Patent Publication Number: US-2021186309-A1

Title: Enhanced flexible robotic endoscopy apparatus

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This application is a divisional of commonly owned U.S. patent application Ser. No. 15/127,398 filed on Sep. 19, 2016, which is a U.S. National Phase application under 35 U.S.C. § 371, of International Application no. PCT/SG2015/050042, with an international filing date of Mar. 19, 2015; all of which are hereby incorporated herein by reference in their entireties. 
    
    
     TECHNICAL FIELD 
     The present disclosure relates to an enhanced flexible robotic endoscopy apparatus having a main body and flexible elongate shaft. The main body includes a housing having a proximal end that carries a plurality of insertion inlets through which a plurality of endoscopy instrument channels are accessible; and the flexible elongate shaft has a proximal end extending away from the distal end of the main body to a distal end, and a plurality of channels therebetween for carrying portions of flexible elongate assemblies insertable into the plurality of channels of the flexible elongate shaft through the inlets. 
     BACKGROUND 
     Surgical robotics has enabled a revolution in surgical techniques, particularly with respect to minimally invasive surgery. The advent of flexible robotic endoscopy has enabled procedures such as Natural Orifice Transluminal Endoscopic Surgery (NOTES) or “incisionless” surgical procedures that do not require a percutaneous access site into the body, whereby a flexible robotic endoscope is inserted into a natural orifice of a subject, such as the subject&#39;s mouth, and is further navigated within or along a natural internal passageway such as portions of the subject&#39;s digestive tract until a distal end of the endoscope is positioned at or proximate to a target site of interest within the subject. Once the distal end of the endoscope is positioned at the target site, a surgical intervention can be performed by way of one or more robot arms and corresponding end effectors that are carried by the endoscope, and which are translatable and manipulable beyond the endoscope&#39;s distal end under robotic control in response to surgeon interaction with a control console. Representative examples of a master-slave flexible robotic endoscope system are described in (a) International Patent Application No. PCT/SG2013/000408; and/or (b) International Patent Publication No. WO 2010/138083. 
     SUMMARY OF THE INVENTION 
     Technical Problems 
     In current flexible robotic endoscopy systems, a number of flexible endoscopic instruments or instrument assemblies such as robotic arms with corresponding end effectors and an imaging assembly probe for capturing images of the end effector(s), are known. The flexible endoscopic instruments are disposable, and can be inserted into or withdrawn from the flexible robotic endoscopy system. 
     Within an operating theater, it is desirable to enhance or maximize the convenience and rapidity of setup/assembly and disassembly of the flexible robotic endoscopy system, while simultaneously ensuring that the overall manner in which the system is setup enables highly precise spatial and temporal control over the robotic elements of the system. Furthermore, under operating theater conditions, a clinician will need to quickly install new flexible endoscopic instruments or replace currently installed flexible endoscopic instruments with new or other types of flexible endoscopic instruments. 
     Unfortunately, existing systems fail to adequately consider the impact of the manner in which the flexible endoscopic system is setup, and the manner in which flexible endoscopic instruments are inserted into and through the flexible robotic endoscopy system and the resulting forces on internal portions of the endoscopic instruments have upon the ability of the system to reliably spatially and temporally control the end effector(s) with maximum precision. 
     Advantageous Effects 
     According to embodiments of the present disclosure, a plurality of flexible robotic elongate assemblies such as actuation assemblies and a flexible imaging endoscopy assembly can be inserted into a transport endoscope and a flexible elongate shaft thereof quickly and conveniently, in a manner that facilitates enhanced precision spatial and temporal control of the robotic elements of such assemblies. 
     According to embodiments of the present disclosure, the transport endoscope is easily and securely detachably engaged with the docking station, for instance, by way of the joint member. The grip on the main body of the transport endoscope is typically positioned toward the distal end of the main body, and the joint member is positioned toward the proximal end of the main body. A clinician such as an endoscopist can hold the grip on the main body, and rapidly and conveniently engage or disengage the main body from the docking station. It is not necessary for the clinician to change or release the grip of the main body from their hand to engage or disengage the transport endoscope with or from the docking station. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIGS. 1A and 1B  are schematic illustrations of a master-slave flexible robotic endoscopy system in accordance with an embodiment of the disclosure. 
         FIG. 2  is a schematic illustration of a master system in accordance with an embodiment of the present disclosure. 
         FIG. 3  is a schematic illustration of a slave system in accordance with an embodiment of the present disclosure. 
         FIGS. 4A-4D  are schematic illustrations of a representative transport endoscope, first and second actuation assemblies, and an imaging endoscope assembly, respectively, in accordance with an embodiment of the present disclosure. 
         FIG. 5  is a schematic illustration of a pair of robotic arms and corresponding end effectors carried thereby, as well as an imaging endoscope, positioned in an environment beyond a distal end of a transport endoscope in accordance with an embodiment of the present disclosure. 
         FIG. 6  illustrates a representative main body  310  in accordance with an embodiment of the present disclosure more specifically. 
         FIGS. 7A-7C  illustrate arrangement of the insertion inlets in accordance with embodiments of the present disclosure. 
         FIG. 8A  is a representative cross sectional illustration of a transport endoscope shaft in accordance with an embodiment of the present disclosure and  FIG. 8B  is a representative cross sectional illustration of a transport endoscope shaft in accordance with another embodiment of the present disclosure. 
         FIGS. 9A-9C  are schematic illustrations showing imaging endoscope assembly insertion into a transport endoscope, imaging connector assembly coupling to an imaging subsystem, imaging input adapter coupling to an imaging output adapter of a motorbox, and an endoscopy support function connector assembly coupling to a valve control unit in accordance with an embodiment of the present disclosure. 
         FIGS. 10A-10B  are schematic illustrations showing transport endoscope docking to a docking station, with portions of outer sleeves/coils of actuation assemblies and an outer sleeve of an imaging endoscope assembly inserted into the transported endoscope, and such outer sleeves securely coupled to a translation unit of the docking station. 
         FIG. 10C  is a schematic illustration showing a representative translation unit carried by the docking station, and a representative manner in which collar elements corresponding to actuation assemblies and an imaging endoscope assembly are retained by the translation unit. 
         FIGS. 11A-11C  illustrate a docking mechanism by which the transport endoscope can be matingly engaged with docking station in accordance with an embodiment of the present disclosure. 
         FIG. 12  illustrates a docking mechanism of  FIGS. 11A-11C  in more details. 
         FIGS. 13A-13C  illustrate a docking mechanism by which the transport endoscope can be matingly engaged with docking station in accordance with another embodiment of the present disclosure. 
         FIG. 14  shows an illustration of transport endoscope&#39;s main body  310  for docking mechanism of  FIGS. 13A-13C  in accordance with an embodiment of the present disclosure. 
         FIG. 15  is a schematic illustration showing coupling of an instrument input adapter of each actuation assembly to a corresponding instrument output adapter corresponding to a motorbox in accordance with an embodiment of the present disclosure. 
         FIG. 16  is a perspective cutaway view showing representative internal portions of an instrument input adapter mounted to an instrument output adapter of the motorbox in accordance with an embodiment of the present disclosure. 
