Patent Description:
Minimally invasive telesurgical systems for use in surgery are being developed to increase a surgeon's dexterity as well as to allow a surgeon to operate on a patient from a remote location. Telesurgery is a general term for surgical systems in which the surgeon uses some form of remote control, e.g., a servomechanism, or the like, to manipulate surgical tool movements rather than directly holding and moving the tools by hand. In such a telesurgery system, the surgeon is provided with an image of the surgical site at the remote location. While viewing typically a stereoscopic image of the surgical site that provides the illusion of depth on a suitable viewer or display, the surgeon performs the surgical procedures on the patient by manipulating master control input devices, which in turn control the motion of corresponding teleoperated tools. The teleoperated surgical tools can be inserted through small, minimally invasive surgical apertures or natural orifices to treat tissues at surgical sites within the patient, often avoiding the trauma generally associated with accessing a surgical worksite by open surgery techniques. These computer-assisted tele-operated systems can move the working ends (end effectors) of the surgical tools with sufficient dexterity to perform quite intricate surgical tasks, often by pivoting shafts of the tools at the minimally invasive aperture, sliding of the shaft axially through the aperture, rotating of the shaft within the aperture, and the like.

<CIT> discloses a robotic surgical system including a master manipulator, slave robotic units having a surgical instrument for performing a Minimal Invasive Surgery (MIS), and a control system for electrically associating the master manipulator with the slave robotic units. The slave robotic unit includes the driving mechanisms which are more compact than those of the conventional MIS system. In use, the existing surgical instruments used in the conventional MIS procedure can be applied to the slave robotic unit. Moreover, by using the pivotal mechanism of the driving mechanisms, a pivot point of the surgical instrument is allowed to be shifted with respect to an incision of a patient. So, the patient's tissues surrounding the surgical instrument are not excessively affected by the surgical instrument during the procedure.

<CIT> discloses a single port surgical robot capable of setting the location of a remote center motion (RCM) point, and a control method thereof includes: a first link connected to a body by a first joint in a direction perpendicular to the body, the first link having a linear structure; a second link connected to the upper end of the first link by a second joint, the second link having a curved structure; a third link connected to the upper end of the second link by a third joint, the third link having a cylindrical structure; a plurality of light-emitting units arranged on the lower end of the third link along the circumference of the third link, and configured to emit light toward a remote center motion (RCM) point; and a controller configured to adjust the location of the RCM point.

<CIT> discloses a robot for laparoscopic surgery which is allowed to easily obtain images of a part doctors operate in various angles with use of an endoscope attached to a cancer having a remote center motion and prevents other surgical tools passing a cutting part from being contacted. In the present invention, the robot for laparoscopic surgery comprises an endoscope assembly to provide the images of the part doctors operate wherein the endoscope assembly has: a rail part which is formed along with some part of the circumference; an extending part which is seated and slides on the rail part and is extended along with some part of the circumference extended toward the upper part of the rail part; and an endoscope arm which an endoscope is mounted on, being connected to the extending part wherein the endoscope arm is vertical for the surface the rail part makes; for a straight line passing the center of the rail; and for the surface extending part makes wherein a straight line passing the center of the extending part passes a fixing contact point which is crossed with at a certain area and is accordingly formed.

<NPL>, discusses a single-port surgical robot. The robot can reach various surgical sites inside the abdominal cavity from a single incision on the body. It has two <NUM>-DOF surgical tools, a <NUM>-DOF endoscope, a flexible hyper-redundant <NUM>-DOF guide tube, and a <NUM>-DOF manipulator.

<CIT> discloses a manipulator for manipulating a surgical instrument relative to a patient's body and, a position sensor for sensing the position of the surgical instrument relative to the patient's body. The manipulator can be manually or computer actuated and can have brakes to limit movement. In a preferred embodiment, orthogonal only motion between members of the manipulator is provided. The position sensor includes beacons connected to the patient and manipulator or surgical instrument and, a three dimensional beacon sensor adapted to sense the location and position of the beacons. Redundant joint sensors on the manipulator may also be provided. The system and method uses a computer to actively interact with the surgeon and can use various different input and output devices and modes. <NPL>, discusses a new robotic uterine positioner for total laparoscopic hysterectomy. The robot is designed to actively position the patient's uterus during surgery.

<NPL> discusses a new remote center-of motion (RCM) mechanism. The remote center-of motion (RCM) mechanism can be used to hold surgical instruments instead of doctors, and then help doctors complete surgical operations (such as holding, stapling or resecting the patient's diseased tissue and organs).

<CIT> discloses a telescopic tilting device comprising a telescopic arm which is extendable and retractable along an arcuate path. Preferably, the telescopic arm includes two arcuate members, which are telescopically slidable relative to each other. More preferably, the device further comprises a drive unit having a flexible belt for moving the telescopic arm. There is also provided an endoscope holding device which has such a telescopic tilting device.

The following summary introduces certain aspects of the inventive subject matter in order to provide a basic understanding. This summary is not an extensive overview of the inventive subject matter, and it is not intended to identify key or critical elements or to delineate the scope of the inventive subject matter. Although this summary contains information that is relevant to various aspects and embodiments of the inventive subject matter, its sole purpose is to present some aspects and embodiments in a general form as a prelude to the more detailed description below. The invention is defined by the appended independent claim <NUM> and further embodiments are disclosed in the dependent claims. The methods mentioned in this description do not form part of the claimed subject-matter.

In one aspect, a teleoperated manipulator system includes a mounting base and an arm attached to the mounting base at a rotational joint. The arm rotates around a yaw axis with reference to the mounting base. A distal portion of the arm defines a pitch arc. A tool actuator assembly is mounted to a tool actuator assembly coupling that translates along the pitch arc. The tool actuation assembly is driven along the pitch arc to move around a center of the pitch arc that is coincident with the yaw axis. The tool actuation assembly inserts a tool along an insertion axis that intersects the yaw axis where the center of the pitch arc is coincident with the yaw axis.

In another aspect, the distal portion of the arm includes a fixed arcuate segment and a movable arcuate segment that telescopes with reference to the fixed arcuate segment. As the tool actuation assembly moves along the pitch arc, the tool actuation assembly coupling moves along the movable arcuate segment, and the movable arcuate segment moves along the fixed arcuate segment.

In further aspects, this disclosure provides devices and methods for minimally invasive robotic surgery using a computer-assisted teleoperated surgery system (a "telesurgical system"). For example, this disclosure provides manipulators for a telesurgical system. In some embodiments, each manipulator includes an arm that is rotatably coupled about a yaw axis to a mounting base that is attachable to a set-up structure. The arm defines an arcuate path along which a tool actuator assembly coupling travels. The tool actuator assembly coupling can receive a surgical tool actuation assembly pod, and it can drive a rotary roll motion of the pod about an insertion axis. In some embodiments, the insertion axis and the yaw axis intersect each other at a point that is coincident with the arcuate path's center point. In some embodiments, a motor-driven link is used to drive the tool actuator coupling along the arcuate path.

