Patent Description:
Minimally invasive procedures allow for access to a targeted site within a patient with minimal trauma to the patient. For example, laparoscopic surgery can allow for surgical access to a patient's cavity through a small incision on the patient's abdomen. A cannula can form a surgical corridor to allow elongate medical instruments to access the internal anatomical site to perform a procedural function such as manipulating or visualizing tissue within the patient. During operation, the cannula and the instrument can be pivoted about a remote center of motion defined at the intersection with the patient body wall, in order to provide access to various areas within the patient cavity without exerting undue stresses on the patient.

<CIT> describes a cannula including a cannula bowl having an opening to receive an instrument configured to be advanced through the cannula, and a cannula tube extending distally from the cannula bowl. The cannula tube may have a proximal end opening, a distal end opening disposed at an opposite end of the cannula from the proximal end opening, and lateral wall defining a passage extending from the proximal end opening to the distal end opening. The lateral wall can have outer dimensions defining a waisted portion with smaller outer dimensions than a region disposed proximally or distally to the waisted portion along a length of the cannula tube. The cannula includes radially protruding ribs extending from an outer lateral wall surface. <CIT> describes a cannula having a proximal and distal series of external fixation elements displaced by a certain distance which provides a central tissue receiving area that receives the proximal and distal surfaces of the tissue. Further prior art is disclosed in <CIT>, <CIT>, <CIT>, <CIT>, <CIT>, <CIT>.

<FIG> illustrate some exemplary embodiments of the invention.

Aspects of the present disclosure may be integrated into a robotically-enabled medical system capable of performing a variety of medical procedures, including both minimally invasive, such as laparoscopy, and non-invasive, such as endoscopy, procedures. Among endoscopy procedures, the system may be capable of performing bronchoscopy, ureteroscopy, gastroscopy, etc..

In addition to performing the breadth of procedures, the system may provide additional benefits, such as enhanced imaging and guidance to assist the physician. Additionally, the system may provide the physician with the ability to perform the procedure from an ergonomic position without the need for awkward arm motions and positions. Still further, the system may provide the physician with the ability to perform the procedure with improved ease of use such that one or more of the instruments of the system can be controlled by a single user.

Various embodiments will be described below in conjunction with the drawings for purposes of illustration. It should be appreciated that many other implementations of the disclosed concepts are possible, and various advantages can be achieved with the disclosed implementations. Headings are included herein for reference and to aid in locating various sections. These headings are not intended to limit the scope of the concepts described with respect thereto. Such concepts may have applicability throughout the entire specification.

The robotically-enabled medical system may be configured in a variety of ways depending on the particular procedure. <FIG> illustrates an embodiment of a cart-based robotically-enabled system <NUM> arranged for a diagnostic and/or therapeutic bronchoscopy procedure. During a bronchoscopy, the system <NUM> may comprise a cart <NUM> having one or more robotic arms <NUM> to deliver a medical instrument, such as a steerable endoscope <NUM>, which may be a procedure-specific bronchoscope for bronchoscopy, to a natural orifice access point (i.e., the mouth of the patient positioned on a table in the present example) to deliver diagnostic and/or therapeutic tools. As shown, the cart <NUM> may be positioned proximate to the patient's upper torso in order to provide access to the access point. Similarly, the robotic arms <NUM> may be actuated to position the bronchoscope relative to the access point. The arrangement in <FIG> may also be utilized when performing a gastro-intestinal (GI) procedure with a gastroscope, a specialized endoscope for GI procedures. <FIG> depicts an example embodiment of the cart in greater detail.

With continued reference to <FIG>, once the cart <NUM> is properly positioned, the robotic arms <NUM> may insert the steerable endoscope <NUM> into the patient robotically, manually, or a combination thereof. As shown, the steerable endoscope <NUM> may comprise at least two telescoping parts, such as an inner leader portion and an outer sheath portion, each portion coupled to a separate instrument driver from the set of instrument drivers <NUM>, each instrument driver coupled to the distal end of an individual robotic arm. This linear arrangement of the instrument drivers <NUM>, which facilitates coaxially aligning the leader portion with the sheath portion, creates a "virtual rail" <NUM> that may be repositioned in space by manipulating the one or more robotic arms <NUM> into different angles and/or positions. The virtual rails described herein are depicted in the Figures using dashed lines, and accordingly the dashed lines do not depict any physical structure of the system. Translation of the instrument drivers <NUM> along the virtual rail <NUM> telescopes the inner leader portion relative to the outer sheath portion or advances or retracts the endoscope <NUM> from the patient. The angle of the virtual rail <NUM> may be adjusted, translated, and pivoted based on clinical application or physician preference. For example, in bronchoscopy, the angle and position of the virtual rail <NUM> as shown represents a compromise between providing physician access to the endoscope <NUM> while minimizing friction that results from bending the endoscope <NUM> into the patient's mouth.

The endoscope <NUM> may be directed down the patient's trachea and lungs after insertion using precise commands from the robotic system until reaching the target destination or operative site. In order to enhance navigation through the patient's lung network and/or reach the desired target, the endoscope <NUM> may be manipulated to telescopically extend the inner leader portion from the outer sheath portion to obtain enhanced articulation and greater bend radius. The use of separate instrument drivers <NUM> also allows the leader portion and sheath portion to be driven independent of each other.

For example, the endoscope <NUM> may be directed to deliver a biopsy needle to a target, such as, for example, a lesion or nodule within the lungs of a patient. The needle may be deployed down a working channel that runs the length of the endoscope to obtain a tissue sample to be analyzed by a pathologist. Depending on the pathology results, additional tools may be deployed down the working channel of the endoscope for additional biopsies. After identifying a nodule to be malignant, the endoscope <NUM> may endoscopically deliver tools to resect the potentially cancerous tissue. In some instances, diagnostic and therapeutic treatments can be delivered in separate procedures. In those circumstances, the endoscope <NUM> may also be used to deliver a fiducial to "mark" the location of the target nodule as well. In other instances, diagnostic and therapeutic treatments may be delivered during the same procedure.

The system <NUM> may also include a movable tower <NUM>, which may be connected via support cables to the cart <NUM> to provide support for controls, electronics, fluidics, optics, sensors, and/or power to the cart <NUM>. Placing such functionality in the tower <NUM> allows for a smaller form factor cart <NUM> that may be more easily adjusted and/or re-positioned by an operating physician and his/her staff. Additionally, the division of functionality between the cart / table and the support tower <NUM> reduces operating room clutter and facilitates improving clinical workflow. While the cart <NUM> may be positioned close to the patient, the tower <NUM> may be stowed in a remote location to stay out of the way during a procedure.

In support of the robotic systems described above, the tower <NUM> may include component(s) of a computer-based control system that stores computer program instructions, for example, within a non-transitory computer-readable storage medium such as a persistent magnetic storage drive, solid state drive, etc. The execution of those instructions, whether the execution occurs in the tower <NUM> or the cart <NUM>, may control the entire system or sub-system(s) thereof. For example, when executed by a processor of the computer system, the instructions may cause the components of the robotics system to actuate the relevant carriages and arm mounts, actuate the robotics arms, and control the medical instruments. For example, in response to receiving the control signal, the motors in the joints of the robotics arms may position the arms into a certain posture.

The tower <NUM> may also include a pump, flow meter, valve control, and/or fluid access in order to provide controlled irrigation and aspiration capabilities to the system that may be deployed through the endoscope <NUM>. These components may also be controlled using the computer system of tower <NUM>. In some embodiments, irrigation and aspiration capabilities may be delivered directly to the endoscope <NUM> through separate cable(s).

The tower <NUM> may include a voltage and surge protector designed to provide filtered and protected electrical power to the cart <NUM>, thereby avoiding placement of a power transformer and other auxiliary power components in the cart <NUM>, resulting in a smaller, more moveable cart <NUM>.

The tower <NUM> may also include support equipment for the sensors deployed throughout the robotic system <NUM>. For example, the tower <NUM> may include opto-electronics equipment for detecting, receiving, and processing data received from the optical sensors or cameras throughout the robotic system <NUM>. In combination with the control system, such opto-electronics equipment may be used to generate real-time images for display in any number of consoles deployed throughout the system, including in the tower <NUM>. Similarly, the tower <NUM> may also include an electronic subsystem for receiving and processing signals received from deployed electromagnetic (EM) sensors. The tower <NUM> may also be used to house and position an EM field generator for detection by EM sensors in or on the medical instrument.

The tower <NUM> may also include a console <NUM> in addition to other consoles available in the rest of the system, e.g., console mounted on top of the cart. The console <NUM> may include a user interface and a display screen, such as a touchscreen, for the physician operator. Consoles in system <NUM> are generally designed to provide both robotic controls as well as pre-operative and real-time information of the procedure, such as navigational and localization information of the endoscope <NUM>. When the console <NUM> is not the only console available to the physician, it may be used by a second operator, such as a nurse, to monitor the health or vitals of the patient and the operation of system, as well as provide procedure-specific data, such as navigational and localization information. In other embodiments, the console <NUM> is housed in a body that is separate from the tower <NUM>.

The tower <NUM> may be coupled to the cart <NUM> and endoscope <NUM> through one or more cables or connections (not shown). In some embodiments, the support functionality from the tower <NUM> may be provided through a single cable to the cart <NUM>, simplifying and de-cluttering the operating room. In other embodiments, specific functionality may be coupled in separate cabling and connections. For example, while power may be provided through a single power cable to the cart, the support for controls, optics, fluidics, and/or navigation may be provided through a separate cable.

<FIG> provides a detailed illustration of an embodiment of the cart from the cart-based robotically-enabled system shown in <FIG>. The cart <NUM> generally includes an elongated support structure <NUM> (often referred to as a "column"), a cart base <NUM>, and a console <NUM> at the top of the column <NUM>. The column <NUM> may include one or more carriages, such as a carriage <NUM> (alternatively "arm support") for supporting the deployment of one or more robotic arms <NUM> (three shown in <FIG>). The carriage <NUM> may include individually configurable arm mounts that rotate along a perpendicular axis to adjust the base of the robotic arms <NUM> for better positioning relative to the patient. The carriage <NUM> also includes a carriage interface <NUM> that allows the carriage <NUM> to vertically translate along the column <NUM>.

