular axis to adjust the base of the robotic arms  12  for desired positioning relative to the patient. 
     The arm support  17  may be configured to vertically translate along the column  14 . In some embodiments, the arm support  17  can be connected to the column  14  through slots  20  that are positioned on opposite sides of the column  14  to guide the vertical translation of the arm support  17 . The slot  20  contains a vertical translation interface to position and hold the arm support  17  at various vertical heights relative to the robotic system base  25 . Vertical translation of the arm support  17  allows the robotic system  10  to adjust the reach of the robotic arms  12  to meet a variety of table heights, patient sizes, and physician preferences. Similarly, the individually-configurable arm mounts on the arm support  17  can allow the robotic arm base  21  of robotic arms  12  to be angled in a variety of configurations. 
     The robotic arms  12  may generally comprise robotic arm bases  21  and end effectors  22 , separated by a series of linking arm segments  23  that are connected by a series of joints  24 , each joint comprising one or more independent actuators  217 . Each actuator may comprise an independently-controllable motor. Each independently-controllable joint  24  can provide or represent an independent degree of freedom available to the robotic arm. In some embodiments, each of the arms  12  has seven joints, and thus provides seven degrees of freedom, including “redundant” degrees of freedom. Redundant degrees of freedom allow the robotic arms  12  to position their respective end effectors  22  at a specific position, orientation, and trajectory in space using different linkage positions and joint angles. This allows for the system to position and direct a medical instrument from a desired point in space while allowing the physician to move the arm joints into a clinically advantageous position away from the patient to create greater access, while avoiding arm collisions. 
     The robotic system base  25  balances the weight of the column  14 , arm support  17 , and arms  12  over the floor. Accordingly, the robotic system base  25  may house certain relatively heavier components, such as electronics, motors, power supply, as well as components that selectively enable movement or immobilize the robotic system. For example, the robotic system base  25  can include wheel-shaped casters  28  that allow for the robotic system to easily move around the operating room prior to a procedure. After reaching the appropriate position, the casters  28  may be immobilized using wheel locks to hold the robotic system  10  in place during the procedure. 
     Positioned at the upper end of column  14 , the console  13  can provide both a user interface for receiving user input and a display screen  16  (or a dual-purpose device such as, for example, a touchscreen) to provide the physician/user with both pre-operative and intra-operative data. Potential pre-operative data on the console/display  16  or display  56  may include pre-operative plans, navigation and mapping data derived from pre-operative computerized tomography (CT) scans, and/or notes from pre-operative patient interviews. Intra-operative data on display may include optical information provided from the tool, sensor and coordinate information from sensors, as well as vital patient statistics, such as respiration, heart rate, and/or pulse. The console  13  may be positioned and tilted to allow a physician to access the console from the side of the column  14  opposite arm support  17 . From this position, the physician may view the console  13 , robotic arms  12 , and patient while operating the console  13  from behind the robotic system  10 . As shown, the console  13  can also include a handle  27  to assist with maneuvering and stabilizing the robotic system  10 . 
     The end effector  22  of each of the robotic arms  12  may comprise, or be configured to have coupled thereto, an instrument device manipulator (IDM)  29 , which may be attached using a sterile adapter component in some instances. The combination of the end effector  22  and associated IDM, as well as any intervening mechanics or couplings (e.g., sterile adapter), can be referred to as a manipulator assembly  111 . In some embodiments, the IDM  29  can be removed and replaced with a different type of IDM, for example, a first type  11  of IDM/instrument may be configured to manipulate an endoscope/shaft, while a second type  19  of IDM/instrument may be associated with the shaft (e.g., coupled to a proximal portion thereof) and configured to roll and/or articulate the shaft, and/or manipulate a basketing device. Another type of IDM/instrument may be configured to hold an electromagnetic field generator  18 . An IDM can provide power and control interfaces. For example, the interfaces can include connectors to transfer pneumatic pressure, electrical power, electrical signals, and/or optical signals from the robotic arm  12  to the IDM. The IDMs  29  may be configured to manipulate medical instruments (e.g., surgical tools/instruments), such as the scope  40 , using techniques including, for example, direct drives, harmonic drives, geared drives, belts and pulleys, magnetic drives, and the like. In some embodiments, the device manipulators  29  can be attached to respective ones of the robotic arms  12 , wherein the robotic arms  12  are configured to insert or retract the respective coupled medical instruments into or out of the treatment site. 
     As referenced above, the system  100  can include certain control circuitry configured to perform certain of the functionality described herein, including the control circuitry  211  of the robotic system  10  and the control circuitry  251  of the control system  50 . That is, the control circuitry of the systems  100 ,  101 ,  104  may be part of the robotic system  10 , the control system  50 , or some combination thereof. Therefore, any reference herein to control circuitry may refer to circuitry embodied in a robotic system, a control system, or any other component of a medical system, such as the medical systems  100 ,  101 , and  104  shown in  FIGS.  1 - 3   , respectively. The term “control circuitry” is used herein according to its broad and ordinary meaning, and may refer to any collection of processors, processing circuitry, processing modules/units, chips, dies (e.g., semiconductor dies including one or more active and/or passive devices and/or connectivity circuitry), microprocessors, micro-controllers, digital signal processors, microcomputers, central processing units, field-programmable gate arrays, programmable logic devices, state machines (e.g., hardware state machines), logic circuitry, analog circuitry, digital circuitry, and/or any device that manipulates signals (analog and/or digital) based on hard coding of the circuitry and/or operational instructions. Control circuitry referenced herein may further include one or more circuit substrates (e.g., printed circuit boards), conductive traces and vias, and/or mounting pads, connectors, and/or components. Control circuitry referenced herein may further comprise one or more storage devices, which may be embodied in a single memory device, a plurality of memory devices, and/or embedded circuitry of a device. Such data storage may comprise read-only memory, random access memory, volatile memory, non-volatile memory, static memory, dynamic memory, flash memory, cache memory, data storage registers, and/or any device that stores digital information. It should be noted that in embodiments in which control circuitry comprises a hardware and/or software state machine, analog circuitry, digital circuitry, and/or logic circuitry, data storage device(s)/register(s) storing any associated operational instructions may be embedded within, or external to, the circuitry comprising the state machine, analog circuitry, digital circuitry, and/or logic circuitry. 
     The control circuitry  211 ,  251  may comprise computer-readable media storing, and/or configured to store, hard-coded and/or operational instructions corresponding to at least some of the steps and/or functions illustrated in one or more of the present figures and/or described herein. Such computer-readable media can be included in an article of manufacture in some instances. The control circuitry  211 / 251  may be entirely locally maintained/disposed or may be remotely located at least in part (e.g., communicatively coupled indirectly via a local area network and/or a wide area network). Any of the control circuitry  211 ,  251  may be configured to perform any aspect(s) of the various processes disclosed herein, including the processes shown in  FIGS.  15 - 1  and  15 - 2   , as described below. 
     With respect to the robotic system  10 , at least a portion of the control circuitry  211  may be integrated with the base  25 , column  14 , and/or console  13  of the robotic system  10 , and/or another system communicatively coupled to the robotic system  10 . With respect to the control system  50 , at least a portion of the control circuitry  251  may be integrated with the console base  51  and/or display unit  56  of the control system  50 . It should be understood that any description herein of functional control circuitry or associated functionality may be understood to be embodied in the robotic system  10 , the control system  50 , or any combination thereof, and/or at least in part in one or more other local or remote systems/devices, such as control circuitry associated with a handle/base of a shaft-type instrument (e.g., endoscope) in accordance with any of the disclosed embodiments. 
     With further reference to  FIG.  4 - 1   , the control system  50  can include various I/O components  258  configured to assist the physician  5  or others in performing a medical procedure. For example, the input/output (I/O) components  258  can be configured to allow for user input to control/navigate the scope  40  and/or basketing system within the patient  7 . In some embodiments, for example, the physician  5  can provide input to the control system  50  and/or robotic system  10 , wherein in response to such input, control signals can be sent to the robotic system  10  to manipulate the scope  40  and/or catheter basketing system  30 . The control system  50  can include one or more display devices  56  to provide various information regarding a procedure. For example, the display(s)  56  can provide information regarding the scope  40  and/or basketing system  30 . For example, the control system  50  can receive real-time images that are captured by the scope  40  and display the real-time images via the display(s)  56 . Additionally or alternatively, the control system  50  can receive signals (e.g., analog, digital, electrical, acoustic/sonic, pneumatic, tactile, hydraulic, etc.) from a medical monitor and/or a sensor associated with the patient  7 , and the display(s)  56  can present information regarding the health or environment of the patient  7 . Such information can include information that is displayed via a medical monitor including, for example, information relating to heart rate (e.g., ECG, HRV, etc.), blood pressure/rate, muscle bio-signals (e.g., EMG), body temperature, blood oxygen saturation (e.g., SpO 2 ), CO 2 , brainwaves (e.g., EEG), environmental and/or local or core body temperature, and so on. 
     The various components of the system  100  can be communicatively coupled to each other over a network, which can include a wireless and/or wired network. Example networks include one or more personal area networks (PANs), local area networks (LANs), wide area networks (WANs), Internet area networks (IANs), cellular networks, the Internet, personal area networks (PANs), body area network (BANs), etc. For example, the various communication interfaces of the systems of  FIG.  4 - 1    can be configured to communicate with one or more device/sensors/systems, such as over a wireless and/or wired network connection. In some embodiments, the various communication interfaces can implement a wireless technology such as Bluetooth, Wi-Fi, near-field communication (NFC), or the like. Furthermore, in some embodiments, the various components of the system  100  can be connected for data communication, fluid exchange, power exchange, and so on via one or more support cables, tubes, or the like. 
     The control system  50  and/or robotic system  10  can include certain user controls (e.g., controls  55 ), which may comprise any type of user input (and/or output) devices or device interfaces, such as one or more buttons, keys, joysticks, handheld controllers (e.g., video-game-type controllers), computer mice, trackpads, trackballs, control pads, and/or sensors (e.g., motion sensors or cameras) that capture hand gestures and finger gestures, touchscreens, and/or interfaces/connectors therefore. Such user controls are communicatively and/or physically coupled to respective control circuitry. In some embodiments, the user may engage the user controls  55  to command robotic shaft rotation/roll, as described herein. 
       FIG.  4 - 2    illustrates medical system components, including scope  519  and basketing  30  devices/assemblies  519  that may be implemented in any of the medical systems of  FIGS.  1 - 3    in accordance with one or more embodiments. In some embodiments, the scope assembly  519  includes a handle or base  31  coupled to an endoscope  40 . For example, the endoscope (i.e., “scope” or “shaft”) can include an elongate shaft including one or more lights  49  and one or more cameras or other imaging devices  48 . The scope  40  can further include one or more working channels  44 , which may run a length of the scope  40 . In some embodiments, such channel(s) may be utilized to provide access for elongate basketing wires/tines through the scope  40 . 
     The basketing assembly  30  can comprise a basket  35  formed of one or more wire tines  36 . For example, the basketing system  30  may comprise four wire tines disposed within a basketing sheath  37  over a length thereof, wherein the tines project from a distal end of the sheath  37  to form the basket form  35 . The tines  36  further extend from the proximal end of the sheath  37 . The tines  36  may be configured to be slidable within the basketing sheath  37 , subject to some amount of frictional resistance. The tines  36  and the sheath  37  can be coupled to respective actuators  195  of a basket cartridge component  32 . The basket cartridge  32  may be physically and/or communicatively coupled to the handle portion/component  31  of the scope assembly  519 . The handle component  31  can be configured to be used to assist in basketing and/or scope control either manually or through robotic control. 