         FIG. 17  is a corresponding cross sectional illustration showing representative internal portions of the instrument adapter and instrument output adapter when coupled together or matingly engaged in accordance with an embodiment of the present disclosure. 
         FIGS. 18A-18D  are cross sectional illustrations showing representative internal portions of actuation engagement structures of the instrument input adapter, and the positions of elements therein, corresponding to particular phases of engagement of the instrument input adapter with and disengagement of the instrument input adapter from the instrument output adapter in accordance with an embodiment of the present disclosure. 
     
    
    
     DETAILED DESCRIPTION OF EXAMPLE EMBODIMENTS 
     In the present disclosure, depiction of a given element or consideration or use of a particular element number in a particular FIG. or a reference thereto in corresponding descriptive material can encompass the same, an equivalent, or an analogous element or element number identified in another FIG. or descriptive material associated therewith. The use of “/” in a FIG. or associated text is understood to mean “and/or” unless otherwise indicated. The recitation of a particular numerical value or value range herein is understood to include or be a recitation of an approximate numerical value or value range, for instance, within +/−20%, +/−15%, +/−10%, or +/−5%. 
     As used herein, the term “set” corresponds to or is defined as a non-empty finite organization of elements that mathematically exhibits a cardinality of at least 1 (i.e., a set as defined herein can correspond to a unit, singlet, or single element set, or a multiple element set), in accordance with known mathematical definitions (for instance, in a manner corresponding to that described in  An Introduction to Mathematical Reasoning: Numbers, Sets, and Functions , “Chapter 11: Properties of Finite Sets” (e.g., as indicated on p. 140), by Peter J. Eccles, Cambridge University Press (1998)). In general, an element of a set can include or be a system, an apparatus, a device, a structure, an object, a process, a physical parameter, or a value depending upon the type of set under consideration. 
     Embodiments of the present disclosure are directed to master-slave flexible robotic endoscopy systems, which include a master-side system and a slave-side system that is controllable or controlled by the master-side system. Also, the embodiments of the present disclosure provide enhanced mechanisms or structures of the slave or slave-side system. 
       FIGS. 1A and 1B  are schematic illustrations of a master-slave flexible robotic endoscopy system  10  in accordance with an embodiment of the disclosure. In an embodiment, the system  10  includes a master or master-side system  100  having master-side elements associated therewith, and a slave or slave-side system  200  having slave-side elements associated therewith. 
     With further reference to  FIG. 5  which shows a distal end of endoscopy apparatus disposed at a slave or slave-side system  200 , in various embodiments, the master system  100  and the slave system  200  are configured for signal communication with each other such that the master system  100  can issue commands to the slave system  200  and the slave system  200  can precisely control, maneuver, manipulate, position, and/or operate (a) a set of robotic arms  400   a,b  and corresponding end effectors  410   a,b  carried or supported by a transport endoscope  300  of the slave system  200 , and possibly (b) an imaging endoscope or imaging probe member  460  carried or supported by the transport endoscope  300 , in response to master system inputs. The master and slave systems  100 ,  200  can further be configured such that the slave system  200  can dynamically provide tactile/haptic feedback signals (e.g., force feedback signals) to the master system  100  as the robotic arms  410   a,b  and/or end effectors  420   a - b  associated therewith are positioned, manipulated, or operated. Such tactile/haptic feedback signals are correlated with or correspond to forces exerted upon the robotic arms  410   a,b  and/or end effectors  420   a - b  within an environment in which the robotic arms  410   a,b  and end effectors  420   a,b  reside. 
     Turning back to  FIGS. 1A and 1B , various embodiments in accordance with the present disclosure are directed to surgical situations or environments, for instance, Natural Orifice Transluminal Endoscopic Surgery (NOTES) procedures performed upon a patient or subject while they are disposed on a surgical table or platform  20 . In such embodiments, at least portions of the slave system  200  are configured to reside within an Operating Theatre (OT) or Operating Room (OR). Depending upon embodiment details, the master system  100  can reside within or outside of (e.g., near or remote from) the OT/OR. Communication between the master system  100  and the slave system  200  can occur directly (e.g., through a set of local communication lines, and/or local wireless communication), or indirectly by way of one or more networks (e.g., a Local Area Network (LAN), a Wide Area Network (WAN), and/or the Internet) in accordance with embodiment details. 
       FIG. 2  is a schematic illustration of a master system  100  in accordance with an embodiment of the present disclosure. In an embodiment, the master system  100  includes a frame or console structure  102  that carries left and right haptic input devices  110   a,b ; a set of additional/auxiliary hand-operated input devices/buttons  115 ; a set of foot operated controls or pedals  120   a - d ; a display device  130 ; and a processing module  150 . The frame/console structure  102  can include a set of wheels  104  such that the master system  100  is readily portable/positionable within an intended usage environment (e.g., an OT/OR, or a room external to or remote therefrom); and a set of arm supports  112 . During a representative endoscopy procedure, a surgeon positions or seats themselves relative to the master system  100  such that their left and right hands can hold or interact with the left and right haptic input devices  110   a,b , and their feet can interact with the pedals  120   a - d . The processing module  150  processes signals receive from the haptic input devices  110   a,b , the additional/auxiliary hand-operated input devices  115 , and the pedals  120   a - d , and issues corresponding commands to the slave system  200  for purpose of manipulating/positioning/controlling the robotic arms  410   a,b  and the end effectors  420   a,b  corresponding thereto, and possibly manipulating/positioning/controlling the imaging endoscope  460 . The processing module  150  can additionally receive tactile/haptic feedback signals from the slave system  200 , and conveys such tactile/haptic feedback signals to the haptic input devices  110   a,b . The processing module  150  includes computing/processing and communication resources (e.g., one or more processing units, memory/data storage resources including Random Access Memory (RAM) Read-only Memory (ROM), and possibly one or more types of disk drives, and a serial communication unit and/or network communication unit) in a manner readily understood by one having ordinary skill in the relevant art. 
       FIG. 3  is a schematic illustration of a slave system  200  in accordance with an embodiment of the present disclosure. In an embodiment, the slave system  200  includes a transport endoscope  300  having a flexible elongate shaft  320 ; a docking station  500  to which the transport endoscope  300  can be selectively/selectably coupled (e.g., mounted/docked and dismounted/undocked); an imaging subsystem  210 ; an endoscopy support function subsystem  250  and an associated valve control unit  270 ; an actuation unit or motorbox  600 ; and a main control unit  800 . In several embodiments, the slave system  200  additionally includes a patient-side cart, stand, or rack  202  configured for carrying at least some slave system elements. The patient side cart  202  typically includes wheels  204  to facilitate easy portability and positioning of the slave system  200  (e.g., at a desired location within an OT/OR). 
