Patent Publication Number: US-2021186644-A1

Title: Functional indicators for robotic medical systems

Description:
PRIORITY APPLICATION 
     This application claims priority to U.S. Provisional Application No. 62/951,799, filed Dec. 20, 2019, which is incorporated herein by reference. Any and all applications for which a foreign or domestic priority claim is identified in the Application Data Sheet as filed with the present application are hereby incorporated by reference under 37 CFR 1.57. 
    
    
     TECHNICAL FIELD 
     This application is directed to robotic medical systems, and more particularly, to functional indicators for robotic medical systems. 
     BACKGROUND 
     Medical procedures, such as laparoscopy or endoscopy, may involve accessing and visualizing an internal region of a patient. In a laparoscopic procedure, for example, a medical instrument can be inserted into an internal region through a laparoscopic access port. Robotically-enabled medical system can be used to perform such medical procedures. The robotically-enabled medical systems may include several robotic components, including, for example, robotic arms, robotic instrument manipulators, and robotic medical instruments, such as robotically controllable laparoscopes or endoscopes. 
     SUMMARY 
     Robotic medical systems that include one or more robotic components can also include functional indicators configured to communicate information about the system or its components. As initial examples, the functional indicators can comprise visual indicators (e.g., lights) and/or audible indicators (e.g., speakers). In some embodiments, the robotic medical systems can include one or more robotic arms positioned on adjustable arm supports configured to move to position the one or more robotic arm supports relative to a patient platform supporting a patient during a robotic medical procedure. The functional indicators can be positioned, for example, on the adjustable arm supports or a patient platform. The indicators can be configured, for example, to provide state and/or identity information associated with the system or its components. The indicators can also be used in non-robotic systems as well. 
     In a first aspect, a robotic medical system includes a patient platform configured to support a patient during a robotic medical procedure; a column supporting the patient platform; an arm support coupled to the column; at least one robotic arm coupled to the arm support; and an indicator positioned on at least one of the arm support and the patient platform, wherein the indicator is configured to indicate state or identity information of the system. 
     The system can include one or more of the following features in any combination: (a) wherein the indicator comprises at least one of a visual indicator and an audible indicator; (b) wherein the arm support comprises an adjustable arm support configured to move the at least one robotic arm relative to the patient platform; (c) wherein the adjustable arm support is configured to move the at least one robotic arm from a stowed position below the patient platform to a deployed position wherein at least a portion of the at least one robotic arm is positioned above the patient platform; (d) wherein the arm support comprises a bar extending along an axis between a first end and a second end, and wherein the at least one robotic arm is movably mounted to the bar such that the at least one robotic arm can translate along the bar; (e) wherein the indicator comprises a visual indicator; (f) wherein the visual indicator is positioned on at least one of a top side, an outer side, an inner side, and a bottom side of the bar; (g) wherein the visual indicator extends onto the first end and the second end of the bar; (h) wherein the visual indicator comprises a strip of light emitting diodes (LEDs); (i) wherein the state information comprises information about movement of at least one of the arm support and the at least one robotic arm; (j) wherein the state information indicates a direction of movement of the arm support; (k) wherein the direction of movement comprises a sweeping movement of the arm support; (l) wherein the direction of movement comprises a translating movement of the arm support; (m) wherein the state information indicates a direction of movement of the at least one robotic arm along the arm support; (n) wherein the state information comprises an identifier for the at least one robotic arm; (o) wherein the state information comprises first state information and second state information; (p) wherein the first state information comprises at least one of: a stand by state, a powered state, an active state, a ready state, an error state and an emergency stop state; (q) wherein the second state information is configured to indicate movement of the arm support; (r) wherein the visual indicator is configured to indicate the first state information and the second state information concurrently; and/or (s) wherein the visual indicator is configured to illuminate a zone around the system indicative of an area through which the arm support will move to provide a visual indication of a zone of danger. 
     In another aspect, a robotic medical system includes a patient platform configured to support a patient during a robotic medical procedure; a column supporting the patient platform; an adjustable arm support coupled to the column and configured to move relative to the patient platform, the adjustable arm support comprising a bar extending along an axis between a first end and a second end; a first robotic arm coupled to the bar of the adjustable arm support and configured to translate along the bar; a second robotic arm coupled to the bar of the adjustable arm support and configured to translate along the bar independently of the first robotic arm; and a light strip positioned on at least one of the patient platform and the bar of the adjustable arm support; and a processor in communication with a memory that stores instructions that configured the processor to: determine a state of the robotic medical system, and activate the light strip to convey the state of the robotic medical system visually. 
     The system can include one or more of the following features in any combination: (a) wherein the light strip comprises a strip of individually-addressable light emitting diodes (LEDs); (b) wherein the light strip is positioned on at least one of a top side, an outer side, inner side, and a bottom side of the bar; (c) wherein the light strip extends onto the first end and the second end of the bar; (d) wherein the state comprises a movement of the adjustable arm support, the first robotic arm, or the second robotic arm, and the processor is configured to activate the light strip to convey a direction of the movement; (e) wherein the movement comprises a translation of the bar of the adjustable arm support or a translation of one of the first robotic arm and the second robotic arm along the bar; (f) wherein the movement comprises a sweeping movement of the bar of the adjustable arm support; (g) wherein the processor determines the state of the robotic medical system based on a user input; (h) wherein the user input comprises a commanded motion for at least one of the first robotic arm and the second robotic arm; (i) wherein the user input comprises at least one of: a stow command for transitioning the adjustable arm support, the first robotic arm, and the second arm support from a deployed position to a stowed position; and a set up command for transitioning the adjustable arm support, the first robotic arm, and the second arm support from a stowed position to a deployed position; and/or (j) wherein upon receipt of the stow command, the system is configured to, at least one of: move the adjustable arm support and the first robotic arm to a draping configuration; and move the adjustable arm support and the first robotic arm to a pre-docking position. 
     In another aspect, a robotic medical system includes: a patient platform configured to support a patient during a robotic medical procedure; a column supporting the patient platform; an adjustable arm support coupled to the column and configured to move relative to the patient platform, the adjustable arm support comprising a bar extending along an axis between the first end and the second end; a first robotic arm coupled to the bar of the adjustable arm support and configured to translate along the bar; and a visual indicator positioned on the adjustable arm support or the patient platform and configured to visually identify the first robotic arm. 
     The system can include one or more of the following features in any combination: (a) wherein the visual indicator comprises a light strip, and wherein a portion of the light strip is configured to illuminate to identify the first robotic arm; (b) wherein the portion of the light strip that illuminates to identify the first robotic arm varies along the light strip as the first robotic arm translates along the bar; (c) wherein the light strip extends along the bar; (d) wherein the light strip extends along the patient platform; (e) a second robotic arm coupled to the bar of the adjustable arm support and configured to translate along the bar independently of the first robotic arm, and wherein the visual indicator is configured to visually identify the second robotic arm; (f) wherein the visual indicator uniquely identifies the first robotic arm and the second robotic arm; (g) wherein the visual indicator uniquely identifies the first robotic arm and the second robotic arm using different color lights; (h) wherein the visual indicator is positioned on at least one of a top side, an outer side, an inner side, and a bottom side of the bar; (i) wherein the visual indicator extends onto the first end and the second end of the bar; (j) wherein the visual indicator is configured provide information based on a state of the robotic system; (k) wherein the state information comprises information about movement of the arm support and the first robotic arm; (l) wherein the state information indicates a direction of movement of the arm support; (m) wherein the direction of movement comprises a sweeping movement of the arm support; (n) wherein the direction of movement comprises a translating movement of the arm support; (o) wherein the state information indicates a direction of movement of the first robotic arm along the arm support; (p) wherein the state information comprises an identifier for the first robotic arm; (q) where in the state information comprises first state information and second state information; (r) wherein the first state information comprises at least one of: a stand by state, a powered state, an active state, a ready state, an error state and an emergency stop state; (s) wherein the second state information is configured to indicate movement of the arm support; (t) wherein the visual indicator is configured to indicate the first state information and the second state information concurrently; and/or (u) wherein the visual indicator is configured to illuminate a zone around the system indicative of an area through which the arm support will move to provide a visual indication of a zone of danger. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The disclosed aspects will hereinafter be described in conjunction with the appended drawings, provided to illustrate and not to limit the disclosed aspects, wherein like designations denote like elements. 
         FIG. 1  illustrates an embodiment of a cart-based robotic system arranged for diagnostic and/or therapeutic bronchoscopy. 
         FIG. 2  depicts further aspects of the robotic system of  FIG. 1 . 
         FIG. 3  illustrates an embodiment of the robotic system of  FIG. 1  arranged for ureteroscopy. 
         FIG. 4  illustrates an embodiment of the robotic system of  FIG. 1  arranged for a vascular procedure. 
         FIG. 5  illustrates an embodiment of a table-based robotic system arranged for a bronchoscopic procedure. 
         FIG. 6  provides an alternative view of the robotic system of  FIG. 5 . 
         FIG. 7  illustrates an example system configured to stow robotic arm(s). 
         FIG. 8  illustrates an embodiment of a table-based robotic system configured for a ureteroscopic procedure. 
         FIG. 9  illustrates an embodiment of a table-based robotic system configured for a laparoscopic procedure. 
         FIG. 10  illustrates an embodiment of the table-based robotic system of  FIGS. 5-9  with pitch or tilt adjustment. 
         FIG. 11  provides a detailed illustration of the interface between the table and the column of the table-based robotic system of  FIGS. 5-10 . 
         FIG. 12  illustrates an alternative embodiment of a table-based robotic system. 
         FIG. 13  illustrates an end view of the table-based robotic system of  FIG. 12 . 
         FIG. 14  illustrates an end view of a table-based robotic system with robotic arms attached thereto. 
         FIG. 15  illustrates an exemplary instrument driver. 
         FIG. 16  illustrates an exemplary medical instrument with a paired instrument driver. 
         FIG. 17  illustrates an alternative design for an instrument driver and instrument where the axes of the drive units are parallel to the axis of the elongated shaft of the instrument. 
         FIG. 18  illustrates an instrument having an instrument-based insertion architecture. 
         FIG. 19  illustrates an exemplary controller. 
         FIG. 20  depicts a block diagram illustrating a localization system that estimates a location of one or more elements of the robotic systems of  FIGS. 1-10 , such as the location of the instrument of  FIGS. 16-18 , in accordance to an example embodiment. 
         FIGS. 21A and 21B  are perspective views of an embodiment of a robotic medical system including functional indicators. 
         FIG. 21A  illustrates the system with adjustable arm supports and robotic arms in an example stowed position below a patient platform. 
         FIG. 21B  illustrates the system with the adjustable arm supports and the robotic arm in an example deployed position. 
         FIG. 22A  illustrates an embodiment an adjustable arm support including a functional indicator comprising an light emitting diode (LED) strip. 
         FIG. 22B  illustrates an embodiment of an adjustable arm support including a functional indicator comprising a plurality of discrete LEDs or discrete LED strips. 
         FIG. 22C  illustrates another embodiment of an adjustable arm support including a functional indicator comprising a plurality of discrete LEDs or discrete LED strips. 
         FIG. 22D  illustrates an embodiment an adjustable arm support including a functional indicator configured as a screen. 
         FIG. 23A  illustrates a cross-sectional view of an embodiment of an adjustable arm support including functional indicators on outer and lower surfaces thereof. 
         FIG. 23B  illustrates a cross-sectional view of another embodiment of an adjustable arm support including functional indicators on outer and lower surfaces thereof. 
         FIG. 24  illustrates a cross-sectional view of an adjustable arm support including functional indicators comprising light guides. 
         FIG. 25  illustrates an embodiments of an adjustable arm support including a plurality of different indicator zones. 
         FIG. 26  illustrates an embodiment of an adjustable arm support including indicators configured as audio devices. 
         FIG. 27A  illustrates a top view of an embodiment of a robotic medical system including functional indicators configured to provide mood lighting around the system. 