     The scope assembly  519  can be powered through a power interface  79  and/or controlled through a control interface  78 , each or both of which may interface with a robotic arm/component of the robotic system  10 . The scope assembly  519  may further comprise one or more sensors  72 , such as pressure and/or other force-reading sensors, which may be configured to generate signals indicating forces experienced at/by one or more of the actuators  195  and/or other couplings of the scope/basket system  519 . 
     The scope assembly  519  includes certain mechanisms for causing the shaft  40  to roll about an axis thereof (e.g., roll about an axis of the shaft at a base/proximal end thereof). For example, the shaft  40  may have associated with a proximal portion thereof a roll gear component  45 . Such roll gear  45  may have one or more teeth or other feature(s) configured to mesh or engage with an actuator component associated with the handle  31  of the scope assembly  519 . The scope assembly shaft  40  may be rolled/rotated by actuating the roll gear  45  using one or more actuator components (e.g., gears, belts, axles, etc.) associated with the handle  31 . In some embodiments, the scope/shaft  40  includes a strain-relief component  43 , which may include a rubber cone or other form/material configured to reduce the strain on the proximal portion/end of the shaft from bending of the shaft and/or to reduce the angle of bend at the proximal portion of the shaft. 
     The roll gear  45  of the shaft  40  may be disposed at least in part within the housing  80  of the handle  31 . Furthermore, additional components configured to cause rolling/rotation of the roll gear  45  and shaft  40  may be disposed at least partially within the housing  80 . In some embodiments, the handle  31  has associated therewith an externally-accessible/actuatable roll axle  85 , which may comprise a drive input configured to be rotated about an axis when engaged with a drive output of a robotic end effector and/or adapter associated therewith. In some embodiments, the roll axle  85  has an axis that is transverse, orthogonal, and/or perpendicular to an axis of the roll gear  45  and/or shaft  40 . Therefore, the handle  31  may further include an angle transform gear  89 , which may be configured to translate/transform the rotation of the roll axle  85  to an axis that is parallel with the axis of the roll gear  45 . The angle transform gear  89  may be, for example, a bevel gear in a mesh engagement with the roll axle  85  or the roll gear  45 . The rotation/roll translator  83  may be configured to translate rotation of the roll axle  85  to rotation of the roll gear  45  through some sort of direct or indirect physical coupling between the roll axle  85  and the roll gear  45 . For example, the roll translator  83  may comprise one or more belts, cables, rods, or the like. In some embodiments, the roll axle  85  is accessible via an aperture on an underside of the handle  31 . 
     The scope assembly can further include a roll axle catch or lock means/mechanism  90 , which may comprise a structure configured to be actuated to assume a locked configuration in which a key component  95  thereof is engaged with a mating feature of the roll axle  85 , or to assume an unlocked position in which the key component  95  is not engaged with the mating feature of the roll axle  85 . The roll axle catch  90  may further include an actuator component  91 , which may be a unitary form with the body of the roll axle  90  and/or key feature  95 . The actuator  91  may be accessible through an aperture or other access  81  in the housing  80 , wherein the access  81  allows for actuation of the roll axle catch actuator  91  from external to the handle  31  and/or housing  80 . The various components of the scope assembly  519  are described in greater detail below. 
     Scope Roll 
       FIG.  5    illustrates a ureteroscope  40  disposed in portions of the urinary system of a patient in accordance with one or more embodiments. As referenced above, ureteroscopic procedures can be implemented for investigating abnormalities in human ureters and/or treating the same. For example, ureteroscope procedures can be implemented to treat and/or remove kidney stones. Such procedures may be implemented manually at least in part and/or may be performed using robotic technologies at least in part. For example, use of robotic devices and/or systems for certain endoscopic procedures can provide relatively greater precision, control, and/or coordination compared to strictly manual procedures. In some embodiments, the scope  40  includes a working channel  44  for deploying a basketing device  30  (e.g., basket component  35 ) to an operative region at a distal end of the scope  40 . 
     The scope/shaft (e.g., endoscope/ureteroscope)  40  may comprise a tubular and flexible medical shaft/instrument that is configured to be inserted into the anatomy of a patient to capture images of the anatomy and to perform certain tasks using one or more working channels thereof. In some embodiments, the scope  40  can accommodate wires and/or optical fibers to transfer signals to/from an optical assembly and a distal end  42  of the scope  40 , which can include an imaging device  48 , such as an optical camera. The scope  40  can further include a light source  49 , such as an LED or fiber-optic light source/lens. 
     The scope shaft  40  can be advanced to the target location through an access sheath  190 . The access sheath  190  may be advanced through the ureter  63  to a position near the renal pelvis  71  and/or ureteropelvic junction  71 . The distal end of the access sheath  190  may be parked at a position in the ureter  63  and/or renal pelvis  71 . The access sheath  190  may be placed as far into the renal anatomy as possible, as permitted by the urinary tract path, which may be somewhat tortuous in certain portions thereof. Generally, the access sheath  190  may not be articulable to the degree that the scope  40  can be articulated, and therefore it may not be practical to navigate/drive the access sheath  190  into the kidney. 
     The scope  40  can be articulable, such as with respect to at least a distal portion  230  of the scope  40 , so that the scope  40  can be steered within the human anatomy. In some embodiments, the scope  40  is configured to be articulated with, for example, six degrees of freedom, including XYZ coordinate movement, as well as pitch, yaw, and roll. Certain position sensor(s) (e.g., electromagnetic sensors) of the scope  40 , where implemented, may likewise have similar degrees of freedom with respect to the positional information they generate/provide. 
     For robotic implementations, robotic arms of a robotic system can be configured/configurable to manipulate the scope  40 . For example, an instrument device manipulator (e.g., scope handle) can be coupled to an end effector of a robot arm and can manipulate the scope  40  using elongate movement members. The elongate movement members may include one or more pull wires (e.g., pull or push wires), cables, fibers, and/or flexible shafts. For example, the robotic end effector may be configured to actuate multiple pull wires (not shown) coupled to the scope  40  to deflect the tip  42  of the scope  40 . Pull wires may include any suitable or desirable materials, such as metallic and non-metallic materials such as stainless steel, Kevlar, tungsten, carbon fiber, and the like. In some embodiments, the scope  40  is configured to exhibit nonlinear behavior in response to forces applied by the elongate movement members. The nonlinear behavior may be based on stiffness and compressibility of the scope, as well as variability in slack or stiffness between different elongate movement members. 
     The camera/imaging device  48  can be used to capture images of an internal anatomical space, such as internal calyces of the kidney  70 . The scope  40  may further be configured to accommodate optical fibers to carry light from proximally-located light sources, such as light-emitting diodes, to the distal end  42  of the scope. In some embodiments, the scope  40  is configured to be controlled by a robotic system similar in one or more respects to the robotic systems  100 ,  101 , and  104  shown in  FIGS.  1 ,  2 , and  3   , respectively. 
     In some embodiments, the shaft (e.g., scope)  40  includes a sensor that is configured to generate and/or send sensor position data to another device or produce a detectable distortion or signature in an electromagnetic field. The sensor position data can indicate a position and/or orientation of the medical instrument  40  (e.g., the distal end  42  thereof) and/or can be used to determine/infer a position/orientation of the medical instrument. For example, a sensor (sometimes referred to as a “position sensor”) can include an electromagnetic (EM) sensor with a coil of conductive material or other form/embodiment of an antenna. 
     Embodiments of the present disclosure relate to the implementation of robotically-controlled shaft roll and the locking of shaft roll functionality when the instrument is undocked from the robotic system. Such robotic shaft roll can be restricted to a limited angle of rotation, which can prevent instrument damage. When a medical instrument and/or handle thereof is unlatched, undocked, or otherwise decoupled from a robotic end effector and/or adapter (e.g., sterile adapter) component associated therewith, the medical instrument and/or handle may be considered to be “off-robot,” whereas when the medical instrument and/or handle thereof is latched, docked, or otherwise coupled to a robotic end effector and/or adapter (e.g., sterile adapter) component associated therewith, the medical instrument and/or handle may be considered to be “on-robot.” 
     The instrument base/handle  31  can be configured to attach, mount, or otherwise be connected or coupled to the robotic end effector  6 . For example, a robotic arm can include an instrument drive mechanism/assembly comprising an end effector and/or sterile adapter and the instrument base/handle  31  can be attached to the instrument drive mechanism/assembly. The instrument drive mechanism can include drive outputs configured to engage with and actuate corresponding drive input(s) on the instrument base/handle  31  to manipulate the medical instrument  19 . For example, one or more drive outputs of the robotic end effector  6  can be configured to control shaft roll, as described in detail herein. The drive outputs of the end effector can be coupled to one or more drive couples of an adapter (e.g., sterile adapter) that are configured to transfer drive torque from the drive output(s) of the end effector to drive output(s) of the adapter. References herein to a robotic end effector and/or drive output(s) or other features thereof can be understood to refer to an adapter (e.g., sterile adapter) coupled to an end effector and/or drive output(s) of the adapter. For example, description of docking of an instrument on an end effector should be understood to refer to docking the instrument on an adapter when an adapter is coupled to the end effector. 
     In some configurations, the elongated shaft  40  of the medical instrument  19  is arranged to form a service loop  43  between the instrument handle  31  and the instrument feeder  11  and/or between the associated robotic arms. The service loop  43  may comprise a length of the shaft  40  between the instrument base/handle  31  and the feeder device  11 . When the length of the shaft  40  exceeds the distance D a  (see  FIG.  1   ) between the instrument base/handle  31  and the feeder device  11 , the shaft  40  may hang down (and/or to the side), forming the service loop  43  between the instrument base/handle  31  and the feeder device  11 . The service loop  43  can provide slack in the shaft  40  that can be used to allow for faster insertion and/or retraction of the shaft  40 . For example, during insertion, the slack in the service loop  49  can be taken up (shortening or contracting the service loop  49 ). During retraction, the service loop  49  can be generated (increasing in length or expanding). 
     The scope  40  can be deflectable in one or two directions within a first/primary plane P p . The scope  40  can also be deflectable in one or two directions in a second/secondary plane P s , which may be orthogonal to the primary plane P p . For example, it can be desirable for the at least the distal section  230  of the scope  40  to be deflectable in more than one plane to reach the desired area, such as the specific anteriorly or posteriorly pointing calyx. Although the primary P p  and secondary P s  deflection planes are shown in a particular configuration, it should be understood that the illustrated secondary plane P s  may be the primary plane P p  and vice versa. 
     In some embodiments, the scope  40  comprises a distal articulation section  230 . One or more cables, pull wires, or pull wire segments can run along the outer surface of the shaft  40 . Additionally, the one or more cables can run along a central lumen of the shaft  40 . Manipulation of the one or more cables results in actuation or deflection of the articulation section  230 . Manipulation of the one or more cables can be controlled via one or more instrument drivers positioned within or connected to the instrument base/handle  31 . 
     The instrument base/handle  31  can generally include an attachment interface having one or more mechanical inputs (e.g., receptacles, pulleys, spools, female inputs, etc.) that are designed to be reciprocally mated with one or more torque couplers on an attachment surface of an instrument driver. The instrument handle  31  can include a plurality of drive inputs. The plurality of control cables can be coupled to the plurality of drive inputs and extend along the flexible shaft  40 . The plurality of drive inputs can be configured to control or apply tension to the plurality of pull wires or control cables in response to drive outputs from the medical robotic system. 