The carriage interface <NUM> is connected to the column <NUM> through slots, such as slot <NUM>, that are positioned on opposite sides of the column <NUM> to guide the vertical translation of the carriage <NUM>. The slot <NUM> contains a vertical translation interface to position and hold the carriage at various vertical heights relative to the cart base <NUM>. Vertical translation of the carriage <NUM> allows the cart <NUM> to adjust the reach of the robotic arms <NUM> to meet a variety of table heights, patient sizes, and physician preferences. Similarly, the individually configurable arm mounts on the carriage <NUM> allow the robotic arm base <NUM> of robotic arms <NUM> to be angled in a variety of configurations.

In some embodiments, the slot <NUM> may be supplemented with slot covers that are flush and parallel to the slot surface to prevent dirt and fluid ingress into the internal chambers of the column <NUM> and the vertical translation interface as the carriage <NUM> vertically translates. The slot covers may be deployed through pairs of spring spools positioned near the vertical top and bottom of the slot <NUM>. The covers are coiled within the spools until deployed to extend and retract from their coiled state as the carriage <NUM> vertically translates up and down. The spring-loading of the spools provides force to retract the cover into a spool when carriage <NUM> translates towards the spool, while also maintaining a tight seal when the carriage <NUM> translates away from the spool. The covers may be connected to the carriage <NUM> using, for example, brackets in the carriage interface <NUM> to ensure proper extension and retraction of the cover as the carriage <NUM> translates.

The column <NUM> may internally comprise mechanisms, such as gears and motors, that are designed to use a vertically aligned lead screw to translate the carriage <NUM> in a mechanized fashion in response to control signals generated in response to user inputs, e.g., inputs from the console <NUM>.

The robotic arms <NUM> may generally comprise robotic arm bases <NUM> and end effectors <NUM>, separated by a series of linkages <NUM> that are connected by a series of joints <NUM>, each joint comprising an independent actuator, each actuator comprising an independently controllable motor. Each independently controllable joint represents an independent degree of freedom available to the robotic arm. Each of the arms <NUM> have seven joints, and thus provide seven degrees of freedom. A multitude of joints result in a multitude of degrees of freedom, allowing for "redundant" degrees of freedom. Redundant degrees of freedom allow the robotic arms <NUM> to position their respective end effectors <NUM> at a specific position, orientation, and trajectory in space using different linkage positions and joint angles. This allows for the system to position and direct a medical instrument from a desired point in space while allowing the physician to move the arm joints into a clinically advantageous position away from the patient to create greater access, while avoiding arm collisions.

The cart base <NUM> balances the weight of the column <NUM>, carriage <NUM>, and arms <NUM> over the floor. Accordingly, the cart base <NUM> houses heavier components, such as electronics, motors, power supply, as well as components that either enable movement and/or immobilize the cart. For example, the cart base <NUM> includes rollable wheel-shaped casters <NUM> that allow for the cart to easily move around the room prior to a procedure. After reaching the appropriate position, the casters <NUM> may be immobilized using wheel locks to hold the cart <NUM> in place during the procedure.

Positioned at the vertical end of column <NUM>, the console <NUM> allows for both a user interface for receiving user input and a display screen (or a dual-purpose device such as, for example, a touchscreen <NUM>) to provide the physician user with both pre-operative and intra-operative data. Potential pre-operative data on the touchscreen <NUM> may include pre-operative plans, navigation and mapping data derived from pre-operative computerized tomography (CT) scans, and/or notes from pre-operative patient interviews. Intra-operative data on display may include optical information provided from the tool, sensor and coordinate information from sensors, as well as vital patient statistics, such as respiration, heart rate, and/or pulse. The console <NUM> may be positioned and tilted to allow a physician to access the console from the side of the column <NUM> opposite carriage <NUM>. From this position, the physician may view the console <NUM>, robotic arms <NUM>, and patient while operating the console <NUM> from behind the cart <NUM>. As shown, the console <NUM> also includes a handle <NUM> to assist with maneuvering and stabilizing cart <NUM>.

<FIG> illustrates an embodiment of a robotically-enabled system <NUM> arranged for ureteroscopy. In a ureteroscopic procedure, the cart <NUM> may be positioned to deliver a ureteroscope <NUM>, a procedure-specific endoscope designed to traverse a patient's urethra and ureter, to the lower abdominal area of the patient. In a ureteroscopy, it may be desirable for the ureteroscope <NUM> to be directly aligned with the patient's urethra to reduce friction and forces on the sensitive anatomy in the area. As shown, the cart <NUM> may be aligned at the foot of the table to allow the robotic arms <NUM> to position the ureteroscope <NUM> for direct linear access to the patient's urethra. From the foot of the table, the robotic arms <NUM> may insert the ureteroscope <NUM> along the virtual rail <NUM> directly into the patient's lower abdomen through the urethra.

After insertion into the urethra, using similar control techniques as in bronchoscopy, the ureteroscope <NUM> may be navigated into the bladder, ureters, and/or kidneys for diagnostic and/or therapeutic applications. For example, the ureteroscope <NUM> may be directed into the ureter and kidneys to break up kidney stone build up using a laser or ultrasonic lithotripsy device deployed down the working channel of the ureteroscope <NUM>. After lithotripsy is complete, the resulting stone fragments may be removed using baskets deployed down the ureteroscope <NUM>.

<FIG> illustrates an embodiment of a robotically-enabled system similarly arranged for a vascular procedure. In a vascular procedure, the system <NUM> may be configured such that the cart <NUM> may deliver a medical instrument <NUM>, such as a steerable catheter, to an access point in the femoral artery in the patient's leg. The femoral artery presents both a larger diameter for navigation as well as a relatively less circuitous and tortuous path to the patient's heart, which simplifies navigation. As in a ureteroscopic procedure, the cart <NUM> may be positioned towards the patient's legs and lower abdomen to allow the robotic arms <NUM> to provide a virtual rail <NUM> with direct linear access to the femoral artery access point in the patient's thigh / hip region. After insertion into the artery, the medical instrument <NUM> may be directed and inserted by translating the instrument drivers <NUM>. Alternatively, the cart may be positioned around the patient's upper abdomen in order to reach alternative vascular access points, such as, for example, the carotid and brachial arteries near the shoulder and wrist.

Embodiments of the robotically-enabled medical system may also incorporate the patient's table. Incorporation of the table reduces the amount of capital equipment within the operating room by removing the cart, which allows greater access to the patient. <FIG> illustrates an embodiment of such a robotically-enabled system arranged for a bronchoscopy procedure. System <NUM> includes a support structure or column <NUM> for supporting platform <NUM> (shown as a "table" or "bed") over the floor. Much like in the cart-based systems, the end effectors of the robotic arms <NUM> of the system <NUM> comprise instrument drivers <NUM> that are designed to manipulate an elongated medical instrument, such as a bronchoscope <NUM> in <FIG>, through or along a virtual rail <NUM> formed from the linear alignment of the instrument drivers <NUM>. In practice, a C-arm for providing fluoroscopic imaging may be positioned over the patient's upper abdominal area by placing the emitter and detector around table <NUM>.

<FIG> provides an alternative view of the system <NUM> without the patient and medical instrument for discussion purposes. As shown, the column <NUM> may include one or more carriages <NUM> shown as ring-shaped in the system <NUM>, from which the one or more robotic arms <NUM> may be based. The carriages <NUM> may translate along a vertical column interface <NUM> that runs the length of the column <NUM> to provide different vantage points from which the robotic arms <NUM> may be positioned to reach the patient. The carriage(s) <NUM> may rotate around the column <NUM> using a mechanical motor positioned within the column <NUM> to allow the robotic arms <NUM> to have access to multiples sides of the table <NUM>, such as, for example, both sides of the patient. In embodiments with multiple carriages, the carriages may be individually positioned on the column and may translate and/or rotate independent of the other carriages. While carriages <NUM> need not surround the column <NUM> or even be circular, the ring-shape as shown facilitates rotation of the carriages <NUM> around the column <NUM> while maintaining structural balance. Rotation and translation of the carriages <NUM> allows the system to align the medical instruments, such as endoscopes and laparoscopes, into different access points on the patient. In other embodiments (not shown), the system <NUM> can include a patient table or bed with adjustable arm supports in the form of bars or rails extending alongside it. One or more robotic arms <NUM> (e.g., via a shoulder with an elbow joint) can be attached to the adjustable arm supports, which can be vertically adjusted. By providing vertical adjustment, the robotic arms <NUM> are advantageously capable of being stowed compactly beneath the patient table or bed, and subsequently raised during a procedure.

The arms <NUM> may be mounted on the carriages through a set of arm mounts <NUM> comprising a series of joints that may individually rotate and/or telescopically extend to provide additional configurability to the robotic arms <NUM>. Additionally, the arm mounts <NUM> may be positioned on the carriages <NUM> such that, when the carriages <NUM> are appropriately rotated, the arm mounts <NUM> may be positioned on either the same side of table <NUM> (as shown in <FIG>), on opposite sides of table <NUM> (as shown in <FIG>), or on adjacent sides of the table <NUM> (not shown).

The column <NUM> structurally provides support for the table <NUM>, and a path for vertical translation of the carriages. Internally, the column <NUM> may be equipped with lead screws for guiding vertical translation of the carriages, and motors to mechanize the translation of said carriages based the lead screws. The column <NUM> may also convey power and control signals to the carriage <NUM> and robotic arms <NUM> mounted thereon.

The table base <NUM> serves a similar function as the cart base <NUM> in cart <NUM> shown in <FIG>, housing heavier components to balance the table/bed <NUM>, the column <NUM>, the carriages <NUM>, and the robotic arms <NUM>. The table base <NUM> may also incorporate rigid casters to provide stability during procedures. Deployed from the bottom of the table base <NUM>, the casters may extend in opposite directions on both sides of the base <NUM> and retract when the system <NUM> needs to be moved.