         FIG. 27B  illustrates a top view of an embodiment of a robotic medical system including functional indicators configured to provide an indication of a keep out zone around the system. 
         FIG. 28A  illustrates a side view of an embodiment of a robotic medical system including functional indicators on an adjustable arm support configured to provide an indication of motion of the adjustable arm support. 
         FIG. 28B  illustrates a side view of an embodiment of a robotic medical system including functional indicators on an adjustable arm support configured to provide an indication of possible pinching due to motion of the system. 
         FIG. 28C  is a perspective view of an embodiment of a robotic medical system including functional indicators on an adjustable arm support configured to provide an indication of a sweeping motion of the adjustable arm support. 
         FIG. 28D  is a perspective view of an embodiment of a robotic medical system including functional indicators on an adjustable arm support configured to provide an indication of translational motion of the adjustable arm support. 
         FIG. 29A  is a perspective view of an embodiment of a robotic medical system including functional indicators on an adjustable arm support configured to provide identity information associated with robotic arms of the system. 
         FIG. 29B  is a perspective view of an embodiment of a robotic medical system including functional indicators on an adjustable arm support configured to provide movement information associated with movement of the robotic arms of the system along the adjustable arm support. 
     
    
    
     DETAILED DESCRIPTION 
     1. Overview. 
     Aspects of the present disclosure may be integrated into a robotically-enabled medical system capable of performing a variety of medical procedures, including both minimally invasive, such as laparoscopy, and non-invasive, such as endoscopy, procedures. Among endoscopic procedures, the system may be capable of performing bronchoscopy, ureteroscopy, gastroscopy, etc. 
     In addition to performing the breadth of procedures, the system may provide additional benefits, such as enhanced imaging and guidance to assist the physician. Additionally, the system may provide the physician with the ability to perform the procedure from an ergonomic position without the need for awkward arm motions and positions. Still further, the system may provide the physician with the ability to perform the procedure with improved ease of use such that one or more of the instruments of the system can be controlled by a single user. 
     Various embodiments will be described below in conjunction with the drawings for purposes of illustration. It should be appreciated that many other implementations of the disclosed concepts are possible, and various advantages can be achieved with the disclosed implementations. Headings are included herein for reference and to aid in locating various sections. These headings are not intended to limit the scope of the concepts described with respect thereto. Such concepts may have applicability throughout the entire specification. 
     A. Robotic System—Cart. 
     The robotically-enabled medical system may be configured in a variety of ways depending on the particular procedure.  FIG. 1  illustrates an embodiment of a cart-based robotically-enabled system  10  arranged for a diagnostic and/or therapeutic bronchoscopy. During a bronchoscopy, the system  10  may comprise a cart  11  having one or more robotic arms  12  to deliver a medical instrument, such as a steerable endoscope  13 , which may be a procedure-specific bronchoscope for bronchoscopy, to a natural orifice access point (i.e., the mouth of the patient positioned on a table in the present example) to deliver diagnostic and/or therapeutic tools. As shown, the cart  11  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 relative to the access point. The arrangement in  FIG. 1  may also be utilized when performing a gastro-intestinal (GI) procedure with a gastroscope, a specialized endoscope for GI procedures.  FIG. 2  depicts an example embodiment of the cart in greater detail. 
     With continued reference to  FIG. 1 , once the cart  11  is properly positioned, the robotic arms  12  may insert the steerable endoscope  13  into the patient robotically, manually, or a combination thereof. As shown, the steerable endoscope  13  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 driver from the set of instrument drivers  28 , each instrument driver coupled to the distal end of an individual robotic arm. This linear arrangement of the instrument drivers  28 , which facilitates coaxially aligning the leader portion with the sheath portion, creates a “virtual rail”  29  that may be repositioned in space by manipulating the one or more robotic arms  12  into different angles and/or positions. The virtual rails described herein are depicted in the Figures using dashed lines, and accordingly the dashed lines do not depict any physical structure of the system. Translation of the instrument drivers  28  along the virtual rail  29  telescopes the inner leader portion relative to the outer sheath portion or advances or retracts the endoscope  13  from the patient. The angle of the virtual rail  29  may be adjusted, translated, and pivoted based on clinical application or physician preference. For example, in bronchoscopy, the angle and position of the virtual rail  29  as shown represents a compromise between providing physician access to the endoscope  13  while minimizing friction that results from bending the endoscope  13  into the patient&#39;s mouth. 
     The endoscope  13  may be directed down the patient&#39;s trachea and lungs after insertion using precise commands from the robotic system until reaching the target destination or operative site. In order to enhance navigation through the patient&#39;s lung network and/or reach the desired target, the endoscope  13  may be manipulated to telescopically extend the inner leader portion from the outer sheath portion to obtain enhanced articulation and greater bend radius. The use of separate instrument drivers  28  also allows the leader portion and sheath portion to be driven independently of each other. 
     For example, the endoscope  13  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 endoscope 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. After identifying a nodule to be malignant, the endoscope  13  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  13  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. 
     The system  10  may also include a movable tower  30 , which may be connected via support cables to the cart  11  to provide support for controls, electronics, fluidics, optics, sensors, and/or power to the cart  11 . Placing such functionality in the tower  30  allows for a smaller form factor cart  11  that may be more easily adjusted and/or re-positioned by an operating physician and his/her staff. Additionally, the division of functionality between the cart/table and the support tower  30  reduces operating room clutter and facilitates improving clinical workflow. While the cart  11  may be positioned close to the patient, the tower  30  may be stowed in a remote location to stay out of the way during a procedure. 
     In support of the robotic systems described above, the tower  30  may include component(s) of a computer-based control system that stores computer program instructions, for example, within a non-transitory computer-readable storage medium such as a persistent magnetic storage drive, solid state drive, etc. The execution of those instructions, whether the execution occurs in the tower  30  or the cart  11 , may control the entire system or sub-system(s) thereof. For example, when executed by a processor of the computer system, the instructions may cause the components of the robotics system to actuate the relevant carriages and arm mounts, actuate the robotics arms, and control the medical instruments. For example, in response to receiving the control signal, the motors in the joints of the robotics arms may position the arms into a certain posture. 
     The tower  30  may also include a pump, flow meter, valve control, and/or fluid access in order to provide controlled irrigation and aspiration capabilities to the system that may be deployed through the endoscope  13 . These components may also be controlled using the computer system of the tower  30 . In some embodiments, irrigation and aspiration capabilities may be delivered directly to the endoscope  13  through separate cable(s). 
     The tower  30  may include a voltage and surge protector designed to provide filtered and protected electrical power to the cart  11 , thereby avoiding placement of a power transformer and other auxiliary power components in the cart  11 , resulting in a smaller, more moveable cart  11 . 
     The tower  30  may also include support equipment for the sensors deployed throughout the robotic system  10 . For example, the tower  30  may include optoelectronics equipment for detecting, receiving, and processing data received from the optical sensors or cameras throughout the robotic system  10 . In combination with the control system, such optoelectronics equipment may be used to generate real-time images for display in any number of consoles deployed throughout the system, including in the tower  30 . Similarly, the tower  30  may also include an electronic subsystem for receiving and processing signals received from deployed electromagnetic (EM) sensors. The tower  30  may also be used to house and position an EM field generator for detection by EM sensors in or on the medical instrument. 
     The tower  30  may also include a console  31  in addition to other consoles available in the rest of the system, e.g., console mounted on top of the cart. The console  31  may include a user interface and a display screen, such as a touchscreen, for the physician operator. Consoles in the system  10  are generally designed to provide both robotic controls as well as preoperative and real-time information of the procedure, such as navigational and localization information of the endoscope  13 . When the console  31  is not the only console available to the physician, it may be used by a second operator, such as a nurse, to monitor the health or vitals of the patient and the operation of the system  10 , as well as to provide procedure-specific data, such as navigational and localization information. In other embodiments, the console  30  is housed in a body that is separate from the tower  30 . 
     The tower  30  may be coupled to the cart  11  and endoscope  13  through one or more cables or connections (not shown). In some embodiments, the support functionality from the tower  30  may be provided through a single cable to the cart  11 , simplifying and de-cluttering the operating room. In other embodiments, specific functionality may be coupled in separate cabling and connections. For example, while power may be provided through a single power cable to the cart  11 , the support for controls, optics, fluidics, and/or navigation may be provided through a separate cable. 
       FIG. 2  provides a detailed illustration of an embodiment of the cart  11  from the cart-based robotically-enabled system shown in  FIG. 1 . The cart  11  generally includes an elongated support structure  14  (often referred to as a “column”), a cart base  15 , and a console  16  at the top of the column  14 . The column  14  may include one or more carriages, such as a carriage  17  (alternatively “arm support”) for supporting the deployment of one or more robotic arms  12  (three shown in  FIG. 2 ). The carriage  17  may include individually configurable arm mounts that rotate along a perpendicular axis to adjust the base of the robotic arms  12  for better positioning relative to the patient. The carriage  17  also includes a carriage interface  19  that allows the carriage  17  to vertically translate along the column  14 . 
     The carriage interface  19  is connected to the column  14  through slots, such as slot  20 , that are positioned on opposite sides of the column  14  to guide the vertical translation of the carriage  17 . The slot  20  contains a vertical translation interface to position and hold the carriage  17  at various vertical heights relative to the cart base  15 . Vertical translation of the carriage  17  allows the cart  11  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 carriage  17  allow the robotic arm base  21  of the robotic arms  12  to be angled in a variety of configurations. 
     In some embodiments, the slot  20  may be supplemented with slot covers that are flush and parallel to the slot surface to prevent dirt and fluid ingress into the internal chambers of the column  14  and the vertical translation interface as the carriage  17  vertically translates. The slot covers may be deployed through pairs of spring spools positioned near the vertical top and bottom of the slot  20 . The covers are coiled within the spools until deployed to extend and retract from their coiled state as the carriage  17  vertically translates up and down. The spring-loading of the spools provides force to retract the cover into a spool when the carriage  17  translates towards the spool, while also maintaining a tight seal when the carriage  17  translates away from the spool. The covers may be connected to the carriage  17  using, for example, brackets in the carriage interface  19  to ensure proper extension and retraction of the cover as the carriage  17  translates. 
     The column  14  may internally comprise mechanisms, such as gears and motors, that are designed to use a vertically aligned lead screw to translate the carriage  17  in a mechanized fashion in response to control signals generated in response to user inputs, e.g., inputs from the console  16 . 
     The robotic arms  12  may generally comprise robotic arm bases  21  and end effectors  22 , separated by a series of linkages  23  that are connected by a series of joints  24 , each joint comprising an independent actuator, each actuator comprising an independently controllable motor. Each independently controllable joint represents an independent degree of freedom available to the robotic arm  12 . Each of the robotic arms  12  may have seven joints, and thus provide seven degrees of freedom. A multitude of joints result in a multitude of degrees of freedom, allowing for “redundant” degrees of freedom. Having redundant degrees of freedom allows 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 cart base  15  balances the weight of the column  14 , carriage  17 , and robotic arms  12  over the floor. Accordingly, the cart base  15  houses heavier components, such as electronics, motors, power supply, as well as components that either enable movement and/or immobilize the cart  11 . For example, the cart base  15  includes rollable wheel-shaped casters  25  that allow for the cart  11  to easily move around the room prior to a procedure. After reaching the appropriate position, the casters  25  may be immobilized using wheel locks to hold the cart  11  in place during the procedure. 
     Positioned at the vertical end of the column  14 , the console  16  allows for both a user interface for receiving user input and a display screen (or a dual-purpose device such as, for example, a touchscreen  26 ) to provide the physician user with both preoperative and intraoperative data. Potential preoperative data on the touchscreen  26  may include preoperative plans, navigation and mapping data derived from preoperative computerized tomography (CT) scans, and/or notes from preoperative patient interviews. Intraoperative 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  16  may be positioned and tilted to allow a physician to access the console  16  from the side of the column  14  opposite the carriage  17 . From this position, the physician may view the console  16 , robotic arms  12 , and patient while operating the console  16  from behind the cart  11 . As shown, the console  16  also includes a handle  27  to assist with maneuvering and stabilizing the cart  11 . 