     In order to navigate the scope  40  through the anatomy, the articulation section  230  of the scope  40  can be deflectable in in the primary plane P p . A distal section of the articulation section  230  may further be deflectable in two directions within the secondary plane P s . Therefore, the distal portion of the articulation section  230  can be deflectable in two planes and four directions (e.g., left/right and up/down). The bend radius of the scope  40  may be greater in the primary plane P p  (e.g., up to 270° or more in either direction) than in the secondary plane P s  (e.g., 180° or less in either direction). Therefore, it may be desirable for the primary plane P p  to be aligned with the plane of the kidney P k  in order to maximize the reach of the articulation portion  230  of the scope  40  within the calyx network of the kidney  70 . The physician may seek to achieve such alignment manually through manual manipulation of the handle  31  prior to docking on the end effector  6 . After manual alignment, the physician may dock the handle  31  on the end effector  6 , which may result in a roll/rotation of the shaft by about, for example, 90°. Embodiments of the present disclosure allow for compensation for such out-of-alignment rotation/roll through robotic roll control, which may be performed automatically after docking of the handle  31  in some implementations. 
     Robotic roll control in accordance with aspects of the present disclosure can involve rotation of the elongate shaft  40  relative to the instrument handle  31  about the longitudinal axis of the elongate shaft  40 , at least at the proximal end thereof. Description herein or shaft roll/rotation about an axis thereof should be understood to refer to rotation of the shaft about an axis thereof at least at a proximal end or portion of the shaft. The rotation of the shaft  40  relative to the handle  31  can be operable to align the shaft  40  within the plane P k  of the kidney, which may be an inferior-superior plane of the patient. For example, although the kidney  70  can be variable in shape, size, and configuration, it is roughly generalizable as a generally planar structure with an upper, middle, and lower pole. From each of these poles stem a series of calyces that point anteriorly or posteriorly. The scope  40  can be rotated/rolled to align the articulation section  230  with the direction of the target calyces. 
       FIG.  6    shows an exploded view of an instrument device manipulator assembly  150  associated with a robotic arm  12  in accordance with one or more embodiments. The instrument device manipulator assembly  150  includes an end effector  6  associated with a distal end of the robotic arm  12 . The instrument manipulator assembly  150  further includes a handle  31  of a shaft-type instrument  19 . The instrument handle  31  can incorporate mechanical (and/or electrical) means for rolling/rotating a shaft component associated therewith, such as an endoscope or other shaft-type instrument. Description herein of upward-facing and downward-facing surfaces, plates, faces, components, and/or other features or structures may be understood with reference to the particular orientation of the instrument device manipulator assembly  150  shown in  FIG.  6   , as assembled (rather than the tilted, exploded orientations shown). That is, although the end effector  6  may generally be configurable to face and/or be oriented in a range of directions and orientations, for convenience, description of such components (and components/devices attached/latched thereto directly or indirectly) herein may be in the context of the generally vertical facing orientation of the end effector  6  shown in  FIG.  6   . 
     In some embodiments, the instrument device manipulator assembly  150  further includes an adapter component  8  that is mountable to the end effector  6  and configured to provide a driver interface between the end effector  6  and the instrument handle  31 . The adapter  8  and/or the instrument handle  31  may be removable or detachable from the robotic arm  12  and may be devoid of any electro-mechanical components, such as motors, in some embodiments. This dichotomy may be driven by the need to sterilize medical instruments used in medical procedures and the inability to adequately sterilize expensive capital equipment due to their intricate mechanical assemblies and sensitive electronics. Accordingly, the instrument handle  31  and/or adapter  8  may be designed to be detached, removed, and interchanged from the end effector  6  (and thus the system) for individual sterilization or disposal. In contrast, the end effector  6  need not be changed or sterilized in some cases and may be draped (e.g., using drape  301 ) for protection. 
     In some embodiments, the adapter  8  can include connectors to transfer pneumatic pressure, electrical power, electrical signals, and/or optical signals from the robotic arm  12  and/or end effector  6  to the instrument handle  31 . The robotic arm  12  can advance/insert or retract the coupled instrument handle  31  into or out of the treatment site. In some embodiments, the instrument handle  31  can be removed and replaced with a different type of instrument. The end effector  6  of the robotic arm  12  can include various components/elements configured to connect to and/or align with components of the adapter  8 , instrument handle, and/or shaft  40 . For example, the end effector  6  can include drive outputs  302  (e.g., drive splines, gears, or rotatable disks with engagement features) to control/articulate a medical instrument, a reader  304  to read data from a medical instrument (e.g., radio-frequency identification (RFID) reader to read a serial number from a medical instrument), one or more fasteners  306  to attach the instrument handle  31  and/or adapter  8  to the end effector  6 , marker(s)  308  to align with an instrument that is manually attached to a patient (e.g., access sheath) and/or to define a front surface of the device manipulator assembly  150 . In some embodiments, a portion (e.g., plate)  315  of the adapter  8  can be configured to rotate/spin independently of one or more other components of the adapter  8  and/or end effector  6  when coupled to the end effector  6 . The adapter  8  can include one or more outputs  309  configured to mate/couple with corresponding input(s)  602  of the handle  31 . 
     In some configurations, a sterile drape  301 , such as a plastic sheet or the like, may be disposed between the end effector  6  and the adapter  8  to provide a sterile barrier between the robot arm  12  and the instrument handle  31 . For example, the drape  301  may be coupled to the adapter  8  in such a way as to allow for translation of mechanical torque from the end effector  6  to the adapter  8 . The adapter  8  may generally be configured to maintain a seal around the actuating components thereof, such that the adapter  8  provides a sterile barrier itself. The use of a drape  301  coupled to the adapter  8  and/or more other component(s) of the device manipulator assembly (i.e., “robotic manipulator” or “robotic manipulator assembly”)  150  may provide a sterile barrier between the robotic arm  12  and the surgical field, thereby allowing for the use of the robotic cart associated with the arm  12  in the sterile surgical field. The end effector  6  may be configured to be coupled to various types of sterile adapters that may be loaded onto and/or removed from the end effector  6  of the robotic arm  12 . With the arm  12  draped in plastic, the physician and/or other technician(s) may interact with the arm  12  and/or other components of the robotic cart (e.g., screen) during a procedure. Draping may further protect against equipment biohazard contamination and/or minimize clean-up after procedure. 
     The instrument handle  31  can include a plurality of drive inputs  602 ,  87  on a lower surface  336  of the housing  80  of the instrument handle  31 . In the illustrated embodiment, the instrument handle  31  includes three drive inputs  602 ,  87 , although other numbers of drive inputs can be included in other embodiments. The drive inputs can be in fixed positions spaced apart along the lower mating surface  336  of the instrument handle  31 , which facilitates coupling the drive inputs  602 ,  87  to the corresponding drive outputs  302  of the end effector  6 , which may be in fixed positions spaced apart along a corresponding mating surface designed for modular use and attachment to a variety of other instruments. The handle  31  can include latching clips  719  or other latching features/means for physically coupling to corresponding structure of the adapter  8  and/or end effector  6 . 
     A mechanical assembly within the instrument handle  31  can allow the drive inputs  602  to be used to drive articulation of the shaft  40 , whereas the drive input  87  can be used to drive roll of the shaft  40 . Each of the drive inputs  602 ,  87  can be configured to engage with a corresponding drive output  302  on the end effector  6 . For example, each drive input can comprise a receptacle configured to mate with a drive output that is configured as a spline. The drive inputs and drive outputs can be configured to engage to transfer motion therebetween. Thus, the drive outputs can be rotated to cause corresponding rotation of the drive inputs to control various functionality of the instrument handle  31 . 
     References herein to an “instrument device manipulator assembly,” “instrument manipulator assembly,” “manipulator,” “manipulator assembly,” as well as other variations thereof, can refer to any subset of the components of the assembly  150  shown in  FIG.  6   , including a robot arm, an end effector of a robot arm, an adapter configured to be coupled to a robotic end effector, an instrument base/handle configured to be coupled to an end effector and/or adapter, and/or other actuator component(s), means, and/or mechanism associated with an instrument base/handle. Furthermore, it should be understood that references herein to an “actuator” can refer to any component of the assembly  150  shown in  FIG.  6    that affects or causes, either directly or indirectly, movement of an instrument/component engaged with, coupled to, or otherwise actuatable by, a component of the assembly  150 . For example, in accordance with embodiments disclosed here, an “actuator” may comprise any set or subset of the following devices or components: feed roller(s), shaft-actuating wheel(s)/roller(s), feed roller channel(s), instrument feeder drive input(s), adapter drive output(s), adapter drive input(s), pulleys, belts, gears, pegs, pins, end effector drive output(s), and/or structures and/or control circuitry configured to cause actuation of the same. For example, an actuator may be any component, device, or structure configured such that movement thereof causes corresponding movement in another component, device, or structure, whether integrated with or separate from the actuator. 
       FIGS.  7 A,  7 B  show cut-away perspective views of an instrument handle configured to implement robotic shaft roll in accordance with one or more embodiments of the present disclosure. Unlike certain solutions in which shaft roll is limited to manual rolling of the shaft and/or handle, some embodiments of the present disclosure advantageously allow for robotic shaft roll control, which may be implemented using one or more mechanical gears and/or other rotation-translation means/mechanisms. 
     The handle  31  has associated therewith one or more mechanism(s) that allows the shaft  40  of the instrument to be rolled/rotated robotically. For example, such mechanism(s) can be configured to transmit rotation of a robotic end effector output drive to the handle/base  31 , and further to a base (e.g., proximal end)  45  of the shaft  40  via a belt  83  or other rotation translator component(s). In some embodiments, a bevel gear or other angle-transform gear/component  89  may be attached to the belt  83 , and thereby to at least one of the roll axle/gear  85  and/or the shaft gear  45 . The bevel gear  89  may convert the rotation of the axle/belt gear  85  by 90°, or some other angle, to allow for mesh engagement with the shaft gear  45  to rotate the shaft gear  45 , thereby rolling the shaft  40 . 
     The proximal end of the elongated shaft  40  extends from the instrument handle/base  31 . In some embodiments, the elongated shaft  40  comprises a flexible shaft and/or an articulating shaft. As described above, pull wires (not shown) can be included in or on the handle  31  and elongate shaft  40  to control articulation of the elongate shaft  40 . The handle  31  is configured to allow both manual control and robotic control of the shaft  40 . For example, the instrument handle  31  can be configured to be physically held and manually manipulated to provide manual control, and to couple to an instrument drive mechanism to provide robotic control. In some embodiments, a sterile adapter can be positioned between the handle  31  and the instrument drive mechanism (e.g., robotic end effector or other robotic manipulator) to maintain a sterile field during a medical procedure. 
     As illustrated, the instrument handle  31  includes a housing  80 , which may contain one or more of the roll control components/mechanisms described herein. The housing  80  of the instrument handle  31  can be shaped to provide an ergonomic fit for the instrument handle in a hand of a user/practitioner and/or for allowing for coupling thereto of another instrument. For example, the housing  80  shape can allow the instrument handle  31  to be more easily or comfortably held during manual control, such as for manually rolling the shaft  40  according to aspects of the present disclosure. Furthermore, the housing  80  shape can provide access to (e.g., not block) one or more robotic drive outputs associated with an adapter and/or end effector to which the handle  31  is physically coupled/latched for use by another instrument/device (e.g., basketing or lasing cartridge). The instrument handle  31  can include a power access port  714  for connecting to a power unit to power the one or more instruments (e.g., internal control circuitry) of a medical instrument system. The power access port  714  can be configured to provide electrical and/or visual connections to the shaft  40 . 