In one aspect, this disclosure is directed to a telesurgical manipulator that includes a mounting base configured to releasably couple with a set-up structure of a telesurgical system; an arm rotatably coupled to the mounting base about a yaw axis, the arm defining a pitch arc; an tool actuator assembly coupling defining an insertion axis and configured to releasably couple with a teleoperated tool actuator assembly, the tool actuator coupling translatable along the pitch arc; and a link pivotably coupled to the tool actuator coupling and movably coupled to the arm such that the link is translatable along the arm.

Such a telesurgical manipulator may optionally include one or more of the following features. The insertion axis and the yaw axis may intersect each other at a center of the pitch arc. In some embodiments, at all positions of the tool actuator coupling along the pitch arc, the insertion axis and the yaw axis intersect may each other at a center of the pitch arc. In particular embodiments, at all positions about the yaw axis of the arm relative to the mounting base, the insertion axis and the yaw axis may intersect each other at a center of the pitch arc. In some embodiments, at all positions of the tool actuator assembly coupling along the pitch arc in combination with any position about the yaw axis of the arm relative to the mounting base, the insertion axis and the yaw axis intersect each other at a center of the pitch arc. Translation of the link along the arm causes curvilinear translation of the tool actuator coupling along the pitch arc. The link may be threadably coupled to a lead screw of the arm such that the arm is linearly translatable along the arm by rotation of the lead screw. Translation of the link along the arm causes curvilinear translation of the tool actuator assembly coupling along the pitch arc. The arm may include a pitch-adjustment motor that drives rotation of the lead screw. The tool actuator assembly coupling may include a roll-adjustment motor for rotatably driving a surgical tool actuator assembly about the insertion axis. The tool actuator assembly coupling may be configured to releasably couple with a cannula configured for providing surgical access through a patient's body wall during surgery using the telesurgical manipulator. The arm may include a projection extending into an internal space defined by the mounting base. The projection may define the yaw axis. The mounting base may include a sector gear affixed in a stationary relationship to the mounting base. The arm may include a yaw-adjustment motor that rotatably drives a yaw-adjustment gear meshed with the sector gear. The arm may include a fixed arcuate segment and a movable arcuate segment that is movably coupled with the fixed arcuate segment. The first arcuate segment in combination with the movable arcuate segment may define the pitch arc.

In another aspect, this disclosure is directed to a telesurgical manipulator including: a mounting base; an arm rotatably coupled to the mounting base; a tool actuator assembly coupling movably coupled to the arm such that the tool actuator assembly coupling is translatable relative to the arm, the tool actuator coupling configured to releasably couple with a telesurgical tool actuator assembly; and a link movably coupled between the tool actuator assembly coupling and the arm.

Such a telesurgical manipulator device may optionally include one or more of the following features. The link may be pivotably coupled to the tool actuator assembly and threadably coupled to the arm. The tool actuator assembly coupling may be translatable along an arc defined by the arm. The arm may include a fixed arcuate segment and a movable arcuate segment that is movably coupled with the fixed arcuate segment. The first arcuate segment in combination with the movable arcuate segment may define the pitch arc. The arm may define an elongate opening in which the tool actuator coupling is translatable along a curvilinear path.

In another aspect, this disclosure is directed to a telesurgical system including: a set-up structure releasably coupleable with a frame; a manipulator device; and a telesurgical tool actuator assembly releasably coupleable with the tool actuator assembly coupling. The tool actuator assembly coupling includes a roll-adjustment motor for rotatably driving the surgical tool actuator assembly about the insertion axis. The manipulator device includes: a mounting base releasably coupleable with the set-up structure; an arm rotatably coupled to the mounting base; a tool actuator assembly coupling movably coupled to the arm such that the tool actuator assembly coupling is translatable relative to the arm, the tool actuator assembly coupling defining an insertion axis; and a link movably coupled between the tool actuator assembly coupling and the arm.

Such a telesurgical system may optionally include one or more of the following features. In some embodiments, an entirety of the tool actuator assembly is rotatably drivable by the roll-adjustment motor. A rotatable coupling between the arm and the mounting base defines a yaw axis. The arm defines a pitch arc along which the tool actuator assembly coupling translates. The insertion axis and the yaw axis intersect each other at a center of the pitch arc. The arm may include a fixed arcuate segment and a movable arcuate segment that is movably coupled with the fixed arcuate segment. The first arcuate segment in combination with the movable arcuate segment define the pitch arc.

Some or all of the embodiments described herein may provide one or more of the following advantages. In some cases, the teleoperated manipulator devices provided herein are advantageously structured to have a low profile, i.e., to be spatially-compact. Such a compact configuration is advantageous in that the working space occupied by the teleoperated surgical manipulators above a patient is minimized, allowing for enhanced patient access by surgical personnel. Additionally, greater visualization of the patient and communications between surgical team members is facilitated by the compact manipulator working space.

Further, lessening the size of the manipulator working space can reduce the potential for collisions between manipulators. As a result, the need for redundant degrees of freedom of the manipulators is reduced or eliminated. Hence, the complexity of the manipulators can be lessened in some cases.

The compact size of teleoperated surgical manipulators described herein can also advantageously facilitate mounting the manipulators to a rail of an operating table in some cases. In such a case, as the operating table is manipulated to enhance surgical access, the table-mounted manipulator devices inherently follow. Therefore, the need to reposition the manipulators in response to movements of the operating table is advantageously reduced or eliminated.

In addition, the teleoperated surgical manipulators described herein are advantageously structured to have a relatively low mass and inertia. In addition, the mass distribution is substantially constant such that the inertia is substantially constant, and therefore predictable.

This description and the accompanying drawings that illustrate inventive aspects, embodiments, implementations, or applications should not be taken as limiting-the claims define the protected invention. Various mechanical, compositional, structural, electrical, and operational changes may be made without departing from the scope of this description and the claims. In some instances, well-known circuits, structures, or techniques have not been shown or described in detail in order not to obscure the invention.

Further, specific words chosen to describe one or more embodiments and optional elements or features are not intended to limit the invention. For example, spatially relative terms-such as "beneath", "below", "lower", "above", "upper", "proximal", "distal", and the like-may be used to describe one element's or feature's relationship to another element or feature as illustrated in the figures. These spatially relative terms are intended to encompass different positions (i.e., translational placements) and orientations (i.e., rotational placements) of a device in use or operation in addition to the position and orientation shown in the figures. For example, if a device in the figures is turned over, elements described as "below" or "beneath" other elements or features would then be "above" or "over" the other elements or features. Thus, the exemplary term "below" can encompass both positions and orientations of above and below. A device may be otherwise oriented (e.g., rotated <NUM> degrees or at other orientations) and the spatially relative descriptors used herein interpreted accordingly. Likewise, descriptions of movement along (translation) and around (rotation) various axes includes various special device positions and orientations. The combination of a body's position and orientation define the body's pose.

Similarly, geometric terms, such as "parallel", "perpendicular", "round", or "square", are not intended to require absolute mathematical precision, unless the context indicates otherwise. Instead, such geometric terms allow for variations due to manufacturing or equivalent functions. For example, if an element is described as "round" or "generally round", a component that is not precisely circular (e.g., one that is slightly oblong or is a many-sided polygon) is still encompassed by this description. The words "including" or "having" mean including but not limited to.