Continuing with <FIG>, the system <NUM> may also include a tower (not shown) that divides the functionality of system <NUM> between table and tower to reduce the form factor and bulk of the table. As in earlier disclosed embodiments, the tower may provide a variety of support functionalities to table, such as processing, computing, and control capabilities, power, fluidics, and/or optical and sensor processing. The tower may also be movable to be positioned away from the patient to improve physician access and de-clutter the operating room. Additionally, placing components in the tower allows for more storage space in the table base for potential stowage of the robotic arms. The tower may also include a master controller or console that provides both a user interface for user input, such as keyboard and/or pendant, as well as a display screen (or touchscreen) for pre-operative and intra-operative information, such as real-time imaging, navigation, and tracking information. In some embodiments, the tower may also contain holders for gas tanks to be used for insufflation.

In some embodiments, a table base may stow and store the robotic arms when not in use. <FIG> illustrates a system <NUM> that stows robotic arms in an embodiment of the table-based system. In system <NUM>, carriages <NUM> may be vertically translated into base <NUM> to stow robotic arms <NUM>, arm mounts <NUM>, and the carriages <NUM> within the base <NUM>. Base covers <NUM> may be translated and retracted open to deploy the carriages <NUM>, arm mounts <NUM>, and arms <NUM> around column <NUM>, and closed to stow to protect them when not in use. The base covers <NUM> may be sealed with a membrane <NUM> along the edges of its opening to prevent dirt and fluid ingress when closed.

<FIG> illustrates an embodiment of a robotically-enabled table-based system configured for a ureteroscopy procedure. In a ureteroscopy, the table <NUM> may include a swivel portion <NUM> for positioning a patient off-angle from the column <NUM> and table base <NUM>. The swivel portion <NUM> may rotate or pivot around a pivot point (e.g., located below the patient's head) in order to position the bottom portion of the swivel portion <NUM> away from the column <NUM>. For example, the pivoting of the swivel portion <NUM> allows a C-arm (not shown) to be positioned over the patient's lower abdomen without competing for space with the column (not shown) below table <NUM>. By rotating the carriage (not shown) around the column <NUM>, the robotic arms <NUM> may directly insert a ureteroscope <NUM> along a virtual rail <NUM> into the patient's groin area to reach the urethra. In a ureteroscopy, stirrups <NUM> may also be fixed to the swivel portion <NUM> of the table <NUM> to support the position of the patient's legs during the procedure and allow clear access to the patient's groin area.

In a laparoscopic procedure, through small incision(s) in the patient's abdominal wall, minimally invasive instruments may be inserted into the patient's anatomy. In some embodiments, the minimally invasive instruments comprise an elongated rigid member, such as a shaft, which is used to access anatomy within the patient. After inflation of the patient's abdominal cavity, the instruments may be directed to perform surgical or medical tasks, such as grasping, cutting, ablating, suturing, etc. In some embodiments, the instruments can comprise a scope, such as a laparoscope. <FIG> illustrates an embodiment of a robotically-enabled table-based system configured for a laparoscopic procedure. As shown in <FIG>, the carriages <NUM> of the system <NUM> may be rotated and vertically adjusted to position pairs of the robotic arms <NUM> on opposite sides of the table <NUM>, such that instrument <NUM> may be positioned using the arm mounts <NUM> to be passed through minimal incisions on both sides of the patient to reach his/her abdominal cavity.

To accommodate laparoscopic procedures, the robotically-enabled table system may also tilt the platform to a desired angle. <FIG> illustrates an embodiment of the robotically-enabled medical system with pitch or tilt adjustment. As shown in <FIG>, the system <NUM> may accommodate tilt of the table <NUM> to position one portion of the table at a greater distance from the floor than the other. Additionally, the arm mounts <NUM> may rotate to match the tilt such that the arms <NUM> maintain the same planar relationship with table <NUM>. To accommodate steeper angles, the column <NUM> may also include telescoping portions <NUM> that allow vertical extension of column <NUM> to keep the table <NUM> from touching the floor or colliding with base <NUM>.

<FIG> provides a detailed illustration of the interface between the table <NUM> and the column <NUM>. Pitch rotation mechanism <NUM> may be configured to alter the pitch angle of the table <NUM> relative to the column <NUM> in multiple degrees of freedom. The pitch rotation mechanism <NUM> may be enabled by the positioning of orthogonal axes <NUM>, <NUM> at the column-table interface, each axis actuated by a separate motor <NUM>, <NUM> responsive to an electrical pitch angle command. Rotation along one screw <NUM> would enable tilt adjustments in one axis <NUM>, while rotation along the other screw <NUM> would enable tilt adjustments along the other axis <NUM>. In some embodiments, a ball joint can be used to alter the pitch angle of the table <NUM> relative to the column <NUM> in multiple degrees of freedom.

For example, pitch adjustments are particularly useful when trying to position the table in a Trendelenburg position, i.e., position the patient's lower abdomen at a higher position from the floor than the patient's lower abdomen, for lower abdominal surgery. The Trendelenburg position causes the patient's internal organs to slide towards his/her upper abdomen through the force of gravity, clearing out the abdominal cavity for minimally invasive tools to enter and perform lower abdominal surgical or medical procedures, such as laparoscopic prostatectomy.

<FIG> illustrate isometric and end views of an alternative embodiment of a table-based surgical robotics system <NUM>. The surgical robotics system <NUM> includes one or more adjustable arm supports <NUM> that can be configured to support one or more robotic arms (see, for example, <FIG>) relative to a table <NUM>. In the illustrated embodiment, a single adjustable arm support <NUM> is shown, though an additional arm support can be provided on an opposite side of the table <NUM>. The adjustable arm support <NUM> can be configured so that it can move relative to the table <NUM> to adjust and/or vary the position of the adjustable arm support <NUM> and/or any robotic arms mounted thereto relative to the table <NUM>. For example, the adjustable arm support <NUM> may be adjusted one or more degrees of freedom relative to the table <NUM>. The adjustable arm support <NUM> provides high versatility to the system <NUM>, including the ability to easily stow the one or more adjustable arm supports <NUM> and any robotics arms attached thereto beneath the table <NUM>. The adjustable arm support <NUM> can be elevated from the stowed position to a position below an upper surface of the table <NUM>. In other embodiments, the adjustable arm support <NUM> can be elevated from the stowed position to a position above an upper surface of the table <NUM>.

The adjustable arm support <NUM> can provide several degrees of freedom, including lift, lateral translation, tilt, etc. In the illustrated embodiment of <FIG>, the arm support <NUM> is configured with four degrees of freedom, which are illustrated with arrows in <FIG>. A first degree of freedom allows for adjustment of the adjustable arm support <NUM> in the z-direction ("Z-lift"). For example, the adjustable arm support <NUM> can include a carriage <NUM> configured to move up or down along or relative to a column <NUM> supporting the table <NUM>. A second degree of freedom can allow the adjustable arm support <NUM> to tilt. For example, the adjustable arm support <NUM> can include a rotary joint, which can allow the adjustable arm support <NUM> to be aligned with the bed in a Trendelenburg position. A third degree of freedom can allow the adjustable arm support <NUM> to "pivot up," which can be used to adjust a distance between a side of the table <NUM> and the adjustable arm support <NUM>. A fourth degree of freedom can permit translation of the adjustable arm support <NUM> along a longitudinal length of the table.

The surgical robotics system <NUM> in <FIG> can comprise a table supported by a column <NUM> that is mounted to a base <NUM>. The base <NUM> and the column <NUM> support the table <NUM> relative to a support surface. A floor axis <NUM> and a support axis <NUM> are shown in <FIG>.

The adjustable arm support <NUM> can be mounted to the column <NUM>. In other embodiments, the arm support <NUM> can be mounted to the table <NUM> or base <NUM>. The adjustable arm support <NUM> can include a carriage <NUM>, a bar or rail connector <NUM> and a bar or rail <NUM>. In some embodiments, one or more robotic arms mounted to the rail <NUM> can translate and move relative to one another.

The carriage <NUM> can be attached to the column <NUM> by a first joint <NUM>, which allows the carriage <NUM> to move relative to the column <NUM> (e.g., such as up and down a first or vertical axis <NUM>). The first joint <NUM> can provide the first degree of freedom ("Z-lift") to the adjustable arm support <NUM>. The adjustable arm support <NUM> can include a second joint <NUM>, which provides the second degree of freedom (tilt) for the adjustable arm support <NUM>. The adjustable arm support <NUM> can include a third joint <NUM>, which can provide the third degree of freedom ("pivot up") for the adjustable arm support <NUM>. An additional joint <NUM> (shown in <FIG>) can be provided that mechanically constrains the third joint <NUM> to maintain an orientation of the rail <NUM> as the rail connector <NUM> is rotated about a third axis <NUM>. The adjustable arm support <NUM> can include a fourth joint <NUM>, which can provide a fourth degree of freedom (translation) for the adjustable arm support <NUM> along a fourth axis <NUM>.

<FIG> illustrates an end view of the surgical robotics system 140A with two adjustable arm supports 105A, 105B mounted on opposite sides of a table <NUM>. A first robotic arm 142A is attached to the bar or rail 107A of the first adjustable arm support 105B. The first robotic arm 142A includes a base 144A attached to the rail 107A. The distal end of the first robotic arm 142A includes an instrument drive mechanism 146A that can attach to one or more robotic medical instruments or tools. Similarly, the second robotic arm 142B includes a base 144B attached to the rail 107B. The distal end of the second robotic arm 142B includes an instrument drive mechanism 146B. The instrument drive mechanism 146B can be configured to attach to one or more robotic medical instruments or tools.

In some embodiments, one or more of the robotic arms 142A, 142B comprises an arm with seven or more degrees of freedom. In some embodiments, one or more of the robotic arms 142A, 142B can include eight degrees of freedom, including an insertion axis (<NUM>-degree of freedom including insertion), a wrist (<NUM>-degrees of freedom including wrist pitch, yaw and roll), an elbow (<NUM>-degree of freedom including elbow pitch), a shoulder (<NUM>-degrees of freedom including shoulder pitch and yaw), and base 144A, 144B (<NUM>-degree of freedom including translation). In some embodiments, the insertion degree of freedom can be provided by the robotic arm 142A, 142B, while in other embodiments, the instrument itself provides insertion via an instrument-based insertion architecture.