     In some embodiments, the instrument handle  31  includes a manual roll input controllable by the shaft strain-relief form  43 . In some embodiments, the elongate shaft  40  extends through the shaft outlet strain-relief form  43  and into the housing  80  of the handle  31 . The shaft outlet strain-relief form  43  can be configured to allow the elongated shaft to rotate relative to the instrument handle  31 . As illustrated, the shaft outlet strain-relief form  43  can be a twistable or rotatable handle or grip that can rotate relative to the housing  80 . For example, the shaft strain-relief form  43  can rotate in a clockwise and/or counterclockwise motion. The shaft  40  can be rotationally fixed relative to the shaft outlet strain-relief form  43 , such that rotation of the shaft strain-relief form  43  causes rotation of the shaft  40 . Rotation of the shaft  40  can be in the same direction and equal/commensurate to corresponding motion of the strain-relief form  43 , although this need not be the case in all embodiments. The shaft  40  may be permitted to rotate (e.g., roll) in both rotational directions by at least 90, at least 100, at least 110, at least 120, at least 130, at least 140, at least 150, at least 160, at least 170, at least 180, at least 190, at least 200, at least 210, at least 220, at least 230, at least 240, at least 250, at least 260, at least 270, at least 280, at least 290, at least 300, at least 310, at least 320, at least 330, at least 340, at least 350, or at least 360 degrees. Such roll may be limited by roll axle rotation limitation feature(s)/mechanism(s) described in detail below with respect to  FIGS.  10 - 1 ,  10 - 2 ,  10 - 3 , and  10 - 4   . 
     The strain-relief feature  43  may comprise a rubber or other at least partially elastic/flexible material in the shape of a tapered cone, as shown. Such a cone may have a circumferential apex  47 , which may provide a visual indication and or manual/tactile engagement feature that indicates a roll position of the shaft  40 . For example, the apex  47  may rotate about the axis of the shaft as the shaft rotates. The form of the cone, such as may be provided at least in part by the apex feature, can provide a manipulation surface for manual manipulation by the user to manually rotate the shaft  40 . Generally, alignment of the apex  47  of the cone  43  with, for example, a side portion  747  or other portion of the handle  31  can be associated with the shaft  40  being rotationally aligned in a home (e.g., zero/locked) position. In some embodiments, the apex  47  may be aligned with a camera and/or working channel of the shaft  40 . In some embodiments, visual indication of the roll position of the shaft  40  may be indicated by one or more other visual markers in addition to the apex and/or as an alternative thereto. For example, a band, notch, or other visual marking(s) on the shaft  40 , strain-relief form, and/or side  747  or other portion of the handle  31  may indicate a roll orientation of the shaft  40 . 
     With reference to  FIGS.  6 ,  7 A, and  7 B , the handle  31  can include a plurality of robotic drive inputs  87 ,  602  (not shown in  FIGS.  7 A,  7 B ; see  FIG.  6   ), which may be accessible via one or more input ports  762 . The robotic drive outputs of the end effector and/or adapter (see  FIG.  6   ) can engage and transfer torque to (e.g., rotate) the robotic endoscope drive inputs  87 ,  602 . For example, the drive input  87  may be associated with the roll axle  85 . Any of the drive inputs may be rotatable in both the clockwise and counterclockwise directions. The drive inputs  87 ,  602  can be configured as grooved or keyed recesses and can be configured to engage robotic drive outputs  302  (see  FIG.  6   ) that are configured as protruding/projecting splines. The robotic drive outputs  302  can be driven by motors to rotate in clockwise and counterclockwise directions. When the robotic drive outputs are engaged with the respective robotic endoscope drive inputs, the robotic drive outputs may generally transfer rotational motion to the robotic endoscope drive inputs. Each of the drive inputs  602  and input ports  762  may be associated with one or more pulley, gears, and/or other mechanism(s) configured to cause articulation of the shaft  40 . 
     The orientation of the shaft  40  may be rotated about 90° in the process of manually docking the handle  31  on an end effector  6  and/or adapter  8 . When manually rolling the shaft  40 , the physician may hold the handle  31  and rotate the entire handle to cause the desired rotation/roll of the shaft  40  to align the plane of articulation P p  of the shaft  40  with the plane of the kidney P k  (e.g., plane generally bisecting the calyx network). When the instrument handle  31  is docked to the robotic end effector  6 , embodiments of the present disclosure may include a mechanism to align the plane of articulation P p  of the shaft  40  with the plane of the kidney P k , wherein such alignment may compensate for and/or be necessitated at least in part by the rotation of the handle  31  for the purpose of docking to the end effector  6 . 
     Robotic shaft roll may be achieved by a first bevel gear  89  and a second bevel gear  45 . That is, in some embodiments, the shaft gear  45  may be a bevel gear. The first bevel gear  89  can be coupled to the robotic drive input  87  and/or roll axle  85 , such that rotation of the drive input  87  and/or roll axle  85  causes rotation of the first bevel gear  89 . The first bevel gear can serve as an angle-transform gear for transforming a torque/rotation axis of the gear  89 , roll axle  85 , and/or roll drive input  87  to an axis that is parallel and/or co-axial with the base of the shaft  40  and/or shaft gear  45 . The shaft gear  45  (e.g., bevel gear) can be attached to the proximal end of the shaft  40  such that rotation of the shaft gear  45  can cause rotation of the elongate shaft  40  relative to the instrument handle  31 . 
     The first and second bevel gears  89 ,  45  can be engaged/meshed to transfer rotational movement of the roll axle  85  to the shaft  40 . For example, as shown, a drive belt  83  or other rotation translator means/mechanism may be used to operatively couple the first bevel gear  89  to the roll axle  85  from a distance. The roll axle  85  and drive input feature  87  thereof, or associated therewith, may be proximal of the angle-transform bevel gear  89 , and may be disposed between the shaft articulation inputs  602 / 762  in some embodiments. Other methods and mechanisms for transferring rotational motion of the roll axle  85  to the shaft  40  are also possible. In some embodiments, as the shaft  40  is rolled, the internal components (e.g., one or more coil pipes, pull wires, electrical wires, and/or fiber optics) may be inclined to twist due to fixation to both the proximal and distal ends of the shaft  40 . Twisting of the internal components can occur throughout much of the length of the elongate shaft  40 , minimizing the resultant force/torque applied to the proximal and distal terminations thereof. 
     With further reference to  FIGS.  7 A and  7 B , as well as  FIG.  5   , implementation of shaft roll in accordance with aspects of the present disclosure may be desirable as a means or mechanism for aligning a deflection plane of the shaft  40  with the plane P k  of a kidney  70 . For example, it may be desirable for a primary deflection plane P p  associated with the shaft  40  to be aligned with the plane P k  of the calyx network of the kidney  70 . Furthermore, shaft roll can be implemented to align a working channel  44  of the shaft  40  in a position that facilitates utilization of a working instrument disposed within the working channel  44 . That is, as shown in the detailed image of  FIG.  5   , the working channel  44  may generally not be at an axial center of the shaft  40 , but rather may be radially offset to one side, at least in part. Therefore, if the working channel  44  is misaligned, the ability to utilize an instrument disposed therein for an intended purpose may be constrained. Generally, the plane P k  of the kidney  70  may correspond to a bisectional plane of the kidney, as shown in  FIG.  5   . However, it should be understood that based on the particular patient anatomy, one or more of the calyces may be slightly off-plane. However, such calyces may be accessible from a position from the primary plane P k  of the kidney. Alignment of the primary deflection plane P p  of the shaft  40  with the plane P k  of the kidney can advantageously provide a maximum/high degree of reach of the shaft  40  within the kidney. 
     As described above, in some embodiments, the shaft  40  may be configured such that articulation thereof in one or more planes may be implemented. For example, in some embodiments, the shaft  40  may be configured to articulate in a primary deflection plane P p  in an amount greater than 180°, such as about 270° or more, whereas the scope can articulate in a secondary deflection plane P s  to a degree that is equal to or less than the degree to which the shaft  40  can articulate the primary articulation plane P p . For example, the shaft  40  may be configured to articulate only up to 90° or less in one or more planes in some embodiments. Shaft roll control in accordance with aspects of the present disclosure can advantageously allow for robotic alignment of the primary articulation plane P p  of the shaft  40  with the area of the calyces within the calyx network to allow for navigation to target kidney stone(s) or other specimen(s) to be extracted. Such described articulation in the primary P p  and secondary P s  plane(s) may advantageously be in both/two directions within the given articulation plane. Generally, the degree of deflection/articulation in a given deflection plane of the shaft  40  may be limited based on the amount of freedom that the individual structural links of the articulation portion  230  of the shaft  40  provide. In some embodiments, a proximal portion of the shaft  40  at, within, and/or near the handle  31  is configured to bend in only 2 directions, whereas a distal portion of the shaft  40  may be configured to bend in 4 directions, or vice versa. 
     In some implementations, after some amount of manual rotation/manipulation, the handle  31  may be placed on a robotic manipulator  6  (see  FIG.  6   ). In such transition between the manual held position and the docked position on the end robotic manipulator (e.g., effector  6  and/or adapter  8 ), the orientation of the instrument handle  31  and/or shaft  40  may be rotated by about 90°, such that the shaft  40  rolls an amount that is commensurate with the rotation of the handle  31 . Therefore, robotic roll adjustment may be desirable after docking of the handle  31  in some cases. For example, the system control circuitry may be configured to drive the relevant actuators/mechanics of the handle  31  to roll of the shaft  40  to compensate for the 90° (or other) change in shaft roll resulting from the docking of the handle  31 . Such automatic roll correction may be based at least in part on the position of the patient. Although automatic shaft roll correction is described, it should be understood that such shaft roll correction may be implemented by the operator using certain user input controls (e.g., control device  55  in  FIG.  1   ), as described herein. 
       FIG.  8    shows a cut-away view of an instrument handle  831  in accordance with one or more embodiments of the present disclosure. The embodiment of  FIG.  8    provides an alternative rotation translation mechanism compared to the embodiment of  FIGS.  7 A and  7 B  for translating rotation of a roll axle  885  of a handle  831  with a shaft base/gear  845 . For example, the embodiment of  FIG.  8    shows an axle-based transmission of rotational force from the roll axle  885  and associated output drive of the robotic end effector/adapter to which the handle  831  is coupled to the shaft hear  845 , wherein rotation of the axle  885  transmits rotation to a transverse-axis rod  883  via a bevel gear  881  or other angle-transform gear. 
     The rotation translation mechanism of  FIG.  8    includes a direct-drive rod  883 , which may be mechanically coupled to the roll axle  885  via a mesh engagement between the roll axle  85  and the bevel gear  881  coupled to the rod  883 . The rod  883  can be coupled to a distal shaft-actuating gear  889 . Generally, compared to a belt or other solution, the use of a rod for driving the shaft roll can advantageously provide relatively less loss. That is, a higher percentage of rotation of the driving gear(s)  885 ,  881  may generally be translated to a working gear  845  than with respect to certain other solutions, such as certain belt-type solutions. 