       FIG. 3  illustrates an embodiment of a robotically-enabled system  10  arranged for ureteroscopy. In a ureteroscopic procedure, the cart  11  may be positioned to deliver a ureteroscope  32 , a procedure-specific endoscope designed to traverse a patient&#39;s urethra and ureter, to the lower abdominal area of the patient. In a ureteroscopy, it may be desirable for the ureteroscope  32  to be directly aligned with the patient&#39;s urethra to reduce friction and forces on the sensitive anatomy in the area. As shown, the cart  11  may be aligned at the foot of the table to allow the robotic arms  12  to position the ureteroscope  32  for direct linear access to the patient&#39;s urethra. From the foot of the table, the robotic arms  12  may insert the ureteroscope  32  along the virtual rail  33  directly into the patient&#39;s lower abdomen through the urethra. 
     After insertion into the urethra, using similar control techniques as in bronchoscopy, the ureteroscope  32  may be navigated into the bladder, ureters, and/or kidneys for diagnostic and/or therapeutic applications. For example, the ureteroscope  32  may be directed into the ureter and kidneys to break up kidney stone build up using a laser or ultrasonic lithotripsy device deployed down the working channel of the ureteroscope  32 . After lithotripsy is complete, the resulting stone fragments may be removed using baskets deployed down the ureteroscope  32 . 
       FIG. 4  illustrates an embodiment of a robotically-enabled system  10  similarly arranged for a vascular procedure. In a vascular procedure, the system  10  may be configured such that the cart  11  may deliver a medical instrument  34 , such as a steerable catheter, to an access point in the femoral artery in the patient&#39;s leg. The femoral artery presents both a larger diameter for navigation as well as a relatively less circuitous and tortuous path to the patient&#39;s heart, which simplifies navigation. As in a ureteroscopic procedure, the cart  11  may be positioned towards the patient&#39;s legs and lower abdomen to allow the robotic arms  12  to provide a virtual rail  35  with direct linear access to the femoral artery access point in the patient&#39;s thigh/hip region. After insertion into the artery, the medical instrument  34  may be directed and inserted by translating the instrument drivers  28 . Alternatively, the cart may be positioned around the patient&#39;s upper abdomen in order to reach alternative vascular access points, such as, for example, the carotid and brachial arteries near the shoulder and wrist. 
     B. Robotic System—Table. 
     Embodiments of the robotically-enabled medical system may also incorporate the patient&#39;s table. Incorporation of the table reduces the amount of capital equipment within the operating room by removing the cart, which allows greater access to the patient.  FIG. 5  illustrates an embodiment of such a robotically-enabled system arranged for a bronchoscopic procedure. System  36  includes a support structure or column  37  for supporting platform  38  (shown as a “table” or “bed”) over the floor. Much like in the cart-based systems, the end effectors of the robotic arms  39  of the system  36  comprise instrument drivers  42  that are designed to manipulate an elongated medical instrument, such as a bronchoscope  40  in  FIG. 5 , through or along a virtual rail  41  formed from the linear alignment of the instrument drivers  42 . In practice, a C-arm for providing fluoroscopic imaging may be positioned over the patient&#39;s upper abdominal area by placing the emitter and detector around the table  38 . 
       FIG. 6  provides an alternative view of the system  36  without the patient and medical instrument for discussion purposes. As shown, the column  37  may include one or more carriages  43  shown as ring-shaped in the system  36 , from which the one or more robotic arms  39  may be based. The carriages  43  may translate along a vertical column interface  44  that runs the length of the column  37  to provide different vantage points from which the robotic arms  39  may be positioned to reach the patient. The carriage(s)  43  may rotate around the column  37  using a mechanical motor positioned within the column  37  to allow the robotic arms  39  to have access to multiples sides of the table  38 , such as, for example, both sides of the patient. In embodiments with multiple carriages, the carriages may be individually positioned on the column and may translate and/or rotate independently of the other carriages. While the carriages  43  need not surround the column  37  or even be circular, the ring-shape as shown facilitates rotation of the carriages  43  around the column  37  while maintaining structural balance. Rotation and translation of the carriages  43  allows the system  36  to align the medical instruments, such as endoscopes and laparoscopes, into different access points on the patient. In other embodiments (not shown), the system  36  can include a patient table or bed with adjustable arm supports in the form of bars or rails extending alongside it. One or more robotic arms  39  (e.g., via a shoulder with an elbow joint) can be attached to the adjustable arm supports, which can be vertically adjusted. By providing vertical adjustment, the robotic arms  39  are advantageously capable of being stowed compactly beneath the patient table or bed, and subsequently raised during a procedure. 
     The robotic arms  39  may be mounted on the carriages  43  through a set of arm mounts  45  comprising a series of joints that may individually rotate and/or telescopically extend to provide additional configurability to the robotic arms  39 . Additionally, the arm mounts  45  may be positioned on the carriages  43  such that, when the carriages  43  are appropriately rotated, the arm mounts  45  may be positioned on either the same side of the table  38  (as shown in  FIG. 6 ), on opposite sides of the table  38  (as shown in  FIG. 9 ), or on adjacent sides of the table  38  (not shown). 
     The column  37  structurally provides support for the table  38 , and a path for vertical translation of the carriages  43 . Internally, the column  37  may be equipped with lead screws for guiding vertical translation of the carriages, and motors to mechanize the translation of the carriages  43  based the lead screws. The column  37  may also convey power and control signals to the carriages  43  and the robotic arms  39  mounted thereon. 
     The table base  46  serves a similar function as the cart base  15  in the cart  11  shown in  FIG. 2 , housing heavier components to balance the table/bed  38 , the column  37 , the carriages  43 , and the robotic arms  39 . The table base  46  may also incorporate rigid casters to provide stability during procedures. Deployed from the bottom of the table base  46 , the casters may extend in opposite directions on both sides of the base  46  and retract when the system  36  needs to be moved. 
     With continued reference to  FIG. 6 , the system  36  may also include a tower (not shown) that divides the functionality of the system  36  between the table and the tower to reduce the form factor and bulk of the table. As in earlier disclosed embodiments, the tower may provide a variety of support functionalities to the table, such as processing, computing, and control capabilities, power, fluidics, and/or optical and sensor processing. The tower may also be movable to be positioned away from the patient to improve physician access and de-clutter the operating room. Additionally, placing components in the tower allows for more storage space in the table base  46  for potential stowage of the robotic arms  39 . The tower may also include a master controller or console that provides both a user interface for user input, such as keyboard and/or pendant, as well as a display screen (or touchscreen) for preoperative and intraoperative information, such as real-time imaging, navigation, and tracking information. In some embodiments, the tower may also contain holders for gas tanks to be used for insufflation. 
     In some embodiments, a table base may stow and store the robotic arms when not in use.  FIG. 7  illustrates a system  47  that stows robotic arms in an embodiment of the table-based system. In the system  47 , carriages  48  may be vertically translated into base  49  to stow robotic arms  50 , arm mounts  51 , and the carriages  48  within the base  49 . Base covers  52  may be translated and retracted open to deploy the carriages  48 , arm mounts  51 , and robotic arms  50  around column  53 , and closed to stow to protect them when not in use. The base covers  52  may be sealed with a membrane  54  along the edges of its opening to prevent dirt and fluid ingress when closed. 
       FIG. 8  illustrates an embodiment of a robotically-enabled table-based system configured for a ureteroscopic procedure. In a ureteroscopy, the table  38  may include a swivel portion  55  for positioning a patient off-angle from the column  37  and table base  46 . The swivel portion  55  may rotate or pivot around a pivot point (e.g., located below the patient&#39;s head) in order to position the bottom portion of the swivel portion  55  away from the column  37 . For example, the pivoting of the swivel portion  55  allows a C-arm (not shown) to be positioned over the patient&#39;s lower abdomen without competing for space with the column (not shown) below table  38 . By rotating the carriage  35  (not shown) around the column  37 , the robotic arms  39  may directly insert a ureteroscope  56  along a virtual rail  57  into the patient&#39;s groin area to reach the urethra. In a ureteroscopy, stirrups  58  may also be fixed to the swivel portion  55  of the table  38  to support the position of the patient&#39;s legs during the procedure and allow clear access to the patient&#39;s groin area. 
     In a laparoscopic procedure, through small incision(s) in the patient&#39;s abdominal wall, minimally invasive instruments may be inserted into the patient&#39;s anatomy. In some embodiments, the minimally invasive instruments comprise an elongated rigid member, such as a shaft, which is used to access anatomy within the patient. After inflation of the patient&#39;s abdominal cavity, the instruments may be directed to perform surgical or medical tasks, such as grasping, cutting, ablating, suturing, etc. In some embodiments, the instruments can comprise a scope, such as a laparoscope.  FIG. 9  illustrates an embodiment of a robotically-enabled table-based system configured for a laparoscopic procedure. As shown in  FIG. 9 , the carriages  43  of the system  36  may be rotated and vertically adjusted to position pairs of the robotic arms  39  on opposite sides of the table  38 , such that instrument  59  may be positioned using the arm mounts  45  to be passed through minimal incisions on both sides of the patient to reach his/her abdominal cavity. 
     To accommodate laparoscopic procedures, the robotically-enabled table system may also tilt the platform to a desired angle.  FIG. 10  illustrates an embodiment of the robotically-enabled medical system with pitch or tilt adjustment. As shown in  FIG. 10 , the system  36  may accommodate tilt of the table  38  to position one portion of the table at a greater distance from the floor than the other. Additionally, the arm mounts  45  may rotate to match the tilt such that the robotic arms  39  maintain the same planar relationship with the table  38 . To accommodate steeper angles, the column  37  may also include telescoping portions  60  that allow vertical extension of the column  37  to keep the table  38  from touching the floor or colliding with the table base  46 . 
       FIG. 11  provides a detailed illustration of the interface between the table  38  and the column  37 . Pitch rotation mechanism  61  may be configured to alter the pitch angle of the table  38  relative to the column  37  in multiple degrees of freedom. The pitch rotation mechanism  61  may be enabled by the positioning of orthogonal axes  1 ,  2  at the column-table interface, each axis actuated by a separate motor  3 ,  4  responsive to an electrical pitch angle command. Rotation along one screw  5  would enable tilt adjustments in one axis  1 , while rotation along the other screw  6  would enable tilt adjustments along the other axis  2 . In some embodiments, a ball joint can be used to alter the pitch angle of the table  38  relative to the column  37  in multiple degrees of freedom. 
     For example, pitch adjustments are particularly useful when trying to position the table in a Trendelenburg position, i.e., position the patient&#39;s lower abdomen at a higher position from the floor than the patient&#39;s upper abdomen, for lower abdominal surgery. The Trendelenburg position causes the patient&#39;s internal organs to slide towards his/her upper abdomen through the force of gravity, clearing out the abdominal cavity for minimally invasive tools to enter and perform lower abdominal surgical or medical procedures, such as laparoscopic prostatectomy. 
       FIGS. 12 and 13  illustrate isometric and end views of an alternative embodiment of a table-based surgical robotics system  100 . The surgical robotics system  100  includes one or more adjustable arm supports  105  that can be configured to support one or more robotic arms (see, for example,  FIG. 14 ) relative to a table  101 . In the illustrated embodiment, a single adjustable arm support  105  is shown, though an additional arm support can be provided on an opposite side of the table  101 . The adjustable arm support  105  can be configured so that it can move relative to the table  101  to adjust and/or vary the position of the adjustable arm support  105  and/or any robotic arms mounted thereto relative to the table  101 . For example, the adjustable arm support  105  may be adjusted one or more degrees of freedom relative to the table  101 . The adjustable arm support  105  provides high versatility to the system  100 , including the ability to easily stow the one or more adjustable arm supports  105  and any robotics arms attached thereto beneath the table  101 . The adjustable arm support  105  can be elevated from the stowed position to a position below an upper surface of the table  101 . In other embodiments, the adjustable arm support  105  can be elevated from the stowed position to a position above an upper surface of the table  101 . 