The end effectors of the system's robotic arms comprise (i) an instrument driver (alternatively referred to as "instrument drive mechanism" or "instrument device manipulator") that incorporate electro-mechanical means for actuating the medical instrument and (ii) a removable or detachable medical instrument, which may be devoid of any electro-mechanical components, such as motors. This dichotomy may be driven by the need to sterilize medical instruments used in medical procedures, and the inability to adequately sterilize expensive capital equipment due to their intricate mechanical assemblies and sensitive electronics. Accordingly, the medical instruments may be designed to be detached, removed, and interchanged from the instrument driver (and thus the system) for individual sterilization or disposal by the physician or the physician's staff. In contrast, the instrument drivers need not be changed or sterilized, and may be draped for protection.

<FIG> illustrates an example instrument driver. Positioned at the distal end of a robotic arm, instrument driver <NUM> comprises of one or more drive units <NUM> arranged with parallel axes to provide controlled torque to a medical instrument via drive shafts <NUM>. Each drive unit <NUM> comprises an individual drive shaft <NUM> for interacting with the instrument, a gear head <NUM> for converting the motor shaft rotation to a desired torque, a motor <NUM> for generating the drive torque, an encoder <NUM> to measure the speed of the motor shaft and provide feedback to the control circuitry, and control circuity <NUM> for receiving control signals and actuating the drive unit. Each drive unit <NUM> being independent controlled and motorized, the instrument driver <NUM> may provide multiple (four as shown in <FIG>) independent drive outputs to the medical instrument. In operation, the control circuitry <NUM> would receive a control signal, transmit a motor signal to the motor <NUM>, compare the resulting motor speed as measured by the encoder <NUM> with the desired speed, and modulate the motor signal to generate the desired torque.

For procedures that require a sterile environment, the robotic system may incorporate a drive interface, such as a sterile adapter connected to a sterile drape, that sits between the instrument driver and the medical instrument. The chief purpose of the sterile adapter is to transfer angular motion from the drive shafts of the instrument driver to the drive inputs of the instrument while maintaining physical separation, and thus sterility, between the drive shafts and drive inputs. Accordingly, an example sterile adapter may comprise of a series of rotational inputs and outputs intended to be mated with the drive shafts of the instrument driver and drive inputs on the instrument. Connected to the sterile adapter, the sterile drape, comprised of a thin, flexible material such as transparent or translucent plastic, is designed to cover the capital equipment, such as the instrument driver, robotic arm, and cart (in a cart-based system) or table (in a table-based system). Use of the drape would allow the capital equipment to be positioned proximate to the patient while still being located in an area not requiring sterilization (i.e., non-sterile field). On the other side of the sterile drape, the medical instrument may interface with the patient in an area requiring sterilization (i.e., sterile field).

<FIG> illustrates an example medical instrument with a paired instrument driver. Like other instruments designed for use with a robotic system, medical instrument <NUM> comprises an elongated shaft <NUM> (or elongate body) and an instrument base <NUM>. The instrument base <NUM>, also referred to as an "instrument handle" due to its intended design for manual interaction by the physician, may generally comprise rotatable drive inputs <NUM>, e.g., receptacles, pulleys or spools, that are designed to be mated with drive outputs <NUM> that extend through a drive interface on instrument driver <NUM> at the distal end of robotic arm <NUM>. When physically connected, latched, and/or coupled, the mated drive inputs <NUM> of instrument base <NUM> may share axes of rotation with the drive outputs <NUM> in the instrument driver <NUM> to allow the transfer of torque from drive outputs <NUM> to drive inputs <NUM>. In some embodiments, the drive outputs <NUM> may comprise splines that are designed to mate with receptacles on the drive inputs <NUM>.

The elongated shaft <NUM> is designed to be delivered through either an anatomical opening or lumen, e.g., as in endoscopy, or a minimally invasive incision, e.g., as in laparoscopy. The elongated shaft <NUM> may be either flexible (e.g., having properties similar to an endoscope) or rigid (e.g., having properties similar to a laparoscope) or contain a customized combination of both flexible and rigid portions. When designed for laparoscopy, the distal end of a rigid elongated shaft may be connected to an end effector extending from a jointed wrist formed from a clevis with at least one degree of freedom and a surgical tool or medical instrument, such as, for example, a grasper or scissors, that may be actuated based on force from the tendons as the drive inputs rotate in response to torque received from the drive outputs <NUM> of the instrument driver <NUM>. When designed for endoscopy, the distal end of a flexible elongated shaft may include a steerable or controllable bending section that may be articulated and bent based on torque received from the drive outputs <NUM> of the instrument driver <NUM>.

Torque from the instrument driver <NUM> is transmitted down the elongated shaft <NUM> using tendons along the shaft <NUM>. These individual tendons, such as pull wires, may be individually anchored to individual drive inputs <NUM> within the instrument handle <NUM>. From the handle <NUM>, the tendons are directed down one or more pull lumens along the elongated shaft <NUM> and anchored at the distal portion of the elongated shaft <NUM>, or in the wrist at the distal portion of the elongated shaft. During a surgical procedure, such as a laparoscopic, endoscopic or hybrid procedure, these tendons may be coupled to a distally mounted end effector, such as a wrist, grasper, or scissor. Under such an arrangement, torque exerted on drive inputs <NUM> would transfer tension to the tendon, thereby causing the end effector to actuate in some way. In some embodiments, during a surgical procedure, the tendon may cause a joint to rotate about an axis, thereby causing the end effector to move in one direction or another. Alternatively, the tendon may be connected to one or more jaws of a grasper at distal end of the elongated shaft <NUM>, where tension from the tendon cause the grasper to close.

In endoscopy, the tendons may be coupled to a bending or articulating section positioned along the elongated shaft <NUM> (e.g., at the distal end) via adhesive, control ring, or other mechanical fixation. When fixedly attached to the distal end of a bending section, torque exerted on drive inputs <NUM> would be transmitted down the tendons, causing the softer, bending section (sometimes referred to as the articulable section or region) to bend or articulate. Along the non-bending sections, it may be advantageous to spiral or helix the individual pull lumens that direct the individual tendons along (or inside) the walls of the endoscope shaft to balance the radial forces that result from tension in the pull wires. The angle of the spiraling and/or spacing there between may be altered or engineered for specific purposes, wherein tighter spiraling exhibits lesser shaft compression under load forces, while lower amounts of spiraling results in greater shaft compression under load forces, but also exhibits limits bending. On the other end of the spectrum, the pull lumens may be directed parallel to the longitudinal axis of the elongated shaft <NUM> to allow for controlled articulation in the desired bending or articulable sections.

In endoscopy, the elongated shaft <NUM> houses a number of components to assist with the robotic procedure. The shaft may comprise of a working channel for deploying surgical tools (or medical instruments), irrigation, and/or aspiration to the operative region at the distal end of the shaft <NUM>. The shaft <NUM> may also accommodate wires and/or optical fibers to transfer signals to/from an optical assembly at the distal tip, which may include of an optical camera. The shaft <NUM> may also accommodate optical fibers to carry light from proximally-located light sources, such as light emitting diodes, to the distal end of the shaft.

At the distal end of the instrument <NUM>, the distal tip may also comprise the opening of a working channel for delivering tools for diagnostic and/or therapy, irrigation, and aspiration to an operative site. The distal tip may also include a port for a camera, such as a fiberscope or a digital camera, to capture images of an internal anatomical space. Relatedly, the distal tip may also include ports for light sources for illuminating the anatomical space when using the camera.

In the example of <FIG>, the drive shaft axes, and thus the drive input axes, are orthogonal to the axis of the elongated shaft. This arrangement, however, complicates roll capabilities for the elongated shaft <NUM>. Rolling the elongated shaft <NUM> along its axis while keeping the drive inputs <NUM> static results in undesirable tangling of the tendons as they extend off the drive inputs <NUM> and enter pull lumens within the elongated shaft <NUM>. The resulting entanglement of such tendons may disrupt any control algorithms intended to predict movement of the flexible elongated shaft during an endoscopic procedure.

<FIG> illustrates an alternative design for an instrument driver and instrument where the axes of the drive units are parallel to the axis of the elongated shaft of the instrument. As shown, a circular instrument driver <NUM> comprises four drive units with their drive outputs <NUM> aligned in parallel at the end of a robotic arm <NUM>. The drive units, and their respective drive outputs <NUM>, are housed in a rotational assembly <NUM> of the instrument driver <NUM> that is driven by one of the drive units within the assembly <NUM>. In response to torque provided by the rotational drive unit, the rotational assembly <NUM> rotates along a circular bearing that connects the rotational assembly <NUM> to the non-rotational portion <NUM> of the instrument driver. Power and controls signals may be communicated from the non-rotational portion <NUM> of the instrument driver <NUM> to the rotational assembly <NUM> through electrical contacts may be maintained through rotation by a brushed slip ring connection (not shown). In other embodiments, the rotational assembly <NUM> may be responsive to a separate drive unit that is integrated into the non-rotatable portion <NUM>, and thus not in parallel to the other drive units. The rotational mechanism <NUM> allows the instrument driver <NUM> to rotate the drive units, and their respective drive outputs <NUM>, as a single unit around an instrument driver axis <NUM>.

Like earlier disclosed embodiments, an instrument <NUM> may comprise an elongated shaft portion <NUM> and an instrument base <NUM> (shown with a transparent external skin for discussion purposes) comprising a plurality of drive inputs <NUM> (such as receptacles, pulleys, and spools) that are configured to receive the drive outputs <NUM> in the instrument driver <NUM>. Unlike prior disclosed embodiments, instrument shaft <NUM> extends from the center of instrument base <NUM> with an axis substantially parallel to the axes of the drive inputs <NUM>, rather than orthogonal as in the design of <FIG>.

