Patent Description:
This document pertains generally, but not by way of limitation, to devices and methods for robot-assisted surgical procedures, such those involving the use of articulating arms that can be moved about multiple axes. More specifically, but not by way of limitation, the present application relates to holders and guides that can be used to position instruments with robotic surgical systems.

Imaging of anatomical features can be useful in preparing for and performing surgical procedures. In some surgical procedures it can be desirable to register the shape of the anatomy in the obtained images with another frame of reference, such as the physical space of an operating room. The physical space of the operating room can be correlated to a frame of reference for a robotic surgical system. Robotic surgical arms are used to hold various instruments in place in a desired orientation relative to both the anatomy and operating room during a procedure so that movement of an instrument in the operating room relative to the anatomy can be tracked on the anatomic imaging based on movement of the robotic surgical arm. It is, therefore, desirable to precisely mount instruments to the robotic surgical arm. An example of an adjustable instrument holder is described in Pub. No. <CIT>, another example of prior art is disclosed in <CIT>.

The present inventors have recognized, among other things, that a problem to be solved with traditional robotic instrument holders can include the requirement of having to change fixed-diameter instrument holders during robotic surgical procedures. During surgeries involving a robotic surgical system, it can be desirable to precisely guide a medical instrument along a planned trajectory based on medical images. In order to maintain the trajectory of the instrument, surgeons use guide tubes or other devices that are mounted to a robotic surgical arm. Depending on the medical instrument the surgeon uses during the surgery, different constant diameter guide tubes are used. If the surgeon desires or needs to use a different instrument with a different diameter, it is typically necessary to change the guide tube mounted to the robotic surgical arm each time an instrument change occurs. Such change-over procedures are time-consuming and require a set of guide tubes corresponding to instruments set to be used during the surgery be available and at hand. Additionally, clean-up and sterilization time and costs are increased due to having to clean multiple guide tubes.

The present subject matter can provide a solution to these and other problems, such as by providing adjustable, e.g., adjustable diameter, instrument positioning devices, such as instrument holders and guides. The present subject matter relates to medical instrument holder devices, such as for robotic surgical systems, that have variable passage sizes, e.g., diameters, and methods of assembly-disassembly for such instrument holder devices. The medical instrument holder devices of the present subject matter facilitate installation of various medical instruments with different diameters during a surgical procedure without performing change-over procedures from a robotic surgical arm for different instrument holders. The internal mechanisms of these medical instrument holders allow for precise alignment of the instrument, ease of assembly-disassembly for sterilization purposes and improved ergonomics for the operator. The present subject matter permits the operator to use, during surgeries, only one instrument holder instead of a set of guide tubes with different diameters in order to guide different instruments with different diameters, which saves time and costs during surgeries as well as allowing use of legacy instrument sets within robotic procedures.

The invention is defined in appended independent claims <NUM> and <NUM>.

In an example, an instrument holder system can comprise a base, a plurality of teeth and a cap. The base can comprise a disk including a central bore, a post extending from the disk along an axis to form an annulus surrounding the central bore, and a plurality of guide slots, each of the plurality of guide slots comprising a disk portion extending in a radial direction along the disk and a post portion extending an axial direction along the post. The plurality of teeth can be positioned in the plurality of guide slots, respectively, and each tooth can comprise a rail for movement in the disk portion, a spoke extending from the rail for movement in the post portion and a tab extending from the rail. The cap can comprise a cover portion configured to cover the base, the cover can include an aperture to receive the post and a plurality of positioning slots disposed in the cover configured to receive the tabs of the plurality of teeth, respectively. Each positioning slot can be disposed oblique to the radial direction such that rotation of the cap causes the rails to move in the disk portions of the plurality of guide slots so that the spokes move relative to the annulus.

In another example, an instrument holder assembly for use with a robotic surgical system can comprise a main shaft for assembling to an arm of the robotic surgical system, a first instrument module and a second instrument module. The main shaft can comprise a first end, a second end and a central passage extending between the first end and the second end. The first instrument module can be couplable to the first end of the main shaft and can comprise a first variable diameter jaw configured to hold or guide a portion of an instrument extending from the central passage at the first end. The second instrument module can be couplable to the second end of the main shaft and can comprise a second variable diameter jaw configured to hold or guide a portion of the instrument extending from the central passage at the second end.

In an additional example, a method of assembling an adjustable, pre-tensioned instrument holder can comprise inserting posts of a tensioner tool into channels of a disk of an instrument holder, positioning the posts against biasing members of the instrument holder, rotating the tensioner tool relative to the instrument holder to move the biasing members with the posts, inserting teeth into slots of the instrument holder, and releasing tension in the biasing members such that the biasing members push the teeth into or away from a passage of the instrument holder.

<FIG> illustrates surgical system <NUM> for operation on surgical area <NUM> of patient <NUM> in accordance with at least one example of the present disclosure. Surgical area <NUM> in one example can include a joint and, in another example, can be a bone. Surgical area <NUM> can include any surgical area of patient <NUM>, including but not limited to the shoulder, head, elbow, thumb, spine, and the like. Surgical system <NUM> can also include robotic system <NUM> with one or more robotic arms, such as robotic arm <NUM>. As illustrated, robotic system <NUM> can utilize only a single robotic arm. Robotic arm <NUM> can be a <NUM> degree-of-freedom (DOF) robot arm, such as the ROSA® robot from Medtech, a Zimmer Biomet Holdings, Inc. In some examples, robotic arm <NUM> is cooperatively controlled with surgeon input on the end effector or surgical instrument, such as surgical instrument <NUM>. In other examples, robotic arm <NUM> can operate autonomously. While not illustrated in <FIG>, one or more positionable surgical support arms can be incorporated into surgical system <NUM> to assist in positioning and stabilizing instruments or anatomy during various procedures.

Each robotic arm <NUM> can rotate axially and radially and can receive a surgical instrument, or end effector, <NUM> at distal end <NUM>. Surgical instrument <NUM> can be any surgical instrument adapted for use by the robotic system <NUM>, including, for example, a guide tube, a holder device, a gripping device such as a pincer grip, a burring device, a reaming device, an impactor device such as a humeral head impactor, a pointer, a probe or the like. Surgical instrument <NUM> can be positionable by robotic arm <NUM>, which can include multiple robotic joints, such as joints <NUM>, that allow surgical instrument <NUM> to be positioned at any desired location adjacent or within a given surgical area <NUM>. As discussed below, robotic arm <NUM> can be used with an instrument positioning device, e.g., instrument holder <NUM> (<FIG>), to position an instrument in a known orientation relative to surgical area <NUM> based on a virtual coordinate system determined by computing system <NUM>.

Robotic system <NUM> can also include computing system <NUM> that can operate robotic arm <NUM> and surgical instrument <NUM>. Computing system <NUM> can include at least memory, a processing unit, and user input devices, as will be described herein. Computing system <NUM> can also include human interface device <NUM> for providing images for a surgeon to be used during surgery. Computing system <NUM> is illustrated as a separate standalone system, but in some examples computing system <NUM> can be integrated into robotic system <NUM>. Human interface device <NUM> can provide images, including but not limited to three-dimensional images of bones, glenoid, joints, and the like. Human interface device <NUM> can include associated input mechanisms, such as a touch screen, foot pedals, or other input devices compatible with a surgical environment.