It should be understood that although this description is made to be sufficiently clear, concise, and exact, scrupulous and exhaustive linguistic precision is not always possible or desirable, since the description should be kept to a reasonable length, and skilled readers will understand background and associated technology. For example, considering a video signal, a skilled reader will understand that an oscilloscope described as displaying the signal does not display the signal itself but a representation of the signal, and that a video monitor described as displaying the signal does not display the signal itself but video information the signal carries.

In addition, the singular forms "a", "an", and "the" are intended to include the plural forms as well, unless the context indicates otherwise. And, the terms "comprises", "includes", "has", and the like specify the presence of stated features, steps, operations, elements, and/or components but do not preclude the presence or addition of one or more other features, steps, operations, elements, components, and/or groups. And, the or each of the one or more individual listed items should be considered optional unless otherwise stated, so that various combinations of items are described without an exhaustive list of each possible combination. The auxiliary verb may likewise imply that a feature, step, operation, element, or component is optional.

Elements described in detail with reference to one embodiment, implementation, or application optionally may be included, whenever practical, in other embodiments, implementations, or applications in which they are not specifically shown or described. For example, if an element is described in detail with reference to one embodiment and is not described with reference to a second embodiment, the element may nevertheless be claimed as included in the second embodiment. Thus, to avoid unnecessary repetition in the following description, one or more elements shown and described in association with one embodiment, implementation, or application may be incorporated into other embodiments, implementations, or aspects unless specifically described otherwise, unless the one or more elements would make an embodiment or implementation non-functional, or unless two or more of the elements provide conflicting functions.

Elements described as coupled may be electrically or mechanically directly coupled, or they may be indirectly coupled via one or more intermediate components.

The term "flexible" in association with a part, such as a mechanical structure, component, or component assembly, should be broadly construed. In essence, the term means the part can be repeatedly bent and restored to an original shape without harm to the part. Many "rigid" objects have a slight inherent resilient "bendiness" due to material properties, although such objects are not considered "flexible" as the term is used herein. A flexible part may have infinite degrees of freedom (DOF's). Examples of such parts include closed, bendable tubes (made from, e.g., NITINOL, polymer, soft rubber, and the like), helical coil springs, etc. that can be bent into various simple or compound curves, often without significant cross-sectional deformation. Other flexible parts may approximate such an infinite-DOF part by using a series of closely spaced components that are similar to a snake-like arrangement of serial "vertebrae". In such a vertebral arrangement, each component is a short link in a kinematic chain, and movable mechanical constraints (e.g., pin hinge, cup and ball, live hinge, and the like) between each link may allow one (e.g., pitch) or two (e.g., pitch and yaw) DOF's of relative movement between the links. A short, flexible part may serve as, and be modeled as, a single mechanical constraint (joint) that provides one or more DOF's between two links in a kinematic chain, even though the flexible part itself may be a kinematic chain made of several coupled links. Knowledgeable persons will understand that a part's flexibility may be expressed in terms of its stiffness.

Unless otherwise stated in this description, a flexible part, such as a mechanical structure, component, or component assembly, may be either actively or passively flexible. An actively flexible part may be bent by using forces inherently associated with the part itself. For example, one or more tendons may be routed lengthwise along the part and offset from the part's longitudinal axis, so that tension on the one or more tendons causes the part or a portion of the part to bend. Other ways of actively bending an actively flexible part include, without limitation, the use of pneumatic or hydraulic power, gears, electroactive polymer (more generally, "artificial muscle"), and the like. A passively flexible part is bent by using a force external to the part (e.g., an applied mechanical or electromagnetic force). A passively flexible part may remain in its bent shape until bent again, or it may have an inherent characteristic that tends to restore the part to an original shape. An example of a passively flexible part with inherent stiffness is a plastic rod or a resilient rubber tube. An actively flexible part, when not actuated by its inherently associated forces, may be passively flexible. A single part may be made of one or more actively and passively flexible parts in series.

Inventive aspects are associated with computer-assisted teleoperated surgical systems. An example of a teleoperated surgical system is a da Vinci® Surgical System, commercialized by Intuitive Surgical, Inc. of Sunnyvale, California. Knowledgeable persons will understand that inventive aspects disclosed herein may be embodied and implemented in various ways, including completely computer-assisted and hybrid combinations of manual and computer-assisted embodiments and implementations. As applicable, inventive aspects may be embodied and implemented in both relatively smaller, hand-held, hand-operated devices and relatively larger systems that have additional mechanical support, as well as in other embodiments of computer-assisted teleoperated medical devices. In addition, inventive aspects are associated with advances in computer-assisted surgical systems that include autonomous rather than teleoperated actions, and so both teleoperated and autonomous surgical systems are included, even though the description concentrates on teleoperated systems.

A computer is a machine that follows programmed instructions to perform mathematical or logical functions on input information to produce processed output information. A computer includes a logic unit that performs the mathematical or logical functions, and memory that stores the programmed instructions, the input information, and the output information. The term "computer" and similar terms, such as "processor" or "controller" or "control system", encompasses both centralized single-location and distributed implementations.

This disclosure provides improved surgical and telesurgical devices, systems, and methods. The inventive concepts are particularly advantageous for use with telesurgical systems in which a plurality of surgical tools are mounted on and moved by an associated plurality of teleoperated manipulators during a surgical procedure. The teleoperated surgical systems will often comprise telerobotic, telesurgical, and/or telepresence systems that include one or more processors configured as master-slave controllers. By providing teleoperated surgical systems employing processors appropriately configured to move manipulator assemblies with articulated linkages having relatively large numbers of degrees of freedom, the motion of the linkages can be tailored for work through a minimally invasive access site. The large number of degrees of freedom may also allow a processor to position the manipulators to inhibit interference or collisions between these moving structures, and the like.

The manipulator assemblies described herein will often include a teleoperated manipulator and a tool mounted thereon (the tool often comprising a surgical instrument in surgical versions), although the term "manipulator assembly" will also encompass the manipulator without the tool mounted thereon. The term "tool" encompasses both general or industrial robotic tools and specialized robotic surgical instruments, with surgical instruments often including an end effector that is suitable for manipulation of tissue, treatment of tissue, imaging of tissue, or the like. The tool/manipulator interface will often be a quick disconnect tool holder or coupling, allowing rapid removal and replacement of the tool with an alternate tool. The manipulator assembly will often have a base that is fixed in space during at least a portion of a telesurgical procedure, and the manipulator assembly may include a number of degrees of freedom between the base and an end effector of the tool. Actuation of the end effector (such as opening or closing of the jaws of a gripping device, energizing an electrosurgical paddle, or the like) will often be separate from, and in addition to, these manipulator assembly degrees of freedom.

The end effector will typically move in the workspace with between two and six degrees of freedom. As used herein, the term "pose" encompasses both position and orientation. Hence, a change in a pose of an end effector (for example) may involve a translation of the end effector from a first position to a second position, a rotation of the end effector from a first orientation to a second orientation, or a combination of both. As used herein, the term "end effector" therefore includes but is not limited to the function of changing the orientation or position (e.g., a "wrist" function, a parallel motion function) of its distal-most part or parts (e.g., jaw(s) and the like).