When coupled to the rotational assembly <NUM> of the instrument driver <NUM>, the medical instrument <NUM>, comprising instrument base <NUM> and instrument shaft <NUM>, rotates in combination with the rotational assembly <NUM> about the instrument driver axis <NUM>. Since the instrument shaft <NUM> is positioned at the center of instrument base <NUM>, the instrument shaft <NUM> is coaxial with instrument driver axis <NUM> when attached. Thus, rotation of the rotational assembly <NUM> causes the instrument shaft <NUM> to rotate about its own longitudinal axis. Moreover, as the instrument base <NUM> rotates with the instrument shaft <NUM>, any tendons connected to the drive inputs <NUM> in the instrument base <NUM> are not tangled during rotation. Accordingly, the parallelism of the axes of the drive outputs <NUM>, drive inputs <NUM>, and instrument shaft <NUM> allows for the shaft rotation without tangling any control tendons.

<FIG> illustrates an instrument having an instrument based insertion architecture in accordance with some embodiments. The instrument <NUM> can be coupled to any of the instrument drivers discussed above. The instrument <NUM> comprises an elongated shaft <NUM>, an end effector <NUM> connected to the shaft <NUM>, and a handle <NUM> coupled to the shaft <NUM>. The elongated shaft <NUM> comprises a tubular member having a proximal portion <NUM> and a distal portion <NUM>. The elongated shaft <NUM> comprises one or more channels or grooves <NUM> along its outer surface. The grooves <NUM> are configured to receive one or more wires or cables <NUM> therethrough. One or more cables <NUM> thus run along an outer surface of the elongated shaft <NUM>. In other embodiments, cables <NUM> can also run through the elongated shaft <NUM>. Manipulation of the one or more cables <NUM> (e.g., via an instrument driver) results in actuation of the end effector <NUM>.

The instrument handle <NUM>, which may also be referred to as an instrument base, may generally comprise an attachment interface <NUM> having one or more mechanical inputs <NUM>, e.g., receptacles, pulleys or spools, that are designed to be reciprocally mated with one or more torque couplers on an attachment surface of an instrument driver.

In some embodiments, the instrument <NUM> comprises a series of pulleys or cables that enable the elongated shaft <NUM> to translate relative to the handle <NUM>. In other words, the instrument <NUM> itself comprises an instrument-based insertion architecture that accommodates insertion of the instrument, thereby minimizing the reliance on a robot arm to provide insertion of the instrument <NUM>. In other embodiments, a robotic arm can be largely responsible for instrument insertion.

Any of the robotic systems described herein can include an input device or controller for manipulating an instrument attached to a robotic arm. In some embodiments, the controller can be coupled (e.g., communicatively, electronically, electrically, wirelessly and/or mechanically) with an instrument such that manipulation of the controller causes a corresponding manipulation of the instrument e.g., via master slave control.

<FIG> is a perspective view of an embodiment of a controller <NUM>. In the present embodiment, the controller <NUM> comprises a hybrid controller that can have both impedance and admittance control. In other embodiments, the controller <NUM> can utilize just impedance or passive control. In other embodiments, the controller <NUM> can utilize just admittance control. By being a hybrid controller, the controller <NUM> advantageously can have a lower perceived inertia while in use.

In the illustrated embodiment, the controller <NUM> is configured to allow manipulation of two medical instruments, and includes two handles <NUM>. Each of the handles <NUM> is connected to a gimbal <NUM>. Each gimbal <NUM> is connected to a positioning platform <NUM>.

As shown in <FIG>, each positioning platform <NUM> includes a SCARA arm (selective compliance assembly robot arm) <NUM> coupled to a column <NUM> by a prismatic joint <NUM>. The prismatic joints <NUM> are configured to translate along the column <NUM> (e.g., along rails <NUM>) to allow each of the handles <NUM> to be translated in the z-direction, providing a first degree of freedom. The SCARA arm <NUM> is configured to allow motion of the handle <NUM> in an x-y plane, providing two additional degrees of freedom.

In some embodiments, one or more load cells are positioned in the controller. For example, in some embodiments, a load cell (not shown) is positioned in the body of each of the gimbals <NUM>. By providing a load cell, portions of the controller <NUM> are capable of operating under admittance control, thereby advantageously reducing the perceived inertia of the controller while in use. In some embodiments, the positioning platform <NUM> is configured for admittance control, while the gimbal <NUM> is configured for impedance control. In other embodiments, the gimbal <NUM> is configured for admittance control, while the positioning platform <NUM> is configured for impedance control. Accordingly, for some embodiments, the translational or positional degrees of freedom of the positioning platform <NUM> can rely on admittance control, while the rotational degrees of freedom of the gimbal <NUM> rely on impedance control.

Traditional endoscopy may involve the use of fluoroscopy (e.g., as may be delivered through a C-arm) and other forms of radiation-based imaging modalities to provide endoluminal guidance to an operator physician. In contrast, the robotic systems contemplated by this disclosure can provide for non-radiation-based navigational and localization means to reduce physician exposure to radiation and reduce the amount of equipment within the operating room. As used herein, the term "localization" may refer to determining and/or monitoring the position of objects in a reference coordinate system. Technologies such as pre-operative mapping, computer vision, real-time EM tracking, and robot command data may be used individually or in combination to achieve a radiation-free operating environment. In other cases, where radiation-based imaging modalities are still used, the pre-operative mapping, computer vision, real-time EM tracking, and robot command data may be used individually or in combination to improve upon the information obtained solely through radiation-based imaging modalities.

<FIG> is a block diagram illustrating a localization system <NUM> that estimates a location of one or more elements of the robotic system, such as the location of the instrument, in accordance to an example embodiment. The localization system <NUM> may be a set of one or more computer devices configured to execute one or more instructions. The computer devices may be embodied by a processor (or processors) and computer-readable memory in one or more components discussed above. By way of example and not limitation, the computer devices may be in the tower <NUM> shown in <FIG>, the cart shown in <FIG>, the beds shown in <FIG>, etc..

As shown in <FIG>, the localization system <NUM> may include a localization module <NUM> that processes input data <NUM>-<NUM> to generate location data <NUM> for the distal tip of a medical instrument. The location data <NUM> may be data or logic that represents a location and/or orientation of the distal end of the instrument relative to a frame of reference. The frame of reference can be a frame of reference relative to the anatomy of the patient or to a known object, such as an EM field generator (see discussion below for the EM field generator).

The various input data <NUM>-<NUM> are now described in greater detail. Pre-operative mapping may be accomplished through the use of the collection of low dose CT scans. Pre-operative CT scans are reconstructed into three-dimensional images, which are visualized, e.g. as "slices" of a cutaway view of the patient's internal anatomy. When analyzed in the aggregate, image-based models for anatomical cavities, spaces and structures of the patient's anatomy, such as a patient lung network, may be generated. Techniques such as center-line geometry may be determined and approximated from the CT images to develop a three-dimensional volume of the patient's anatomy, referred to as model data <NUM> (also referred to as "preoperative model data" when generated using only preoperative CT scans). The use of center-line geometry is discussed in <CIT>. Network topological models may also be derived from the CT-images, and are particularly appropriate for bronchoscopy.

In some embodiments, the instrument may be equipped with a camera to provide vision data <NUM>. The localization module <NUM> may process the vision data to enable one or more vision-based location tracking. For example, the preoperative model data may be used in conjunction with the vision data <NUM> to enable computer vision-based tracking of the medical instrument (e.g., an endoscope or an instrument advance through a working channel of the endoscope). For example, using the preoperative model data <NUM>, the robotic system may generate a library of expected endoscopic images from the model based on the expected path of travel of the endoscope, each image linked to a location within the model. Intra-operatively, this library may be referenced by the robotic system in order to compare real-time images captured at the camera (e.g., a camera at a distal end of the endoscope) to those in the image library to assist localization.

Other computer vision-based tracking techniques use feature tracking to determine motion of the camera, and thus the endoscope. Some features of the localization module <NUM> may identify circular geometries in the preoperative model data <NUM> that correspond to anatomical lumens and track the change of those geometries to determine which anatomical lumen was selected, as well as the relative rotational and/or translational motion of the camera. Use of a topological map may further enhance vision-based algorithms or techniques.

Optical flow, another computer vision-based technique, may analyze the displacement and translation of image pixels in a video sequence in the vision data <NUM> to infer camera movement. Examples of optical flow techniques may include motion detection, object segmentation calculations, luminance, motion compensated encoding, stereo disparity measurement, etc. Through the comparison of multiple frames over multiple iterations, movement and location of the camera (and thus the endoscope) may be determined.

The localization module <NUM> may use real-time EM tracking to generate a real-time location of the endoscope in a global coordinate system that may be registered to the patient's anatomy, represented by the preoperative model. In EM tracking, an EM sensor (or tracker) comprising of one or more sensor coils embedded in one or more locations and orientations in a medical instrument (e.g., an endoscopic tool) measures the variation in the EM field created by one or more static EM field generators positioned at a known location. The location information detected by the EM sensors is stored as EM data <NUM>. The EM field generator (or transmitter), may be placed close to the patient to create a low intensity magnetic field that the embedded sensor may detect. The magnetic field induces small currents in the sensor coils of the EM sensor, which may be analyzed to determine the distance and angle between the EM sensor and the EM field generator. These distances and orientations may be intra-operatively "registered" to the patient anatomy (e.g., the preoperative model) in order to determine the geometric transformation that aligns a single location in the coordinate system with a position in the pre-operative model of the patient's anatomy. Once registered, an embedded EM tracker in one or more positions of the medical instrument (e.g., the distal tip of an endoscope) may provide real-time indications of the progression of the medical instrument through the patient's anatomy.

Robotic command and kinematics data <NUM> may also be used by the localization module <NUM> to provide localization data <NUM> for the robotic system. Device pitch and yaw resulting from articulation commands may be determined during pre-operative calibration. Intra-operatively, these calibration measurements may be used in combination with known insertion depth information to estimate the position of the instrument. Alternatively, these calculations may be analyzed in combination with EM, vision, and/or topological modeling to estimate the position of the medical instrument within the network.