Computing system <NUM> can receive pre-operative medical images. These images can be received in any manner and the images can include, but are not limited to, computed tomography (CT) scans, magnetic resonance imaging (MRI), two-dimensional x-rays, three-dimensional x-rays, ultrasound, and the like. These images in one example can be sent via a server as files attached to an email. In another example the images can be stored on an external memory device such as a memory stick and coupled to a USB port of the robotic system to be uploaded into the processing unit. In yet other examples, the images can be accessed over a network by computing system <NUM> from a remote storage device or service.

After receiving one or more images, computing system <NUM> can generate one or more virtual models related to surgical area <NUM>. Alternatively, computer system <NUM> can receive virtual models of the anatomy of the patient prepared remotely. Specifically, a virtual model of the anatomy of patient <NUM> can be created by defining anatomical points within the image(s) and/or by fitting a statistical anatomical model to the image data. The virtual model, along with virtual representations of implants, can be used for calculations related to the desired height, depth, inclination angle, or version angle of an implant, stem, surgical instrument, or the like related to be utilized in surgical area <NUM>. In another procedure type, the virtual model can be utilized to determine insertion location, trajectory and depth for inserting an instrument. The virtual model can also be used to determine bone dimensions, implant dimensions, bone fragment dimensions, bone fragment arrangements, and the like. Any model generated, including three-dimensional models, can be displayed on human interface device <NUM> for reference during a surgery or used by robotic system <NUM> to determine motions, actions, and operations of robotic arm <NUM> or surgical instrument <NUM>. Known techniques for creating virtual bone models can be utilized, such as those discussed in <CIT>, titled "Deformable articulating templates" or <CIT>, titled "Method of generating a patient-specific bone shell" both by Mohamed Rashwan Mahfouz, as well as other techniques known in the art.

Computing system <NUM> can also communicate with tracking system <NUM> that can be operated by computing system <NUM> as a stand-alone unit. Surgical system <NUM> can utilize the Polaris optical tracking system from Northern Digital, Inc. of Waterloo, Ontario, Canada. Additionally, tracking system <NUM> can comprise the tracking system shown and described in Pub.

Tracking system <NUM> can monitor a plurality of tracking elements, such as tracking elements <NUM>, affixed to objects of interest to track locations of multiple objects within the surgical field. Tracking system <NUM> functions to create a virtual three-dimensional coordinate system within the surgical field for tracking patient anatomy, surgical instruments, or portions of robotic system <NUM>. Tracking elements <NUM> can be tracking frames including multiple IR reflective tracking spheres, or similar optically tracked marker devices. In one example, tracking elements <NUM> can be placed on or adjacent one or more bones of patient <NUM>. In other examples, tracking elements <NUM> can be placed on robot robotic arm <NUM>, surgical instrument <NUM>, and/or an implant to accurately track positions within the virtual coordinate system associated with surgical system <NUM>. In each instance tracking elements <NUM> can provide position data, such as patient position, bone position, joint position, robotic arm position, implant position, or the like.

Robotic system <NUM> can include various additional sensors and guide devices. For example, robotic system <NUM> can include one or more force sensors, such as force sensor <NUM>. Force sensor <NUM> can provide additional force data or information to computing system <NUM> of robotic system <NUM>. Force sensor <NUM> can be used to monitor impact or implantation forces during certain operations, such as insertion of an implant stem into a humeral canal. Monitoring forces can assist in preventing negative outcomes through force fitting components. In other examples, force sensor <NUM> can provide information on soft-tissue tension in the tissues surrounding a target joint. In certain examples, robotic system <NUM> can also include laser pointer <NUM> that can generate a laser beam or array that is used for alignment of implants during surgical procedures.

In order to ensure that computing system <NUM> is moving robotic arm <NUM> in a known and fixed relationship to surgical area <NUM> and patient <NUM>, the space of surgical area <NUM> and patient <NUM> can be registered to computing system <NUM> via a registration process involving registering fiducial markers attached to patient <NUM> with corresponding images of the markers in patient <NUM> recorded preoperatively or just prior to a surgical procedure. For example, a plurality of fiducial markers can be attached to patient <NUM>, images of patient <NUM> with the fiducial markers can be taken or obtained and stored within a memory device of computing system <NUM>. Subsequently, patient <NUM> with the fiducial markers can be moved into, if not already there because of the imaging, surgical area <NUM> and robotic arm <NUM> can touch each of the fiducial markers. Engagement of each of the fiducial markers can be cross-referenced with, or registered to, the location of the same fiducial marker in the images. As such, the real-world, three-dimensional geometry of the anatomy attached to the fiducial markers can be correlated to the anatomy in the images and movements of instruments <NUM> attached to robotic arm <NUM> based on the images will correspondingly occur in surgical area <NUM>.

Subsequently, other instruments and devices attached to surgical system <NUM> can be positioned by robotic arm <NUM> into a known and desired orientation relative to the anatomy. For example, robotic arm <NUM> can be coupled to an adjustable instrument holder of the present disclosure. Robotic arm <NUM> can move the adjustable instrument holder into different positions relative to anatomy of the patient such that an axis of the adjustable instrument holder extends along a desired orientation relative to the anatomy. The adjustable instrument holders of the present application can enable the use of different sized surgical instruments to be held by the robotic arm without requiring change-out of a fixed-sized instrument holder form robotic arm <NUM>.

<FIG> is a schematic view of robotic arm <NUM> of <FIG> including instrument holder <NUM>, which can be positioned by robotic arm <NUM> relative to surgical area <NUM> (<FIG>) in a known orientation. Instrument holder <NUM> can comprise upper module <NUM>, lower module <NUM> and shaft <NUM>. Passage <NUM> can extend through upper module <NUM>, shaft <NUM> and lower module <NUM> along axis <NUM>. Instrument holder <NUM> can be coupled to robotic arm <NUM> via extension <NUM> and mounting plate <NUM>.

Robotic arm <NUM> can include joint 135A that permits rotation about axis 216A, joint 135B that can permit rotation about axis 216B, joint 135C that can permit rotation about axis 216C and joint 135D that can permit rotation about axis 216D.

In order to position instrument holder <NUM> relative to anatomy of patient <NUM> (<FIG>), surgical system <NUM> (<FIG>) can manipulate robotic arm <NUM> automatically by computing system <NUM> or a surgeon manually operating computing system <NUM> to move instrument holder <NUM> to the desired location, e.g., a location called for by a surgical plan to align an instrument relative to the anatomy. For example, robotic arm <NUM> can be manipulated along axes 216A - 216D to position passage <NUM> of instrument holder <NUM> along a trajectory for which an instrument is to be guided.