     The adjustable arm support  105  can provide several degrees of freedom, including lift, lateral translation, tilt, etc. In the illustrated embodiment of  FIGS. 12 and 13 , the arm support  105  is configured with four degrees of freedom, which are illustrated with arrows in  FIG. 12 . A first degree of freedom allows for adjustment of the adjustable arm support  105  in the z-direction (“Z-lift”). For example, the adjustable arm support  105  can include a carriage  109  configured to move up or down along or relative to a column  102  supporting the table  101 . A second degree of freedom can allow the adjustable arm support  105  to tilt. For example, the adjustable arm support  105  can include a rotary joint, which can allow the adjustable arm support  105  to be aligned with the bed in a Trendelenburg position. A third degree of freedom can allow the adjustable arm support  105  to “pivot up,” which can be used to adjust a distance between a side of the table  101  and the adjustable arm support  105 . A fourth degree of freedom can permit translation of the adjustable arm support  105  along a longitudinal length of the table. 
     The surgical robotics system  100  in  FIGS. 12 and 13  can comprise a table supported by a column  102  that is mounted to a base  103 . The base  103  and the column  102  support the table  101  relative to a support surface. A floor axis  131  and a support axis  133  are shown in  FIG. 13 . 
     The adjustable arm support  105  can be mounted to the column  102 . In other embodiments, the arm support  105  can be mounted to the table  101  or base  103 . The adjustable arm support  105  can include a carriage  109 , a bar or rail connector  111  and a bar or rail  107 . In some embodiments, one or more robotic arms mounted to the rail  107  can translate and move relative to one another. 
     The carriage  109  can be attached to the column  102  by a first joint  113 , which allows the carriage  109  to move relative to the column  102  (e.g., such as up and down a first or vertical axis  123 ). The first joint  113  can provide the first degree of freedom (Z-lift) to the adjustable arm support  105 . The adjustable arm support  105  can include a second joint  115 , which provides the second degree of freedom (tilt) for the adjustable arm support  105 . The adjustable arm support  105  can include a third joint  117 , which can provide the third degree of freedom (“pivot up”) for the adjustable arm support  105 . An additional joint  119  (shown in  FIG. 13 ) can be provided that mechanically constrains the third joint  117  to maintain an orientation of the rail  107  as the rail connector  111  is rotated about a third axis  127 . The adjustable arm support  105  can include a fourth joint  121 , which can provide a fourth degree of freedom (translation) for the adjustable arm support  105  along a fourth axis  129 . 
       FIG. 14  illustrates an end view of the surgical robotics system  140 A with two adjustable arm supports  105 A,  105 B mounted on opposite sides of a table  101 . A first robotic arm  142 A is attached to the bar or rail  107 A of the first adjustable arm support  105 B. The first robotic arm  142 A includes a base  144 A attached to the rail  107 A. The distal end of the first robotic arm  142 A includes an instrument drive mechanism  146 A that can attach to one or more robotic medical instruments or tools. Similarly, the second robotic arm  142 B includes a base  144 B attached to the rail  107 B. The distal end of the second robotic arm  142 B includes an instrument drive mechanism  146 B. The instrument drive mechanism  146 B can be configured to attach to one or more robotic medical instruments or tools. 
     In some embodiments, one or more of the robotic arms  142 A,  142 B comprises an arm with seven or more degrees of freedom. In some embodiments, one or more of the robotic arms  142 A,  142 B can include eight degrees of freedom, including an insertion axis (1-degree of freedom including insertion), a wrist (3-degrees of freedom including wrist pitch, yaw and roll), an elbow (1-degree of freedom including elbow pitch), a shoulder (2-degrees of freedom including shoulder pitch and yaw), and base  144 A,  144 B (1-degree of freedom including translation). In some embodiments, the insertion degree of freedom can be provided by the robotic arm  142 A,  142 B, while in other embodiments, the instrument itself provides insertion via an instrument-based insertion architecture. 
     C. Instrument Driver &amp; Interface. 
     The end effectors of the system&#39;s robotic arms may comprise (i) an instrument driver (alternatively referred to as “instrument drive mechanism” or “instrument device manipulator”) that incorporates electro-mechanical means for actuating the medical instrument and (ii) a removable or detachable medical instrument, which may be devoid of any electro-mechanical components, such as motors. 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 medical instruments may be designed to be detached, removed, and interchanged from the instrument driver (and thus the system) for individual sterilization or disposal by the physician or the physician&#39;s staff. In contrast, the instrument drivers need not be changed or sterilized, and may be draped for protection. 
       FIG. 15  illustrates an example instrument driver. Positioned at the distal end of a robotic arm, instrument driver  62  comprises one or more drive units  63  arranged with parallel axes to provide controlled torque to a medical instrument via drive shafts  64 . Each drive unit  63  comprises an individual drive shaft  64  for interacting with the instrument, a gear head  65  for converting the motor shaft rotation to a desired torque, a motor  66  for generating the drive torque, an encoder  67  to measure the speed of the motor shaft and provide feedback to the control circuitry, and control circuitry  68  for receiving control signals and actuating the drive unit. Each drive unit  63  being independently controlled and motorized, the instrument driver  62  may provide multiple (e.g., four as shown in  FIG. 15 ) independent drive outputs to the medical instrument. In operation, the control circuitry  68  would receive a control signal, transmit a motor signal to the motor  66 , compare the resulting motor speed as measured by the encoder  67  with the desired speed, and modulate the motor signal to generate the desired torque. 
     For procedures that require a sterile environment, the robotic system may incorporate a drive interface, such as a sterile adapter connected to a sterile drape, that sits between the instrument driver and the medical instrument. The chief purpose of the sterile adapter is to transfer angular motion from the drive shafts of the instrument driver to the drive inputs of the instrument while maintaining physical separation, and thus sterility, between the drive shafts and drive inputs. Accordingly, an example sterile adapter may comprise a series of rotational inputs and outputs intended to be mated with the drive shafts of the instrument driver and drive inputs on the instrument. Connected to the sterile adapter, the sterile drape, comprised of a thin, flexible material such as transparent or translucent plastic, is designed to cover the capital equipment, such as the instrument driver, robotic arm, and cart (in a cart-based system) or table (in a table-based system). Use of the drape would allow the capital equipment to be positioned proximate to the patient while still being located in an area not requiring sterilization (i.e., non-sterile field). On the other side of the sterile drape, the medical instrument may interface with the patient in an area requiring sterilization (i.e., sterile field). 
     D. Medical Instrument. 
       FIG. 16  illustrates an example medical instrument with a paired instrument driver. Like other instruments designed for use with a robotic system, medical instrument  70  comprises an elongated shaft  71  (or elongate body) and an instrument base  72 . The instrument base  72 , also referred to as an “instrument handle” due to its intended design for manual interaction by the physician, may generally comprise rotatable drive inputs  73 , e.g., receptacles, pulleys or spools, that are designed to be mated with drive outputs  74  that extend through a drive interface on instrument driver  75  at the distal end of robotic arm  76 . When physically connected, latched, and/or coupled, the mated drive inputs  73  of the instrument base  72  may share axes of rotation with the drive outputs  74  in the instrument driver  75  to allow the transfer of torque from the drive outputs  74  to the drive inputs  73 . In some embodiments, the drive outputs  74  may comprise splines that are designed to mate with receptacles on the drive inputs  73 . 
     The elongated shaft  71  is designed to be delivered through either an anatomical opening or lumen, e.g., as in endoscopy, or a minimally invasive incision, e.g., as in laparoscopy. The elongated shaft  71  may be either flexible (e.g., having properties similar to an endoscope) or rigid (e.g., having properties similar to a laparoscope) or contain a customized combination of both flexible and rigid portions. When designed for laparoscopy, the distal end of a rigid elongated shaft may be connected to an end effector extending from a jointed wrist formed from a clevis with at least one degree of freedom and a surgical tool or medical instrument, such as, for example, a grasper or scissors, that may be actuated based on force from the tendons as the drive inputs rotate in response to torque received from the drive outputs  74  of the instrument driver  75 . When designed for endoscopy, the distal end of a flexible elongated shaft may include a steerable or controllable bending section that may be articulated and bent based on torque received from the drive outputs  74  of the instrument driver  75 . 
     Torque from the instrument driver  75  is transmitted down the elongated shaft  71  using tendons along the elongated shaft  71 . These individual tendons, such as pull wires, may be individually anchored to individual drive inputs  73  within the instrument handle  72 . From the handle  72 , the tendons are directed down one or more pull lumens along the elongated shaft  71  and anchored at the distal portion of the elongated shaft  71 , or in the wrist at the distal portion of the elongated shaft. During a surgical procedure, such as a laparoscopic, endoscopic or hybrid procedure, these tendons may be coupled to a distally mounted end effector, such as a wrist, grasper, or scissor. Under such an arrangement, torque exerted on drive inputs  73  would transfer tension to the tendon, thereby causing the end effector to actuate in some way. In some embodiments, during a surgical procedure, the tendon may cause a joint to rotate about an axis, thereby causing the end effector to move in one direction or another. Alternatively, the tendon may be connected to one or more jaws of a grasper at the distal end of the elongated shaft  71 , where tension from the tendon causes the grasper to close. 
     In endoscopy, the tendons may be coupled to a bending or articulating section positioned along the elongated shaft  71  (e.g., at the distal end) via adhesive, control ring, or other mechanical fixation. When fixedly attached to the distal end of a bending section, torque exerted on the drive inputs  73  would be transmitted down the tendons, causing the softer, bending section (sometimes referred to as the articulable section or region) to bend or articulate. Along the non-bending sections, it may be advantageous to spiral or helix the individual pull lumens that direct the individual tendons along (or inside) the walls of the endoscope shaft to balance the radial forces that result from tension in the pull wires. The angle of the spiraling and/or spacing therebetween may be altered or engineered for specific purposes, wherein tighter spiraling exhibits lesser shaft compression under load forces, while lower amounts of spiraling results in greater shaft compression under load forces, but limits bending. On the other end of the spectrum, the pull lumens may be directed parallel to the longitudinal axis of the elongated shaft  71  to allow for controlled articulation in the desired bending or articulable sections. 
     In endoscopy, the elongated shaft  71  houses a number of components to assist with the robotic procedure. The shaft  71  may comprise a working channel for deploying surgical tools (or medical instruments), irrigation, and/or aspiration to the operative region at the distal end of the shaft  71 . The shaft  71  may also accommodate wires and/or optical fibers to transfer signals to/from an optical assembly at the distal tip, which may include an optical camera. The shaft  71  may also accommodate optical fibers to carry light from proximally-located light sources, such as light emitting diodes, to the distal end of the shaft  71 . 
     At the distal end of the instrument  70 , the distal tip may also comprise the opening of a working channel for delivering tools for diagnostic and/or therapy, irrigation, and aspiration to an operative site. The distal tip may also include a port for a camera, such as a fiberscope or a digital camera, to capture images of an internal anatomical space. Relatedly, the distal tip may also include ports for light sources for illuminating the anatomical space when using the camera. 
     In the example of  FIG. 16 , the drive shaft axes, and thus the drive input axes, are orthogonal to the axis of the elongated shaft  71 . This arrangement, however, complicates roll capabilities for the elongated shaft  71 . Rolling the elongated shaft  71  along its axis while keeping the drive inputs  73  static results in undesirable tangling of the tendons as they extend off the drive inputs  73  and enter pull lumens within the elongated shaft  71 . The resulting entanglement of such tendons may disrupt any control algorithms intended to predict movement of the flexible elongated shaft  71  during an endoscopic procedure. 