As <FIG> shows, a number of other input data can be used by the localization module <NUM>. For example, although not shown in <FIG>, an instrument utilizing shape-sensing fiber can provide shape data that the localization module <NUM> can use to determine the location and shape of the instrument.

The localization module <NUM> may use the input data <NUM>-<NUM> in combination(s). In some cases, such a combination may use a probabilistic approach where the localization module <NUM> assigns a confidence weight to the location determined from each of the input data <NUM>-<NUM>. Thus, where the EM data may not be reliable (as may be the case where there is EM interference) the confidence of the location determined by the EM data <NUM> can be decrease and the localization module <NUM> may rely more heavily on the vision data <NUM> and/or the robotic command and kinematics data <NUM>.

As discussed above, the robotic systems discussed herein may be designed to incorporate a combination of one or more of the technologies above. The robotic system's computer-based control system, based in the tower, bed and/or cart, may store computer program instructions, for example, within a non-transitory computer-readable storage medium such as a persistent magnetic storage drive, solid state drive, or the like, that, upon execution, cause the system to receive and analyze sensor data and user commands, generate control signals throughout the system, and display the navigational and localization data, such as the position of the instrument within the global coordinate system, anatomical map, etc..

Embodiments of the present disclosure relate to cannulas that may be utilized to provide access for a surgical procedure. In accordance with embodiments described herein, a cannula may be configured as an elongate device having a passage through which a medical instrument can be introduced into a patient. The cannula may be configured to be installed at an incision or a natural orifice to facilitate safe passage of the medical instrument through the cannula to an internal anatomical site. In some embodiments, the cannula may be configured with a seal to form a trocar that maintains pressure or fluids within the targeted site while allowing the instrument to pass through the cannula.

With reference to <FIG>, an exemplary cannula <NUM> is shown. In the depicted example, the cannula <NUM> may displace or dissect soft tissue to allow the cannula <NUM> to be inserted into the patient cavity to provide access to a surgical site. Optionally, an obturator may be inserted through the cannula <NUM> during an initial insertion to provide a dilating or blunt tip that facilitates insertion of the cannula <NUM> through an incision or other opening on the patient. According to some embodiments, the cannula <NUM> is configured to provide access to a surgical site in the patient's abdomen for laparoscopic procedures. Additionally or alternatively, the cannula <NUM> can be configured to provide access to a site for urological, endoscopic, percutaneous, orthopedic, and/or or other medical or minimally invasive procedures in which a medical instrument is introduced to the site through the cannula <NUM>. In some applications, the cannula <NUM> provides access to a surgical site for robotic procedures performed by robotic systems described herein. Additionally or alternatively, the cannula <NUM> may be configured for use in manual procedures.

In the depicted example, a proximal portion of the cannula <NUM> is configured as a funnel portion <NUM>, which has a generally larger diameter than the cannula shaft <NUM>. The funnel portion <NUM> may transition to the smaller diameter cannula shaft <NUM> to facilitate insertion of tools from an opening at the proximal end of the cannula <NUM>. Optionally, the funnel portion <NUM> of the cannula can be utilized by clinicians or other users as a handle to advance the cannula <NUM> or to otherwise apply force to the cannula <NUM>. In some embodiments, the funnel portion <NUM> may form an attachment point that can be engaged by a robotic manipulator to manipulate movement of the cannula <NUM>. In some embodiments, the funnel portion <NUM> includes a removable or fixed seal that aids in sealing fluids, such as insufflation gas or liquids, within a patient cavity. A fluid port <NUM> (such as a stop cock or luer fitting) may be positioned at the funnel portion <NUM> of the cannula <NUM> to provide connection point through which fluids may flow through the cannula <NUM> and into or out of the patient.

As illustrated, cannula shaft <NUM> is configured as a tubular portion that extends distally from the funnel portion <NUM>. A lumen of the cannula shaft <NUM> provides a passage through which a shaft of an instrument may extend to access a surgical site. The cannula lumen can provide a working corridor or working channel through which tools can be inserted, manipulated, and/or removed along a longitudinal axis <NUM> of the cannula. Optionally, the movement of the cannula <NUM> and the tools can be manipulated or controlled by robotic systems described herein. In the illustrated embodiment, the cannula shaft <NUM> is configured as a straight tube that terminates at a beveled distal end <NUM>, but the cannula <NUM> and cannula shaft <NUM> may have a variety of configurations. For example, the cannula shaft <NUM> may be curved, bent, or angled, or the distal end of the cannula shaft <NUM> may be flat or have other geometries.

As seen in <FIG>, cannula <NUM> may include a series of ridges <NUM> arranged along an outer surface of the cannula shaft <NUM>. The ridges <NUM> may be configured to engage a tissue wall of the patient when the cannula is inserted into the patient, aiding in placement or stability of the cannula <NUM>. The ridges may include a series of peaks and valleys that are arranged axially along all or a portion of the cannula shaft <NUM>. As the cannula <NUM> is advanced distally or retracted proximally, the ridges may slide against the patient tissue wall and may provide tactile feedback to the clinician. Additionally or alternatively, the ridges <NUM> may serve to retain the cannula <NUM> at a desired insertion depth and stabilize the cannula <NUM> within the patient.

As seen in <FIG>, the cannula <NUM> may include a defined remote center of motion <NUM> at a location along the cannula shaft <NUM>. The remote center of motion <NUM> (also referred to herein as simply a "remote center" or "RCM") may correspond to a predetermined axial location along the cannula shaft <NUM> about which the cannula is pivoted by a robotic system when movement of the cannula is manipulated robotically. The remote center <NUM> may also indicate a desired insertion depth of the cannula <NUM>, where the cannula shaft <NUM> is designed to intersect with a body wall layer of the patient.

<FIG> depicts an exemplary system where a manipulator <NUM> of a robotic system is configured to manipulate cannula <NUM> and a medical instrument <NUM> inserted through the cannula <NUM>. The manipulator <NUM> may be coupled to a distal end of a robotic arm and may be configured in accordance with any of the manipulators or instrument drivers described herein (e.g., <NUM>, <NUM>, <NUM>, <NUM>). The medical instrument <NUM> may include an elongate instrument shaft <NUM> and may be configured in accordance with any of the medical instruments described herein (e.g., <NUM>, <NUM>, <NUM>, <NUM>).

Manipulator <NUM> may be configured to dock to medical devices, such as the cannula <NUM> and/or the medical instrument <NUM>, such that the manipulator may control movement of these devices. <FIG> illustrates various components of the system in an undocked configuration for purposes of illustration. As seen in <FIG>, manipulator <NUM> includes an instrument dock <NUM>, configured to attach to a base <NUM> of the medical instrument <NUM>, and a cannula dock <NUM>, configured to attach to the funnel portion <NUM> of the cannula <NUM>. In the illustrated embodiment, the instrument dock <NUM> is positioned on a first side of the manipulator <NUM> and the cannula dock <NUM> is positioned on a second side of the manipulator <NUM>. The manipulator <NUM> further includes a passage <NUM> to accommodate the shaft <NUM> of the medical instrument <NUM> and permit the shaft <NUM> of the medical instrument <NUM> to extend through the manipulator <NUM>.

Each of the docks <NUM>, <NUM> may include a suitable attachment mechanism (e.g., a latch) that facilitates docking and undocking of the respective device while securing the device to a body of the manipulator <NUM> when the device is in a docked configuration. In use, the cannula <NUM> may be inserted into a patient at a desired entry opening for the procedure. The manipulator <NUM> may then be moved to the position of the cannula <NUM>, and the cannula dock <NUM> may be attached to the cannula <NUM>. The instrument <NUM> may then be inserted through the cannula <NUM> and attached to the instrument dock <NUM>. When in a docked configuration, the instrument <NUM> and cannula <NUM> may be coaxially aligned along an insertion axis <NUM> such that the shaft <NUM> can extend through the passage <NUM> and the cannula <NUM>.

While <FIG> depicts a single manipulator docked to both the instrument <NUM> and the cannula <NUM>, it is possible for multiple robotic manipulators or arms to be employed such that movement of the cannula <NUM> and the instrument <NUM> are controlled by separate robotic manipulator or arms. Further, the manipulator <NUM> may be configured to attach to the instrument <NUM> and the cannula <NUM> directly, or the manipulator <NUM> may be configured to attach to the instrument <NUM> and the cannula <NUM> through an intervening sterile barrier.

<FIG> illustrates a front view of a cannula <NUM> inserted into a patient's tissue <NUM> to access the patient cavity. During operation, the cannula <NUM> can be pivoted to move the cannula <NUM> within the patient cavity to provide access to various areas within the patient cavity. In some applications, the pivot point, or remote center of motion <NUM> of the cannula <NUM> can be established by a robotic surgery system.

As can be appreciated, the robotic arm and/or surgical system can establish and maintain the position of the remote center of motion <NUM> for the instrument and/or for a cannula <NUM>. Depending on the implementation, the remote center of motion <NUM> can be maintained either mechanically or by software executed on one or more processors of the system. During a surgical procedure, the instrument may be inserted through the patient's body wall <NUM> to gain access to an internal region of the patient, via a cannula <NUM>. The remote center of motion RCM can be located at the intersection between the body wall or patient tissue <NUM> and the cannula <NUM>, and more particularly at, for example, an axial location along the cannula shaft predetermined to intersect a muscle layer (e.g., of the abdomen) of the body wall where excessive lateral stresses may be undesirable, in order to prevent and/or reduce movement of the body wall during the procedure, thereby enabling the surgical procedure to safely take place. For example, if the location of the intersection between the cannula <NUM> is not held substantially stationary during the pivoting motions of the cannula <NUM>, the cannula may apply unnecessary force to the body wall, potentially tearing the body wall. Thus, it is desirable to maintain the remote center of motion <NUM> to prevent unnecessary forces from being applied to the body wall or patient tissue <NUM>. Prior to operation, a clinician can advance the cannula <NUM> through the patient's tissue <NUM> such that the remote center of motion <NUM> is placed at a desired insertion depth, where the remote center intersects a desired layer of the patient's body wall and passes through the patient's tissue to minimize trauma as the cannula is pivoted about the remote center of motion <NUM>.