Robotic arm <NUM> can be separately registered to the coordinate system of surgical system <NUM>, such via use of a tracking element <NUM>. Fiducial markers can additionally be separately registered to the coordinate system of surgical system <NUM> via engagement with a probe having a tracking element <NUM> attached thereto. As such, some or all of the components of surgical system <NUM> can be individually registered to the coordinate system and, if desired, movement of such components can be continuously or intermittently tracked with a tracking element <NUM>.

It can be a difficult task to ensure instruments attached to robotic arm <NUM> are accurately aligned with patient <NUM>, particularly if multiple instruments have to be successively mounted to robotic arm <NUM>. For example, if instruments are not precisely aligned through the center of an instrument holder, the instrument will not be positioned relative to robotic arm <NUM> in a location where surgical system <NUM> understands it to be within the virtual coordinate system. For example, if an instrument is positioned within an instrument holder having a larger passage than the instrument, the instrument can be skewed relative to axis <NUM> or can be offset in a parallel position from axis <NUM>.

In order to improve the alignment of instruments with axis <NUM> and to reduce times in changing instruments coupled to robotic arm <NUM> along axis <NUM> or other axes, the present application describes various instrument positioning devices, such as instrument holders and guides, that can accommodate different instruments without requiring change-out of the instrument positioning device from robotic arm <NUM> or recalibration of the instrument holder <NUM>.

In some robotic procedures instruments can be separately tracked using an optical navigation system that, under ideal condition, alleviate the need for precisely maintaining axis <NUM> through different instrument changes, as the optical navigation system can provide the surgical computer system information to compensate for any changes. However, as optical navigation systems require line of sight with the instruments to be maintained, there is a significant advantage in not requiring instruments to be navigated (or at least not constantly navigated). Accordingly, the ability to precisely maintain axis <NUM> provides the additional advantage of at least reducing, and possibly eliminating, the need to navigate instruments during a robotic procedure.

<FIG> is a perspective view of instrument holder <NUM> comprising first module <NUM>, second module <NUM>, shaft <NUM> and passage <NUM>. Instrument <NUM> can be positioned within passage <NUM>. <FIG> is a perspective exploded view of instrument holder <NUM> uncoupled from a robotic arm comprising first (top) module <NUM>, main (middle) shaft <NUM> and second (bottom) module <NUM>. <FIG> and <FIG> are discussed concurrently.

First module <NUM> can comprise first base <NUM>, first cap <NUM>, first teeth <NUM> and first fastener <NUM>, and first lamellar spring <NUM> (<FIG>). Second module <NUM> can comprise second base <NUM>, second cap <NUM>, second teeth <NUM> and second fastener <NUM>. Shaft <NUM> can comprise outer barrel <NUM> in which main body <NUM> (<FIG>) can be disposed. Main body <NUM> can comprise first coupler <NUM>, second coupler <NUM>, flange <NUM> and fastener <NUM>.

First module <NUM> and second module <NUM> can comprise devices for holding an instrument, such as medical instruments including catheters, cannulas and guidewires. First module <NUM> and second module <NUM> can comprise adjustable jaws having teeth that can be retracted away from a center axis to adjust the width or diameter of passage <NUM>. The jaws can be biased, such as is described with respect to <FIG>. However, the jaws can also not be biased, such as is described with reference to <FIG>. In the illustrated example, first module <NUM> is biased and second module <NUM> is not biased.

Mounting plate <NUM> can be mounted to robotic arm <NUM> (<FIG>) such as by inserting threaded fasteners into bores <NUM>. Extension <NUM> can be coupled to mounting plate <NUM> to provide a mounting arm for coupling with instrument holder <NUM>. Extension <NUM> can include seat <NUM> having a semi-circular or circular arc length shape to receive and mate with main body <NUM> of shaft <NUM>. Extension <NUM> and main body <NUM> can be coupled using any suitable means, such as fasteners or metallurgical bonding. Extension <NUM> can extend along an axis that is perpendicular to axis <NUM>. Extension <NUM> is configured to align passage <NUM> extending through outer barrel <NUM> and main body <NUM> at a known position relative to bores <NUM> such that the position of passage <NUM> to robotic arm <NUM> is in a known, e.g., known to computing system <NUM>, orientation. Thus, as robotic arm <NUM> moves instrument holder <NUM>, the position of instrument holder <NUM> relative to surgical area <NUM> (<FIG>) will also be known.

After instrument holder <NUM> is attached to robotic arm (<FIG>) via mounting plate <NUM>, second module <NUM> can be opened to a widened diameter to not obstruct passage <NUM>, such as by rotating second cap <NUM>. In the described examples, first module <NUM> can be biased to a closed position by a biasing mechanism described herein. However, in other examples first module <NUM> could be biased to an open position. The size of the opening of first module <NUM> can be adjusted by rotating first cap <NUM> and simultaneously inserting instrument <NUM> into passage <NUM>. Releasing of first cap <NUM> will release the biasing mechanism to reposition the adjustable jaw formed by teeth <NUM> therein to close teeth <NUM> around instrument <NUM>. Thereafter, first cap <NUM> can be manually rotated to move teeth <NUM> around instrument <NUM>. Fasteners <NUM> and <NUM> can be adjusted to lock caps <NUM> and <NUM> in place, thereby immobilizing teeth <NUM> and <NUM>. The use of two adjustable jaws around instrument <NUM> facilitates alignment of instrument <NUM> along axis <NUM> (<FIG>) due to providing two reference points along axis <NUM> formed by each adjustable jaw. Fastener <NUM> can be adjusted to immobilize main body <NUM> within outer barrel <NUM>. For example, threaded shaft <NUM> of fastener <NUM> could be rotated in bore <NUM> via head <NUM> to extend into outer barrel <NUM> and hold main body <NUM> concentrically within outer barrel <NUM>. In additional examples, threaded shaft <NUM> can extend through main body <NUM> into passage <NUM> and engage instrument <NUM>.

With reference to <FIG>, instrument holder <NUM> can be assembled by attaching first coupler <NUM> to main body <NUM>. Second coupler <NUM> can be integral with main body <NUM>. First base <NUM> can be attached to first coupler <NUM>, such as via threaded engagement. For example, external thread on first coupler <NUM> can engage internal thread <NUM> (<FIG>) on first base <NUM>. Second base <NUM> can be attached to second coupler <NUM>, such as via threaded engagement. For example, external thread on second coupler <NUM> can engage internal thread on bore <NUM> of second base <NUM>.

Teeth <NUM> can be positioned in first slots <NUM> of first base <NUM>. Teeth <NUM> can be positioned to engage biasing elements <NUM> with the interaction of first cap <NUM>, through its designated pins 306A, 306B and 306C. Teeth <NUM> can be positioned in second slots <NUM>. First cap <NUM> can be coupled to first base <NUM> to secure and position the teeth <NUM> in equal radial fashion to provide the symmetry condition / synchronization of teeth <NUM>. Second cap <NUM> can be coupled to second base <NUM> to secure teeth <NUM>. First fastener <NUM> can be coupled to first base <NUM> to secure first cap <NUM>. Second fastener <NUM> can be coupled to second base <NUM> to secure second cap <NUM> using slots 304A, 304B, 304C to maintain the synchronization condition.