       FIG. 17  illustrates an alternative design for an instrument driver and instrument where the axes of the drive units are parallel to the axis of the elongated shaft of the instrument. As shown, a circular instrument driver  80  comprises four drive units with their drive outputs  81  aligned in parallel at the end of a robotic arm  82 . The drive units, and their respective drive outputs  81 , are housed in a rotational assembly  83  of the instrument driver  80  that is driven by one of the drive units within the assembly  83 . In response to torque provided by the rotational drive unit, the rotational assembly  83  rotates along a circular bearing that connects the rotational assembly  83  to the non-rotational portion  84  of the instrument driver  80 . Power and controls signals may be communicated from the non-rotational portion  84  of the instrument driver  80  to the rotational assembly  83  through electrical contacts that may be maintained through rotation by a brushed slip ring connection (not shown). In other embodiments, the rotational assembly  83  may be responsive to a separate drive unit that is integrated into the non-rotatable portion  84 , and thus not in parallel to the other drive units. The rotational mechanism  83  allows the instrument driver  80  to rotate the drive units, and their respective drive outputs  81 , as a single unit around an instrument driver axis  85 . 
     Like earlier disclosed embodiments, an instrument  86  may comprise an elongated shaft portion  88  and an instrument base  87  (shown with a transparent external skin for discussion purposes) comprising a plurality of drive inputs  89  (such as receptacles, pulleys, and spools) that are configured to receive the drive outputs  81  in the instrument driver  80 . Unlike prior disclosed embodiments, the instrument shaft  88  extends from the center of the instrument base  87  with an axis substantially parallel to the axes of the drive inputs  89 , rather than orthogonal as in the design of  FIG. 16 . 
     When coupled to the rotational assembly  83  of the instrument driver  80 , the medical instrument  86 , comprising instrument base  87  and instrument shaft  88 , rotates in combination with the rotational assembly  83  about the instrument driver axis  85 . Since the instrument shaft  88  is positioned at the center of instrument base  87 , the instrument shaft  88  is coaxial with instrument driver axis  85  when attached. Thus, rotation of the rotational assembly  83  causes the instrument shaft  88  to rotate about its own longitudinal axis. Moreover, as the instrument base  87  rotates with the instrument shaft  88 , any tendons connected to the drive inputs  89  in the instrument base  87  are not tangled during rotation. Accordingly, the parallelism of the axes of the drive outputs  81 , drive inputs  89 , and instrument shaft  88  allows for the shaft rotation without tangling any control tendons. 
       FIG. 18  illustrates an instrument having an instrument based insertion architecture in accordance with some embodiments. The instrument  150  can be coupled to any of the instrument drivers discussed above. The instrument  150  comprises an elongated shaft  152 , an end effector  162  connected to the shaft  152 , and a handle  170  coupled to the shaft  152 . The elongated shaft  152  comprises a tubular member having a proximal portion  154  and a distal portion  156 . The elongated shaft  152  comprises one or more channels or grooves  158  along its outer surface. The grooves  158  are configured to receive one or more wires or cables  180  therethrough. One or more cables  180  thus run along an outer surface of the elongated shaft  152 . In other embodiments, cables  180  can also run through the elongated shaft  152 . Manipulation of the one or more cables  180  (e.g., via an instrument driver) results in actuation of the end effector  162 . 
     The instrument handle  170 , which may also be referred to as an instrument base, may generally comprise an attachment interface  172  having one or more mechanical inputs  174 , e.g., receptacles, pulleys or spools, that are designed to be reciprocally mated with one or more torque couplers on an attachment surface of an instrument driver. 
     In some embodiments, the instrument  150  comprises a series of pulleys or cables that enable the elongated shaft  152  to translate relative to the handle  170 . In other words, the instrument  150  itself comprises an instrument-based insertion architecture that accommodates insertion of the instrument, thereby minimizing the reliance on a robot arm to provide insertion of the instrument  150 . In other embodiments, a robotic arm can be largely responsible for instrument insertion. 
     E. Controller. 
     Any of the robotic systems described herein can include an input device or controller for manipulating an instrument attached to a robotic arm. In some embodiments, the controller can be coupled (e.g., communicatively, electronically, electrically, wirelessly and/or mechanically) with an instrument such that manipulation of the controller causes a corresponding manipulation of the instrument e.g., via master slave control. 
       FIG. 19  is a perspective view of an embodiment of a controller  182 . In the present embodiment, the controller  182  comprises a hybrid controller that can have both impedance and admittance control. In other embodiments, the controller  182  can utilize just impedance or passive control. In other embodiments, the controller  182  can utilize just admittance control. By being a hybrid controller, the controller  182  advantageously can have a lower perceived inertia while in use. 
     In the illustrated embodiment, the controller  182  is configured to allow manipulation of two medical instruments, and includes two handles  184 . Each of the handles  184  is connected to a gimbal  186 . Each gimbal  186  is connected to a positioning platform  188 . 
     As shown in  FIG. 19 , each positioning platform  188  includes a SCARA arm (selective compliance assembly robot arm)  198  coupled to a column  194  by a prismatic joint  196 . The prismatic joints  196  are configured to translate along the column  194  (e.g., along rails  197 ) to allow each of the handles  184  to be translated in the z-direction, providing a first degree of freedom. The SCARA arm  198  is configured to allow motion of the handle  184  in an x-y plane, providing two additional degrees of freedom. 
     In some embodiments, one or more load cells are positioned in the controller. For example, in some embodiments, a load cell (not shown) is positioned in the body of each of the gimbals  186 . By providing a load cell, portions of the controller  182  are capable of operating under admittance control, thereby advantageously reducing the perceived inertia of the controller while in use. In some embodiments, the positioning platform  188  is configured for admittance control, while the gimbal  186  is configured for impedance control. In other embodiments, the gimbal  186  is configured for admittance control, while the positioning platform  188  is configured for impedance control. Accordingly, for some embodiments, the translational or positional degrees of freedom of the positioning platform  188  can rely on admittance control, while the rotational degrees of freedom of the gimbal  186  rely on impedance control. 
     F. Navigation and Control. 
     Traditional endoscopy may involve the use of fluoroscopy (e.g., as may be delivered through a C-arm) and other forms of radiation-based imaging modalities to provide endoluminal guidance to an operator physician. In contrast, the robotic systems contemplated by this disclosure can provide for non-radiation-based navigational and localization means to reduce physician exposure to radiation and reduce the amount of equipment within the operating room. As used herein, the term “localization” may refer to determining and/or monitoring the position of objects in a reference coordinate system. Technologies such as preoperative mapping, computer vision, real-time EM tracking, and robot command data may be used individually or in combination to achieve a radiation-free operating environment. In other cases, where radiation-based imaging modalities are still used, the preoperative mapping, computer vision, real-time EM tracking, and robot command data may be used individually or in combination to improve upon the information obtained solely through radiation-based imaging modalities. 
       FIG. 20  is a block diagram illustrating a localization system  90  that estimates a location of one or more elements of the robotic system, such as the location of the instrument, in accordance to an example embodiment. The localization system  90  may be a set of one or more computer devices configured to execute one or more instructions. The computer devices may be embodied by a processor (or processors) and computer-readable memory in one or more components discussed above. By way of example and not limitation, the computer devices may be in the tower  30  shown in  FIG. 1 , the cart  11  shown in  FIGS. 1-4 , the beds shown in  FIGS. 5-14 , etc. 
     As shown in  FIG. 20 , the localization system  90  may include a localization module  95  that processes input data  91 - 94  to generate location data  96  for the distal tip of a medical instrument. The location data  96  may be data or logic that represents a location and/or orientation of the distal end of the instrument relative to a frame of reference. The frame of reference can be a frame of reference relative to the anatomy of the patient or to a known object, such as an EM field generator (see discussion below for the EM field generator). 
     The various input data  91 - 94  are now described in greater detail. Preoperative mapping may be accomplished through the use of the collection of low dose CT scans. Preoperative CT scans are reconstructed into three-dimensional images, which are visualized, e.g. as “slices” of a cutaway view of the patient&#39;s internal anatomy. When analyzed in the aggregate, image-based models for anatomical cavities, spaces and structures of the patient&#39;s anatomy, such as a patient lung network, may be generated. Techniques such as center-line geometry may be determined and approximated from the CT images to develop a three-dimensional volume of the patient&#39;s anatomy, referred to as model data  91  (also referred to as “preoperative model data” when generated using only preoperative CT scans). The use of center-line geometry is discussed in U.S. patent application Ser. No. 14/523,760, the contents of which are herein incorporated in its entirety. Network topological models may also be derived from the CT-images, and are particularly appropriate for bronchoscopy. 
     In some embodiments, the instrument may be equipped with a camera to provide vision data (or image data)  92 . The localization module  95  may process the vision data  92  to enable one or more vision-based (or image-based) location tracking modules or features. For example, the preoperative model data  91  may be used in conjunction with the vision data  92  to enable computer vision-based tracking of the medical instrument (e.g., an endoscope or an instrument advance through a working channel of the endoscope). For example, using the preoperative model data  91 , the robotic system may generate a library of expected endoscopic images from the model based on the expected path of travel of the endoscope, each image linked to a location within the model. Intraoperatively, this library may be referenced by the robotic system in order to compare real-time images captured at the camera (e.g., a camera at a distal end of the endoscope) to those in the image library to assist localization. 
     Other computer vision-based tracking techniques use feature tracking to determine motion of the camera, and thus the endoscope. Some features of the localization module  95  may identify circular geometries in the preoperative model data  91  that correspond to anatomical lumens and track the change of those geometries to determine which anatomical lumen was selected, as well as the relative rotational and/or translational motion of the camera. Use of a topological map may further enhance vision-based algorithms or techniques. 
     Optical flow, another computer vision-based technique, may analyze the displacement and translation of image pixels in a video sequence in the vision data  92  to infer camera movement. Examples of optical flow techniques may include motion detection, object segmentation calculations, luminance, motion compensated encoding, stereo disparity measurement, etc. Through the comparison of multiple frames over multiple iterations, movement and location of the camera (and thus the endoscope) may be determined. 
     The localization module  95  may use real-time EM tracking to generate a real-time location of the endoscope in a global coordinate system that may be registered to the patient&#39;s anatomy, represented by the preoperative model. In EM tracking, an EM sensor (or tracker) comprising one or more sensor coils embedded in one or more locations and orientations in a medical instrument (e.g., an endoscopic tool) measures the variation in the EM field created by one or more static EM field generators positioned at a known location. The location information detected by the EM sensors is stored as EM data  93 . The EM field generator (or transmitter), may be placed close to the patient to create a low intensity magnetic field that the embedded sensor may detect. The magnetic field induces small currents in the sensor coils of the EM sensor, which may be analyzed to determine the distance and angle between the EM sensor and the EM field generator. These distances and orientations may be intraoperatively “registered” to the patient anatomy (e.g., the preoperative model) in order to determine the geometric transformation that aligns a single location in the coordinate system with a position in the preoperative model of the patient&#39;s anatomy. Once registered, an embedded EM tracker in one or more positions of the medical instrument (e.g., the distal tip of an endoscope) may provide real-time indications of the progression of the medical instrument through the patient&#39;s anatomy. 
     Robotic command and kinematics data  94  may also be used by the localization module  95  to provide localization data  96  for the robotic system. Device pitch and yaw resulting from articulation commands may be determined during preoperative calibration. Intraoperatively, these calibration measurements may be used in combination with known insertion depth information to estimate the position of the instrument. Alternatively, these calculations may be analyzed in combination with EM, vision, and/or topological modeling to estimate the position of the medical instrument within the network. 
     As  FIG. 20  shows, a number of other input data can be used by the localization module  95 . For example, although not shown in  FIG. 20 , an instrument utilizing shape-sensing fiber can provide shape data that the localization module  95  can use to determine the location and shape of the instrument. 
     The localization module  95  may use the input data  91 - 94  in combination(s). In some cases, such a combination may use a probabilistic approach where the localization module  95  assigns a confidence weight to the location determined from each of the input data  91 - 94 . Thus, where the EM data may not be reliable (as may be the case where there is EM interference) the confidence of the location determined by the EM data  93  can be decrease and the localization module  95  may rely more heavily on the vision data  92  and/or the robotic command and kinematics data  94 . 