In some applications, a clinician may not have an indication of where the desired remote center of motion RCM of the cannula <NUM> is located during insertion or advancement of the cannula <NUM>.

<FIG> illustrates a front view of the cannula <NUM> moved out of alignment with the patient's tissue <NUM>. In some applications, the cannula <NUM> can move or slip relative to the patient tissue <NUM>, causing the remote center of motion to be moved out of alignment with the patient tissue <NUM>. In some embodiments, such movement of the cannula <NUM> can cause the cannula to be dislodged from the passage <NUM> formed through the patient's tissue <NUM>, requiring the cannula <NUM> to be reinserted through the patient's tissue <NUM>, requiring additional time and potentially causing additional trauma to the patient. In some applications, the cannula <NUM> can move relative to the patient tissue <NUM> due to movement of the robotic arm, inadvertent contact, or the positioning of the cannula <NUM>. As can be appreciated, laterally positioned cannulas <NUM> may be more likely to move relative to the patient tissue <NUM>.

With certain cannulas a clinician may not have an indication of where the desired remote center of motion is located. Further, with certain cannulas, the cannula may slip relative to the patient's tissue, displacing the cannula relative to the patient cavity. Accordingly, during some procedures, the remote center of motion may not be aligned with the patient's tissue, causing trauma as the cannula is moved. Further, in certain applications, the cannula may be inadvertently moved from the patient cavity, requiring reinsertion of the cannula, adding time and risking trauma to the patient.

Advantageously, embodiments disclosed herein can allow a clinician to identify the location of a desired remote center of motion. Further, in some embodiments, the cannulas can include features that facilitate retention of the cannulas in a desired position relative to the patient cavity, preventing the cannula from being displaced and allowing more control when adjusting the position of the cannula within the patient cavity. As can be appreciated, the configuration of the disclosed cannulas can reduce clinical errors, reduce procedure time, and simplify workflow.

<FIG> illustrates a front view of a cannula <NUM>. The cannula <NUM> can be configured in accordance with any of the cannulas described herein and can include any of the features described with respect to cannulas herein (e.g., cannula <NUM>). In the depicted example, the cannula <NUM> provides access to the patient cavity. In some applications, the cannula <NUM> provides access to a surgical site for robotic laparoscopic procedures performed by robotic systems described herein. Optionally, the movement of the cannula <NUM> and the tools can be manipulated or controlled by robotic systems described herein. In some embodiments, portions of the cannula <NUM> can be formed from plastic, metal, or other materials.

As illustrated, the cannula <NUM> includes a cannula shaft <NUM> extending from a proximal portion or funnel <NUM> of the cannula <NUM>. The shaft <NUM> defines a shaft lumen <NUM> therein that provides access between the end portion <NUM> and the funnel <NUM>. As described herein, the end portion <NUM> of the shaft <NUM> can be advanced into the patient cavity to allow access to the patient cavity via the funnel <NUM>. Optionally, the end portion <NUM> can include a beveled portion to displace tissue as the cannula <NUM> (or the trocar assembly generally) is advanced through the patient cavity. In some applications, an obturator can utilized to assist in advancing the cannula through the patient cavity. The obturator can extend through the cannula lumen.

<FIG> is a cross-sectional view of the cannula <NUM> of <FIG> inserted into a patient's tissue to access the patient cavity. With reference to <FIG> and <FIG>, the cannula <NUM> can include features to aid in the placement and stability of the cannula <NUM> with respect to the patient tissue <NUM> and with respect to the remote center of motion. In the depicted example, the cannula shaft <NUM> can include one or more ridges <NUM> disposed along the outer surface <NUM>. The ridges <NUM> can be configured to engage or grab onto the peritoneum, thereby preventing or reducing a tendency of the cannula <NUM> to inadvertently insert or retract during use.

The ridges <NUM> can be circumferentially formed in the outer surface <NUM> of the shaft <NUM>. The ridges <NUM> can form recessed portions along the outer surface <NUM> of the shaft <NUM>. The ridges <NUM> can be generally circular around the outer diameter of the cannula shaft to permit the shaft <NUM> to rotate relative to the patient cavity and the peritoneum <NUM> of the patient. In some applications, the ridges <NUM> can include smooth portions and/or textured portions. Optionally, the ridges <NUM> can be laser etched.

As can be appreciated, the geometry of the ridges <NUM> can affect the engagement of the ridges <NUM> with the peritoneum. The ridges <NUM> can be designed to permit cannula <NUM> insertion and removal with minimal patient trauma while providing intra-operative stability, allowing the cannulas <NUM> to remain in position during use. In some embodiments, the ridges <NUM> can include tapered edges to adjust the insertion and removal resistance of the cannula <NUM>. For example, the ridges <NUM> can allow for a cannula <NUM> to have a high removal resistance and a lower insertion resistance. For example, a ridge <NUM> can have a proximal edge 483b that has a straight or squared edge to increase the removal force of the cannula <NUM>. Further, a ridge <NUM> can have a distal edge 483a that is tapered to minimize the insertion force as the cannula <NUM> is advanced through the peritoneum <NUM>. In some embodiments, the radius or slope of the distal edge 483a of a ridge <NUM> is less than the radius or slope of the proximal edge 483b of the ridge <NUM>.

As illustrated, the cannula <NUM> can include multiple ridges <NUM> disposed along the outer surface <NUM>. Optionally, the ridges <NUM> can have varying depths and lengths. As illustrated, multiple ridges <NUM> can be grouped together along the outer surface <NUM> in segments <NUM>. Segments <NUM> of ridges are separated by a non-ridged segment <NUM> of the cannula shaft.

In some embodiments, the ridges <NUM> are disposed along the length of the cannula shaft <NUM> in groups or segments <NUM> of varying quantities. Optionally, the ridges <NUM> can be disposed along a portion or portions of the shaft <NUM>. The various portions or segments <NUM> of the ridges <NUM> can be spaced apart. The pitch or spacing between the ridges <NUM> and/or the segments <NUM> can be even or varied. Each segment <NUM> of ridges <NUM> can include ridges <NUM> of the same or similar geometry or ridges <NUM> of differing geometry. As described herein, the spacing and geometry of the ridges <NUM> can indicate particular portions of the cannula <NUM>, including, but not limited to, various remote center of motions identified for the cannula <NUM>.

In the depicted example, the cannula <NUM> allows for the remote center of motion to be identified by a clinician. In some embodiments, the ridges <NUM> described herein can be utilized as an identifier of the location of the remote center of motion RCM. In some embodiments, the ridges <NUM> or segments <NUM> of ridges can define a pattern to identify the location of the remote center of motion. In some embodiments, the geometry of the ridges <NUM> provides tactile feedback as the cannula <NUM> is positioned to align a remote center of mass RCM with the peritoneum <NUM> of the patient.

In <FIG>, non-ridged segment <NUM> is co-located with and axially overlaps with remote center <NUM>, such that the non-ridged segment <NUM> provides a visual and tactile indication of the location of the remote center <NUM>. Further, because ridged segments <NUM> are positioned proximal and distal to the location of the remote center <NUM>, the ridges <NUM> engage the tissue wall to facilitate retention of the cannula <NUM> with the remote center <NUM> at the desired insertion depth.

In some embodiments, the pattern of ridges may provide an indication of proximity to the remote center. For example, as seen in <FIG>, a segment <NUM> of ridges can be spaced apart from the defined remote center of motion <NUM> by a fixed distance, such that when the defined remote center of motion is at the proper insertion depth within the patient, the proximal (upper) end <NUM> of the segment <NUM> is visible outside of the patient, confirming proper insertion of the cannula <NUM>. Further, if the cannula <NUM> is inserted deeper than the proper insertion depth, such that the remote center of motion is misaligned, the proximal end of the segment <NUM> can be obscured within the patient.

As illustrated, an indicator or identifier <NUM> can be defined by the absence of ridges <NUM> or spacing between ridges <NUM> to define the location of a remote center of motion RCM. Optionally, the indicator can include a smooth segment between ridges <NUM> and/or a textured segment between ridges <NUM>. The textured segment of the indicator can be a different texture than the texture applied to the ridges <NUM>. Optionally, the axial length of the indicator portion is shorter than the axial length of one or more of the ridge segments <NUM>.

In some embodiments, the identifier <NUM> can include an optical or colored marking. Such markings may, for example, be formed by laser etched portions of the cannula shaft. Therefore, as the cannula <NUM> is positioned, the indicator can provide visual feedback to align the remote center of motion with the pivot point within the patient. Optionally, the indicator can axially overlap with ridges <NUM>.

Certain robotic systems can utilize multiple robotic arms (e.g., three arms on each side of a patient) to perform very complex medical procedures. The robotic arms can be designed to be optimized for a variety of different poses depending on the type of medical procedure to be performed. These poses can impose different optimization constraints on one or more of the robotic arms' remote center distances. Example optimization constraints may include variables such as the spacing between ports/cannulas, the extension of a robotic arm to reach a port/cannula, collision avoidance, pose optimization (e.g., for singularity avoidance, to improve natural frequency, to maximize workspace, etc.), and instrument reach. In order to accommodate these optimization constraints, the system can enable one or more of the robotic arms to have a variable remote center distance, even within a single treatment episode. Therefore, some embodiments are configurable to allow the cannula to pivot about multiple remote centers of motion, allowing a clinician to select a desired remote center of motion for the cannula. Advantageously, different remote centers of motion can be selected to adjust the access or reach of the cannula within the patient cavity. The use of software-based setting of different remote center distances can enable the system to, for example, move a robotic arm in a null-space DoF and/or increase a maximum distance the medical tool is able to be inserted into the patient.

<FIG> depicts an example where cannula <NUM> is configured with multiple remote center locations. Cannula <NUM> may otherwise be configured in accordance with any of the cannulas described herein. Here, cannula <NUM> includes a dual remote center configuration including a first defined remote center 410a and a second defined remote center 410b. The use of two discrete remote centers are predetermined axial locations can improve usability by reducing confusion during use, but in other arrangements, more than two remote centers may be defined along the cannula shaft. As seen in <FIG>, the system may be operated (e.g., intraoperatively) to switch between the first remote center 410a to the second remote center 410b to, for example, extend reach of the instrument <NUM>.