     The distal drive gear  889  and the shaft gear  845  may be spur gears in some embodiments. In some embodiments, the proximal drive gear  881  is a bevel gear configured to allow for meshing of the proximal drive gear  881  with a bevel-type roll axle  885 , wherein the roll axle  885  is orthogonal/transverse relative to the proximal drive gear  881 . Implementing spur gears for one or more of the roll axle  885 , proximal drive gear  881 , distal drive gear  889 , and/or shaft gear  845  can be desirable due to the relatively secure meshing of teeth of spur gears relative to bevel gears in some cases. That is, positioning and engagement of bevel gears may require relatively greater precision compared to spur gears due to the tendency thereof to bind and/or split. Therefore, use of spur gears for one or more of the gears of the device can provide a higher degree of freedom with respect to position and/or angle of the gears compared to bevel gears and/or other solutions. 
     The distal drive gear  889  may advantageously be positioned in a location that allows for a distal cable (e.g., power cable/wire(s)) to pass thereby and through the port  814 . Compared to a belt-type roll control system as shown in  FIG.  7 A and  7 B , a cable or rod-based mechanism may have less play/give, but may be relatively more difficult to install and/or assemble. Furthermore, for a belt-based system, such system may be more or less inclined to lose tension over time. 
       FIG.  9    shows a cut-away view of an instrument handle  931  having a rod-based rotation translation mechanism, which may be similar in certain respects to the embodiment shown in  FIG.  8   , in accordance with one or more embodiments of the present disclosure. In the embodiment of  FIG.  9   , the distal drive gear  989  is configured to transmit rotation of the rod  983  to the shaft gear  945  via a belt  901  or other rotation translator engaged with both of the gears  989 ,  945 . 
       FIGS.  10 - 1 ,  10 - 2 , and  10 - 3    show perspective views of a roll axle assembly  105  in accordance with one or more embodiments of the present disclosure.  FIG.  10 - 4    shows an exploded view of the roll axle assembly  105  shown in  FIGS.  10 - 1 ,  10 - 2 , and  10 - 3   . The roll axle assembly  105  includes a roll axle  85 , which may represent an embodiment of any of the roll axles disclosed herein. The roll axle assembly  105  includes the roll axle  85 , as well as a rotation-limiting slider component/portion  26 , and an axle-retention structure  84  having certain rotation-limitation features according to aspects of the present disclosure. 
     Generally, a full 360°, or more, of rotation of a shaft of a medical instrument in either/both direction(s) (i.e., clockwise and counterclockwise) may be desirable. However, with respect to robotically controlled shaft roll, it may not be desirable to permit infinite roll, as such rolling beyond 360° can cause damage to wires and other components associated with the shaft from twisting due to over-rolling. Therefore, it may be desirable to limit the rotation of the axle  85  in order to avoid twisting and/or damage of/to certain pull wires, camera wires, and/or other wires, cables, or other components that may emanate from the proximal end of the shaft and/or shaft gear. That is, it may be desirable to limit the rotation of the axle  85  to prevent the axle  85  and/or shaft gear  45  from rotating more than about 360° in either direction (e.g., less than 720° in total rotation). 
     Limitation of rotation of the axle  85  may be achieved using an open annular channel  118  of the axle  85  and/or an open annular channel  111  of the axle-retention structure  84 , wherein such channels may be open towards one another in some embodiments. Although annular channels are shown as being associated with both the axle  85  and the retention structure  84 , it should be understood that axle rotation limitation may be implemented using an annular channel in either, but not both, of the axle  85  and retention structure  84 . For example, the axle  85  may generally be a rotating component, whereas the axle-retention structure  84  may generally be a static/stationary component, wherein rotation of the axle  85  in one or both directions may be stopped by direct or indirect contact between a stopper contact surface/face  116 ,  117  of the axle  85  that is exposed within the channel  118  and a stopper contact surface/face  114 ,  115  of the axle-retention structure  84  that is exposed within the annular channel  111  of the retention structure  84 . Such contact between the axle  85  and the axle-retention structure  84  may be made indirectly via the slider structure/component  26 , which may translate contact within the annular channel  118  of the axle  85  to the contact surface(s)  114 ,  115  of the annular channel  111  of the sensor-retention structure  84 . For example, the slider  26  may include a lower engagement feature  125  configured to fit at least partially within the annular channel  118  of the axle  85  and slidably move therein. The slider  26  may further include an upper engagement feature  127  configured to fit at least partially within the annular channel  111  of the axle-retention structure  84  and slidably move therein. 
     The rotation of the axle  85  may be limited by contact with the slider  26  on either annular end thereof with stopper surfaces of the axle and the axle retention structure, respectively. For example, such stopper surfaces may be exposed within the open annular channels  111 ,  118  of the axle  85  and axle-retention structure  84 , respectively. That is, as the axle  85  rotates in a given direction, the lower portion  125  of the slider  26  may be configured to sit within the open annular channel  118  of the axle  85  and may slide within the channel until it contacts a stopper surface of, and exposed within, the channel  118 . With the slider in contact with the stopper surface within the open annular channel  118  of the axle  85 , the axle may be permitted to continue to rotate until the upper portion  127  of the slider  26  reaches a hard stop against a stopper surface of, and exposed within, the channel  111  of the axle-retention structure  84 . 
     The slider  26  can advantageously extend the rotation range of the axle  85  through sliding movement within the annular channel  111  of the sensor-retention structure  84 . For example, when rotating the axle  85  in a given direction, such rotation may be stopped by a hard stop caused by contact surfaces of the slider  26  and axle channel  118  coming into contact with one another, wherein, after contacting the stopper surface of the axle channel  118  and after further rotation of the axle in the same direction, a contact surface on an opposite end of the slider may also come into contact with a hard stop surface of the open channel  111  of the axle-retention structure  84 . As an example use case,  FIG.  10 - 1    shows the roll axle  85  at its furthest permitted clockwise rotation.  FIG.  10 - 2    shows the roll axle  85  rotated counterclockwise (compared to the configuration of  FIG.  10 - 1   ) to a contact position with the an opposite end of the slider  26 ; a side  112  and/or inside  129  surface of the slider  26  in an area associated with the lower portion  125  of the slider  26  is in contact with the stopper surface  117  inside the channel  118  of the axle  85 . In  FIG.  10 - 2   , the axle  85  can continue to rotate counterclockwise until the side surface  113  of the upper portion  127  of the slider  26  is stopped by the inside stopper contact surface  115  of the annular channel  111  of the retention structure  84 , which configuration is shown in  FIG.  10 - 3   . 
     The slider  26  can advantageously extend the permitted rotation of the axle beyond the limits of the axle channel  118  by extending the effective contact of the axle  85  into the annular channel  111  of the axle-retention structure  84 , and allowing the axle  85  to rotate an additional amount equivalent to the arclength L c1  of the channel  111  minus the arc length L s  of the slider  26 . Therefore, the total amount of permitted rotation of the axle  85  may be about equal to (or proportional to) the sum, in degrees, of the arclength L c1  of the axle channel  118  and the arclength L 2  of the retention structure channel  111 , minus two-times the arclength L s  of the slider; the arclength L s  of the slider may need to be accounted for with respect to its space occupied in both the axle channel  118  and the retention structure channel  111 . In some embodiments, while the axle channel  118  may allow for an amount of rotation that is less than 360°, the additional engagement of the slider  26  with the axle channel  111  of the retention structure  84  can extend the rotation range of the axle, even beyond 360°. 
     The annular/arc length L c1  of the slider channel  118  of the axle  85  may be restricted at least in part by the presence of the mating feature/channel  88 , which may provide a keyway/locking aspect/area for the axle  85 , as described in detail below. That is, in some embodiments, the size of the mating feature/channel  88  occupies space that takes away from the usable annular length of the channel  118  of the axle  85 . 
     The range of rotation of the roll axle  85  may be determined at least in part by the arclength L s  of the slider  26 . That is, the longer the arc length L s  of the slider  26  with respect to the amount of annular length within the channel  118  of the axle  85  and the channel  111  of the retention structure  84  occupied by the respective portions of the slider, the smaller the range of rotation permitted. 
     Generally, the radial thickness T s  and arc length L s  of the slider  26  may be determined to provide a desired structural stability for the slider  26  with respect to the propensity of the slider  26  to bind within one or more channels and/or withstand hard stop forces against the respective stopper surfaces. For example, if the slider  26  is too narrow with respect to annular length L s  and/or too narrow with respect to radial thickness T s , breaking and/or sheering can result from hard stop forces thereon. However, such dimensions can limit the rotation of the axle  85  and/or require greater size/space. Therefore, the design of the slider involves a trade-off between structural stability and size. For example, it may be desirable to design the slider  26  to be relatively robust for the purpose of facilitating the sliding thereof within the annular channel  118  of the axle  85  and the annular channel  111  of the retention structure  84  and for providing convenient fit therein. Furthermore, relatively longer annular length L s  of the slider  26  can facilitate sliding in the respective channels and reduce the risk of the slider  26  tipping over and binding or otherwise becoming askew within the channel(s). 
     The axle  85 , slider  26 , and retention structure  84  assembly  105  shown in  FIGS.  10 - 1  through  10 - 4    provides a solution for increasing a rotation range of a rotation-limited axle that may be suitable in certain applications. Additional solutions may be implemented to increase rotation range of roll axles in connection with embodiments of the present disclosure, such as by varying the gear diameter(s) associated with one or more of the roll-control gears associated with the relevant handle/instrument. For example, reducing the gear diameter of a shaft gear associated with a proximal end of an instrument shaft can increase the permitted rotation of the shaft. Additionally, increasing the diameter of a distal drive gear can increase rotation of the shaft relative to rotation of the roll axle, thereby increasing an operable range of roll. The particular assembly shown in  FIGS.  10 - 1  through  10 - 4    can be suitable for providing the desired shaft roll range in environments limited by space constraints, such as within a handle, as shown in various figures of the present disclosure. 
     In some implementations, embodiments of the present disclosure allow for a shaft-type instrument be used both manually and robotically. As may be desirable in such implementations, certain embodiments of the present disclosure relate to instrument handles configured to lock or fix shaft rotation in place automatically when the handle is manually manipulated. For example, such instrument handles may be configured such that when the handle is docked to a robotic end effector, rotation/roll of the shaft is automatically unlocked and allowed to be robotically controlled via the end effector (and/or attached adapter) and one or more components associated with the handle of the instrument. It should be understood that any reference herein to an end effector and/or component(s) or feature(s) thereof can refer to similar component(s) or feature(s) associated with an adapter coupled to an end effector, rather than to the end effector itself. 
       FIGS.  11 A,  11 B, and  11 C  show perspective views of certain instrument handle components, including an axle catch  90  in a locked position in which rotation of a roll axle  85  is limited/restricted by the axle catch  90 , in accordance with one or more embodiments of the present disclosure.  FIGS.  12 A,  12 B, and  12 C  show perspective views of the instrument handle components shown in  FIGS.  11 A- 11 C , wherein the axle catch is in an unlocked position in which an actuator-engagement boss  9  of an adapter or end effector device has engaged, and caused vertical translation of, the catch  90  to thereby lift/move the key feature  95  of the catch  90  out of the mating feature  88  of the roll axle  85 , thereby allowing the roll axle  85  to freely rotate in response to drive input. Any of the description below may be understood with respect to  FIGS.  11 A- 11 C and/or  12 A- 12 C . 