When used for minimally invasive teleoperated surgery, movement of the manipulator assembly is controlled by a processor of the system so that a shaft or intermediate portion of the tool is constrained to a safe motion through a minimally invasive surgical access site or other aperture. Such motion may include, for example, axial insertion of the shaft along its long axis through the aperture site, rotation of the shaft about its long axis, and pivotal motion of the shaft about a pivot point (a remote center of motion) on its long axis that is adjacent the access site. But, such motion will often preclude excessive lateral motion of the shaft at the aperture site that might otherwise tear the tissues adjacent the aperture or enlarge the access site inadvertently. Some or all of such constraint on the manipulator motion at the access site may be imposed by using mechanical manipulator joint linkages that inhibit undesired motions (i.e., the hardware constrains motion at the remote center of motion), or the constraint may in part or in full by using robotic data processing and control techniques (i.e., software control constrains motion at the remote center of motion). Hence, such minimally invasive aperture-constrained motion of the manipulator assembly may employ between zero and three degrees of freedom of the manipulator assembly.

Many of the exemplary manipulator assemblies described herein will have more degrees of freedom than are needed to pose and move an end effector within a surgical site in Cartesian space (e.g., <NUM>, <NUM>, <NUM>, <NUM>, or more). For example, a manipulator assembly that can move a surgical end effector in six degrees of freedom in Cartesian space at an internal surgical site through a minimally invasive aperture optionally may have nine degrees of freedom (six end effector degrees of freedom-three for position, and three for orientation-plus three additional manipulator assembly degrees of freedom to comply with access site constraints, collision avoidance, etc.). Highly configurable manipulator assemblies having more degrees of freedom than are needed for a given end effector pose can be described as having or providing sufficient degrees of freedom to allow a range of joint states for an end effector pose in a workspace. For example, for a given end effector position, the manipulator assembly may occupy (and be driven between) any of a range of alternative manipulator linkage poses. Similarly, for a given end effector velocity vector, the manipulator assembly may have a range of differing joint movement speeds for the various joints of the manipulator assembly.

Referring to <FIG>, telesurgical systems optionally include a manipulating subsystem <NUM> (e.g., a patient-side unit) and a user control subsystem <NUM> (e.g., a surgeon control console) at which commands are entered to control tool motion in the manipulating subsystem <NUM>.

In the depicted embodiment, the manipulating subsystem <NUM> includes a base <NUM>, a first manipulator arm assembly <NUM>, a second manipulator arm assembly <NUM>, a third manipulator arm assembly <NUM>, and a fourth manipulator arm assembly <NUM>. As shown, the base <NUM> includes a portion that rests on the floor, a vertical column that extends vertically from the base, and a horizontal boom that extends from the top of the column. Other base configurations to mechanically ground the patient-side unit may optionally be used (e.g., ceiling-, wall-, table-mounted, etc.). Each manipulator arm assembly <NUM>, <NUM>, <NUM>, and <NUM> is pivotably coupled to the base <NUM>. In some embodiments, fewer than four or more than four robotic manipulator arm assemblies may be included as part of the manipulating subsystem <NUM>. While in the depicted embodiment the base <NUM> includes casters to allow ease of mobility, in some embodiments the manipulating subsystem <NUM> is fixedly mounted to a floor, ceiling, operating table, structural framework, or the like.

In a typical application, two of the manipulator arm assemblies <NUM>, <NUM>, <NUM>, or <NUM> each hold a surgical tool, and a third or the manipulator arm assemblies <NUM>, <NUM>, <NUM>, or <NUM> holds a stereoscopic endoscope. The remaining manipulator arm assembly is available so that another tool may be introduced at the work site. Alternatively, the remaining manipulator arm assembly may be used for introducing a second endoscope or another image capturing device, such as an ultrasound transducer, to the work site.

Each of the manipulator arm assemblies <NUM>, <NUM>, <NUM>, and <NUM> includes links that are coupled together and manipulated through actuatable (motorized) joints. Each of the manipulator arm assemblies <NUM>, <NUM>, <NUM>, and <NUM> includes a setup arm portion and a manipulator. The setup arm portion holds the manipulator to place the manipulator's remote center of motion where the tool enters the patient's body at an incision or natural orifice. The device manipulator may then manipulate its tool; so that it may be pivoted about the remote center of motion, inserted into and retracted out of the entry aperture, and rotated about its longitudinal shaft axis.

In the depicted embodiment, the user control subsystem <NUM> includes a stereo vision display <NUM> so that the user may view the surgical work site in stereoscopic vision from images captured by the stereoscopic camera of the manipulating subsystem <NUM>. Left and right eyepieces <NUM> and <NUM> are provided in the stereo vision display <NUM> so that the user may view left and right display screens inside the display <NUM> respectively with the user's left and right eyes. While viewing typically an image of the surgical site on a suitable viewer or display, the surgeon performs a surgical procedure on the patient by controlling one or more master input devices, which in turn control the motion of corresponding tools in the manipulating subsystem.

The user control subsystem <NUM> also includes left and right master input devices <NUM>, <NUM> that the user may grasp respectively with the left and right hands to manipulate tools held by the manipulator arm assemblies <NUM>, <NUM>, <NUM>, and <NUM> of the manipulating subsystem <NUM> in preferably six or more degrees-of-freedom ("DOF"). Foot pedals <NUM> are provided on the user control subsystem <NUM> so the user may control movement and/or actuation of devices associated with the foot pedals. Additional input to the system may be made via one or more other inputs, such as buttons, touch pads, voice, and the like, as illustrated by input <NUM>.

A processor <NUM> is provided in the user control subsystem <NUM> for control and other purposes. The processor <NUM> performs various functions in the telesurgical system. One function performed by processor <NUM> is to translate and transfer the mechanical motion of master input devices <NUM>, <NUM> to actuate their respective joints in their corresponding manipulator arm assemblies <NUM>, <NUM>, <NUM>, and <NUM> so that the user can effectively manipulate tools, such as the surgical tools and endoscopic camera. Another function of the processor <NUM> is to implement the methods, cross-coupling control logic, and controllers described herein.

Although described as a processor, it is to be appreciated that the processor <NUM> may be implemented by any combination of hardware, software, and firmware. Also, its functions as described herein may be performed by one unit or divided up among a number of subunits, each of which may be implemented in turn by any combination of hardware, software, and firmware. Further, although being shown as part of or being physically adjacent to the surgeon control unit <NUM>, the processor <NUM> may also be distributed as subunits throughout the telesurgery system. Accordingly, control aspects referred to herein are implemented via processor <NUM> in either a centralized or distributed form.

Referring to <FIG>, the robotic manipulator arm assemblies <NUM>, <NUM>, <NUM>, and <NUM> can manipulate tools such as surgical tools to perform minimally invasive surgery. For example, in the depicted arrangement the manipulator arm assembly <NUM> includes an tool holder assembly <NUM>. A cannula <NUM> and a surgical tool <NUM> and are, in turn, releasably coupled to the tool holder assembly <NUM>. The cannula <NUM> is a tubular member that is located at the patient interface site during a surgery. The cannula <NUM> defines a lumen in which an elongate shaft <NUM> of the surgical tool <NUM> is slidably disposed.