     In brief, the imaging subsystem  210  facilitates the provision or delivery of illumination to the imaging endoscope  460 , as well as the processing and presentation of optical signals captured by the imaging endoscope  460 . The imaging subsystem  210  includes an adjustable display device  220  configured for presenting (e.g., on a real-time basis) images captured by way of the imaging endoscope  460 , in a manner readily understood by one having ordinary skill in the relevant art. The endoscopy support function subsystem  250  in association with the valve control unit  270  facilitates the selective controlled provision of insufflation or positive pressure, suction or negative/vacuum pressure, and irrigation to the transport endoscope  300 , as also readily understood by one having ordinary skill in the relevant art. The actuation unit/motorbox  600  provides a plurality of actuators or motors configured for driving the robotic arms  410   a,b  and the end effectors  420   a,b  under control of the main control unit  800 , which includes a set of motor controllers. 
     The main control unit  800  additionally manages communication between the master system  100  and the slave system  200 , and processes input signals received from the master system  100  for purpose of operating the robotic arms  410   a,b  and end effectors  420   a,b  in a manner that directly and precisely corresponds to surgeon manipulation of the master system&#39;s haptic input devices  110   a,b . In multiple embodiments, the main control unit  800  additionally generates the aforementioned tactile/haptic feedback signals, and communicates such tactile/haptic feedback signals to the master system  100  on a real-time basis. In several embodiments, the tactile/haptic feedback signals can be generated by way of sensors that are disposed proximal to the flexible elongate shaft  320  and/or body  310  (e.g., sensors that reside in the motorbox  600 ), without use or exclusive of sensors carried within or distal to the flexible elongate shaft  320  and/or body  310  (e.g., sensors carried on, near, or generally near a robotic arm  410  or end effector  420 ). Representative manners of generating tactile/haptic feedback signals are described in detail in International Patent Application No. WO 2010/138083. The main control unit  800  includes signal/data processing, memory/data storage, and signal communication resources (e.g., one or more microprocessors, RAM, ROM, possibly a solid state or other type of disk drive, and a serial communication unit and/or network interface unit) in a manner readily understood by one having ordinary skill in the relevant art. 
       FIG. 4A  is an illustration of a representative transport endoscope  300  and  FIGS. 4B-4D  are illustrations of representative flexible elongate assemblies which can be inserted to or withdrawn from the transport endoscope  300  in accordance with an embodiment of the disclosure. The flexible elongate assemblies may comprise the actuation assemblies  400   a ,  400   b  as shown in  FIGS. 4B-4C  and a flexible imaging endoscope assembly  450  as shown in  FIG. 4D . 
     The actuation assemblies  400   a ,  400   b  may include or be robotic surgical instruments, e.g., a grasper  400   a  as shown in  FIG. 4B  or e.g., a cautery spatula  400   b  as shown in  FIG. 4C  in accordance with an embodiment of the disclosure. Also, flexible imaging endoscope assembly  450  may be an imaging endoscope probe in accordance with an embodiment of the disclosure as shown in  FIG. 4D . 
     With reference to  FIG. 4A , the transport endoscope  300  comprises a main body  310  at a proximal end and a flexible elongate shaft  320  toward a distal end. In a preferred embodiment, the main body  310  may be made of rigid material(s) such as hard plastics or metals and the flexible elongate shaft  320  is made of flexible materials such as rubber, rubber-like, and/or soft plastic materials. 
     The main body  310  includes or defines a proximal portion, border, surface, or end of the transport endoscope  300 , and provides a plurality of insertion inlets  315  through which channels that extend within and along the flexible elongate shaft  320  are accessible. The main body  310  comprises a proximal end portion or proximal end  311   a  and a distal end portion or distal end  311   b , and a housing  312  that extends between or from the proximal end  311   a  to the distal end  311   b . The housing  312  comprises a plurality of surfaces and the plurality of insertion inlets  315 . The plurality of insertion inlets  315  is carried by the proximal end  311   a  of the main body  310 , for instance, such that the plurality of insertion inlets  315  resides on at least one surface of the housing  312  at the main body&#39;s proximal end  311   a  (e.g., a top surface or a set of top surfaces of the housing  312  at the main body&#39;s proximal end  311   a ). 
     In several embodiments, the main body  310  additionally provides a control interface for the transport endoscope  300 , by which an endoscopist can exert navigational control over the flexible elongate shaft  320 . For instance, the main body  310  can include a number of control elements, such as one or more buttons, knobs, switches, levers, joysticks, and/or other control elements to facilitate endoscopist control over transport endoscope operations, in a manner readily understood by one having ordinary skill in the relevant art. 
     The flexible elongate shaft  320  is configured to extend away from the distal end  311   b  of the main body  310  and terminate at a distal end of the transport endoscope  300 . The flexible elongate shaft  320  comprises a proximal end  321   a , a distal end  321   b , a central axis (not shown) and a plurality of channels therewithin for carrying portions of flexible elongate assemblies and an opening disposed at the flexible elongate shaft&#39;s distal end  321   b  for each of the plurality of channels. 
     The plurality of channels may comprise a set of instrument channels which carry actuation assemblies  400   a ,  400   b  as shown in  FIGS. 4B-4C . In various embodiments, the channels may also comprise passages for enabling the delivery of insufflation or positive pressure, suction or vacuum pressure, and irrigation to an environment in which the distal end of the flexible elongate shaft  320  resides. 
     Each actuation assembly  400   a,b  typically corresponds to a given type of endoscopic tool. For instance, in a representative implementation, a first actuation assembly  400   a  can carry a first robotic arm  410   a  having a grasper or similar type of end effector  420   a  as shown in  FIG. 4B ; and a second actuation assembly  400   b  can carry a second robotic arm  410   b  having a cautery spatula or similar type of cauterizing end effector  420   b  as shown in  FIG. 4C . 
     In an embodiment indicated in  FIGS. 4B-4C , a given actuation assembly  400   a,b  includes a robot arm  410   a,b  and its corresponding end effector  420   a,b ; a flexible elongate outer sleeve and/or coil  402   a,b  that internally carries a plurality of tendon/sheath elements, such that tension or mechanical forces can be selectively applied to particular tendon elements for precisely manipulating and controlling the operation of the robot arm  410   a,b  and/or the end effector  420   a,b ; and an instrument input adapter  710   a,b  by which tendons within the outer sleeve  402   a,b  can be mechanically coupled to corresponding actuators within the motorbox  600 , as further detailed below. Representative types of tendon/sheath elements, robotic arms  410   a,b , and end effectors  420   a,b , as well as representative manners in which tendon elements can couple to and control portions of a robot arm  410   a,b  (e.g., joints/joint primitives) and/or a corresponding end effector  420   a,b  to provide maneuverability/manipulability relative to available DOFs are described in detail in (a) International Patent Application No. PCT/SG2013/000408; and/or (b) International Patent Publication No. WO 2010/138083. A given tendon and its corresponding sheath can be defined as a tendon/sheath element. 
     In  FIGS. 4B and 4C , the robot arm  410   a,b , end effector  420   a,b , and portions of the outer sleeve/coil  402   a,b  can be inserted into an instrument channel of the flexible elongate shaft  320 , such that the robot arm  410   a,b  and the end effector  420   a,b  reach or approximately reach, and can extend a predetermined distance beyond, the distal end  321   b  of the flexible elongate shaft  320 . As described in detail below, the actuation assembly&#39;s outer sleeve/coil  402   a,b , and hence the robot arm  410   a,b  and end effector  420   a,b , can be selectively longitudinally translated or surged (i.e., displaced distally or proximally with respect to the distal end  321   b  of the flexible elongate shaft  320 ) by way of a translation unit such that the proximal-distal positions of the robotic arm  410   a,b  and the end effector  420   a,b  relative to the distal end  321   b  of the flexible elongate shaft  320  can be adjusted within an environment beyond the distal end  321   b  of the flexible elongate shaft  320 , up to a predetermined maximum distance away from the distal end  321   b  of the flexible elongate shaft  320 , for purpose of carrying out an endoscopic procedure. In a number of embodiments, an actuation assembly  400  can be disposable. 