     As described above, in some cases, physicians or other operators/technicians may execute instrument shaft roll by holding a handle of an instrument in their hand and rotating their arm and/or hand to rotate the handle and shaft coupled thereto together as a unit. That is, with respect to any of the figures/embodiments of the present disclosure, when manually rolling a shaft  40  of an instrument  19 , it may be necessary or desirable for the roll of the shaft  40  relative to the handle  31  thereof to be restricted/locked to allow rotation of the handle  31  to be translated to the shaft  40 . Generally, implementation of hand-held manual roll/rotation may allow for about 180° of rotation, wherein such rotation is limited by the physical constraints of the arm and/or hand/wrist, which may vary to some degree across users. 
     The instrument handle  31  of  FIGS.  11 A- 11 C and  12 A- 12 C  includes a roll axle locking structure/catch  90  that may be configured to translate and key with the roll axle  85 . The term “catch” is used herein according to its broad and ordinary meaning, and may refer to any type of locking, stopping, blocking, impeding, or interfering structure, which may be understood with respect to a rotating axle component, feature, or device. When the instrument is used manually, such that the handle  31  is manually held/manipulated by the user, a spring or other biasing feature  93  may bias the catch structure  90  towards the roll axle  85  in a manner as to engage a key component  95  of the catch  90  with a mating feature  88  (e.g., keyway) of the roll axle  85 . For example, when the user manually rotates the shaft  40  (not shown in  FIGS.  11 A- 11 C ) to align a meeting feature of the roll axle  85  with the key feature  95  of the axle catch  90 , the biasing of the catch  90  towards the plane of the roll axle  85  can cause the key feature  95  to engage with the keyway mating feature  88 , thereby locking the rotation of the roll axle  85  in place. In such a locked state, the shaft  40  may not be permitted to freely rotate and/or be actuated through robotic driving. 
     In  FIGS.  11 A- 11 B and  12 A- 12 B , the roll axle  85  is rotated to a home/zero position in which the mating feature  88  is rotationally aligned with the key feature  95 , such that the key feature  95  can move into and out of the mating feature  88 . If the roll axle  85  is not in the home rotational position, which may be associated with a predefined angular position with respect to the shaft  40  about a roll axis thereof and/or the roll axle  85  about a rotational axis thereof, it may not be possible to implement shaft roll lock as described herein. Therefore, prior to latching or unlatching the handle  31  from the robotic system, it may be necessary or desirable to rotate the shaft  40  and/or axle  85  to the home position to enable shaft roll lock. For example, if the shaft  40  and/or axle  85  are rotated to the home position prior to unlatching/undocking of the handle  31 , such unlatching/undocking may automatically cause the catch  90  to lock the axle  85 . In some implementations, system control circuitry is configured to automatically roll the shaft  40  and/or axle  85  to the home position prior to undocking of the handle  31 . In some implementations, unlatching/undocking may be restricted/locked unless and until the shaft  40  and/or axle  85  is/are in the home position. Whether the shaft roll is in the home position may be determined electronically and/or mechanically. 
     With reference back to  FIG.  6   , the robotic end effector  6  and/or adapter component  8  associated therewith may include a catch actuation boss  9  or other feature configured to depress an actuator feature  91  of the catch  90  when the handle  31  is docked on the end effector/adapter  8 , wherein such actuator engagement can serve to disengage the lockout mechanism of the catch  90  by translating the key feature  95  of the catch  90  out of the mating feature (e.g., keyway)  88  of the axle  85 . That is, by pushing the handle  31  down onto the adapter  8  to latch the handle  31  to the adapter  8 , the catch-actuating projection/boss  9  may automatically press against the actuator contact surface  98  to dislodge/translate the axle catch  90  vertically (with respect to the orientation shown) from its locked position, removing the key  95  from the mating feature  88  of the axle  85 . Therefore, embodiments of the present disclosure provide solutions that allow a user to unlock a shaft roll control mechanism associated with an instrument handle by docking the handle on an end effector and/or adapter  8  (or other type of robotic manipulator). In such unlocked state, the handle may be free to operate to cause the shaft of the instrument to roll in response to certain control signals and/or drive input. 
     The key feature  95  provides a locking feature for the axle  85 . In some embodiments, the key feature  95  keys into the mating feature  88  of the axle  85  in a locked position in which rotation of the axle  85  is restricted. The fit of the key  95  in the mating feature  88  may advantageously be tight enough to prevent backlash/ejection of the key feature  95  when restricting roll/rotation of the axle, but not too tight to cause binding friction when actuating the catch into and/or out of mating engagement with the mating feature  88 . For example, the catch actuator component  91  may be positioned at a separate end  501  of the catch  90  relative to the key feature  95 , such that actuation of the catch actuator  91  (e.g., vertical translation thereof) may result in a tendency of the catch  90  to bind due to the uneven application of force to the catch  90 . Therefore, some amount of clearance around the key feature  95  may be desirable. However, any amounts of clearance between the key feature  95  within the mating feature  88  may translate to allowable rotation of the axle  85  when the key  95  is in the locked position. Therefore, the key  95  may fit relatively snuggly within the mating feature  88  in some embodiments. 
     In some embodiments, with respect to an axis A a  of the axle  85 , the axle catch  90  may be configured to translate vertically in parallel with the axis A a , such that the key  95  rises out of the mating feature  88 . The axle-retention structure  84  (not shown in  FIGS.  11 A- 11 C and  12 A- 12 B  for clarity) can present a limit on how far the catch  90  can translate vertically. With reference also to  FIGS.  10 - 1  through  10 - 4   , the axle cover/retention feature  84  can serve to align the roll axle  85  with the drive input associated therewith. In some embodiments, a pin  181  is disposed in an axial cup  119  of the axle  85  and within a corresponding opposite-facing cup  120  of the axle-retention structure  84 . Alternatively, the alignment pin  181  may be an integrated form with the cover  94 . The pin  181  may advantageously allow for rotation thereabout by the axle  85 . 
     The axle  85  may be biased in the locked position shown in  FIGS.  11 A- 11 C , wherein the axle catch  90  is positioned such that the key  95  is engaged with the mating feature  88  of the axle  85 . In some embodiments, such biasing may be implemented using one or more springs  122  or other biasing features. For example, the spring  122  may push downward (with respect to the shown orientation) on the axle catch  90  to bias the key feature  95  down into the mating feature/channel  88 . In some embodiments, the spring  122  presses against an underside/surface of one or more components of the handle housing, such as the underside of the axle-retention structure  84  or other structure. In some embodiments, the axle catch  90  includes a spring-retention feature  93 , such as a cup or recess feature, as shown in  FIGS.  11 A and  11 B . For example, the spring-retention feature  93  may have an open cylindrical form, with a seating  94  on which the spring  122  can apply biasing force. Although a cup-type spring retention feature is shown, it should be understood that any type of spring-retention form or structure may be implemented, such as an attachment means or mechanism for securing the spring  122  to the catch  90  (e.g., one or more hooks, clips, adhesives, or the like). 
     One or more alignment pins  121  may be utilized to facilitate translation of the catch  90  that is generally parallel with the axis A a  of the axle  50 . That is, the pin(s)  121  can be configured to control/guide the direction and/or orientation of travel of the catch  90  to thereby keep the catch  90  in-plane when translating (e.g., with respect to a flat top surface of the catch  90 ). For example, embodiments in which the biasing component (e.g., spring)  122  is disposed relatively close to one end  501  of the catch  90 , the biasing force provided thereby may be inclined to cause the catch  90  to tip and/or bind when translating. The pins  121  may prevent/reduce such tipping/binding. In some embodiments, the catch  90  includes one or more apertures or other features  92  configured to have the pin(s)  121  disposed therein to provide a track/guide for the catch  90  about the pin(s)  121 . The pin(s)  121  may be secured to the housing  80  in some manner, and may be integrated with other structure of the handle or may be separate components that are secured in place by being nested with one or more retention features of the housing and/or axle retention structure  84 . 
     With reference also back to  FIG.  6   , the adapter component  8  includes a catch actuator engagement feature/boss  9 , which is configured to engage with the actuator  91  when the handle  31  is latched to the adapter  8  and/or end effector  6 . For example, when the handle  31  is latched/docked to the adapter  8  and/or end effector  6 , the boss  9  can be configured to press against the engagement surface  98  of the actuator  91 , thereby causing the catch actuator  91  and coupled/integrated catch  90  to translate in a direction generally parallel with an axis of the boss  9 , actuator  91 , and/or catch actuator access channel  176 . By such means, the boss  9  may be configured to unlock the axle  85  by causing the catch  90  to translate such that the key  95  moves out of the mating feature  88  of the axle  85 . Such unlocking may be performed from outside of the housing  30  of the handle  31 . In some embodiments, the axle actuator  91  is axially aligned with the spring-retention cup  93 , as shown in  FIG.  11 C . 
     In some embodiments, the catch actuator  91  (e.g., plug, pin, button, peg, plunger, or other actuator means or form) projects into and/or through the actuator access channel  176  of the handle housing  80 . In some embodiments, the actuator  91  includes an annular gap or space  96 , which may accommodate an O-ring or other type of sealing component configured to prevent fluid ingress into the handle housing  80  through the actuator channel  176 . In some embodiments, the annular gap/channel  96  does not have a sealing feature disposed therein, but rather provides an airgap in which any fluid passing around the actuator periphery may generally collect in the gap space  96 . 
     The catch  90  may have a height dimension H 1  corresponding to a height of an area of the catch including the alignment pin channels  92 , wherein the height dimension H 1  provides surface area around the alignment pins  121  to facilitate alignment thereof and to keep the alignment channels  92  substantially parallel with the alignment pins. For example, it may be advantageous to prevent the catch  90  from being permitted to rock/tip when translating, wherein such inclination to rock/tip may be dependent at least in part on the height dimension H 1  and/or the clearance around the pins within the alignment channel(s)  92 . Therefore, to reduce rocking/tipping, the alignment channel  92  may advantageously fit relatively closely around the alignment pins  121  with little clearance, while allowing some amount of clearance to avoid frictional restraint on the catch  90  around the pins when axially translating. Furthermore, the height of the catch H 1  in the area of the alignment channel(s)  92  may be made as great as possible in view of the relevant space constraints within the housing  80 . For example, pulleys, wires, and/or other components of the handle  31  may be disposed at least partially above the catch  90  within the housing  80 , wherein the catch  90  does not occupy such space during the unlocked or locked configurations. The topology of the underside of the catch  90  may advantageously fill available space within the housing  80  to provide one or more bearing surfaces in which the catch  90  contacts structural component(s) of the base of the housing  80  on bottom surface(s) thereof when the catch  90  is in the locked position to allow the catch  90  to rest in the locked position. The catch  90  may have a total height H 2  including the actuator  91  that is greater than the height H 1  of the body of the catch  90 . 
     The actuator-engagement boss  9  of the adapter  8  (and/or end effector  6 ) may be limited in height to avoid contacting instrument components when other instruments other than the handle  31  are latched thereto. For example, the adapter  8  may be configured to have various types of instruments attached thereto, including catheter-type instruments and/or the like. In some embodiments, the pin has a height of about 2.2 mm, or less. In some embodiments, the pin is more than 2.2 mm tall. 
     The catch  90  may have a length dimension L and a width dimension W, as shown, wherein the length dimension L is greater than the width dimension W. For example, the width dimension W may generally be parallel with a projection dimension of the key  95 , whereas the length dimension L may be transverse/orthogonal to the width dimension W. The ends  501 ,  502  of the catch  90  may be considered to be lengthwise halves or thirds of the catch  90 ; in some embodiments, the key  95  may be part of, or otherwise associated with, an opposite lengthwise side/end  502  of the catch  90  from the actuator  91  and/or the spring  122  and spring-retention cup  93 . At least one alignment pin  121  and/or associated alignment pin channel  92  may be associated with a medial lengthwise portion of the catch  90  between the opposite ends  501 ,  502 . 