Teeth <NUM> and <NUM> can be moved closer to and further away from axis <NUM> to close and open passage <NUM>, thereby facilitating engagement with different sized instruments. Caps <NUM> and <NUM> can be manipulated by a surgeon or technician to adjust the position of teeth <NUM> and <NUM>, respectively. Teeth <NUM> and <NUM> provide multiple contact points spaced axially apart along the instrument to provide stability and alignment on the instrument with axis <NUM>. Further, teeth <NUM> and <NUM> can have axial length to further provide stability and alignment to the instrument. As shown in <FIG>, components of instrument holder <NUM> can be disassembled for cleaning and sterilization for re-use with a subsequent medical procedure performed with robotic arm <NUM> (<FIG>).

<FIG> is a perspective, partially-exploded view of first module <NUM> of <FIG> along with tooth holder <NUM> and tensioner tool <NUM>. As described herein, first module <NUM> can be adjusted to hold an instrument of a given size. Tooth holder <NUM> and tensioner tool <NUM> comprise tools used in the assembly of first module <NUM>, which are ultimately removed before use of first module <NUM>. Tooth holder <NUM> can be used to hold first teeth 224A - 224C as a unit for insertion of first teeth 224A -22C into slots 260A - 260C of first base <NUM>. Tensioner tool <NUM> can be used to retract biasing elements 262A - 262C within spaces 320A - 320C to a position where cap <NUM> will fit over teeth 224A - 224C by making enough space for pins 306A - 306C to fit within spaces 320A - 320C (e.g. biasing elements 262A - 262C should be kept in constant tension against pins 306A - 306C during use in surgery and not in assembly). Before mounting cap <NUM>, tensioner tool <NUM> can be turned in counterclockwise direction and pressed against two guides 286A and 286B to press against biasing elements 262A - 262C. After cap <NUM> is positioned correctly over first base <NUM>, the two guides can be released and both tensioner tool <NUM> and tooth holder <NUM> can be removed. After teeth 224A - 224C are inserted, tooth holder <NUM> can be removed from teeth 224A - 224C and tensioner tool <NUM> can be removed from first base <NUM>.

First module <NUM> can comprise first base <NUM>, first cap <NUM>, first teeth 224A - 224C, first fastener <NUM> and biasing elements 262A - 262C. <FIG> is a schematic illustration showing perspective top views of base <NUM> of first module <NUM> and tensioner tool <NUM> and a perspective bottom view of cap <NUM> of first module <NUM>. <FIG> is a perspective view of partially assembled first module <NUM> showing biasing elements 262A - 262C engaged with posts 282A - 282C of tensioner tool <NUM> and teeth 224A - 224C positioned proximate tooth holder <NUM>. In order to understand the assembly and operation of the various components and features of instrument holder <NUM>, <FIG> are discussed concurrently.

First base <NUM> can comprise first disk <NUM> having first bore <NUM>, first channels 273A - 273C, first post <NUM>, first guide slots 260A - 260C and pedestals 275A - 275C. Slot 260A can comprise disk portion 276A and post portion 278A; slot 260B can comprise disk portion 276B and post portion 278B; and slot 260C can comprise disk portion 276C and post portion 278C. Disk portions 276A - 276C can be formed via flanges or walls <NUM> extending from first disk <NUM>. Post portions 278A - 278C can be formed via slots or gaps in first post <NUM>.

Tensioner tool <NUM> can comprise platform <NUM>, posts 282A - 282C, pads 284A - 284C and guides 286A - 286B. Tension tool <NUM> can comprise a device to pre-tension or otherwise move biasing elements 262A - 262C to facilitate positioning of teeth 224A - 224C into slots 260A - 260C. Before mounting cap <NUM>, tensioner tool <NUM> can be turned in counterclockwise direction and pressed against two guides 286A and 286B to press against biasing elements 262A - 262C.

After cap <NUM> is positioned correctly over first base <NUM>, the two guides can be released and both tensioner tool <NUM> and tooth holder <NUM> can be removed.

Tooth holder <NUM> can comprise handle shaft <NUM>, knob <NUM> and socket portion <NUM>. As can be seen in <FIG>, socket portion <NUM> can include sockets 294A, 294B and 294C. Socket portion <NUM> can comprise a cartridge for holding teeth 224A - 224C together as a unit in a prearranged configuration commensurate with the shape of slots 260A -260C.

First cap <NUM> can comprise top panel <NUM>, sidewall <NUM>, aperture <NUM> and cut-outs 302A - 302C. As can be seen in <FIG>, first cap <NUM> can further comprise positioning slots 304A - 304C and pegs 306A - 306C.

Tooth 224A can comprise rail 308A, spoke 310A and tab 312A; tooth 224B can comprise rail 308B, spoke 310B and tab 312B; and tooth 224C can comprise rail 308C, spoke 310C and tab 312C.

As can be seen in <FIG>, biasing elements 262A -262C can comprise resilient members configured to deflect and absorb energy from a force and then return to their original shape after the force has been removed. In an example, biasing elements 262A - 262C can comprise lamellar spring elements. For example, biasing elements 262A - 262C can comprise rectangular strips of a resilient material, such as metal, that can be bent into three sections. In an example, biasing element 262A can comprise straight first section 314A, curved second section 316A and straight third section 318A; biasing element 262B can comprise straight first section 314B, curved second section 316B and straight third section 318B; and biasing element 262C can comprise straight first section 314C, curved second section 316C and straight third section 318C.

In order to assemble first module <NUM>, biasing elements 262A - 262C can be assembled to first base <NUM> first. For example, curved second section 316A can be positioned between first post <NUM> and first pedestal 275A so that straight first section 314A is positioned against one of walls <NUM>. Thus, straight second section 316A can be spaced an amount from another of walls <NUM> to form gap 320A. Posts 282A of tensioner device can be inserted into space 320A. Likewise, biasing elements 262B and 262C can be positioned in base <NUM> and engaged with posts 282B and 282C, respectively, in spaces 320B and 320C.

Tensioner tool <NUM> can be positioned underneath first base <NUM> such that posts 282A - 282C align with channels 273A - 273C, respectively. Platform <NUM> can be pushed towards first base <NUM> until pads 284A - 284C engage the bottom of disk <NUM>. In such a position, guides 286A and 286B can engage the side of disk <NUM> to facilitate rotation of platform <NUM> relative to disk <NUM> and posts 282A - 282C can be positioned within spaces 320A - 320C, respectively. Guides 286A and 286B can be positioned within cut-outs 322A and 322B, respectively, to prevent relative movement between disk <NUM> and platform <NUM>. With tensioner tool <NUM> locked into place via guides 286A and 286B, spaces 320A - 320C can be held in an enlarged state while posts 282A - 282C hold biasing elements 262A - 262C.