     In particular embodiments, the actuation assembly  400   a,b  includes a collar element, collet, or band  430   a,b  that surrounds at least a portion of the outer sleeve/coil  402   a,b  at a predetermined distance away from the distal tip of the end effector  420   a,b . As detailed below, the collar element  430   a,b  is designed to matingly engage with a receiver of the translation mechanism, such that longitudinal/surge translation of the collar element  430   a,b  across a given distance relative to the distal end of the flexible elongate shaft  320  results in corresponding longitudinal/surge translation of the robotic arm  410   a,b  and end effector  420   a,b.    
     In several embodiments, the plurality of channels provided within the flexible elongate shaft  320  additionally include an imaging endoscope channel, which is configured for carrying portions of a flexible imaging endoscope assembly  450  as shown in  FIG. 4D  that can be inserted into and/or withdrawn from the transport endoscope  300 . Referring to  FIG. 4D , in a manner analogous or generally analogous to that described above for the actuation assembly  400   a,b , in an embodiment the imaging endoscope assembly  450  includes a flexible outer sleeve, coil, or shaft  452  that surrounds or forms an outer surface of the flexible imaging endoscope  460 ; an imaging input adapter  750  by which a set of tendons corresponding to or within the imaging endoscope  460  can be mechanically coupled to corresponding actuators within the motorbox  600  such that a distal portion of the imaging endoscope  460  can be selectively maneuvered or positioned in accordance with one or more DOFs (e.g., heave and/or sway motion) within an environment at, near, and/or beyond the distal end  321   b  of the flexible elongate shaft  320 ; and an imaging connector assembly  470  by which optical elements (e.g., optical fibers) of the imaging endoscope  460  can be optically coupled to an image processing unit of the imaging subsystem  210 . For instance, the imaging endoscope  460  can include or be coupled to tendons such that a distal end or face of the imaging endoscope  460  can selectively/selectably capture anterograde and retrograde images of the robotic arms  410   a,b  and end effectors  420   a,b  during an endoscopic procedure. Representative embodiments of imaging endoscopes and control elements such as tendons associated therewith that can be incorporated into an imaging endoscope assembly  450  in accordance with an embodiment of the present disclosure are described in International Patent Application No. PCT/SG2013/000408 hereto. In some embodiments, the imaging endoscope assembly  450  can be disposable. 
     In a manner identical, essentially identical, or analogous to that for the actuation assembly  400   a,b , the outer sleeve  452  of the imaging endoscope assembly  450 , and hence the distal end of the imaging endoscope  460 , can be selectively longitudinally translated/surged relative to the distal end  321   b  of the flexible elongate shaft  320  by way of the translation mechanism, such that the longitudinal or proximal-distal position of the imaging endoscope  460  can be adjusted at, near, and/or beyond the distal end of the flexible elongate shaft  320  across a predetermined proximal-distal distance range in association with an endoscopic procedure. 
     In a number of embodiments, the imaging endoscope assembly  450  includes a collar element  430   c  that surrounds at least portions of the imaging endoscope assembly&#39;s outer sleeve  452  at a predetermined distance away from the distal end  460  of the imaging endoscope  450 . The collar element  430   c  is configured for mating engagement with a receiver or receiving structure of the translation mechanism, such that longitudinal/surge displacement of the collar element  430   c  across a given distance relative to the distal end of the flexible elongate shaft  320  results in corresponding longitudinal/surge displacement of the distal end of the imaging endoscope  460 . 
     As a result, in several embodiments the transport endoscope  300  may have two robotic arms  410   a,b  and corresponding end effectors  420   a,b  carried thereby, as well as a flexible imaging endoscope, positioned in an environment beyond a distal end of a transport endoscope in accordance with an embodiment of the present disclosure as shown in  FIG. 5 . 
     In an embodiment, the flexible elongate assemblies comprising actuation assemblies  400   a ,  400   b  and a flexible imaging endoscope assembly  450  may be insertable to the plurality of channels within the flexible elongate shaft  320  through the insertion inlets  315 , with axes of the flexible elongate assemblies being parallel to the central axis of the flexible elongate shaft. In other words, the actuation assemblies  400   a,b  of  FIGS. 4B and 4C  and the flexible imaging endoscope assembly  450  of  FIG. 4D  are configured for insertion into and withdrawal from instrument channels and an imaging endoscope channel of the transport endoscope  300 , respectively, with axes of the actuation assemblies  400   a,b  and axis of the flexible imaging endoscope assembly being parallel to the central axis of the flexible elongate shaft  320  as shown in  FIG. 9A , or parallel to the instrument channels or the imaging endoscope channel carried by the flexible elongate shaft  320  as readily understood by one having ordinary skill in the relevant art. Correspondingly or equivalently, each of the insertion inlets  315  can have an insertion axis corresponding thereto, along which an actuation assembly  400  or the flexible imaging endoscope assembly  450  is insertable, such that the insertion axes of the insertion inlets  315  are parallel to the central axis of the flexible elongate shaft  320  at the proximal region or end of the flexible elongate shaft  320 . For a given insertion inlet  315 , a plane of an aperture or opening of the insertion inlet  315  into and through which an actuation assembly  400  or the flexible imaging endoscope assembly  450  is insertable/inserted is transverse or perpendicular to its insertion axis. 
     Referring further to  FIGS. 4B-4C , when the actuation assemblies  400   a,b  and the flexible imaging endoscope assembly  450  have been fully inserted into the transport endoscope  300  prior to their manipulation in an environment external to the distal end of the flexible elongate shaft  320  during an endoscopic procedure, each collar element  430   a - c  remains outside of and at least slightly away from the flexible elongate shaft  320 , and in various embodiments outside of and at least slightly away from the transport endoscope&#39;s main body  310 , such that longitudinal translation or surge motion of a given collar element  430   a - c  across a predetermined proximal-distal distance range can freely occur by way of the translation unit, without interference from the flexible elongate shaft  320  and/or main body  310 . Thus, the outer sleeve/coil  402   a,b  of each actuation assembly  400   a,b  must distally extend a sufficient length away from a distal border of its collar element  430   a,b , such that the end effector  420   a,b  reaches or approximately reaches the distal end  321   b  of the flexible elongate shaft  320  when the collar element  430   a,b  resides at a most-proximal position relative to the translation unit. Similarly, the imaging endoscope assembly&#39;s outer sleeve  452  must distally extend a sufficient length away from its collar element  430   c  such that the distal end of the imaging endoscope  460  resides at an intended position at, proximate to, or near the distal end  321   b  of the flexible elongate shaft  320  when the collar element  430   c  is at a most-proximal position relative to the translation unit. 