The tool holder assembly <NUM> includes a spar <NUM>, a cannula clamp <NUM>, and a tool carriage <NUM>. In the depicted embodiment, the cannula clamp <NUM> is fixed to a distal end of the spar <NUM>. The cannula clamp <NUM> can be actuated to couple with, or to uncouple from, the cannula <NUM>. The tool holder carriage <NUM> translates linearly along spar <NUM> to move a tool coupled to carriage <NUM> proximally (withdraw) or distally (insert). The movement of the tool holder carriage <NUM> along spar <NUM> is controlled by the processor <NUM>, in part while a master control input is controlling insertion and withdrawal movements of the tool. As shown, tool holder carriage <NUM> includes electric motors that drive mechanical inputs on tool <NUM> that control end effector and other component movements.

The surgical tool <NUM> includes a transmission assembly <NUM>, the elongate shaft <NUM>, and an end effector <NUM>. The transmission assembly <NUM> is releasably coupleable with the tool holder carriage <NUM>. The shaft <NUM> extends distally from the transmission assembly <NUM>. The end effector <NUM> is disposed at a distal end of the shaft <NUM>.

The shaft <NUM> defines a longitudinal axis <NUM> that is coincident with a longitudinal axis of the cannula <NUM>. As the tool holder carriage <NUM> translates along the spar <NUM>, the elongate shaft <NUM> of the surgical tool <NUM> is moved along the longitudinal axis <NUM>. In such a manner, the end effector <NUM> can be inserted and/or retracted from a surgical workspace within the body of a patient.

Also referring to <FIG>, another example manipulating subsystem <NUM> for telesurgery includes a first manipulator arm assembly <NUM> and a second robotic manipulator arm assembly <NUM> that are each mounted to an operating table <NUM>. In some cases, this configuration of manipulating system <NUM> can be used as an alternative to the manipulating subsystem <NUM> of <FIG>. While only two manipulator arm assemblies <NUM> and <NUM> are depicted, it should be understood that one, or more than two (e.g., three, four, five, six, and more than six) manipulator arm assemblies can be included in some configurations.

In some cases, the operating table <NUM> may be moved or reconfigured during surgery. For example, in some cases, the operating table <NUM> may be tilted about various axes, raised, lowered, pivoted, rotated, and the like. In some cases, by manipulating the orientation of the operating table <NUM>, a clinician can utilize the effects of gravity to position internal organs of the patient in positions that facilitate enhanced surgical access (i.e., gravity retraction). In some cases, such movements of the operating table <NUM> may be integrated as a part of the telesurgical system and controlled by the system.

Also referring to <FIG>, a variety of alternative telesurgical tools of different types and differing end effectors <NUM> may be used, with the tools of at least some of the manipulators being removed and replaced with another tool during a surgical procedure. As the manipulator moves, the tool moves as a whole. The manipulator optionally also provides mechanical input to the tool in order to move one or more tool components, such as an end effector. Optionally, a tool may include one or more motors that move an associated one or more tool components. And so, some DOFs are associated with moving the tool as a whole (e.g., tool pitch or yaw about the remote center of motion, tool insertion and withdrawal through the remote center of motion), and some DOFs are associated with moving a tool component (e.g., rolling the end effector by rolling the shaft, end effector pitch or yaw with respect to the shaft, etc.). A tool's end effector is moved by both these types of DOFs, often working in concert to perform the desired end effector pose change in space. It can be seen that the manipulator arm assemblies <NUM>, <NUM>, <NUM>, and <NUM> will often undergo significant movement outside patient during a surgical procedure in order to move a corresponding tool end effector as commanded by the corresponding master input device.

End effectors may include first and second end effector elements 56a, 56b which pivot relative to each other so as to define a pair of end effector jaws, for example DeBakey Forceps 56i, microforceps 56ii, and Potts scissors 56iii. Other end effectors may have a single end effector element, for example scalpels and electrocautery elements. For tools having end effector jaws, the jaws will often be actuated by squeezing grip members on master input devices <NUM>, <NUM>. Other end effector mechanical DOFs may include functions such as staple application, clip application, knife blade movement, and the like.

Referring to <FIG>, an example telesurgical system <NUM> includes a surgical tool <NUM>, a surgical tool actuator assembly <NUM> (also referred to herein as a "pod"), and a manipulator assembly <NUM>. Pod <NUM> is compatible with tool <NUM>, and tool <NUM> is removably coupled to Pod <NUM>. Pod <NUM> is coupled to manipulator assembly <NUM>. In some embodiments, the pod <NUM> is readily detachable from the manipulator assembly <NUM> such that the pod <NUM> can be conveniently interchanged with another pod. The manipulator assembly <NUM> can be adjustably mounted to a frame or a structure (such as the set-up structure <NUM> of <FIG>). Manipulator assembly <NUM> and pod <NUM> together form a manipulator.

When surgical tool <NUM> is coupled with pod <NUM>, a shaft <NUM> of the surgical tool <NUM> slidably extends through a cannula <NUM> that is releasably coupled to the manipulator assembly <NUM>. In use, the cannula <NUM> can extend through a patient's body wall or natural orifice. Surgical tool <NUM> includes an end effector <NUM> that is controlled by the user operating a master input device to perform telesurgery.

Pod <NUM> defines a space configured to receive surgical tool <NUM>. When the surgical tool <NUM> is coupled pod <NUM>, pod <NUM> can actuate movements of the surgical tool <NUM> as a whole and movements of the end effector <NUM> with reference to the main body of the tool. For example, the pod <NUM> can actuate translational movements of the surgical tool along the longitudinal axis <NUM> of the pod <NUM> to insert or withdraw the end effector. Hence, the longitudinal axis <NUM> may also be referred to as the insertion axis <NUM>, which is coincident with tool <NUM>'s long axis.

The manipulator assembly <NUM> includes a mounting base <NUM>, an arm <NUM>, a tool actuator assembly coupling <NUM> (a "pod coupling"), and a drive link <NUM>. The mounting base <NUM> is configured to releasably couple with a set-up structure of a telesurgical system (such as the set-up structure <NUM> of <FIG>). The arm <NUM> is rotatably coupled to the mounting base <NUM> to rotate about axis <NUM>.

Pod coupling <NUM> is configured to releasably couple with pod <NUM>, and it is movably coupled with the arm <NUM> such that pod coupling <NUM> is translatable along an arcuate path defined by the arm <NUM> (a "pitch arc"). As shown, the pitch arc <NUM> is defined in a distal portion of arm <NUM>.

The drive link <NUM> is movably coupled between the arm <NUM> and the pod coupling <NUM>. A first end of the link <NUM> is coupled to an actuator of the arm <NUM>. A second end of the link <NUM> is coupled to the pod coupling <NUM>. Hence, an actuator in arm <NUM> drives pod coupling <NUM> along the pitch arc <NUM> via drive link <NUM>.

The telesurgical system <NUM> is configured to actuate pitch, roll, and yaw motions of the surgical tool <NUM> in response to input (e.g., user input using the control subsystem <NUM> as described in reference to <FIG>). For example, the arm <NUM> is rotatably coupled to the mounting base <NUM> such that the arm <NUM> can be controlled to rotate about yaw axis <NUM> in relation to mounting base <NUM>, as indicated by arrows <NUM>. In addition, the tool actuator assembly coupling <NUM> is movably coupled to the arm <NUM> such that the tool actuator assembly coupling <NUM> can be controlled to translate along pitch arc <NUM> as indicated by arrows <NUM>. Further, at pod coupling <NUM>, pod <NUM> is rotatable about insertion axis <NUM> in relation to the arm <NUM>, as indicated by arrows <NUM>. As shown, in some embodiments pod coupling <NUM> includes a motor <NUM> that drives pod <NUM> rotation about axis <NUM>.