     Although a single actuator peg/form  91 , channel  176 , and actuator boss  9  are shown and described above, it should be understood that the catch  90 , housing  80 , and/or adapter  8  may be implemented with any number of actuator, actuator access channel, and/or actuator pin components. For example, by including two catch actuators, the stability of the catch  90  during translation can be improved. For example, such multiple actuators and associated components/features may be associated with separate sides/ends  501 ,  502  of the catch  90 , and/or between the ends/sides  501 ,  502 . Generally, the position of the actuator  91  in the end region  501  may not be ideal from a translation alignment standpoint. However, due to certain physical/positional constraints associated with the handle housing  80 , the configuration illustrated in  FIGS.  11 A- 11 C and  12 A- 12 C  may be necessary or desirable, wherein any alignment deficiencies presented by the position/location of the actuator  91  may be compensated for using one or more of the alignment pin channel(s)  92 , spring-retention cup(s)  93 , height/thickness dimensions H 1 , H 2 , and key-axle engagement features. 
       FIGS.  13 - 1  and  13 - 2    show perspective views of certain instrument handle components including an axle catch  146  in accordance with one or more embodiments. Compared to the embodiment shown in  FIGS.  11 A- 11 C and  12 A- 12 C , use of a rotating catch rather than a vertically-translating catch can provide certain benefits. For example, with respect to vertically-translating catch structures, certain contaminants can become trapped within the actuator channel associated therewith, which may be relatively difficult to sanitize/clean. For example, with respect to the plug-type actuator embodiment of  FIGS.  11 A- 11 C and  12 A- 12 C , the area between the actuator contact surface  98  and the base of the actuator plug  91  may be difficult to clean and/or access. With respect to the rotating actuator of  FIGS.  13 A- 13 C , the actuator  140  thereof may not be prone to have contaminants pass around the actuator  140  due to the actuator merely rotating in place as opposed to physically translating along an axis and/or into the housing of the handle. 
     In some embodiments, the actuator  140  of the catch  146  is a cam actuator. In such a system, the adapter and/or end effector  147  to which the handle  131  is attached can include an actuator-engagement projection/boss  143 , which can have any suitable or desirable shape or configured to actuate the cam socket  141  of the actuator  140 . For example, the actuator-engagement projection/boss  143  may have a rectangular/oblong cross-sectional shape, as shown. By pushing the actuator-engagement projection/boss  143  into the cam socket  141 , the angled/curved cam surfaces/grooves  142  of the cam socket  141  may cause the axle catch  146  to rotate about the axis A c  of the actuator  140 , thereby causing the bent projection  149  of the catch  146  rotate out of the mating feature  148  of the axle  145 . The catch  146  may be biased in a locked position in which the end  144  of the bent projection  149  protrudes into the mating feature  148  associated with the side of the axle  145 , thereby locking the rotation of the axle. 
     The catch  146  may be biased toward the roll axle  145  via a torsion spring or some other biasing device/mechanism, wherein the catch  146  is configured to automatically rotate away from the roll axle  145  when docked on the end effector and/or adapter associated therewith. 
     With respect to the cam actuator  140 , the more aggressive the angle of the angled/curved cam surfaces/grooves  142 , the more rotation is translated to the catch  146  per unit of distance projected into the cam socket  141  of the actuator  140  by the actuator-engagement boss  143 , which may increase the probability that successful unlatching/unlocking may be achieved when the handle  131  is docked on the adapter/end effector  147 . Generally, the actuator-engagement boss  143  may need to overcome the biasing force (e.g., spring force) in order to effect rotation of the cam catch  146 . 
     The rotating axle catch  146  is configured to rotate to engage with the keyed feature  148  of the axle  145 , rather than translating vertically to engage and disengage with/from the mating feature of the axle. Rotation may be achieved using a cam feature formed in the catch  146  and/or associated therewith in some manner. The rotating catch embodiment of  FIGS.  13 - 1  and  13 - 2    may be suitable to prevent fluid ingress. 
       FIGS.  14 - 1  and  14 - 2    show a roll-lock feature  163  for an instrument having an instrument handle  175  and a shaft  40  component in accordance with one or more embodiments. The roll-lock feature  163  can comprise a forked shaft rotation stopper that may be disposed generally radially outside of the adapter and/or end effector component(s) to which the instrument handle  175  is attached in some embodiments. The stopper  163  may be configured to lock the shaft  440  by directly contacting the shaft  440  and/or base  151  or strain-relief form  153  associated therewith. The shaft roll stopper  163  can extend out distally from a distal portion of the handle  175  of the instrument. 
     The stopper  163  may include a strip  166  or area having high-friction-coefficient material configured to increase the roll resistance when the strip  166  and a component/portion of the shaft  440  are in contact. References herein to the shaft  440  can refer to the elongate tubular shaft portion  440  itself and/or to either or both of the shaft base  151  and the strain-relief form  153 . In some embodiments, the stopper feature  163  includes a key feature (not shown) that is configured to key into a corresponding engagement feature associated with the shaft  440 , strain-relief form  153 , and/or base  151  thereof. 
     The base  151  of the shaft  440  can be coupled to and/or integrated with the shaft  440  in a manner such that the shaft  440  and base rotate together. In some embodiments, the base  151  comprises a rigid cylindrical base structure  151  of the shaft  440 , which may be proximal to the strain-relief feature  153  (where present) in some embodiment, and may provide the engagement surface for the stopper feature  163 . For example, the forked portion  162  of the stopper  163  can be configured to engage/contact the exterior surface of the base portion  151  to provide roll-stopping resistance/traction for the shaft  440 . 
     The stopper  163  may include a base portion  160 , which may be generally straight and/or elongate as shown in  FIGS.  14 - 1  and  14 - 2   , or may have any other suitable or desirable shape configured to permit vertical sliding or other movement (e.g., rotation) of the stopper  163  to bring the contact surface  166  thereof into contact with a portion of the shaft  440  (e.g., shaft base  151 ). In some embodiments, the base portion  160  includes a slot  161  or other feature configured to facilitate translation/sliding of the stopper  163 . For example, a pin  152  or other form/component may be inserted/disposed at least partially within the slot  161  to retain the stopper  163  while allowing for translation of the stopper  163  corresponding to movement of the stopper such that the pin  152  slides within the slot  161  between locked and unlocked positions. For example, for the unlocked position ( FIG.  14 - 1   ), the pin  152  may be at or near the top of the slot  161 , whereas for the locked position ( FIG.  14 - 2   ), the pin  152  may be at or near the bottom of the slot  161 .  FIG.  14 - 1    shows the stopper  163  in the unlocked position, in which the stopper sits within a housing  170  such that the contact area/strip  166  is not in contact with the shaft  440  or component(s) associated therewith (e.g., shaft base  151 ). 
       FIG.  14 - 2    shows the stopper  163  in the locked position in which the stopper  163  has been vertically translated/actuated to exert force at the contact area  166  against a component of the shaft  440 , such as the shaft base  151 , strain-relief component  153 , and/or shaft body  440 . Actuation of the stopper  163  between the locked and unlocked positions may be achieved using any suitable or desirable actuator means or mechanism. In some embodiments, the stopper  163  is biased such as through the use of one or more springs or other biasing devices, in either the locked or unlocked position. In some embodiments, the stopper  163  is configured to be robotically actuated in some manner. Although the forked portion  162  of the stopper  163  is illustrated as having a semicircular shape/form, it should be understood that such components/portions may have any suitable or desirable shape and/or contact surface/area. 
     Shaft Roll Processes 
       FIGS.  15 - 1 ,  15 - 2 , and  15 - 3    provide a flow diagram for a process  1500  for rolling an instrument shaft  154  in accordance with one or more embodiments.  FIGS.  16 - 1 ,  16 - 2 , and  16 - 3    show certain images corresponding to various blocks, states, and/or operations associated with the process  1500  of  FIGS.  15 - 1 ,  15 - 2 , and  15 - 3   , respectively, in accordance with one or more embodiments. The process  1500  may be performed at least in part by certain robotic system control circuitry, as described herein. 
     The process  1500  may be implemented in connection with a medical procedure, such as a kidney stone removal procedure, or other procedure that may be implemented using a shaft-type medical instrument  159 , such as an endoscope, ureteroscope, or the like. That is, the process  1500  may be implemented at least in part following placement of a distal end of a shaft  154  of the shaft-type medical instrument  159  (e.g., endoscope) within certain target anatomy of a patient, such as a calyx network of a kidney of the patient. One or more operations of the process  1500  may be implemented prior to access of the target anatomy by the distal end of the shaft of the medical instrument. 
     At block  1502 , the process  1500  involves manually rotating a shaft  154  of a medical instrument  159  relative to a handle  151  thereof to bring the shaft  154  into a home position, wherein a shaft roll locking mechanism of the handle  151  may be configured to engage/lock when the shaft is rotated manually to the home position, as shown in image  1602 . For example, the handle  151  may have associated therewith one or more markings or features indicating an alignment of the shaft  154  relative to the handle  151 . For example, a strain relief form  153 , such as a cone-type form as described in detail herein, may have one or more features, such as a circumferential apex or other feature, indicating the orientation of the shaft  154 . For example, the marker/indicator may be aligned with a working channel of the shaft  154 , or other feature(s). In some implementations, the operation(s) associated with block  1502  of the process  1500  involve manually holding or grabbing the strain-relief feature  153  associated with a proximal end portion of the shaft  154  and rotating such form/feature  153  into an indicated home position, which may thereby cause a roll lock catch or other feature to engage a roll axle of the handle  151 , thereby locking relative roll between the shaft  154  and the handle  151  of the medical instrument  159 . 
     At block  1504 , the process  1500  involves manually rolling/rotating the shaft  154  of the medical instrument  159  by manually rotating the handle  151  with the shaft  154  in a relative locked roll configuration implemented by shaft roll lock biasing (e.g., spring-loading on an axle lock/catch biasing the axle lock/catch in a locked configuration), as described herein. For example, the shaft  154  may be associated with the handle  151 , which may be coupled to a proximal portion of the shaft  154 . Due to the automatic roll locking, the medical instrument  159  may be configured such that rotation of the handle  151  translates to rotation of the shaft  154 . That is, the shaft  154  may not be free to rotate relative to the handle  151 , but rather may have a locked rotation relative to the handle  151 . For example, the handle  151  may have associated therewith a roll-locking catch feature, as described in detail herein, wherein such feature may be biased in the locked position to prevent relative rotation between the shaft  154  and the handle  151  when the instrument  159  is manually manipulated/operated. Manually rolling the handle  151  of the medical instrument  159  in connection with block  1504  may be performed to bring a deflection plane of the shaft  154  and/or a distal end portion thereof into alignment with a plane of the particular anatomy in which the shaft is disposed. For example, manual handling and rotating of the handle  159  of the medical instrument may be performed to bring the shaft  154  into alignment with a kidney of the patient with respect to a renal operation. 
     At block  1506 , the process  1500  involves docking the handle  151  of the medical instrument  159  on a robotic end effector/system  158 . For example, the handle  151  may be docked on an adapter, such as a sterile adapter as described in detail herein, which may in turn be physically coupled to the end effector of a robot arm of a robotic system (e.g., cart system). Docking the handle  151  can involve rotating the handle lengthwise by about 90° to align the handle  31  with the engagement surface of the robotic instrument manipulator assembly  158  (e.g., adapter and/or end effector). 