     Referring back to  FIG. 4A , the transport endoscope  300  may additionally include an endoscopy support function connector assembly  370  by which the transport endoscope&#39;s main body  310  can be coupled to the endoscopy support function subsystem  250 , in a manner readily understood by one having ordinary skill in the relevant art. 
       FIG. 6  illustrates a representative main body  310  in accordance with an embodiment of the present disclosure more in details. As shown in  FIG. 6 , the main body  310  may comprise a housing  312  that extends to the proximal end  311   a , a joint member  316  on a surface of the housing  312  and a grip  313  toward the distal end  311   b . Also, the main body  310  may further comprise a connector  314  which connects the main body  310  and the flexible elongate shaft  320 . In a more refined or preferred embodiment, the housing  312  may include or be a cuboid or generally cuboid structure (e.g., a rectangular or generally rectangular cuboid tube), and a plurality of insertion inlets  315  may be formed on an upper and/or top surface thereof toward the proximal end of the housing  312 . Also, a joint member engages the transport endoscope  300  with other elements of the slave system  200 , e.g. the docking station  500 , as will be described later and may be provided on a side surface of the housing  312 . The grip  313  provides a region, portion, or structure that a clinician (e.g., an endoscopist or surgeon) can hold to couple or engage the transport endoscope  300  with other elements of the slave system, and spatially adjust, position, or move portions of the transport endoscope  300  relative to other elements of the slave system and/or the subject or patient. 
     In accordance with an embodiment of the present disclosure, a joint member  316  is located on a side surface of the housing  312  that extends from the proximal end  311   a  to the distal end  311   b  and a grip  313  is located toward the distal end of the transport endoscope  300 . That is, the join member  316  is positioned toward the proximal end of the transport endoscope  300  and the grip  313  is positioned toward distal end of the transport endoscope  300  on the main body  310 . Therefore, it is not necessary for a clinician to change or release the grip of main body to engage or disengage the transport endoscope  300  with or from docking station  500 , or the docking mechanism as shown in  FIGS. 11-14 . Also, the docking mechanism can be more stable since a clinician can mount the transport endoscope  300  on the docking station  500  while the grip  313  of the main body  310  is held. 
     Depending upon embodiment details, the insertion inlets  315  on a surface of the main body  310  may be arranged in various ways. In a refined or preferred embodiment, the insertion inlets may be arranged such that it reduces or minimizes mechanical stress(es) on both the transport endoscope  300  and the flexible elongate assemblies including the actuation assemblies  400   a ,  400   b  and a flexible imaging endoscope assembly  450  when the clinician inserts/withdraws the flexible elongate assemblies into/from transport endoscope  300  or the slave or slave side system  200 . In an embodiment, the insertion inlets  315  may be arranged in a linear or generally linear manner (e.g., along a line) as shown in  FIGS. 7A-7B . Also, the insertion inlets  315  may be arranged in a line parallel to a given boundary, border, edge, or sideline of the surface, as shown in  FIG. 7A , or arranged in a diagonal line as shown in  FIG. 7B . Also, the number of the insertion inlets may be changed according to the number of flexible endoscope assemblies to be inserted to the transport endoscope  300  as shown in  FIG. 7C  and the arrangement thereof may be changed accordingly. 
     Representative embodiments of the transport endoscope  300  are described in detail in International Patent Application No. PCT/SG2013/000408 hereto. In certain embodiments, the transport endoscope  300  can be configured for carrying another number of actuation assemblies  400 . Furthermore, the cross-sectional dimensions of the transport endoscope  300 , the channels/passages therein, one or more actuation assemblies  400 , and/or an imaging endoscope assembly  450  can be determined, selected, or specified in accordance with a given type of surgical/endoscopic procedure and/or transport endoscope shaft size/dimensional constraints under consideration. 
       FIG. 8A  is a representative cross sectional illustration of a flexible elongate shaft  320  in accordance with another embodiment of the present disclosure, in which the channels/passages therein include a primary instrument channel  330  having a large or maximal cross-sectional area/diameter configured for accommodating a high/maximum DOF robot arm/end effector  410 ,  420 ; a secondary instrument channel  360  having a smaller or significantly smaller cross-sectional area/diameter than the primary instrument channel  330 , which can be configured for accommodating a manually operated conventional endoscopic instrument/tool, such as a conventional grasper (e.g., in such an embodiment, a robotic actuation assembly  400  as well as a conventional/manual actuation assembly can be inserted into corresponding ports in the transport endoscope body  310 ); and an imaging endoscope channel  335  configured for accommodating an imaging endoscope  460 . 
     In an alternate embodiment, a flexible elongate shaft  320  such as that shown in  FIG. 8A  can exclude or omit an imaging endoscope channel  335  configured for accommodating an imaging endoscope  460 , and can rather include or carry conventional endoscopic imaging elements or devices that are separate from, are not carried by, or do not form portions of an imaging endoscope  460  that is insertable into and removable from the flexible elongate shaft  320  (e.g., by way of an imaging endoscope channel  335 ), but which are configured to facilitate or enable the capture of images of an environment beyond the flexible elongate shaft&#39;s distal end  321   b  (e.g., one or more images of a robotic end effector  420  and/or a manually operated end effector) during an endoscopic procedure). Depending upon embodiment details, such conventional endoscopic imaging elements can include a set of illumination sources or devices (e.g., LEDs) and/or optical fibers corresponding thereto; an image capture device (e.g., a CCD chip and/or other type of image sensor); and a lens, at least some of which are positionally fixed with respect to the flexible elongate shaft  320 , for instance, as a result of being embedded within or securely mounted on the flexible endoscope shaft  320 , in a manner readily understood by individuals having ordinary skill in the art. For instance, in such an alternate embodiment, the lens can be carried by, disposed on, or mounted to the distal end  321   b  of the flexible elongate shaft  320  (e.g., on a vertical or angled distal face thereof), and the image sensor can be disposed behind the lens. 
       FIG. 8B  is a representative cross sectional illustration of a flexible elongate shaft  320  in accordance with yet another embodiment of the present disclosure, in which the channels/passages therein include a first and a second instrument channel  332   a,b  having relatively small(er) cross-sectional areas or diameters configured for accommodating reduced/limited DOF robotic arms/end effectors  410   a,b ,  420   a,b  compared to the flexible elongate shaft embodiment of  FIG. 8A ; and an imaging endoscope channel  335  configured for accommodating an imaging endoscope  460 . 
     Flexible elongate shaft embodiments such as those shown in  FIGS. 8A and 8B  can result in smaller overall cross-sectional areas than a flexible elongate shaft  320  described elsewhere herein, for purpose of facilitating an given type of endoscopic procedure and/or improving intubation, in a manner readily understood by one having ordinary skill in the relevant art. 
     Representative Procedural Setup and Interface Coupling to Motorbox 
       FIGS. 9A-9C  illustrate portions of a representative setup procedure by which an imaging endoscope assembly  450  and a pair of actuation assemblies  400   a,b  can be inserted into the transport endoscope  300  and coupled to or interfaced with other portions of the slave system  200 , including the motorbox  600 . 