In some embodiments (such as the depicted embodiment), the insertion axis <NUM> and the yaw axis <NUM> intersect each other at a center point of the pitch arc <NUM> to define a remote center of motion <NUM>. The remote center of motion <NUM> is a point in space around which the roll, pitch, and yaw motions described above are made. For example, as the arm <NUM> is rotated in relation to the mounting base <NUM> to generate a yaw motion of the surgical tool <NUM>, the position of the remote center of motion <NUM> is unchanged because the yaw axis <NUM> passes through the remote center of motion <NUM>. In addition, as the pod coupling <NUM> is translated in relation to the arm <NUM> along the pitch arc <NUM> to generate a pitch motion of the surgical tool <NUM>, the position of the remote center of motion <NUM> is unchanged because the center point of the pitch arc <NUM> is located at the remote center of motion <NUM>. Further, as the pod <NUM> is rotated in relation to the arm <NUM> about the insertion axis <NUM> to generate a roll motion of the surgical tool <NUM>, the position of the remote center of motion <NUM> is unchanged because the insertion axis <NUM> passes through the remote center of motion <NUM>. Hence, it can be said that telesurgical system <NUM> is a hardware-constrained remote center of motion system.

In use, the remote center of motion <NUM> (which is typically at a location coincident with a region of the cannula <NUM>) may be positioned at the patient's body wall or natural orifice. One advantage of such an arrangement is that while the surgical tool <NUM> undergoes roll, pitch, and yaw motions, the resulting trauma applied to the body wall by the cannula <NUM> is reduced or eliminated because the portion of the cannula <NUM> (at the remote center of motion <NUM>) that interfaces with the body wall moves a relatively small amount while the surgical tool <NUM> undergoes the roll, pitch, and yaw motions.

Further, in regard to the hardware-constrained remote center of motion, it should be understood that at all pod <NUM> positions along pitch arc <NUM>, the insertion axis <NUM> and the yaw axis <NUM> intersect each other at the center of the pitch arc where the remote center of motion <NUM> is located. In addition, at all positions about the yaw axis <NUM> of the arm <NUM> relative to the mounting base <NUM>, the insertion axis <NUM> and the yaw axis <NUM> intersect each other at the center of the pitch arc where the remote center of motion <NUM> is located. Further, at all positions of the pod coupling <NUM> along the pitch arc <NUM> in combination with any position about the yaw axis <NUM> of the arm <NUM> relative to the mounting base <NUM>, the insertion axis <NUM> and the yaw axis <NUM> intersect each other at a center of the pitch arc where the remote center of motion <NUM> is located.

Referring also to <FIG>, pod <NUM> is shown in isolation from the surgical tool <NUM> and the manipulator assembly <NUM>. Pod <NUM> includes a proximal end <NUM> and a distal end <NUM>, and the longitudinal axis <NUM> is defined between these proximal and distal ends.

In the depicted embodiment, the pod <NUM> includes a proximal end plate <NUM>, a distal end plate <NUM>, and a housing <NUM>. The housing <NUM> extends between the proximal end <NUM> and the distal end <NUM>.

In the depicted embodiment, the proximal end plate <NUM> is a C-shaped plate, and the distal end plate <NUM> is a fully circumferential plate that defines an open center. The opening in the proximal end plate <NUM> aligns with a slot opening <NUM> defined by the housing <NUM>. The slot opening <NUM> and the opening in the C-shaped proximal end plate <NUM> provide clearance for a handle <NUM> of the surgical tool <NUM> to project radially from the housing <NUM> while the surgical tool <NUM> is coupled with the tool drive system <NUM>.

In the depicted embodiment, pod <NUM> also includes a roll driven gear <NUM> located at the distal end <NUM>. The pod's roll driven gear <NUM> can mesh with and be driven by a roll drive gear <NUM> (refer to <FIG>, <FIG>, and <FIG>) coupled to a roll drive motor <NUM> of the pod coupling <NUM> when the pod <NUM> is coupled with the manipulator assembly <NUM>. When the roll drive gear <NUM> drives the roll driven gear <NUM>, the entire pod <NUM> rotates to roll about the longitudinal axis <NUM>. As a result, when the surgical tool <NUM> is engaged with the pod <NUM>, the surgical tool <NUM> as a whole also rotates to rolls about the longitudinal axis <NUM> (i.e., about shaft <NUM>). Alternatively, in some embodiments, a roll drive motor (to which a roll drive gear is coupled) is a component of the pod <NUM>, and a roll driven gear is a component of the pod coupling <NUM>. The roll driven gear can be fixed to the pod coupling <NUM> in some embodiments. In such an arrangement, when the roll driven gear is driven by the roll drive motor, the entire pod <NUM> rotates to rolls about the longitudinal axis <NUM>. Rotating the tool as a whole rotates the tool's end effector, and so the tool may be simplified by eliminating an end effector DOF for roll with reference to the main body of the tool.

Referring also to <FIG>, <FIG>, and <FIG>, the example manipulator assembly <NUM> is shown in isolation from the surgical tool <NUM> and the pod <NUM>. In the example embodiment, it can be seen that the proximal end of mounting base <NUM> includes a ball configured to releasably couple with a corresponding socket in a set-up structure of a telesurgical system (such as the set-up structure <NUM> of <FIG>). The ball and socket form a spherical joint that advantageously allows the mounting base to be posed in various ways to align with a cannula for surgery. In other embodiments, other joint configurations may be used between the manipulator and the setup portion of the arm.

In the depicted embodiment, the pod coupling <NUM> includes roll drive motor <NUM> that drives pod <NUM> to rotate about insertion axis <NUM>. An open interior space is defined in pod coupling <NUM>. This open space receives pod <NUM>'s distal end portion <NUM> and is aligned with insertion axis <NUM> when pod <NUM> is mounted on pod coupling <NUM>. Inserting pod <NUM>'s distal end portion <NUM> engages the pod with roll drive motor <NUM>, which may then drive pod <NUM> to roll about insertion axis <NUM>. Details of roll drive motor <NUM> placement are discussed further below.

The link <NUM> is movably coupled between the arm <NUM> and the pod coupling <NUM>. A first end of the link <NUM> is coupled to an actuator (e.g., a linear actuator) of the arm <NUM>. A second end of the link <NUM> is coupled to the pod coupling <NUM>. Hence, the pod coupling <NUM> is driven along the curvilinear path of the pitch arc <NUM> by the link <NUM> that is driven by an actuator of the arm <NUM>. Various linear actuator types may be used, including motors that drive lead or ball screws with threaded nuts that translate as the screw turns, chain or belt drives, hydraulic or pneumatic actuators, electromagnetic or piezo electric linear drives, and the like.

Referring also to <FIG>, <FIG>, and <FIG>, portions of the example manipulator assembly <NUM> are shown transparently so internal components of the manipulator assembly <NUM> can be visualized.