Teeth 224A - 224C can be positioned within slots 260A - 260C, respectively, of tooth holder <NUM>. Teeth 224A - 224C can be assembled into first base <NUM> using tooth holder <NUM>. Specifically, as shown in <FIG>, spokes 310A - 310C can be inserted into sockets 294A - 294C, respectively. Spokes 310A - 310C can be pentagon shaped with two parallels sides such that two other sides form an apex pointing toward axis <NUM>. The apex can be rounded to engage the surgical instrument. Sockets 294A - 294C can be correspondingly shaped and correspondingly sized such that spokes 310A - 310C can be freely inserted but retained. As such, tooth holder <NUM> can be grasped at knob <NUM> and orientated to the position of <FIG> for loading of teeth 224A - 224C into tooth holder <NUM> and the reoriented to the position of <FIG> for insertion of teeth 224A - 224C into slots 260A - 260C, respectively. From the position of <FIG>, tooth holder <NUM> can be advanced toward base <NUM> to position rails 308A - 308C into disk portions 276A - 276C of slots 260A - 260C and spokes 310A - 310C into post portions 278A - 278C of slots 260A - 260C. Thus, spokes 310A - 310B can be sandwiched between portions of post <NUM> and rails 308A - 308C can be sandwiched between two adjacent walls <NUM>. Positioned as such, teeth 224A - 224C can freely slide in slots 260A - 260C to move toward and away from axis <NUM>. Teeth 224A - 224C can be slid toward axis <NUM> to contact each other in order to constrict passage <NUM>. The apex of spokes 310A - 310B can be rounded to provide a minimum diameter for passage <NUM>. Teeth 224A - 224C can be retracted away from axis <NUM> until rails 308A - 308C contact sidewall <NUM> of cap <NUM> to thereby open passage <NUM>. Movement of teeth 224A - 224C can be controlled by rotation of cap <NUM> and engagement of tabs 312A - 312C with 304A - 304C, respectively.

First cap <NUM> can be assembled to first base <NUM> by positioning first post <NUM> into aperture <NUM>. Aperture <NUM> can be un-threaded such that first cap <NUM> can freely rotate about first post <NUM> at shoulder <NUM>. As can be seen in <FIG>, cap <NUM> can include slots 304A - 304C and pegs 306A - 306C for engagement with biasing elements 262A - 262C and teeth 224A - 224C, respectively. Each of slots 304A -304C can comprise a straight segment extending at a forty-five-degree angle relative to a radial direction extending from axis <NUM> (<FIG>) Cap <NUM> can be rotated back-and-forth to position pegs 306A - 306C into spaces 320A - 320C, respectively, and slots 304A - 304C can receive tabs 312A - 312C, respectively. Cut-outs 302A - 302C can be aligned with slots 260A - 260C to facilitate positioning of cap <NUM> around tooth holder <NUM>, tooth holder <NUM> can subsequently be removed from engagement with teeth 224A - 224C, and fastener <NUM> can be positioned around post <NUM> to secure cap <NUM> to base <NUM>, as is shown in <FIG>.

<FIG> is a partially exploded and cut-away view of assembled first module <NUM> together with tensioner tool <NUM> and tooth holder <NUM>. Fastener <NUM> is positioned to receive post <NUM> of base <NUM>, after tooth holder <NUM> is removed from teeth 224A - 224C. Fastener <NUM> can comprise socket <NUM> to which post <NUM> can be coupled, such as via threaded engagement. Socket <NUM> can include internal threading that can receive external threading on the exterior of post <NUM>. As can be seen in <FIG>, peg 306A can be positioned to engage straight third section 318A of biasing element 262A.

<FIG> is a sectioned perspective view of the first module <NUM> assembled with shaft <NUM>. Cap <NUM> can be rotated counter-clockwise to move teeth 224A - 224C away from axis <NUM> and clockwise to move teeth 224A - 224C toward axis <NUM>, as tabs 312A - 312C are driven by sidewalls of slots 304A - 304C. Biasing elements 262A - 262C can be used to rotate cap <NUM> in a clockwise direction to move teeth 224A - 224C to an inward position to constrict around an instrument, so a user does not have to do it. For example, the user can rotate cap <NUM> in a counter-clockwise direction, insert instrument <NUM> and then releases cap <NUM> to hold the instrument. Cap <NUM> can rotate by itself in clockwise direction via biasing elements 232A - 232C. To secure that position, for accidental position deviations from axis <NUM> during use, fastener <NUM> can be used. Additionally, the user can rotate cap <NUM> in a clockwise direction to move teeth 224A - 224C to an inward position to constrict around an instrument. While holding cap <NUM> in a desired position, fastener <NUM> can be tightened down on post <NUM> to push cap <NUM> against walls <NUM> of base <NUM>. Thus, biasing elements 262A - 262C will be constrained from moving teeth 224A - 224C and passage <NUM> can be held at a fixed size to guide the instrument. Biasing elements 262A - 262C can give enough force to the teeth 224A - 224C to hold any instrument to prevent falling, and thus offering more ease during use for other hand manipulations. In order to remove an instrument or reset first module <NUM> to a fully open position, fastener <NUM> can be rotated to move away from cap <NUM> so that module <NUM> can be opened, such as by applying a user-generated force to cap <NUM> in a counter-clockwise direction so that teeth 224A - 224C can be opened, overcoming force form biasing elements 262A - 262C.

As mentioned, in other examples, biasing elements 262A - 262C can bias cap <NUM> in the counter-clockwise direction to bias teeth 224A - 224C away from each other. In such a configuration, first module <NUM> will bias to an open position, thereby facilitating one-handed release.

As such, first module <NUM> provides an adjustable instrument holding or guiding device that can be disassembled for cleaning and sterilization. Peripheral devices <NUM> and <NUM> can be used to easily re-assemble and disassemble first module <NUM>. Once assembled, cap <NUM> can be rotated to a desired position to facilitate guiding of instruments having different sizes or diameters.

<FIG> is a perspective view of second module <NUM> of <FIG> showing base <NUM>, teeth <NUM> coupled to tooth holder <NUM>, cap <NUM> and fastener <NUM>. Note, tooth holder <NUM> as depicted in <FIG> has a slightly different geometry than tooth holder <NUM> depicted in <FIG> (the three outer projections help the correct assembly of cap <NUM> through cut-outs 302A - 302C as a foolproof system, whereas the tooth holder <NUM> in <FIG> holds teeth 232A - 232C equidistant while cap <NUM> is continuously rotated against the tooth holder until it is positioned correctly). Second module <NUM> can be configured similarly as first module <NUM>, but without biasing elements 262A - 262C. Thus, the construction of base <NUM> can be simplified as compared to base <NUM>. For example, channels 273A - 273C and pedestals 275A -275C can be omitted, as coupling with tensioner tool <NUM> and securing of biasing elements 262A - 262C is not needed. Fastener <NUM> can be configured similarly as fastener <NUM>.