     As indicated in  FIG. 9A , portions of the imaging endoscope assembly&#39;s outer sleeve  452  distal to the collar element  430   c  corresponding thereto can be inserted into one of insertion inlets  315  formed in the transport endoscope&#39;s main body  310 , such that the imaging endoscope  460  can be fed into and distally advanced along the ‘s shaft  320  to an initial intended, default, or parked position relative to the distal end  321   b  thereof. As previously indicated, the collar element  430   c  coupled to the imaging endoscope assembly&#39;s outer sleeve  452  remains external to the flexible elongate shaft  320 . More particularly, in the embodiment shown, the collar element  430   c  remains external to the transport endoscope&#39;s main body  310 , such that the collar element  430   c  resides a given distance proximate to the port that received the outer sleeve  452  of the imaging endoscope assembly  450 . The imaging connector assembly  470  can be coupled to the imaging subsystem  210 , for instance, as in a manner indicated in  FIG. 9A , as readily understood by one having ordinary skill in the relevant art, such that the imaging endoscope  460  can output illumination and capture images. 
     As further indicated in  FIG. 9B , the imaging endoscope assembly&#39;s imaging input adapter  750  can be coupled to a corresponding imaging output adapter  650  of the motorbox  600 . By way of such adapter-to-adapter coupling, a set of tendons internal to the imaging endoscope assembly&#39;s outer sleeve  452  can be mechanically coupled or linked to one or more actuators or motors within the motorbox  600 . Such tendons are configured for positioning or maneuvering the imaging endoscope  460  in accordance with one or more DOFs, for instance, in a manner indicated in International Patent Application No. PCT/SG2013/000408 hereto. Consequently, the imaging endoscope  460  can be selectively positioned or manipulated in particular manners relative to the distal end  321   b  of the flexible elongate shaft  320  as a result of the selective application of tension to the imaging endoscope assembly&#39;s tendons by way of one or more actuators within the motorbox  600  that are associated with imaging endoscope position control. 
     In addition to the foregoing, the transport endoscope&#39;s support function connector assembly  370  can be coupled to the endoscopy support function subsystem  250 , for instance, in a manner indicated in  FIG. 9C , in order to facilitate the provision of insufflation or positive pressure, suction or negative/vacuum pressure, and irrigation in a manner readily understood by an individual having ordinary skill in the relevant art. 
       FIGS. 10A-10C  illustrate portions of docking mechanism by which the transport endoscope  300 , and an imaging endoscope assembly  450  and a pair of actuation assemblies  400   a,b  can be matingly engaged with docking station  500  and translation unit  510  thereof. With reference to  FIG. 10A , the transport endoscope&#39;s main body  310  can be docked or mounted to the docking station  500 , and the imaging endoscope assembly&#39;s collar element  430   c  can be inserted into or matingly engaged with a corresponding receiver or clip  530   c  provided by a translation unit  510  associated with the docking station  500 . Once the imaging endoscope assembly&#39;s collar element  430   c  is securely held by its corresponding clip  530   c , the imaging endoscope assembly&#39;s sleeve  452  can be selectively/selectably longitudinally translated or surged by the translation unit  510  across a predetermined proximal-distal distance range, as further detailed below, for instance, in response to surgeon manipulation of a haptic input device  110   a,b  or other control (e.g., a foot pedal) at the master station  100 , and/or endoscopist manipulation of a control element on the transport endoscope&#39;s main body  310  (e.g., where surgeon input can override endoscopist input directed to longitudinally translating/surging the imaging endoscope  460 ). 
     With further reference to  FIG. 10B , in a manner analogous to that described above in  FIG. 10A , portions of each actuation assembly  400   a,b  distal to a corresponding actuation assembly collar element  430   a,b  can be inserted into an intended/appropriately dimensioned port within the main body  310  of the transport endoscope  300 . As a result, each robot arm  410   a,b  and end effector  420   a,b  can be fed into and distally advanced along the flexible elongate shaft  320  toward and to an initial intended, default, or parked position relative to the flexible elongate shaft&#39;s distal end  321   b . The collar element  430   a,b  carried by each actuation assembly&#39;s outer sleeve/coil  402   a,b  remains external to the flexible elongate shaft  320 , and in several embodiments external to the transport endoscope&#39;s main body  310 , such that each collar element  430   a,b  resides a given distance proximate to the port that received the outer sleeve/coil  402   a,b  of the actuation assembly  400   a,b.    
     In a manner analogous to that for the imaging endoscope assembly  450 , each actuation assembly&#39;s collar element  430   a,b  can be inserted into or matingly engaged with a corresponding receiver or clip  530   a,b  provided by the translation unit  510 . Once each such collar element  430   a,b  is securely retained by its corresponding clip  530   a,b , the translation unit  510  can selectively/selectably longitudinally translate or surge one or both of the actuation assemblies  400   a,b  (e.g., in an independent manner) across a predetermined proximal-distal distance range, for instance, in response to surgeon manipulation of one or both haptic input devices  110   a,b  at the master station  100 . 
       FIG. 10C  is a schematic illustration showing a representative translation unit  510  associated with or carried by the docking station  500 , and a representative manner in which the collar elements  430   a - c  corresponding to the actuation assemblies  400   a,b  and the imaging endoscope assembly  450  are retained by corresponding translation unit clips  530   a - c . The translation unit  510  can include an independently adjustable/displaceable translation stage corresponding to each actuation assembly  400   a,b  as well as the imaging endoscope assembly  450 . In a representative implementation, a given translation stage can include or be a ball screw or a linear actuator configured for providing longitudinal/surge displacement to a corresponding clip  530  across a predetermined maximum distance range, in a manner readily understood by one having ordinary skill in the relevant art. 
       FIGS. 11A-11C  illustrate a docking mechanism by which the transport endoscope  300  can be matingly engaged with docking station  500  in accordance with an embodiment of the present disclosure. Referring to  FIG. 11A-11C , a joint member  540  is formed on a surface of docking station  500 . The joint member  540  comprises a protrusion  541 , a plurality of bumps  542  formed on side surfaces of the protrusion  541  and a locking lever  543 . As shown in  FIG. 11A , an endoscopist aligns and engages the transport endoscope&#39;s main body  310  with the joint member  540  in a direction indicated by arrow  551   a . And then, as shown in  FIG. 11B , when the endoscopist rotates the locking lever  543  in the direction of arrow  551   b , the transport endoscope&#39;s main body  310  is docked with the joint member  540  of docking station. Also, the endoscopist can release the transport endoscope  300  by rotating the locking lever  543  in the direction of arrow  551   c  and disengaging the transport endoscope  300  in the direction of arrow  551   d.    
       FIG. 12  shows the docking mechanism of  FIGS. 11A-11C  in more detail. As shown in  FIG. 12 , a joint member  340  of transport endoscope may comprise a groove  342  for accommodating the docking station&#39;s joint member  540  and slots  344   a ˜ 344   d  which are matingly engaged with bumps  542  of joint member of docking station  500 . In the embodiment described referring to  FIGS. 11A-12  or  FIG. 10A , the transport endoscope  300  is engageable with the docking station  500  from the same direction as the direction from which the at least one of flexible elongate is matingly engaged with the translation unit  510 . 