     As discussed above, the robotic systems discussed herein may be designed to incorporate a combination of one or more of the technologies above. The robotic system&#39;s computer-based control system, based in the tower, bed and/or cart, may store computer program instructions, for example, within a non-transitory computer-readable storage medium such as a persistent magnetic storage drive, solid state drive, or the like, that, upon execution, cause the system to receive and analyze sensor data and user commands, generate control signals throughout the system, and display the navigational and localization data, such as the position of the instrument within the global coordinate system, anatomical map, etc. 
     2. Functional Indicators for Robotic Medical Systems. 
     Robotic medical systems can include indicators-such as visual or audible indicators, among others—that can be configured to communicate or otherwise provide information about the systems to users. Such indicators can be particularly useful for robotic medical systems that include a plurality of robotically controlled moveable components, although the indicators are also useful in less complex systems as well. The indicators can be configured to provide various functions as will be described below, including, for example, providing state and or identity information for the robotic system and/or components thereof. In some embodiments, state information can comprise, for example, a stand by state, a powered state, an active state, a ready state, an error state (e.g., a fault or collision state), a deployment state, a storage state, an emergency stop state, a motion (or impending motion) state, etc., of the robotic system and/or a component of the robotic system (such as a robotic arm, a medical instrument, an instrument driver, or an arm support). Identity information can comprise, for example, information that can be used to identify the robotic system and/or components thereof (for example, to distinguish one robotic arm from another or to distinguish one robotic tool from another). 
     As an initial example, the indicators can be configured to provide or communicate state and/or identity information about the system and/or its components. For example, an indicator can be configured to communicate that one or more components of the system are about to move and/or are moving. The indication can serve to notify users in the vicinity of the system about the movement so that unintentional contact between the users and the system can be avoided. Thus, in some embodiments, the indicators can be configured to provide information related to a movement state of the system. This can increase safety for those using this system. 
     As another example, an indicator can serve to provide identification information for a component of the robotic system. As noted above, a robotic system can include one or more robotic arms. An indicator can be configured to provide identification information associated with the one or more robotic arms. For example, a first robotic arm can be associated with an indicator of a first color, while a second robotic arm can be associated with an indicator of a second color. Users of the system can then identify the first and second robotic arms by referring to the first and second colors. This can facilitate use of the system by providing a mechanism by which the components of the robotic system can be identified and referenced. Advantageously, providing such identification information on the one or more robotic arms communicates to a clinician or clinician&#39;s assistant information with ease and enhances safety before and during a surgical procedure. 
     As will be described in more detail below, the indicators can advantageously be positioned on various components of the robotic system. In some embodiments, for example, the indicators can be positioned on adjustable arm supports and/or on a patient platform of the robotic medical system. Other locations for the indicators are also possible. 
       FIGS. 21A and 21B  illustrate an embodiment of a robotic system  200  that may include one or more indicators  201 . In the illustrated embodiment, the indicators  201  comprise light emitting diode (LED) light strips, although, as noted below, other types of indicators (e.g., other types of visual or audible indicators, etc.) can also be used. For example, other visual indicators can include lasers or moveable colored markers. Further, in the illustrated embodiment, the indicators  201  are positioned on adjustable arm supports  203  and a patient platform  205  of the system  200 . The illustrated positions of the indicators  201  are provided by way of example, not limitation. Further, not all indicators  201  need be included in all embodiments. For example, in some embodiments, the indicators  201  can be omitted from the patient platform  205  or the adjustable arm supports  203 . 
     The system  200  can be similar in some respects to the systems  100 ,  140 A described above with reference to  FIGS. 12-14 . For example, the adjustable arm supports  203  can be similar to the adjustable arm supports  105 , and the patient platform  205  can be similar to the patient platform  101  previously described. The patient platform  205  is configured to support a patient during a robotic medical procedure. The adjustable arm supports  203  can be configured so as to be moveable or adjustable relative to the patient platform  205 , in a similar manner as described above with reference to the systems of  FIGS. 12-14 . 
     In the illustrated embodiment, the adjustable arm supports  203  include a rail or bar that can be configured to support one or more robotic arms  207 . The adjustable arm supports  203  and robotic arms  207  can be moved between a wide variety of positions, for example, to facilitate a robotic medical procedure (e.g., to a position as shown in  FIG. 21B ) and/or to facilitate storage of the adjustable arm supports  203  and robotic arms  207  beneath the patient platform  205  (e.g., as shown in  FIG. 21A ). As described above with reference to  FIGS. 12-14 , the adjustable arm supports  203  can be configured for movement in multiple degrees of freedom. For example, the adjustable arm supports  203  can move in all three spatial directions, including up and down, and enable the robotic arms  207  that are attached thereto to be stored underneath the patient platform  205 . 
     As apparent from the preceding description, the robotic medical systems  200  can include a plurality of moveable/adjustable robotic components. In view of the high degree of movement, it can become important that the system  200  is configured to effectively and efficiently communicate various types of information about the system to users. As described below, the indicators  201  described in this section can be configured for this and other purposes. For example, during movement of components of the system  200 , there can be a risk of harm to users of the systems in a variety of situations. One such situation is the deployment of the robotic arms  207  as they are moved from their stowed position under the patient platform  205  to a deployed position on either side of the patient platform  205 . Another potentially dangerous situation is the autonomous or remotely controlled movement of the arm supports  203  during a procedure, whereby the risk can be particularly pronounced for any sterile users supporting the procedure that are, for example, standing next to the system. As described in more detail below, the indicators  201  described herein can be configured to communicate information regarding movement or other states of the various robotic components of the system to nearby users to mitigate the risk of harm or otherwise facilitate a robotic medical procedure. As one example, an indicator  201  can flash or change color to indicate that an associated robotic component is about to move. This may provide an indication to users in the vicinity to keep clear, improving safety in the operating room. 
     These and other features and functions of the indicators  201  and system  200  will become more fully apparent from the following sections that describe (A) indicators  201  on arm supports  203 , (B) indicators  201  on patient platforms  205 , and (C) functions or features that can be provided by the indicators  201 . Although sections (A) and (B) describe example indicator locations on arm supports  203  and patient platforms  205 , other locations for indicators  201  are also possible. Further, the indicators  201  can also be used in other types of medical systems that may not include adjustable arm supports  203  or patient platforms  205 . 
     A. Indicators on Arm Supports. 
     As shown in  FIGS. 21A and 21B , in some embodiments, indicators  201  can be included on each of the adjustable arm supports  203  of the system  200 . This may be advantageous because it can provide indicators on each side of the patient platform  205  (if adjustable arm supports  203  are included on each side as illustrated) and can provide the indicators directly on one of the moveable components of the system  200 . In the illustrated embodiment, the indicators  201  on the adjustable arm supports  203  comprise one or more lights (e.g., LEDs or LED arrays), while in other embodiments, the indicator/signifier can comprise one or more audible speakers (see  FIG. 26 ) or a combination of a visual and audible indicators (e.g., LEDs embedded in the speakers themselves). The indicators  201  can be used at different periods of a surgical procedure, including during set-up, intraprocedure, or take-down. 
     In the illustrated embodiment of  FIGS. 21A and 21B , the indicator  201  on the adjustable arm support  203  comprises an LED light strip that is positioned along one or more side surfaces of the adjustable arm support  203 . In some embodiments, one or more additional indicators  201  can also be provided, alternatively or additionally, on one or more additional surfaces of the adjustable arm support  203  as shown, for example, in  FIGS. 22A-22D .  FIGS. 22A-22D  illustrate example indicators  201  on the adjustable arm support  203  (e.g., on the bar or rail of the adjustable arm support  203 ) according to several embodiments to illustrate certain features of this disclosure. 
       FIG. 22A  is a perspective view of an adjustable arm support  203  that includes an indicator  201 . In the illustrated embodiment, the indicator  201  comprises an LED light strip. The LED light strip can include a plurality of LEDs. The LEDs can be individually addressable such that they can be controlled individually. Thus, in some embodiments, different portions or regions of the indicator  201  can be activated (e.g., lit up) or deactivated (e.g., turned on) individually as will be described in more detail below. Further, in some embodiments, the LEDs of the indicator  201  may be configured to light up in different colors and/or to provide illumination at different intensities. Although described as including LEDs, other types of light-based indicators can also be used. In addition, though not shown in  FIG. 22A , speakers and/or other indicators/signifiers may be included with the LEDs. 
     In the illustrated embodiment, the indicator  201  is positioned on an outer surface  209  of the adjustable arm support  203 . The outer surface  209  may be a surface of the adjustable arm support  203  that faces away from the patient platform  205 . This placement location can provide good visibility to users standing on the side of the patient platform  205 . Additionally, in the illustrated embodiment of  FIG. 22A , the indicator  201  extends onto end surfaces  211  of the adjustable arm support  203 . Thus, the indicator  201  can “wrap around” the adjustable arm support  203 . In some embodiments, the indicator  201  extends onto both end surfaces  211  of the adjustable arm support. In some embodiments, indicators  201  that wraparound multiple surfaces of the adjustable arm support  203  can be visible to users positioned at different locations around the patient platform  205 , such as at the head end or foot end of the patient platform  205 . Although not visible in  FIG. 22A , in some embodiments, the indicator  201  can further extend onto an inner surface  213 , upper surface, and/or lower surface of the adjustable arm support  203 . Also, although the indicator  201  is illustrated as a continuous strip in  FIG. 22A , this need not be the case in all embodiments, as shown, for example, in the embodiment of  FIG. 22B . 
       FIG. 22B  illustrates a perspective view of an additional embodiment of an adjustable arm support  203  that includes a plurality of discrete indicators  201 . In the illustrated embodiment, the indicators  201  are illustrated as light sources, such as LEDs, although other types of indicators  201  can be used. The individual or discrete indicators  201  can be individually addressable such that they can be controlled individually. Thus, in some embodiments, different indicators  201  can be activated (e.g., lit up) or deactivated (e.g., turned on) individually as will be described in more detail below. Further, in some embodiments, the LEDs of each indicator  201  may be configured to light up in different colors. In the illustrated embodiment, the individual indicators  201  are positioned on the outer surface  209  of the adjustable arm support  203 . Additionally, indicators  201  are positioned so as to extend onto the end surfaces  211  of the adjustable arm support  203 . 
       FIG. 22C  illustrates an additional embodiment of an adjustable arm support  203  that includes a plurality of discrete indicators  201 . In this embodiment, the indicators  201  comprise light strips (e.g., LED strips) that wrap around a lower surface  215 , the outer surface  209 , and an upper surface  217  of the adjustable arm support  203 . In some embodiments, the indicators  201  may further extend onto the inner surface  213  of the adjustable arm support  203 . As noted before, the indicators  201  can be individually addressable and controllable and/or configured to provide light of different colors and/or intensities. 
       FIG. 22D  illustrates an additional embodiment of an adjustable arm support  203  that includes an indicator  201  that is configured to display text, symbols, images, etc. For example, the indicator  201  can comprise a matrix of individually addressable light sources (e.g., LEDs) or any other type of screen (e.g., an LCD, an LED, or an OLED screen). Such an indicator  201  may be capable of providing more complex information, such as text or diagrams, to a user. In the illustrated embodiment, the indicator  201  is positioned on the outer surface  209  of the adjustable arm support  203 . Other locations for the indicator  201  are also possible (such as any of the other surfaces) and can be used in place of or in addition to the indicator  201  as illustrated. 
       FIGS. 23A and 23B  illustrate cross-sectional views of an adjustable arm support  203  including one or more indicators  201 , in accordance with some embodiments. In the illustrated embodiment, the adjustable arm support  203  includes indicators  201  positioned on an outer surface  209  and a lower surface  215  thereof. Further, in the illustrated embodiment, the indicators  201  comprise light sources, such as LEDs.  FIGS. 23A and 23B  illustrate that the indicators  201  can be configured to provide different types of illumination, among other functions. For example, in  FIG. 23A , the indicators  201  are configured to provide generally diffuse light that is emitted from the indicator  201  in numerous general directions.  FIG. 23B , on the other hand, illustrates that the indicators  201  can be configured to provide light that is focused in a particular direction. For example, as shown in  FIG. 23B , both the indicator  201  positioned on the lower surface  215  and the indicator  201  positioned on the outer surface  209  are configured to provide light that is focused towards the ground  219 . As will be described in more detail below with reference to  FIGS. 27A and 27B , light which illuminates the ground can be used for general illumination and/or to identify one or more zones around a robotic medical system. In some embodiments, light which is illuminated downward, whether directed specifically downward or not, may be beneficial as it may be more easily seen when components of the robotic system are covered by a sterile drape. 