First, the mechanisms used for yaw motions of the manipulator assembly <NUM> will be described. The arm <NUM> includes a cylindrical projection <NUM> that extends into an internal space defined by the mounting base <NUM> and forms a roll joint between the arm and the mounting base. Spaced-apart yaw bearings 824a and 824b are disposed between the projection <NUM> and the internal space defined by the mounting base <NUM> to provide for the rotatable interface between base <NUM> and arm <NUM>. The longitudinal axis of the cylindrical projection <NUM> defines the yaw axis <NUM>. A yaw-adjustment motor <NUM> is disposed within the arm <NUM>, with an axis of rotation parallel to and offset from yaw axis <NUM>. A yaw drive gear <NUM> is driven by the yaw-adjustment motor <NUM>. The yaw drive gear <NUM> is meshed with a yaw driven gear <NUM> that is affixed in a stationary relationship to the mounting base <NUM> and around yaw axis <NUM>. In the depicted embodiment, the yaw driven gear <NUM> is a sector gear (e.g., an arcuate gear rack) sufficient to accommodate the desired yaw range of motion. While the mounting base <NUM> is held stationary by a set-up structure, actuation of the yaw-adjustment motor <NUM> will rotate the yaw drive gear <NUM>, which will then travel along a circular path around the yaw driven gear <NUM> (i.e., around yaw axis <NUM>). As a result, the arm <NUM> will rotate about the yaw axis <NUM> in relation to the mounting base <NUM>. Optionally, however, a projection may extend from base <NUM> into arm <NUM>, and the components described above modified accordingly. And, optionally the motor and drive gear may be stationary in base <NUM> and drive arm <NUM> to rotate.

Now the mechanisms used for pitch motions of the manipulator assembly <NUM> will be described. The arm <NUM> includes a pitch-adjustment motor <NUM>. In the depicted embodiment, two pitch-adjustment motors <NUM> are ganged together for greater torque, but two motors are not required in all embodiments. In some embodiments, a single pitch-adjustment motor <NUM> is included. A pitch drive gear <NUM> coupled to the shaft of the pitch-adjustment motor <NUM> is rotated by the pitch-adjustment motor <NUM>. A pitch driven gear <NUM> is driven by the pitch drive gear <NUM>. In some embodiments, one or more intermediate gears may be positioned between the pitch drive gear <NUM> and the pitch driven gear <NUM>. The pitch driven gear <NUM> is affixed to a lead screw <NUM> that is rotatably coupled within the arm <NUM>. Thus, the lead screw <NUM> is rotated about its longitudinal axis as the pitch driven gear <NUM> is rotated by the pitch drive gear <NUM> (which is rotated by the pitch-adjustment motor <NUM>). A nut <NUM> is threadably coupled with the lead screw <NUM>. The nut <NUM> is restrained from rotating along with the lead screw <NUM> as the lead screw <NUM> is rotating. Therefore, as the lead screw <NUM> rotates, the nut <NUM> translates along the longitudinal axis of the lead screw <NUM>. A first end <NUM> of the link <NUM> is pivotably coupled to the nut <NUM>. A second end <NUM> of the link <NUM> is pivotably coupled to the pod coupling <NUM>. Hence, as the nut <NUM> translates along the longitudinal axis of the lead screw <NUM>, the second end <NUM> of the link <NUM> drives translation of the pod coupling <NUM>. Translations of the pod coupling <NUM> follow the curvilinear path of the pitch arc <NUM>. That is the case because the pod coupling <NUM> includes four bearings <NUM> that travel within arcuate grooves <NUM> defined within the arm <NUM>. The arcuate grooves <NUM> define the pitch arc <NUM>. Other embodiments optionally use other pitch arc designs, such as a single arcuate groove with one or more bearings, one or more arcuate rails with bearings on either side, one or more parallel arcuate rails with individual bearings inside each rail, one or more arcuate gear racks with mating pinions, one or more arcuate rods with one or more bearings sliding on the rod, and the like. And, other linear actuator types may be used, as described above.

Referring to <FIG> and <FIG>, yaw motions (as represented by arrow <NUM>) of the example manipulator device <NUM> can be further visualized. The mounting base <NUM> is stationary (e.g., coupled to a set-up structure), and the arm <NUM> is rotatable about the yaw axis <NUM> in relation to the mounding base <NUM>.

The arm <NUM> includes the yaw-adjustment motor <NUM>. The yaw drive gear <NUM> is rigidly coupled to the shaft of the yaw-adjustment motor <NUM>. Hence, actuation of the yaw-adjustment motor <NUM> will rotate the yaw drive gear <NUM>. The yaw-adjustment motor <NUM> can rotate bi-directionally.

The yaw drive gear <NUM> is meshed with the yaw driven gear <NUM> that is affixed in a stationary relationship to the mounting base <NUM> around the yaw axis <NUM>. Since the mounting base <NUM> is held stationary by a set-up structure, actuation of the yaw-adjustment motor <NUM> (which rotates the yaw drive gear <NUM>) will cause the yaw drive gear <NUM> to travel along a circular path around the yaw driven gear <NUM>. In result, the arm <NUM> will rotate in relation to the mounting base <NUM> about the yaw axis <NUM>.

In the depicted embodiment, the manipulator device <NUM> can rotatably adjust through a range of about <NUM>° of yaw motion. That is, the arm <NUM> can rotate in relation to the mounting base <NUM> about the yaw axis <NUM> through about <NUM>° of travel. In some embodiments, the manipulator device <NUM> is configured to facilitate a range of yaw motion of about <NUM>° to about <NUM>°, about <NUM>° to about <NUM>°, about <NUM>° to about <NUM>°, about <NUM>° to about <NUM>°, about <NUM>° to about <NUM>°, or about <NUM>° to about <NUM>°. Yaw range of motion may be constrained by hardware (e.g., the end of an arcuate rack, a physical hard stop between base and arm, and the like) or may be constrained by software control of motor <NUM>.

Placing the manipulator assembly yaw and pitch actuator motors in arm <NUM> advantageously allows base <NUM> to be relatively short, allows the pitch drive to be folded back on itself, and allows the yaw drive to occupy the same length as the pitch drive for an overall compact arm and manipulator assembly design.

Referring to <FIG>, pitch motions (as represented by arrow <NUM>) of the example manipulator assembly <NUM> can be further visualized. The pitch motions of the manipulator assembly <NUM> entail curvilinear translational movements of the pod coupling <NUM> along the pitch arc <NUM> as indicated by arrow <NUM>.

The arm includes one or more pitch-adjustment motors <NUM> which bi-directionally, rotatably drive the leadscrew <NUM>. The nut <NUM> is threadably coupled to the leadscrew <NUM> and is rotationally constrained such that rotations of the leadscrew <NUM> result in translational movements of the nut <NUM>. The first end <NUM> of the link <NUM> is pivotably coupled to the nut <NUM>. The second end <NUM> of the link <NUM> is pivotably coupled to the pod coupling <NUM>. Hence, as the nut <NUM> translates along the longitudinal axis of the lead screw <NUM>, the second end <NUM> of the link <NUM> drives translation of the pod coupling <NUM>. Translations of the pod coupling <NUM> follow the curvilinear path of the pitch arc <NUM> because the pod coupling <NUM> includes four bearings <NUM> that travel within the arcuate grooves <NUM> (<FIG> and <FIG>) defined within the arm <NUM>. The arcuate grooves <NUM> define the pitch arc <NUM>. The four bearings <NUM> are advantageously spaced apart from each other so as to provide structural stability and rigidity of the pod coupling <NUM> in relation to the arm <NUM>.