       FIGS. 13A-13C  illustrate a docking mechanism by which the transport endoscope  300  can be matingly engaged with docking station  500  in accordance with another embodiment of the present disclosure. Referring to  FIG. 13A-13C , a joint member  550  of docking station  500  may comprise a slot  551  where the main body  310  of transport endoscope may be inserted and a pair of release buttons  552  which, when pushed, releases the engagement of the joint member  550  and the main body  310  of the transport endoscope. As shown in  FIG. 13A-13B , an endoscopist may align and engage the main body  310  with the joint member  550  of the docking station by sliding the main body  310  into the slot  551  in a direction of arrow  553   a . When a set of release buttons  552  is activated in a direction of the depicted arrow  553   b , the main body  310  may be released from the docking station  500 , in a manner readily understood by one having ordinary skill in the relevant art. 
       FIG. 14  shows an illustration of transport endoscope&#39;s main body  310  for the docking mechanism of  FIGS. 13A-13C  in accordance with an embodiment of the present disclosure. As shown  FIG. 14 , the joint member  350  of transport endoscope&#39;s main body  310  may comprise clamping member  355  which may accommodate a counterpart inside slot  551  of joint member  550  in docking station  500  (not shown). In the embodiment described referring to  FIGS. 13A-14 , the transport endoscope is engageable with the docking station from a direction parallel to the central axis of the flexible elongate shaft  320 , e.g., at the flexible elongate shaft&#39;s proximal end  321   a.    
       FIG. 15  is a schematic illustration showing coupling of each actuation assembly&#39;s instrument input adapter  710   a,b  to a corresponding instrument output adapter  610   a,b  of the motorbox  600  in accordance with an embodiment of the present disclosure. By way of such adapter-to-adapter coupling, tendons internal to each actuation assembly&#39;s outer sleeve/coil  402   a,b  can be mechanically coupled or linked to particular actuators or motors within the motorbox  600 . For any given actuation assembly  400 , such tendons are configured for positioning or maneuvering the robot arm  410   a,b  and corresponding end effector  420   a,b  in accordance with predetermined DOFs, for instance, in a manner indicated in (a) International Patent Application No. PCT/SG2013/000408; and/or (b) International Patent Publication No. WO 2010/138083. Consequently, each actuation assembly&#39;s robot arm  410   a,b  and end effector  402   a,b  can be selectively positioned or manipulated relative to the distal end  321   b  of the flexible elongate shaft  320  as a result of the selective application of tension to the tendons within the actuation assembly  400   a,b  by way of one or more actuators/motors within the motorbox  600  that are associated with robot arm/end effector position control. Moreover, such adapter-to-adapter coupling enables the establishment, re-establishment, or verification of intended, desired, or predetermined tension levels in the tendons within each actuation assembly  400   a,b  prior to the initiation of an endoscopic procedure (e.g., tendon pretension levels), and in some embodiments on-the-fly establishment or adjustment of tendon tension levels during an endoscopic procedure. Furthermore, in various embodiments, such adapter-to-adapter coupling enables the maintenance of a given or predetermined tension level (e.g., a predetermined minimum tension level) in actuator assembly tendons when the instrument input adapter  710   a,b  is not engaged with, or disengaged from, the instrument output adapter  610   a,b , as further detailed hereafter. 
     Representative Input Adapter and Output Adapter Structures and Couplings 
       FIG. 16  is a perspective cutaway view showing representative internal portions of an actuation assembly&#39;s instrument input adapter  710  mounted to an instrument output adapter  610  of the motorbox  600  in accordance with an embodiment of the present disclosure.  FIG. 17  is a corresponding cross sectional illustration showing representative internal portions of the instrument adapter  710  and instrument output adapter  610  when coupled together or matingly engaged in accordance with an embodiment of the present disclosure.  FIGS. 18A-18D  are cross sectional illustrations showing representative internal portions of actuation engagement structures  720  provided by the instrument input adapter  710 , and the positions of elements therein, corresponding to various phases of engagement of the instrument input adapter  710  with and disengagement of the instrument input adapter  710  from the instrument output adapter  610  in accordance with an embodiment of the present disclosure. 
     With reference to  FIG. 16 , in an embodiment the instrument input adapter  710  includes a plurality of actuation engagement structures  720 , such as an individual actuation engagement structure  720  for each motorbox actuator/motor  620  that is configured for controlling the robot arm/end effector  410 ,  412  of the particular actuation assembly  400  with which the instrument input adapter  710  is associated. 
     In certain embodiments, the motorbox  600  includes a single actuator/motor for controlling each DOF of the robot arm/end effector  410 ,  412 , in which case the instrument input adapter  710  includes a single actuation engagement structure  720  corresponding to each such DOF. In such embodiments, any given DOF corresponds to a single tendon (which resides within its particular sheath). 
     In various embodiments, the motorbox  600  includes dual or paired actuators/motors  620  for controlling each DOF provided by the actuation assembly&#39;s robot arm/end effector  410 ,  412 . In such embodiments, any given DOF corresponds to a pair of tendons (e.g., a first tendon that resides within a first sheath, and a second tendon that resides within a second sheath). In this case, two actuators/motors within the motorbox  600  are actuated synchronously relative to each other such that a given pair of tendons (e.g., the first tendon and the second tendon) control a given DOF of the robot arm/end effector  410 ,  412 . 
     As a result, the instrument input adapter  710  correspondingly includes a pair of actuation engagement structures  720  corresponding to each robot arm/end effector DOF. In a representative implementation in which a robot arm/end effector  410 ,  412  are positionable/manipulable with respect to six DOFs, the motorbox  600  includes twelve actuators/motors  600   a - 1  for controlling this robot arm/end effector  410 ,  412 , and the instrument input adapter  710  includes twelve actuation engagement structures  720   a - 1 . The instrument input adapter  710  mounts to the motorbox  600  such that a particular pair of actuation engagement structures  720  (e.g., actuation engagement structures  720  disposed in a side-by-side manner relative to each other along a length of the instrument input adapter  710 ) corresponds to and is mechanically coupled to a counterpart pair of actuators/motors  620   a - 1  within the motorbox  600  for providing robot arm/end effector manipulability/positionability with respect to a particular robot arm/end effector DOF. 
     As indicated in  FIG. 17  and also  FIGS. 18A-18D , in an embodiment an actuation engagement structure  720  includes (a) a frame member  722  having a plurality of arm members  723  that support a frame member platform  724  that defines an upper boundary of the frame member  722 , where the frame member platform  724  is perpendicular or transverse to such arm members  723 ; (b) an elongate input shaft  726  that extends upwardly through a center or central region of the frame member&#39;s platform  724 , and downwardly toward an output disk  626  of the motorbox output adapter  610  such that it can be engaged thereby, and which is displaceable along a longitudinal axis (e.g., in a vertical direction parallel to its length); (c) a drum structure  730  mounted to and circumferentially disposed around the input shaft  726 , which includes (i) a tapered drum  732  having an upper surface, an outer surface, and a bottom surface, and (ii) a first ratchet element  734  carried perpendicular or transverse to the input shaft  726  at a predetermined distance away from the bottom surface of the drum  732 ; (d) a resilient biasing element or spring  728  circumferentially disposed around the input shaft  726 , between an underside of the frame member&#39;s platform  724  and the upper surface of the drum  732 ; and (e) a second ratchet element  744  perpendicular or transverse to and circumferentially disposed around the input shaft  726 , and disposed below the first ratchet element  734  at a predetermined distance away from the underside of the frame member&#39;s platform  724 . In various embodiments, the second ratchet element  744  is positionally fixed, immovable, or non-displaceable relative to the input shaft  726 . 