<FIG> is a perspective view of top or outside of base <NUM> of <FIG> showing slots 260A - 260C for teeth 232A - 232C. Second base <NUM> can comprise second disk <NUM> having second bore <NUM>, slots 260A - 260C, second post <NUM> and pads 334A - 334C. Pads 334A - 334C can form sidewalls for forming disk portions of slots 260A - 260C and second post <NUM> can include cut-outs or slots for forming post portions of slots 262A - 262C. Second bore <NUM> can be threaded for mating with second coupler <NUM>. Teeth 232A - 232C can be configured similarly as teeth 224A - 224C.

<FIG> is a perspective view of the bottom or inside of cap <NUM> of <FIG> showing arcuate adjustment slots 336A - 336C for guiding movement of teeth 232A - 232C. Cap <NUM> can be configured similarly as cap <NUM>, but without cut-outs 302A - 302C and pegs 306A - 306C. Pegs 306A - 306C are not needed because interaction with biasing elements 262A - 262C is not needed. Cut-outs 302A - 302C are not needed because it is not necessary for cap <NUM> to be particularly aligned so that pegs 306A - 306C align with spaces 320A - 320C. Furthermore, since the presence of pegs 306A - 306C is not required, slots 336A - 336C can be longer than slots 304A - 304C. Each of slots 336A - 336C can comprise a circular arc segment having a radius of curvature center eccentric with axis <NUM> (<FIG>). As such the stroke-length of cap <NUM> can be increased as compared to that of cap <NUM>. In other words, a larger rotation of cap <NUM> will be produce the same amount of movement of teeth <NUM> as a smaller rotation of cap <NUM> will produce for teeth <NUM>. For example, full movement of teeth <NUM> can be produced with a one-third turn, whereas full movement of teeth <NUM> with cap <NUM> can be produced with a one-ninth turn. The longer stroke length provides an operator the ability of small and more precise/fine adjustment if needed, or a faster interaction with the device as first module.

<FIG> is a sectioned perspective view of second module <NUM> of <FIG> in an assembled state with teeth <NUM> in a closed position. <FIG> is a top view of second module <NUM> of <FIG> showing contact of teeth <NUM> with each other. However, as discussed above, the radially inner tips of spokes 310A - 310C that face toward axis <NUM> can be blunted or rounded to provide a minimum diameter for passage <NUM> even when teeth <NUM> are brought into contact with each other.

<FIG> is a sectioned perspective view of second module <NUM> of <FIG> in an assembled state with teeth <NUM> in an open position. <FIG> is a top view of second module <NUM> of <FIG> showing teeth <NUM> moved away from each other to open passage <NUM> through second module <NUM>.

<FIG> is an exploded view of alternative module <NUM> where diaphragm <NUM> acts to open and close passage <NUM> therethrough. <FIG> is an assembled view of the alternative module of <FIG> showing blades 416A - 416C closing passage <NUM> therethrough. Alternative module <NUM> can comprise base <NUM>, cap <NUM>, first blade locker <NUM>, ring <NUM> and second blade locker <NUM>. Diaphragm <NUM> can comprise blades 416A, 416B and 416C, and springs 418A, 418B and 418C.

Cap <NUM> can comprise aperture <NUM>, lid <NUM> and sidewall <NUM>. Base <NUM> can comprise base <NUM>, threaded edge <NUM>, guide walls <NUM> and aperture <NUM>. Ring <NUM> can comprise lip <NUM> and threaded wall <NUM>. Diaphragm <NUM> can be mounted onto platform <NUM>, which can include bores <NUM> for coupling to blades 416A - 416C and pegs <NUM> for coupling to springs 418A - 418C. For example, springs 418A - 418C can comprise sockets <NUM> for receiving pegs <NUM>, and blades 416A - 416C can include posts <NUM> for insertion into bores <NUM>.

Second blade locker <NUM> can include shaft <NUM> and pegs <NUM>. First blade locker <NUM> can include hub <NUM> and pegs <NUM>. Blade lockers <NUM> and <NUM> can be used to adjust the position of blades 416A - 416C via engagement of bores <NUM>. Second blade locker <NUM> can be used to adjust diaphragm <NUM>. First blade locker <NUM> can be used to adjust an additional diaphragm (not visible) mounted to the underside of platform <NUM>. Blade lockers <NUM> and <NUM> can be mainly designed for and used in the assembly process. For the bottom side, blades 416A - 416C can be placed on blade locker <NUM>, having base <NUM> in between and aligned into place, the three springs on the bottom can be armed afterwards. Platform <NUM> will be then lowered and aligned to position. Use of blade locker <NUM> comes next, maintaining the same sequence as above, and further, cap <NUM> can be mounted over. To secure assembly alignment, the removal of the blade lockers <NUM> and <NUM> will only take place after ring <NUM> is inserted and secured.

Blades 416A - 416C can further comprise slots <NUM> and platform <NUM> can comprise slots <NUM>. As is shown in <FIG>, cap <NUM> can include posts <NUM> and posts <NUM> for engaging slots of each diaphragm mechanism, respectively. Posts <NUM> can engage slots <NUM> of blades 416A - 416C directly. Posts <NUM> can engage bores of the lower diaphragm after extending through slots <NUM>.

<FIG> is a perspective view of an underside of cap <NUM> for alternative module <NUM> of <FIG> and <FIG>. Cap <NUM> can comprise posts <NUM> and posts <NUM>. Posts <NUM> are longer than posts <NUM>. Posts <NUM> can extend from lid <NUM> directly into slots <NUM>. Cap <NUM> can be rotated to adjust the position of blades 416A - 416C via engagement of posts <NUM> with slots <NUM>. Blades 416A - 416C can rotate on posts <NUM> in bores <NUM>. Springs 418A - 418C can bias blades 416A - 416C to close in together within passage <NUM>. Cap <NUM> can thus be rotated to move blades 416A - 416C away from each other to open passage <NUM> for the insertion of an instrument therein. As blades 416A - 416C rotate, slots <NUM> can allow posts <NUM> to extended through platform <NUM> to reach the blades of the additional diaphragm (not visible). Blades 416A - 416C can include notches <NUM> to accommodate posts <NUM>. Posts <NUM> can interact with blades of the additional diaphragm the same way that posts <NUM> interact with blades 416A - 416C. Thus, cap <NUM> can be rotated to simultaneously open passage <NUM>. Providing two levels of blades provides a lengthier, e.g., compared to having only own level of blades, path along which to guide an instrument. However, the instrument holders of the present application can be implemented with only a single level of blades, such as by having blades 416A - 416C only. Once cap <NUM> is moved to the desired position to hold a specific instrument, ring <NUM> can be tightened down on base <NUM> by engagement of threaded wall <NUM> with threaded edge <NUM>.