<FIG> is a front view of cannula <NUM>. The cannula <NUM> allows for each remote center of motion 410a, 410b to be identified by a clinician, permitting the clinician to confirm the desired remote center of motion is aligned within the patient.

In some embodiments, the ridges <NUM> described herein can be utilized as an identifier of the location of each remote center of motion. As can be appreciated, the cannula <NUM> can include or identify more than two remote centers of motion. In some embodiments, the ridges <NUM> or segments <NUM> of ridges can define a pattern to identify the location of each remote center of motion 410a, 410b. As can be appreciated, the upper segments 585d, 585c axially surrounding the upper remote center of motion 410b can define a similar pattern or a different pattern than the lower segments 585a, 585b surrounding the lower remote center of motion 410a. In some embodiments, the geometry of the ridges <NUM> provides tactile feedback as the cannula <NUM> is positioned to align a remote center of motion 410a, 410b with the peritoneum of the patient. The ridges <NUM> of each of the segments 585a, 585b, 585c, and 585d can include different depths, axial lengths, or other geometric features, or the ridges may be uniform in depth, length, geometry, etc.. Each of the segments 585a, 585b, 585c, and 585d can include different numbers of ridges <NUM> and/or ridge pitches, or the numbers and/or pitches of ridges may be the same. In some embodiments, the ridges <NUM> can provide different tactile feedback for the proximal (upper) remote center of motion 410b and the distal (lower) remote center of motion 410a,.

Optionally, the upper segments 585c, 585d can be spaced apart from the upper remote center of motion 410b by a fixed distance, such that when the defined remote center of motion 410b is at the proper insertion depth within the patient, the upper end of segment 585a is visible outside of the patient, confirming proper insertion of the cannula <NUM> at the upper remote center of motion 410b. Similarly, the lower segments 585a, 585b can be spaced apart from the lower remote center of motion 410a by a fixed distance, such that when the defined remote center of motion 410a is at the proper insertion depth within the patient, the upper end of segment 585b is visible outside of the patient, confirming proper insertion of the cannula <NUM> at the lower remote center of motion 410a. Further, if the cannula <NUM> is inserted deeper than the proper insertion depth for a respective remote center of motion, such that either remote center of motion 410a, 410b is misaligned, the upper end of the segment 585b, 585d can be obscured within the patient.

As illustrated, identifiers can be defined by the absence of ridges <NUM> at non-ridged segments 586a, 586b interposed between the lower segments 585a,585b and the upper segments 585c, 585d, respectively, indicating the axial location of remote centers of motion 410a, 410b. Optionally, the indicators can include a smooth segment or a textured segment between ridges of the lower segments 585a,585b and the upper segments 585c, 585d. The textured segment of the indicators can be a different texture than the texture applied to the ridges <NUM>. Optionally, the axial length of the indicator portion is shorter than the axial length of one or more of the ridge segments 585a, 585b, 585c, 585d.

In some embodiments, the cannula includes markings to indicate locations of multiple remote centers of motions. The markings may provide visual indicators (e.g., colored or shaded markings) that provide a visible indication of the location of multiple remote centers. In some embodiments, the markings may be distinguishable from each other such that the multiple remote centers may be discriminated from one another. Additionally or alternatively, the markings may indicate a priority for one of the remote centers of the other. As with the non-ridged indicators described above, the markings may be formed as circumferential indicators around the outer surface of the cannula shaft such that the indicators can be observed when the cannula is rolled about its longitudinal axis. In some embodiments, proximity markings are included proximal (above) or distal (below) the remote center indicators to indicate a proximity to the remote center location when the remote center indicator is obscured from view (for example, within the patient body wall). In some embodiments, the proximity markings may include directionality indications such that neighboring proximity marking scan be distinguished from one another and such that the correct remote center corresponding to the proximity marking can be identified.

<FIG> depict cannulas having multiple sets of markings indicative of multiple defined remote centers 410a, 410b, in accordance with various embodiments. The markings may be laser etched, cut into the outer surface, painted on, or otherwise formed on the surface of the cannula such that the markings are visible to a user. In the illustrated embodiments, the cannula shafts <NUM> are shown with smooth and non-ridged outer surfaces <NUM>, but in other embodiments, the markings may be integrated with ridges sections of the cannula such as those described above.

With reference to <FIG>, the cannula <NUM> includes a first remote center indicator 705a indicative of a first defined remote center 410a, and a second remote center indicator 705b indicative of a second defined remote center 410b. Each of the first and second remote center indicators is formed of a circumferential shaded marking that forms a visible indicator at the axial location corresponding to the respective remote center.

The cannula <NUM> further includes a first pair of proximity indicators 750a, 750b corresponding to the first remote center 410a, and a second pair of proximity indicators 760a, 760b corresponding to the second remote center 410b. Each proximity indicator is positioned a fixed and predetermined distance axially away from the corresponding remote center along the cannula shaft, such that the proximity indicator indicates proximity to corresponding remote center, and such that the proximity indicator can indicate a location of the corresponding remote center when the remote center is not otherwise visible. As seen in <FIG>, the first pair of proximity indicators 750a, 750b includes a first distal indicator 750a positioned distal to the first remote center 410a and a first proximal indicator 750b positioned proximal to the first remote center 410a. Similarly, the second pair of proximity indicators 760a, 760b includes a second distal indicator 760a positioned distal to the second remote center 410b (and proximal to the first remote center 410a), and a second proximal indicator 760b positioned proximal to the second remote center 410b. Each of the proximity indicators is also formed of a thinner circumferential band than the remote center indicators such that the proximity indicator markings can be discriminated from the remote center indicator markings.

With reference to <FIG>, cannula <NUM> may be similar to cannula <NUM> or any other cannula herein, but here, the first and second remote center indicators 805a and 805b are made of visually distinct markings such that the first remote center 410a or the second remote center 410b can be identified and discriminated from each other based on their appearance. In this example, each remote center indicator includes a series of horizontal (circumferential markings), wherein the first and second remote centers 805a, 805b have different numbers and/or thicknesses of bands to discriminate one from the other.

With reference to <FIG>, cannula <NUM> may be similar to cannula <NUM> or any other cannula herein, but here, the first and second remote center indicators 905a and 905b are made of vertical bands superimposed on circumferential bands, where different numbers or sizes of the vertical bands are used to discriminate one remote center indicator from the other.

With reference to <FIG>, cannula <NUM> may be similar to cannula <NUM> or any other cannula herein, but here, the first and second remote center indicators 1005a and 1005b include alphanumeric characters on circumferential bands, where different characters are used to discriminate one remote center indicator from the other. Here, the first remote center 410a is indicated with a first numeral ("<NUM>"), and the second remote center 410b is indicated with a second numeral ("<NUM>"), but other characters such as other numerals or letters may be used. In this example, the indicators also indicate a priority of the indicators. The first indicator 1006a indicates a primary remote center, which is located more distal along the shaft <NUM>, closer to the tip of the cannula, and which is intended to be used as the default remote center. The second indicator 1006b indicates a secondary remote center, which is located more proximal along the shaft and is intended to be used in special circumstances, such as when additional reach with an instrument is desired, as shown in <FIG>. The discriminations and indicators of priority may aid the user in understanding which remote center to use during placement or when switching between remote centers.

With reference to <FIG>, cannula <NUM> may be similar to cannula <NUM> or any other cannula herein, but here, each of the proximity indicators 1150a,b, 1160a,b further includes a directionality marking pointing in the axial direction of corresponding nearest remote center. Here, the directionality marking is configured as an arrow, but the directionality marking may be configured as any other marking depicting a preferential axial direction. For example, the directionality marking may include a set of one or more graded markings that gradually decreases or otherwise changes in density, size, or color, as the graded markings get closer to the remote center. The directionality can aid a user in understanding a direction of the remote center for the given proximity marking and discriminating between adjacent proximity markings (e.g., 1150b, 1160a).

Although embodiments are described herein with respect to cannulas, remote center and stability systems described herein may be applied to other medical devices. For example, any of the indicators or stability ridges disclosed herein may be applied to an elongate shaft of other medical devices besides cannulas, including, for example, medical instrument shafts and other access devices.

It should be noted that the terms "couple," "coupling," "coupled" or other variations of the word couple as used herein may indicate either an indirect connection or a direct connection. For example, if a first component is "coupled" to a second component, the first component may be either indirectly connected to the second component via another component or directly connected to the second component.

The method steps and/or actions do not form part of the claimed invention.

As used herein, the term "plurality" denotes two or more. For example, a plurality of components indicates two or more components.

Claim 1:
A robotic medical system comprising:
a cannula (<NUM>) having a first defined remote center of motion (410a) and a second defined remote center of motion (410b) spaced apart axially from the first defined remote center, wherein an outer surface (<NUM>) of the cannula comprises stability ridges (<NUM>) configured to engage a tissue wall of a patient;
an elongate medical instrument (<NUM>) configured to be inserted into the patient through the cannula;
a robotic arm (<NUM>, <NUM>) configured to manipulate the elongate medical instrument to perform a medical procedure; and
a controller (<NUM>) configured to control movement of the robotic arm while maintaining movement about the first defined remote center and to switch from maintaining movement about the first defined remote center to maintaining movement about the second defined remote center,
wherein a first segment (<NUM>) of the stability ridges is disposed on a first side of the first defined remote center and a second segment (<NUM>) of the stability ridges is disposed on a second side of the first defined remote center axially spaced apart from the first side of the first defined remote center, wherein the first segment of the stability ridges is separated from the second segment of the stability ridges by a non-ridged segment (<NUM>) of the cannula, wherein the first defined remote center is positioned at the non-ridged segment, and wherein a third segment (585c) of the stability ridges is disposed on a first side of the second defined remote center and a fourth segment (585d) of the stability ridges is disposed on a second side of the second defined remote center axially spaced apart from the first side of the second defined remote center.