       FIG. 24  illustrates a cross-sectional view of an adjustable arm support  203  including indicators  201  that are embedded within the adjustable arm support  203 , in accordance with some embodiments. In the illustrated embodiment, the indicators  201  comprise light sources, such as LEDs. The light from the indicators  201  can be directed in desired directions using light guides  221 . As shown in the illustrated embodiment of  FIG. 24 , the light guides  221  can be configured to direct light emitted from the indicators  201  towards the ground  219 . This, however, need not always be the case, and the light guides  221  can be configured to orient the light from the indicators in other directions. 
     As mentioned above, the indicator(s)  201  can be configured with different segments or zones that can be individually controlled.  FIG. 25  illustrates an example adjustable arm support  203  that includes an indicator  201  that comprises a plurality of individual zones  223 ,  225 ,  227 . In the illustrated embodiment, the indicator  201  comprises an LED light strip as described above with reference to  FIG. 22A . In the embodiment of  FIG. 25 , a center zone  223  and two end zones  225 ,  227  can each be independently controllable such that they can be activated or deactivated individually. As will be described below, activating different zones of the indicator  201  can be useful for indicating different states or identity information for a robotic system. Although  FIG. 25  illustrates three zones, other numbers of individually controllable zones are also possible. For example, the indicator  201  can comprise one, two, three, four, five, six, seven, eight, nine, ten, or more zones. As mentioned above, in some embodiments, each light of the indicator  201  can be individually controllable. 
     In each of the embodiments of  FIGS. 22A-25  described above, the indicators  201  comprise light sources. Other types of indicators (such as audible indicators, for example) can also be used, in addition to or in place of the visual or light-based indicators  201 .  FIG. 26 , for example, illustrates an embodiment where the indicators  201  comprises audio devices, such as speakers, configured to provide audible alerts or indications. In the illustrated embodiment, three speaker-type indicators  201  are illustrated on an outer face of the adjustable arm support  203 . Other numbers and placements for audible indicators  201  can be included in other embodiments. 
       FIGS. 22A-26  are intended to provide examples of placement locations for indicators  201  on adjustable arm supports  203 . The illustrated embodiments are not intended to be limiting and other locations and placements for the indicators  201  on the adjustable arm supports  203  are also possible. In the alternative, or in addition, other types of combinations indicators  201  may be placed on one or more of the arm supports  203 . In addition, the indicators in  FIGS. 22A-26  may not be exclusive from one another. For example, in some embodiments, the light strip in  FIG. 22A  can be combined with indicators on a lower surface of the arm support as shown in  FIG. 23A . 
     B. Indicators on Patient Platforms. 
     As shown in  FIGS. 21A and 21B , indicators  201  can be positioned on the patient platform  205 . The indicators  201  on the patient platform  205  can be included in addition to or in place of the indicators  201  on the adjustable arm supports  203  described previously. In some embodiments, the indicators  201  on the patient platform  205  can share the same or similar functions as the indicators  201  on the adjustable arm supports  203 , as described above. In some embodiments, the patient platform  205  is adjustable, such that an angle of the patient platform  205  can be adjusted as desired. For example, the patient platform  205  can be configured to allow for longitudinal and/or lateral tilt. In some embodiments, tilt of the patient platform  205  can be robotically controlled. 
     In the illustrated embodiment, the patient platform  205  includes a head section  229 , a torso section  231 , and a leg section  233 . The head section  229  can be configured to support a head of a patient, the torso section  231  can be configured to support a torso of the patient, and the leg section  233  can be configured to support legs of the patient. In some embodiments, one or more of these sections  229 ,  231 ,  233  is configured to be independently adjustable. For example, in some embodiments, an angle or pitch of one or more of these sections  229 ,  231 ,  233  is configured to be independently adjustable. Adjustment of the sections  229 ,  231 ,  233  may allow the patient platform  205  to position the patient in various orientations that can be advantageous for a medical procedure. 
     As illustrated, the patient platform  205  can include one or more indicators  201 . The indicators  201  on the patient platform  205  may be any type of indicator as described above, including visual and audible indicators. In the illustrated embodiment, the indicators  201  comprise visual indicators configured as LED strips. As shown in the illustrated embodiment, discrete LED strips can be arranged along one or more of the edges or sides of the head section  229 , the torso section  231 , and the leg section  233 . For example, in the illustrated embodiment, indicators  201  are positioned on lateral sides of each of the head section  229 , the torso section  231 , and the leg section  233 . In some embodiments, the indicators  201  are included only on some of the sections  229 ,  231 ,  233 . For example, the indicators  201  may be positioned only on the torso section  231 . 
     Further, in the illustrated embodiment, indicators are also positioned on ends of the patient platform  205 . As shown in  FIGS. 21A and 21B , an indicator  201  is included on the end of the head section  229 . An indicator  201  can also be included on an end of the leg section  233 . 
     Positioning the indicators  201  on more than one side of the patient platform  205  can increase the likelihood that users located at different positions around the table can see the indicators  201 . When positioned on multiple sides of the patient platform  205 , the indicators  201  can be considered to “wrap around” the patient platform  205  as described above. 
     Although illustrated as LED strips, indicators  201  on the patient platform  205  can embody other forms. For example, other types of visual and audible indicators  201  can be used. Further, the principles described above with regard to the indicators  201  on the adjustable arm supports  203  may also be applied to the indicators  201  on the patient platform  205 . For example, in place of LED light strips, individual LEDs or other light sources can be used, the indicators  201  can comprise one or more screens, the indicators  201  can be configured to direct light in desired directions, the indicators  201  can be individually controllable so as to provide different zones, etc. 
       FIGS. 21A and 21B  are intended to provide examples of placement locations for indicators  201  on the patient platform  205 . The illustrated embodiments are not intended to be limiting and other locations and placements for the indicators  201  on the patient platform  205  are also possible. In the alternative, or in addition, other types of combinations indicators  201  may be placed on one or more portions of the patient platform  205 . 
     C. Indicator Function. 
     As mentioned above, the indicators  201  described above can be configured to communicate information about the robotic medical system to users. Such information can comprise state or identity information for the system. As used herein, “state information” refers broadly to any information indicative of a state, status, or condition of the robotic medical system or a component thereof. “Identity information” is also used broadly to refer to information that can be used to identify a component of a robotic medical system. Examples of state and identity information are provided and discussed below. Other functions and uses of the indicators  201  are also described below. 
     As shown in the previously described examples, in some embodiments, the indicators  201  can comprise visual indicators. As noted above, visual indicators can comprise lights positioned on the robotic medical system. Visual indicators  201  configured as lights can be configured to serve one or more purposes as described below. For example, visual indicators  201  can be configured to provide illumination in the operating room. In many cases, robotic medical procedures are performed in darkened operating rooms so as to facilitate remote viewing of the robotically controlled instruments on a screen or console. While low light facilitates remote viewing of the robotic medical procedure, sterile users directly interacting with the patient or the robotic medical system can have difficulty seeing. The visual indicators  201  can provide illumination around the robotic medical system to improve visibility for those users. In some embodiments, the illumination provided by the indicators  201  can be oriented to illuminate a region below and around the patient platform  201 . This may help users in proximity to the robotic system to see while minimizing any negative impact on remote viewers. In some embodiments, visual indicators can direct light towards the ground  219  as described above with reference to  FIGS. 23B and 24 . 
       FIGS. 27A and 27B  are top views of an embodiment of the robotic medical system  200  illustrating additional functionality that can be provided by visual indicators  201 . In these figures, only the patient platform  205  and the adjustable arm supports  203  are illustrated. Additional features, such as robotic arms  207  have been omitted for clarity. The adjustable arm supports  203  and/or the patient platform  205  (or other components of the system  200 ) can include visual indicators  201  configured as described above. The visual indicators  201  are not pictured in  FIGS. 27A and 27B , but approximate areas of illumination provided by the visual indicators  201  are illustrated using dashed lines. In some embodiments, the areas of illumination are regions on the ground that are illuminated by the visual indicators  201 . 
     As shown in  FIG. 27A , in some embodiments, visual indicators  201  can be configured to provide an area of illumination  235  positioned generally around the patient platform  205 . The area of illumination  235  can be provided, for example, by visual indicators  201  that are configured to direct light substantially downward below the adjustable arm supports  203  and patient platform  205 . Examples of such visual indicators  201  are shown on the lower surface  215  of the adjustable arm supports  203  of  FIGS. 23B and 24 . Other locations for visual indicators  201  configured to direct light downward are also possible. In some embodiments, the area of illumination  235  can provide “mood” lighting for the system  200 . Such mood lighting can provide an elevated user experience. In some embodiments, the color of the mood lighting can be customized. For example, a surgeon can select a desired color of the mood lighting. The mood lighting may also facilitate visualization of the region below and around the patient platform  205 . 
       FIG. 27B  illustrates that, in some embodiments, the visual indicators  201  can be configured to provide a larger area of illumination  237  around the system  200 . The larger area of illumination  237  can be provided, for example, by visual indicators  201  that are configured to direct light outwardly and downward below the adjustable arm supports  203  and patient platform  205 . Examples of such visual indicators  201  are shown on the outer surface  209  of the adjustable arm supports  203  of  FIGS. 23B and 24 . Other locations for visual indicators  210  configured to direct light outwardly and downward are also possible. A larger area of illumination  237  can further improve visibility around the system  200 . 
     In some embodiments, the area of illumination  237  can be configured to indicate a “keep out zone” in order to improve the safety of those users located around the patient platform  205 . As noted previously, the system  200  may comprise one or more robotically moveable components, such as the adjustable arm supports  203  and/or robotic arms  207 . In some embodiments, when the adjustable arm supports  203  and/or robotic arms  207  are about to move and/or during movement, the visual indicators  201  can provide an area of illumination  237  that corresponds to an area through which (or above which) the components will move. The area of illumination  237  can provide an indication to users in the area to keep clear of that area to avoid unintentional contact with the system. In some embodiments, for example, the area of illumination  237  can be provided in a specific color indicative of the keep out zone. For example, the area of illumination  237  can be illuminated in red. In another example, the area of illumination  237  can flash to attract the users&#39; attention, while also indicating the keep out zone. 
     The areas of illumination  235 ,  237  shown in  FIGS. 27A and 27B , may be approximate. For example, the boundaries of the illumination may not be clearly defined (e.g., through the use of generally diffuse light sources). In other embodiments, the areas of illumination  235 ,  237  shown in  FIGS. 27A and 27B , may be definite, for example, with boundaries of the illumination may that are clearly defined (e.g., through the use of crisp or focused light sources). In some embodiments, to provide well defined boundaries, the indicators  201  may comprise lasers configured to project clearly onto the floor, 
     In some embodiments, the visual indicators  201  can provide different types of illumination based on different functions of the system. For example, in the embodiments shown in  FIGS. 27A and 27B , for a first function (e.g., the mood lighting as shown in  FIG. 27A ), the visual indicators  201  can illuminate at a first intensity (e.g., a lower intensity), while for a second function (e.g., the “keep out zone” lighting as shown in  FIG. 27B ), the visual indicators  201  can illuminate at a greater intensity. In addition, in some embodiments, for the first function, the visual indicators  201  can provide a constant light, while for the second function, the visual indicators  201  can provide a non-constant light that flashes, blinks, or otherwise has variable intensity. The visual indicators  201  can also incorporate different color lights to signify different functions. 