<FIG> are top views of alternative module <NUM> of <FIG> and <FIG> with diaphragm <NUM> in open, partially open and closed states, respectively. In <FIG>, blades 416A - 416C are shown fully retracted away from passage <NUM> and aperture <NUM> in cap <NUM>. In <FIG>, cap <NUM> can be rotated to move blades 416A - 416C partially into passage <NUM>. In <FIG>, cap <NUM> can be further rotated in the clockwise direction to bring blades 416A - 416C into close proximity to each other, thereby constricting the width of passage <NUM>. A second layer of blades beneath blades 416A - 416C can be seen in <FIG>.

<FIG> is a flowchart illustrating actions or steps of methods or technique <NUM> for assembling an instrument holder configured for use with a robotic surgical system, exchanging instruments mounted to the instrument holder and cleaning the instrument holder.

At step <NUM>, instrument holder <NUM> can be removed from sterile storage, such as a surgical cabinet or disposable packaging. Individual modules, such as module <NUM>, <NUM> and <NUM> can be individually stored and selected for assembling with shaft <NUM>. Individual components of each module can be stored in a disassembled state for assembly immediately before or during a surgical procedure. Alternatively, individual components of each module can be stored in an assembled stated and pre-assembled pre-operatively.

In order to assemble instrument holder <NUM> for use with first module <NUM>, biasing elements <NUM> can be assembled with first base <NUM>, as shown in <FIG>. For example, curved second sections 316A - 316C can be tucked behind pedestals 275A - 275C. Positioned as such, straight third sections 318A - 318C will be spaced from walls <NUM> to form spaces 320A - 320C.

At step <NUM>, tensioner tool <NUM> can be assembled with first base <NUM>, as shown in <FIG>. Specifically, posts 282A - 282C can be inserted into channels 273A - 273C of first base <NUM>. Posts 282A - 282C can be positioned in spaces 320A -320C. Pads 284A - 284C on platform <NUM> can be engaged with the bottom of disk <NUM> and guides 286A and 286B can be engaged with the side of disk <NUM>.

At step <NUM>, teeth 224A -224C can be inserted into tooth holder <NUM>, as shown in <FIG>. A user can grip knob <NUM> in one hand and insert spokes 310A - 310C of teeth 224A - 224C into sockets 294A - 294C of socket portion <NUM> with the other hand.

At step <NUM>, teeth 224A - 224C can be inserted into slots 260A - 260C of base <NUM> together with tensioner tool <NUM>, as shown in <FIG>. A user can align rails 308A - 308C with disk portions 276A - 276C and spokes 310A - 310C with post portions 278A - 278C.

At step <NUM>, cap <NUM> can be mounted and aligned with teeth 224A - 224C while tooth holder <NUM> is being held, as shown in <FIG>.

At step <NUM>, tooth holder <NUM> can be removed from teeth 224A - 224C, as shown in <FIG>.

At step <NUM>, fastener <NUM> can be attached to first base <NUM>, as shown in <FIG>.

At step <NUM>, tensioner tool <NUM> can be removed from base <NUM>, as shown in <FIG>. Removal of tensioner tool <NUM> can allow biasing members 262A - 262C to retract teeth 224A - 224C to a closed position, thereby closing passage <NUM>.

At step <NUM>, first base <NUM> and tensioner tool <NUM> can be rotated relative to each other to widen spaces 320A - 320C to facilitate assembly with an instrument, as shown in <FIG> (fastener <NUM> not shown in <FIG> for clarity). Disk <NUM> of base <NUM> can be gripped with the other hand of the user and disk <NUM> can be rotated to engage guides 286A and 286B with cut-outs 322A and 322B, respectively, to open spaces 320A - 320C.

As such, first module is ready to be used in a procedure to hold or guide an instrument, such as instrument <NUM>. Assembly of a second of first instrument holder <NUM> or second instrument holder <NUM> to shaft <NUM> can also be completed, such as by repeating some or all of steps <NUM> - <NUM>. Thus, steps <NUM> - <NUM> can describe a method of assembling an instrument holder including a sub-method of assembling an individual module of an instrument holder.

Steps <NUM> - <NUM> can describe a method of performing a medical procedure involving sequentially attaching one or more instruments of different sizes to an adjustable instrument holder.

At step <NUM>, instrument <NUM> can be inserted into instrument holder <NUM>. Instrument <NUM> can be positioned in passage <NUM> and cap <NUM> can be released to bring teeth 224A - 224C in close proximity to, into contact with, or into force against instrument <NUM>, such as under operation of biasing elements 262A - 262C. As such, instrument <NUM> can be guided, held in place or immobilized. Furthermore, fastener <NUM> can be used as a safety measure to secure 224A - 224C in place.

At step <NUM>, fastener <NUM> can be tightened against cap <NUM> via threaded engagement with post <NUM>. Fastener <NUM> can immobilize cap <NUM> to hold teeth 224A - 224C in the desired position set at step <NUM>.

At step <NUM>, a medical procedure or a step of a medical procedure can be performed with instrument <NUM> held in a desired orientation, such as an orientation according to a medical plan. After the medical procedure or step has been completed, instrument <NUM> can be removed from first module <NUM>. First, fastener <NUM> can be disengaged from cap <NUM> by loosening the threaded engagement with post <NUM>. Release of cap <NUM> by fastener <NUM> can result in biasing members 262A -262C moving teeth 224A - 224C to a closed position toward axis <NUM> and instrument <NUM>. As such, another instrument can be assembled to or guided with first module <NUM>. The robotic arm, e.g. robotic arm <NUM> of <FIG>, can be repositioned and then a subsequent instrument can be attached to first module <NUM> by repeating steps <NUM> - <NUM>.

At step <NUM>, instrument holder <NUM> can be disassembled. Fastener <NUM> can be removed from post <NUM>. Subsequently, cap <NUM> can be removed from post <NUM>. Teeth 224A - 224C can be removed from slots 260A - 260C, with or without the use of tooth holder <NUM>. Biasing elements 262A - 262C can be removed from engagement with pedestals 275A - 275C.

At step <NUM>, the disassembled components of instrument holder <NUM>, e.g., base <NUM>, cap <NUM>, teeth 224A - 224C, biasing elements 262A - 262C and fastener <NUM> can be cleaned, sterilized, packaged and stored for later use in a different medical procedure. The disassembled components can be reassembled by repeating steps <NUM> - <NUM>.

<FIG> illustrates system <NUM> for performing techniques described herein, in accordance with some embodiments. System <NUM> can include robotic surgical device <NUM> coupled to adjustable instrument holder <NUM> (e.g., instrument holder <NUM>), which may interact with tracking system <NUM>. Tracking system <NUM> can include tracking element <NUM>, camera <NUM> and fiducial marker <NUM>. System <NUM> can include display device <NUM>, which can be used to display user interface <NUM>. System <NUM> can include control system <NUM> (e.g., a robotic controller), including processor <NUM> and memory <NUM>. In an example, display device <NUM> can be coupled to one or more of robotic surgical device <NUM>, probe device <NUM>, or control system <NUM>.