     At block  1508 , the process  1500  involves unlocking a roll axle of (e.g., within) the handle  151  of the medical instrument  159 . For example, such unlocking may happen substantially automatically when the handle  151  is latched on the end effector/adapter  158 . For example, one or more features of the end effector/adapter  158  may be configured to actuate an axle catch component of the handle  151  when the handle  151  is placed on and/or pressed against the end effector/adapter  158 . 
     At block of  1510 , the process  1500  involves robotically rolling the shaft  154  relative to the handle  151  of the medical instrument  159 . For example, one or more drive outputs of the robotic system  158  may be implemented to cause shaft roll through engagement with drive input(s) of the instrument handle  151 . At block  1512 , the process  1500  may involve returning the shaft  154  to the home position with respect to roll orientation thereof relative to the handle. Such action may be performed robotically or manually, and may occur before or after undocking of the handle/instrument  151  from the robotic system  158 . 
     At block  1514 , the process  1500  involves unlatching/undocking the handle  151  from the end effector/adapter  158 , thereby locking the rotation of the shaft  154  relative to the handle  151 . In the event that the shaft  154  has not been brought into the home position yet, it may be necessary to manually rotate the shaft  154  relative to the handle  151  to bring the shaft  154  into the home roll position, thereby enabling locking of the shaft  154  roll through biasing of the axle catch of the handle  151 . 
     Described herein are systems, devices, and methods to facilitate the robotic rolling of shafts of medical instruments, as well as the limiting and/or restriction of such rolling, in connection with certain medical procedures. In particular, systems, devices, and methods in accordance with one or more aspects of the present disclosure can facilitate the locking of robotic shaft roll, which may be implemented automatically in connection with undocking of the instrument from a robotic end effector or other system component. Robotic shaft roll, shaft roll locking, and shaft roll restriction/limitation in accordance with the various embodiments disclosed herein can advantageously reduce certain risks and/or inefficiencies associated with rolling of an instrument. 
     In some implementations, the present disclosure relates to a medical instrument comprising an elongate shaft defining a roll axis and a handle coupled to the elongate shaft. The handle comprises a robotic drive input operable to rotate the elongate shaft with respect to the handle about the roll axis and a lockout mechanism movable between an engaged position in which the lockout mechanism impedes rotation of the elongate shaft with respect to the handle about the roll axis, and a disengaged position in which the lockout mechanism permits rotation of the elongate shaft with respect to the handle about the roll axis. 
     The lockout mechanism can be configured to move to the engaged position in a configuration where the handle is off-robot. In some embodiments, the lockout mechanism is configured to move to the engaged position in a configuration where the handle is off-robot and the elongate shaft is at a predefined angular position about the roll axis. 
     The medical instrument can further comprise an axle having a first axis, a shaft gear associated with a proximal end of the elongate shaft, the shaft gear having a second axis that is transverse with respect to the first axis, and a bevel gear having a third axis that is parallel with the first axis, the bevel gear being in a mesh configuration with the shaft gear. The bevel gear can be coupled to the axle by a belt configured to translate rotational movement of the axle to the bevel gear. 
     The medical instrument can further comprise an axle having a first axis, a shaft gear associated with a proximal end of the elongate shaft, the shaft gear having a second axis that is transverse with respect to the first axis, a bevel gear disposed in the handle in a mesh configuration with the axle, the bevel gear being configured to rotate about a third axis that is parallel to the second axis, and a rod coupled to, and coaxial with, the bevel gear. The rod can be configured to cause rotation of the shaft gear. 
     The medical instrument can further comprise an axle actuatable by the robotic drive input, and an axle-retention structure disposed at least partially over the axle, the axle-retention structure being configured to limit rotation of the axle. In some embodiments, the axle-retention structure includes a first open annular channel and one or more first stopper surfaces exposed within the first open annular channel and configured to limit rotation of the axle. For example, the axle can include a second open annular channel that is open to the first open annular channel at least in part and one or more second stopper surfaces exposed within the second open annular channel and configured to limit rotation of the axle. The medical instrument can further comprise a slider form comprising a first portion configured to be disposed at least partially within the first open annular channel and contact the one or more first stopper surfaces and a second portion configured to be disposed at least partially within the second open annular channel and contact the one or more second stopper surfaces. 
     In some implementations, the present disclosure relates to a robotic medical system comprising a robotic manipulator comprising a plurality of drive outputs and a boss. The robotic medical system further comprises a medical instrument comprising a handle mountable to the adapter and an elongate shaft insertable into a patient, the handle comprising a plurality of drive inputs and a lockout mechanism configured to selectively permit or impede rotation of the elongate shaft with respect to the handle. The boss is configured to disengage the lockout mechanism upon mounting the handle to the adapter. 
     In some embodiments, the robotic manipulator assembly comprises a robotic end effector including a plurality of drive outputs and an adapter mountable on the robotic end effector and comprising a plurality of drive couplers and the boss. The boss can be configured to vertically translate at least a portion of the lockout mechanism. In some embodiments, the boss is configured to rotate at least a portion of the lockout mechanism. 
     In some implementations, the present disclosure relates to a medical instrument comprising an elongate shaft, a handle coupled to a proximal portion of the elongate shaft, an axle associated with the handle, the axle being configured such that rotation of the axle causes the elongate shaft to rotate about an axis of the elongate shaft, and an axle catch disposed at least partially within the handle and configured to be actuated to impede rotation of the axle. 
     In some embodiments, the axle catch comprises a key configured to engage with a mating feature of the axle. For example, when the key is disposed at least partially within the mating feature of the axle, rotation of the axle can be restricted. The key of the axle catch can be configured to enter the mating feature of the axle in an axial direction with respect to an axis of the axle. In some embodiments, the axle catch is configured to be actuated in a direction parallel to an axis of the axle. For example, the axle catch can include one or more alignment pin channels that have axes that are parallel with the axis of the axle and are configured to have respective alignment pins disposed at least partially therein, the respective alignment pins guiding actuation of the axle catch in the direction parallel to the axis of the axle. The key of the axle catch can be configured to enter the mating feature of the axle through a side portion of the axle. For example, the axle catch can be configured to rotate about an axis that is parallel with an axis of the axle. In some embodiments, the key comprises a bent projection. 
     The axle catch can comprise a catch actuator. For example, the catch actuator may be a unitary form with the axle catch. In some embodiments, the catch actuator is associated with a first longitudinal end of the axle catch and the catch actuator is associated with a second longitudinal end of the axle catch. In some embodiments, the catch actuator is accessible from outside of the handle. For example, the catch actuator can comprise a plug configured to be disposed at least partially in an aperture form of the handle. Alternatively, the catch actuator can comprise a cam structure configure to rotate about an axis of the cam structure. 
     In some implementations, the present disclosure relates to the axle catch is biased in a locked configuration in which rotation of the axle is impeded. The medical instrument can further comprise a spring disposed at least partially within a cup form of the axle catch and configured to exert force on the axle catch biasing the axle catch in the locked configuration. In some embodiments, the medical instrument further comprises an axle retainer structure disposed within the handle, wherein the axle retainer structure axially secures the axle in place and the spring is configured to push against an underside of the axle retainer structure when disposed at least partially within the cup form. 
     For purposes of summarizing the disclosure, certain aspects, advantages and novel features have been described. It is to be understood that not necessarily all such advantages may be achieved in accordance with any particular embodiment. Thus, the disclosed embodiments may be carried out in a manner that achieves or optimizes one advantage or group of advantages as taught herein without necessarily achieving other advantages as may be taught or suggested herein. 
     Additional Embodiments 
     Depending on the embodiment, certain acts, events, or functions of any of the processes or algorithms described herein can be performed in a different sequence, may be added, merged, or left out altogether. Thus, in certain embodiments, not all described acts or events are necessary for the practice of the processes. 
     Conditional language used herein, such as, among others, “can,” “could,” “might,” “may,” “e.g.,” and the like, unless specifically stated otherwise, or otherwise understood within the context as used, is intended in its ordinary sense and 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 author input or prompting, whether these features, elements and/or steps are included or are to be performed in any particular embodiment. The terms “comprising,” “including,” “having,” and the like are synonymous, are used in their ordinary sense, and are used inclusively, in an open-ended fashion, and do not exclude additional elements, features, acts, operations, and so forth. Also, the term “or” is used in its inclusive sense (and not in its exclusive sense) so that when used, for example, to connect a list of elements, the term “or” means one, some, or all of the elements in the list. Conjunctive language such as the phrase “at least one of X, Y and Z,” unless specifically stated otherwise, is understood with the context as used in general to convey that an item, term, element, etc. may be either X, Y or Z. Thus, such conjunctive language is not generally intended to imply that certain embodiments require at least one of X, at least one of Y and at least one of Z to each be present. 
     It should be appreciated that in the above description of embodiments, various features are sometimes grouped together in a single embodiment, Figure, or description thereof for the purpose of streamlining the disclosure and aiding in the understanding of one or more of the various inventive aspects. This method of disclosure, however, is not to be interpreted as reflecting an intention that any claim require more features than are expressly recited in that claim. Moreover, any components, features, or steps illustrated and/or described in a particular embodiment herein can be applied to or used with any other embodiment(s). Further, no component, feature, step, or group of components, features, or steps are necessary or indispensable for each embodiment. Thus, it is intended that the scope of the inventions herein disclosed and claimed below should not be limited by the particular embodiments described above, but should be determined only by a fair reading of the claims that follow. 
     It should be understood that certain ordinal terms (e.g., “first” or “second”) may be provided for ease of reference and do not necessarily imply physical characteristics or ordering. Therefore, as used herein, an ordinal term (e.g., “first,” “second,” “third,” etc.) used to modify an element, such as a structure, a component, an operation, etc., does not necessarily indicate priority or order of the element with respect to any other element, but rather may generally distinguish the element from another element having a similar or identical name (but for use of the ordinal term). In addition, as used herein, indefinite articles (“a” and “an”) may indicate “one or more” rather than “one.” Further, an operation performed “based on” a condition or event may also be performed based on one or more other conditions or events not explicitly recited. 
     Unless otherwise defined, all terms (including technical and scientific terms) used herein have the same meaning as commonly understood by one of ordinary skill in the art to which example embodiments belong. It be further understood that terms, such as those defined in commonly used dictionaries, should be interpreted as having a meaning that is consistent with their meaning in the context of the relevant art and not be interpreted in an idealized or overly formal sense unless expressly so defined herein. 
     The spatially relative terms “outer,” “inner,” “upper,” “lower,” “below,” “above,” “vertical,” “horizontal,” and similar terms, may be used herein for ease of description to describe the relations between one element or component and another element or component as illustrated in the drawings. It be understood that the spatially relative terms are intended to encompass different orientations of the device in use or operation, in addition to the orientation depicted in the drawings. For example, in the case where a device shown in the drawing is turned over, the device positioned “below” or “beneath” another device may be placed “above” another device. Accordingly, the illustrative term “below” may include both the lower and upper positions. The device may also be oriented in the other direction, and thus the spatially relative terms may be interpreted differently depending on the orientations. 
     Unless otherwise expressly stated, comparative and/or quantitative terms, such as “less,” “more,” “greater,” and the like, are intended to encompass the concepts of equality. For example, “less” can mean not only “less” in the strictest mathematical sense, but also, “less than or equal to.”