     In other embodiments, the first function (e.g., the mood lighting) can be provided by a first visual indicator  201  and the second function (e.g., the keep out zone lighting) can be provided by a second visual indicator  201 . For example, the first function can be provided with the visual indicator  201  on the bottom or lower surface  215  of the adjustable arm support  203  in  FIGS. 23B and 24 , and the second function can be provided with the visual indicator  201  on the outer surface  209  of the adjustable arm support  203  in  FIGS. 23B and 24 . Configuring different visual indicators  201  for different functions can allow the visual indicators to provide both functions at the same time. 
     As described above with reference to  FIG. 25 , indicators  201  can be configured with independently configurable segments or zones. Activating (e.g., lighting up) indicators  201  within certain zones can provide several useful functions. In some embodiments, visual indicators  201  can be provided whereby different segments or zones of the visual indicators  201  light up depending on the purpose of the communication.  FIGS. 28A-28D  illustrate various functionality that can be provided by independently activating different zones or segments of the indicators  201 . 
       FIG. 28A  illustrates a side view of the system  200  with the adjustable arm support  203  in a storage configuration below the patient platform  205 . In the illustrated embodiment, the adjustable arm support  203  includes a visual indicator  201  configured as an LED strip having a center zone  223  and two end zones  225 ,  227  as described above with reference to  FIG. 25 . In some embodiments, with the robotic system  200  in a first state or configuration, the three zones  223 ,  225 ,  227  of the visual indicator  201  (or combinations of the zones) can light up as a warning during deployment and stowing motion. 
       FIG. 28B  illustrates that, with the robotic system  200  in a second state or configuration, different segments of the light strip can light up to highlight pinching dangers or warnings. For example, as illustrated, end zones  225 ,  227  can be activated to indicate a pinching danger between the ends of the adjustable arm support  203  and a base  239  of the system  200 . In some embodiments, different color lights, flashing patterns, and/or different illumination intensity patterns can also be used on the different zones  225 ,  223 ,  227  of the visual indicator to indicate different functionality. For example, during a stowing motion, all three zones  223 ,  225 ,  227  can illuminate, with the end zones  225 ,  227  providing a different color or illumination pattern to indicate a pinching danger. As another example, visual indicators  201  can be used to minimize or reduce a trip hazard and/or to facilitate prompt discovery of any buttons or plugs located at or around the base of the patient platform. Such buttons may include, but are not limited, to actuators required in an emergency scenario. For example, portions of the indicators  201  corresponding to the locations of the buttons or plugs can light up in order to warn users in the area of their presence and/or to help the users find them more easily. 
       FIG. 28C  illustrates a perspective view of the system  200 , including the adjustable arm supports  203 , a plurality of robotic arms  207 , and the patient platform  205 . In the illustrated embodiment, a visual indicator  201  is provided along the outer surface  209  of the adjustable arm support  203 . As described above with reference to  FIGS. 12-14 , the adjustable arm support  203  can be configured for a wide variety of motions.  FIG. 28C  illustrates an example sweeping motion (illustrated with the dashed arrow), wherein the adjustable arm support  203  is swept upward. This motion may be used, for example, to move the robotic arms  207  into position for a robotic medical procedure. During this movement state, the visual indicator  201  (or portions thereof, including combinations or patterns of the portions) may light up along its length to provide an indication to surrounding users of this movement. 
       FIG. 28D  illustrates another motion of the adjustable arm support  203  wherein the adjustable arm support  203  translates relative to the patient platform  205  (illustrated with the dashed arrow). As shown in  FIG. 28D , during this movement state, an end zone  227  of the visual indicator may be activated to indicate the direction of motion of the adjustable arm support. In the illustrated embodiment, the end zone  227  wraps around the end of the adjustable arm support  203 . This configuration can allow users standing in front of the patient platform to see the indication. In some embodiments, a moving pattern of lights along the adjustable arm support  203  may also provide an indication of a translational movement of the adjustable arm support  203 . 
     The indicators  201  can also be configured to provide identity information for components of the robotic medical system  200 .  FIG. 29A , for example, illustrates an embodiment of the robotic medical system  200 , wherein the indicators  201  are configured to provide identity information for the robotic arms  207 . In  FIG. 29A , the system  200  comprises three robotic arms  207 A,  207 B,  207 C mounted on an adjustable arm support  203 . As illustrated, the adjustable arm support  203  comprises an indicator  201  configured as an LED strip as described above. Indicator regions  201 A,  201 B,  201 C of the indicator  201  can be illuminated to identify each of the robotic arms  207 A,  207 B,  207 C. For example, a first region  201 A can illuminate in a first color to identify the first robotic arm  207 A. The first region  201 A can be, for example, a portion of the indicator  201  in proximity to a base of the first robotic arm  207 A. Similarly, a second region  201 B can illuminate in a second color to identify the second robotic arm  207 B. The second region  201 B can be, for example, a portion of the indicator  201  in proximity to a base of the second robotic arm  207 B. A third region  201 C can illuminate in a third color to identify the third robotic arm  207 C. The third region  201 C can be, for example, a portion of the indicator  201  in proximity to a base of the third robotic arm  207 C. 
     In this way, users can identify each of the robotic arms  207 A,  207 B,  207 C by referring to the first, second, and third colors respectively. The first, second, and third colors may also be visible to a user that is controlling the robotic system  200  (e.g., a surgeon). The surgeon or user that is controlling the robotic system  200  is often not sterile, and thus is unable to interact directly with the robotic system  200  without scrubbing in, which can be a time consuming process. Still, during a robotic system, the surgeon may desire to have one or more components of the robotic system adjusted. The surgeon can refer to the first, second, and third colors to direct sterile users to the correct components of the robotic system  200 . 
     Although described with reference to colors, the indicator  201  and indicator regions  201 A,  201 B,  201 C can be configured to display identity information in different ways. For example, in some embodiments, the indicator  201  and indicator regions  201 A,  201 B,  201 C can be configured to display identity via different patterns of illumination, changes in light intensity, sound, etc. In embodiments wherein the indicator  201  is configured as a screen (e.g., as shown in  FIG. 22D ), identity information can be displayed through text on the screen. For example, the indicator regions  201 A,  201 B,  201 C associated with robotic arms  207 A,  207 B,  207 C can display “arm  1 ,” “arm  2 ,” and “arm  3 ,” for example. Additionally, although identity information has been described above with reference to robotic arms  207 , identity information can be communicated with the indicator  201  for other components of the robotic system  200 . For example, identity information can be related to medical instruments connected to the robotic arms  207 , the adjustable arm supports  203 , the patient, the patient platform  205 , etc. Additionally, identity information can be provided on indicators  201  provided elsewhere on the robotic system  200 , such as on indicators  201  on the patient platform  205 . 
       FIG. 29B  is a perspective view of an embodiment of the robotic medical system  200  illustrating that the indicator  201  can be configured to provide an indication related to movement of robotic arms  207 . As described above, in some embodiments, the robotic arms  207  may be movably mounted on the adjustable arm support  203 . For example, a base of the robotic arm  207  can translate along the adjustable arm support  203 . During this motion, there can be a risk of inadvertent contact between the robotic arm  207  and users in the vicinity.  FIG. 29B  illustrates that the indicator  201  can be configured to provide an indication of the motion of the robotic arm  207  to alert users to the motion of the arm. 
     For example, in  FIG. 29B , the robotic arm  207  is (or is about to move) from a first location to a second location in the direction illustrated with the dashed arrow. A first indicator region  201 A 1  of the indicator  201  can indicate the current location of the robotic arm  207  and a second indicator region  201 A 2  can show the final position of the robotic arm  207 . In some embodiments, a path between the first indicator region  201 A 1  and the second indicator region  201 A 2  can also be shown. Other methods for illustrating movement of the robotic arms  207  can also be used. Further, motion information for other components of the robotic system  200  can be provided with the indicators  201 . As shown and described, in some embodiments, the indicators  201  can advantageously be configured to provide lighting that is capable of dynamically shifting along a length of the adjustable arm support  203  and/or patient platform  205  to track the movable robotic arms  207 . For example, in the embodiment illustrated in  FIG. 29A , the indicator  201  can comprise lights that can illuminate on the adjustable arm support  203  immediately adjacent to respective robotic arms  207 , and, as the robotic arms  207  move, the lights can shift such they follow the position of the movable robotic arms  207 , as shown in  FIG. 29B . 
     In some embodiments, indicators  201  may be configured to provide an indication of a collision between components of the system, such as a collision between two robotic arms. For example, if two robotic arms  207  collide, indicators on the arm can be activated such that the collision can quickly and easily be identified. 
     In some embodiments, indicators  201  provide state information about medical instruments, such as medical instruments connected to the robotic arms  207 . For example, indicators  201  can provide an indication that the system  200  is in an instrument docking state or that an instrument has been successfully docked to a robotic arm. 
     In some embodiments, the robotic systems can include torque sensors in or associated with the arms such that any collision can immediately trigger an emergency stop of the arm motion. In some embodiment, the system can be designed such that a deployment path or footprint size of the arms designed such that footprint increase is kept to a minimum. In some embodiments, audible indicators are configured to provide sound alarms while arms are deploying to alert everyone in the room to stop what they are doing and pay attention to the arms. In some embodiments, audible indicators are configured to provide vocal notifications from the system. For example, an audible indicator may state, “Attention—arms are deploying. Please step away from surgical bed.” Different variations and combinations of indicators may be implemented depending on the particular application or medical procedure. 
     3. Implementing Systems and Terminology. 
     Implementations disclosed herein provide systems, methods and apparatus for functional lighting for robotic medical systems. 
     It should be noted that the terms “couple,” “coupling,” “coupled” or other variations of the word couple as used herein may indicate either an indirect connection or a direct connection. For example, if a first component is “coupled” to a second component, the first component may be either indirectly connected to the second component via another component or directly connected to the second component. 
     Any phrases referencing specific computer-implemented processes/functions described herein may be stored as one or more instructions on a processor-readable or computer-readable medium. The term “computer-readable medium” refers to any available medium that can be accessed by a computer or processor. By way of example, and not limitation, such a medium may comprise random access memory (RAM), read-only memory (ROM), electrically erasable programmable read-only memory (EEPROM), flash memory, compact disc read-only memory (CD-ROM) or other optical disk storage, magnetic disk storage or other magnetic storage devices, or any other medium that can be used to store desired program code in the form of instructions or data structures and that can be accessed by a computer. It should be noted that a computer-readable medium may be tangible and non-transitory. As used herein, the term “code” may refer to software, instructions, code or data that is/are executable by a computing device or processor. 
     The methods disclosed herein comprise one or more steps or actions for achieving the described method. The method steps and/or actions may be interchanged with one another without departing from the scope of the claims. In other words, unless a specific order of steps or actions is required for proper operation of the method that is being described, the order and/or use of specific steps and/or actions may be modified without departing from the scope of the claims. 
     As used herein, the term “plurality” denotes two or more. For example, a plurality of components indicates two or more components. The term “determining” encompasses a wide variety of actions and, therefore, “determining” can include calculating, computing, processing, deriving, investigating, looking up (e.g., looking up in a table, a database or another data structure), ascertaining and the like. Also, “determining” can include receiving (e.g., receiving information), accessing (e.g., accessing data in a memory) and the like. Also, “determining” can include resolving, selecting, choosing, establishing and the like. 
     The phrase “based on” does not mean “based only on,” unless expressly specified otherwise. In other words, the phrase “based on” describes both “based only on” and “based at least on.” 
     The previous description of the disclosed implementations is provided to enable any person skilled in the art to make or use the present invention. Various modifications to these implementations will be readily apparent to those skilled in the art, and the generic principles defined herein may be applied to other implementations without departing from the scope of the invention. For example, it will be appreciated that one of ordinary skill in the art will be able to employ a number corresponding alternative and equivalent structural details, such as equivalent ways of fastening, mounting, coupling, or engaging tool components, equivalent mechanisms for producing particular actuation motions, and equivalent mechanisms for delivering electrical energy. Thus, the present invention is not intended to be limited to the implementations shown herein but is to be accorded the widest scope consistent with the principles and novel features disclosed herein.