<FIG> illustrates a block diagram of an example machine <NUM> upon which any one or more of the techniques discussed herein may perform in accordance with some embodiments. In alternative embodiments, machine <NUM> may operate as a standalone device or may be connected (e.g., networked) to other machines. In a networked deployment, machine <NUM> may operate in the capacity of a server machine, a client machine, or both in server-client network environments. In an example, machine <NUM> may act as a peer machine in peer-to-peer (P2P) (or other distributed) network environment. Machine <NUM> may be a personal computer (PC), a tablet PC, a set-top box (STB), a personal digital assistant (PDA), a mobile telephone, a web appliance, a network router, switch or bridge, or any machine capable of executing instructions (sequential or otherwise) that specify actions to be taken by that machine.

Machine (e.g., computer system) <NUM> may include hardware processor <NUM> (e.g., a central processing unit (CPU), a graphics processing unit (GPU), a hardware processor core, or any combination thereof), main memory <NUM> and static memory <NUM>, some or all of which may communicate with each other via interlink (e.g., bus) <NUM>. Machine <NUM> may further include display unit <NUM>, alphanumeric input device <NUM> (e.g., a keyboard), and user interface (UI) navigation device <NUM> (e.g., a mouse). In an example, display unit <NUM>, input device <NUM> and UI navigation device <NUM> may be a touch screen display. Machine <NUM> may additionally include storage device (e.g., drive unit) <NUM>, signal generation device <NUM> (e.g., a speaker), network interface device <NUM>, and one or more sensors <NUM>, such as a global positioning system (GPS) sensor, compass, accelerometer, or other sensor. Machine <NUM> may include output controller <NUM>, such as a serial (e.g., Universal Serial Bus (USB), parallel, or other wired or wireless (e.g., infrared (IR), near field communication (NFC), etc.) connection to communicate or control one or more peripheral devices (e.g., a printer, card reader, etc.).

Storage device <NUM> may include machine readable medium <NUM> on which is stored one or more sets of data structures or instructions <NUM> (e.g., software) embodying or utilized by any one or more of the techniques or functions described herein. Instructions <NUM> may also reside, completely or at least partially, within main memory <NUM>, within static memory <NUM>, or within hardware processor <NUM> during execution thereof by machine <NUM>. In an example, one or any combination of hardware processor <NUM>, main memory <NUM>, static memory <NUM>, or storage device <NUM> may constitute machine readable media.

While machine readable medium <NUM> is illustrated as a single medium, the term "machine readable medium" may include a single medium or multiple media (e.g., a centralized or distributed database, and/or associated caches and servers) configured to store the one or more instructions <NUM>. The term "machine readable medium" may include any medium that is capable of storing, encoding, or carrying instructions for execution by machine <NUM> and that cause machine <NUM> to perform any one or more of the techniques of the present disclosure, or that is capable of storing, encoding or carrying data structures used by or associated with such instructions. Non-limiting machine readable medium examples may include solid-state memories, and optical and magnetic media.

Instructions <NUM> may further be transmitted or received over communications network <NUM> using a transmission medium via network interface device <NUM> utilizing any one of a number of transfer protocols (e.g., frame relay, internet protocol (IP), transmission control protocol (TCP), user datagram protocol (UDP), hypertext transfer protocol (HTTP), etc.). Example communication networks may include a local area network (LAN), a wide area network (WAN), a packet data network (e.g., the Internet), mobile telephone networks (e.g., cellular networks), Plain Old Telephone (POTS) networks, and wireless data networks (e.g., Institute of Electrical and Electronics Engineers (IEEE) <NUM> family of standards known as Wi-Fi®, IEEE <NUM> family of standards known as WiMax®), IEEE <NUM>. <NUM> family of standards, peer-to-peer (P2P) networks, among others. In an example, network interface device <NUM> may include one or more physical jacks (e.g., Ethernet, coaxial, or phone jacks) or one or more antennas to connect to communications network <NUM>. In an example, network interface device <NUM> may include a plurality of antennas to wirelessly communicate using at least one of single-input multiple-output (SIMO), multiple-input multiple-output (MIMO), or multiple-input single-output (MISO) techniques. The term "transmission medium" shall be taken to include any intangible medium that is capable of storing, encoding or carrying instructions for execution by machine <NUM>, and includes digital or analog communications signals or other intangible medium to facilitate communication of such software.

The systems, devices and methods discussed in the present application can be useful in performing robotic-assisted surgical procedures that utilize robotic surgical arms that can be coupled to instrument holders used to precisely align trajectories of instruments relative to anatomy of a patient registered to the space of an operating room. The present disclosure describes adjustable instrument holders that can remain mounted to a robotic surgical arm throughout a surgical procedure. The adjustable instrument holders can be adjusted to hold instruments of different sizes, e.g., different diameters, without removing the instrument holder form the robotic arm. The adjustable instrument holders can be easily and quickly manipulated to remove a first instrument of a first size and insert a second instrument of a second size, thereby decreasing time for performing a surgical procedure. The adjustable instrument holders can include passages that have variable orifice sizes, e.g., variable diameters, formed by adjustable members, such as jaws or blades, that form adjustable jaws, chucks or diaphragms to align an instrument and hold an instrument along a trajectory. The adjustable instrument holders can include adjustment members that provide axial length along an axis of the trajectory to provide stability to the instrument. The adjustable instrument holders can additionally be easily and quickly assembled and disassembled for cleaning, sanitizing and sterilizing procedures.

However, the present inventor also contemplates examples in which only those elements shown or described are provided. Moreover, the present inventor also contemplates examples using any combination or permutation of those elements shown or described (or one or more aspects thereof), either with respect to a particular example (or one or more aspects thereof), or with respect to other examples (or one or more aspects thereof) shown or described herein.

The above description is intended to be illustrative, and not restrictive.

Claim 1:
An instrument holder system comprising:
a base (<NUM>) comprising:
a disk (<NUM>) including a central bore (<NUM>);
an annular post (<NUM>) extending from the disk along an axis to form an annulus surrounding the central bore; and
a plurality of guide slots (<NUM>), each of the plurality of guide slots comprising:
a disk portion (<NUM>) extending in a radial direction along the disk; and
a post portion (<NUM>) extending an axial direction along the annular post;
a plurality of teeth (<NUM>) positioned in the plurality of guide slots, respectively, each tooth comprising:
a rail (<NUM>) for movement in the disk portion;
a spoke (<NUM>) extending from the rail for movement in the post portion; and
a tab (<NUM>) extending from the rail; and
a cap (<NUM>) comprising:
a cover portion (<NUM>) configured to cover the base, the cover including an aperture (<NUM>) to receive the annular post; and
a plurality of positioning slots (<NUM>/<NUM>) disposed in the cover configured to receive the tabs of the plurality of teeth, respectively;
wherein each positioning slot is disposed oblique to the radial direction such that rotation of the cap causes the rail of each tooth to move in a respective one of the disk portions of the plurality of guide slots so that the spoke of each tooth moves relative to the annulus and
the system further comprises a biasing mechanism to bias the cap (<NUM>) into a position where the plurality of teeth (<NUM>) is withdrawn from the annulus to an inward position in order to constrict around the instrument.