     The drum structure includes a collar portion  733  that defines a spatial gap between the bottom surface of the drum  732  and an upper surface of the first ratchet element  734 . A proximal end of a tendon can be coupled, linked, or secured to a portion of the drum structure  730  (e.g., a crimp fixture/abutment carried on an upper surface of the first ratchet element  734 ), and the tendon can be tightly wound around the circumference of the drum structure&#39;s collar portion  733 , such that the collar portion  733  carries multiple or many tendon windings thereabout. In a direction toward its opposite/distal end, the tendon wound about the collar portion  722  can extend away from the drum structure  730 , toward, into, and along the length of the actuator assembly&#39;s outer sleeve/coil  402 , until reaching a given location on the actuator assembly&#39;s robotic arm  410  (e.g., at a particular position relative to a robotic arm joint or joint element) or end effector  420 . 
     Rotation of the drum structure  730 , or correspondingly rotation of the input shaft  726 , results in further winding of the tendon about the drum structure&#39;s collar portion  733 , or partial unwinding of the tendon from the collar portion  733 , depending upon the direction in which the drum structure  730  is rotated. Winding of the tendon about the collar portion  733  results in an increase in tendon tension, and can reduce the length of the tendon that resides within the actuator assembly&#39;s outer sleeve/coil  402 ; and unwinding the tendon from the collar portion  733  results in a decrease in tendon tension, and can increase the length of the tendon that resides within the actuation assembly&#39;s outer sleeve/coil  402 , in a manner readily understood by one having ordinary skill in the relevant art. Consequently, selective tendon winding/unwinding facilitates or enables the precise manipulation/positioning of the robotic arm/end effector  410 ,  412  relative to a particular DOF. 
     More particularly, in an embodiment providing dual motor control for each DOF, synchronous winding/unwinding of paired tendons corresponding to a specific DOF, by way of synchronous rotation of counterpart drum structures  730 , results in the manipulation/positioning of the robotic arm/end effector  410 ,  412  in accordance with this DOF. Such synchronous drum structure rotation can selectively/selectably occur by way of a pair of actuator/motors  620  and corresponding output disks  626  to which actuation engagement structure input shafts  726  can be rotationally coupled, as further detailed below. 
     When the instrument input adapter  710  is not engaged with or has been disengaged from the instrument output adapter  610  of the motorbox  600 , an actuation engagement structure&#39;s spring  728  biases or pushes the actuation engagement structure&#39;s drum structure  730  downward to a first or default position, such that the first ratchet element  734  securely matingly engages with the second ratchet element  744 . Such engagement of the first ratchet element  734  with the second ratchet element  744  when the spring  728  biases the drum structure downward  730  is illustrated in  FIG. 18  A. As a result of such engagement of the first and second ratchet elements  734 ,  744 , the drum structure  730  is prevented from rotating, and thus the tension in the tendon corresponding to the drum structure  730  is maintained or preserved (e.g., the tension in the tendon cannot change or appreciably change). 
     As indicated above, the actuation engagement structure&#39;s input shaft  726  is displaceable parallel to or along its longitudinal axis. As the instrument input adapter  710  is mounted or installed onto the instrument output adapter  610  of the motorbox  600  (e.g., by way of one or more snap-fit couplings), a bottom surface of a lower plate  728  carried by the input shaft  726  below the second ratchet element  744  contacts a set of projections carried by an upper surface of an output disk  628  associated with a particular actuator/motor  620 . Consequently, the spring  728  is compressed, and the input shaft  726  and the drum structure  730  carried thereby are upwardly displaced such that the distance between the upper surface of the drum  732  and the underside of the frame member&#39;s platform  724  decreases, as indicated in  FIG. 18B . Such upward displacement of the drum structure  730  causes the first ratchet element  734  to disengage from the second ratchet element  744 . This can correspond to a situation in which the instrument input adapter  710  is installed or mounted on the instrument output adapter of the motorbox  600 , but the input shaft  726  is not yet rotationally rotatably/rotationally coupled to with the output disk  626  of the actuator/motor  620 . 
     During the mounting of the instrument input adapter  710  onto the instrument output adapter  610  of the motorbox  600 , or once the instrument input adapter  710  is fully/securely mounted onto the instrument output adapter  610  (e.g., as can be detected by way of a set of sensors), corresponding to a situation in which the input shaft  726  and drum structure  730  have been vertically displaced upward and the first and second ratchet elements have become disengaged from each other, the actuators/motors  620  within the motorbox  600  commence an initialization process (e.g., under the direction of the control unit  800 ). During the initialization process, each actuator/motor  620  rotates its corresponding output disk  628  until the set of projections carried by the output disk  628  catch or matingly engage with counterpart recesses within the bottom surface of the input shaft&#39;s lower plate  728 . 
     Once the projections carried by the output disk  628  catch or matingly engage with counterpart recesses formed in the input shaft&#39;s lower plate  728 , the input shaft  726  is rotationally coupled to an intended actuator/motor  620 , in a manner illustrated in  FIG. 18C . When such output disk projections and lower plate recesses are rotationally coupled, the actuator/motor  620  can selectively precisely control the winding and unwinding of the tendon about the collar portion  733  of the drum structure  730 , and/or precisely control tendon tension, to thereby manipulate/position the robotic arm/end effector  410 ,  412  in an intended manner in response to surgeon input received at the master station  100 . 
     When the instrument input adapter  710  is disengaged, dismounted, or detached from the instrument output adapter  610 , decompression of the spring  728  pushes the upper surface of the drum structure  730  downward, such that the first ratchet element  734  matingly engages with the second ratchet element  744  in a manner illustrated in  FIG. 18D . Rotation of the input shaft  726  and the disc structure  730  are then prevented, and tendon tension is thus maintained in a manner essentially identical or analogous to that described above in relation to  FIG. 18A . 
     Aspects of particular embodiments of the present disclosure address at least one aspect, problem, limitation, and/or disadvantage associated with exiting master-slave flexible robotic endoscopy systems and devices. While features, aspects, and/or advantages associated with certain embodiments have been described in the disclosure, other embodiments may also exhibit such features, aspects, and/or advantages, and not all embodiments need necessarily exhibit such features, aspects, and/or advantages to fall within the scope of the disclosure. It will be appreciated by a person of ordinary skill in the art that several of the above-disclosed systems, components, processes, or alternatives thereof, may be desirably combined into other different systems, components, processes, and/or applications. In addition, various modifications, alterations, and/or improvements may be made to various embodiments that are disclosed by a person of ordinary skill in the art within the scope of the present disclosure.