Forces from the surgical tool <NUM> and/or cannula <NUM> (<FIG>) that are generally parallel with the insertion axis <NUM> are transferred to the arm <NUM> via the four spaced-apart bearings <NUM> that travel within arcuate grooves <NUM> defined within the arm <NUM>. Forces from the surgical tool <NUM> and/or cannula <NUM> that are transverse to the insertion axis <NUM>, and torsional forces from the surgical tool <NUM> and/or cannula <NUM>, are transferred to the arm <NUM> via multiple bearings <NUM>. The bearings <NUM> are rotatably coupled to the pod coupling <NUM> and roll on inner planar surfaces of the arm <NUM>. In the depicted embodiment, eight bearings <NUM> are included (four on each side of the pod coupling <NUM> that rides within the distal arcuate portion of the arm <NUM>). These eight bearings <NUM> are spaced apart from each other to advantageously provide structural stability and rigidity of the pod coupling <NUM> in relation to the arm <NUM>. In some embodiments, more or fewer than eight bearings <NUM> are included. For example, in some embodiments two, three, four, five, six, seven, nine, ten, eleven, twelve, or more than twelve bearings <NUM> are included.

The center point of the radius <NUM> of the pitch arc <NUM> is coincident with the remote center of motion <NUM>. Hence, pitch motions of the manipulator device <NUM> are made about the remote center of motion <NUM> because the center point of the radius <NUM> of the pitch arc <NUM> is coincident with the remote center of motion <NUM>.

In the depicted embodiment, the manipulator device <NUM> can adjust through a range of about <NUM>° of pitch motion. That is, the pod coupling <NUM> can translate in relation to the arm <NUM> along the pitch arc <NUM> through about <NUM>° of travel. In some embodiments, the manipulator device <NUM> is configured to facilitate a range of pitch motion of about <NUM>° to about <NUM>°, about <NUM>° to about <NUM>°, about <NUM>° to about <NUM>°, about <NUM>° to about <NUM>°, about <NUM>° to about <NUM>°, or about <NUM>° to about <NUM>°. Range of motion may be constrained by physical hard stop, such as reaching the end of an arcuate groove or a dedicated mechanical stop, or it may be constrained by software control of the motor.

The range of pitch motion of the manipulator device <NUM> is advantageously facilitated in part by the configuration of the link <NUM>. That is, the second end <NUM> of the link <NUM> is forked to provide clearance for the roll-adjustment motor <NUM> to travel within the space between the forks while the pod coupling <NUM> is positioned in relation to the arm <NUM> as shown in <FIG>, <FIG>, and <FIG>. Placing the roll drive motor <NUM> proximally on the pod coupling <NUM> prevents the motor from projecting distally and interfering with another manipulator or surgical tool or clinical personnel as the surgical tool is driven to its full pitch-back range of motion limit, and forking the link <NUM> allows the motor to travel within the link to increase the surgical tool's full pitch-forward range of motion limit. Alternatively, however, the roll drive motor may be placed distally or to the side on the pod coupling. And, rather than forking link <NUM>, a non-forked single link offset to the side of motor <NUM>, or two links on either side of link <NUM>, may optionally be used.

As described previously, the nut <NUM> is constrained from rotating. One mechanism by which the nut <NUM> is so constrained also advantageously helps prevent or reduce the exertion of undesirable lateral forces to the leadscrew <NUM>. In particular, the arm <NUM> defines two elongate linear channels <NUM> (e.g., refer to <FIG>) that extend parallel to the leadscrew <NUM> on opposite sides of the leadscrew <NUM>. Two bearings <NUM> are movably engaged within the two elongate linear channels <NUM>. The two bearings <NUM> can be rotatably coupled with the nut <NUM> or with the first end <NUM> of the link <NUM>. This arrangement will transfer forces from the link <NUM> (that would otherwise be exerted laterally to the leadscrew <NUM>) via the bearings <NUM> to the elongate linear channels <NUM>.

In some embodiments, the manipulator assembly <NUM> may include electronic sensors and the like for various advantageous purposes. For example, encoders may be coupled to the drive trains of the motorized pitch, roll, and/or yaw adjustment mechanisms. In some embodiments, position sensors may be used that can positively identify the locations of the movable components of the manipulator device <NUM>.

Referring to <FIG>, another example telesurgical system manipulator <NUM> includes the surgical tool <NUM> that is selectively coupleable with a compatible surgical tool actuator assembly <NUM> (again, a "pod") that is, in turn, coupleable with an example manipulator assembly <NUM> to form a teleoperated tool manipulator. The configuration of surgical tool <NUM> is as described above, and the description of pod <NUM> above generally applies to pod <NUM>, with certain differences noted in the description below. Manipulator assembly <NUM> and its components are generally similar to manipulator assembly <NUM> and its components (e.g., base, arm, pod coupling) as described above, with certain differences noted in the description below. Cannula <NUM> and its mounting is generally similar to cannula <NUM> described above. The remote center of motion <NUM> and associated yaw, pitch, and insertion axes are as described above.

As shown in <FIG>, the surgical tool actuator assembly coupling <NUM> (again, a "pod coupling") is movably coupled with the arm <NUM> such that pod coupling <NUM> translates along an arcuate path <NUM> (again, the "pitch arc") defined by the distal portion of arm <NUM>. In the depicted embodiment the arcuate path <NUM> is defined by a combination of a fixed arcuate segment <NUM> (i.e., fixed in relation to other main portions of the arm <NUM>) and a movable arcuate segment <NUM>. The movable arcuate segment <NUM> is movably coupled to the fixed arcuate segment <NUM> in a telescopic arrangement, as described further below in reference to <FIG>.

The link <NUM> is similar to link <NUM> and is movably coupled between the arm <NUM> and the pod coupling <NUM>. A first end of the link <NUM> is coupled to an actuator of the arm <NUM> that is similar to the pitch-adjustment actuator of arm <NUM>. A second end of the link <NUM> is coupled to pod coupling <NUM>. Hence, pod <NUM> is driven along the curvilinear path of the pitch arc <NUM> by the link <NUM> that is driven by an actuator of the arm <NUM>.

The telesurgery surgery system <NUM> is configured to actuate yaw, pitch, and roll motions of surgical tool <NUM> in response to user input as described above, with arm <NUM> rotating around associated yaw axis <NUM> (arrows <NUM>), pod coupling <NUM> translating along pitch arc <NUM> (arrows <NUM>), and pod <NUM> rotating around insertion axis <NUM> (arrows <NUM>). As described above, pod <NUM> controls tool insertion and withdrawal along axis <NUM> and tool <NUM> distal component movements.

Referring also to <FIG>, pitch motions (as represented by arrows <NUM>) of the example manipulator assembly <NUM> will now be further described. The pitch motions of the manipulator device <NUM> entail curvilinear translational movements of the pod coupling <NUM> along the pitch arc <NUM> as depicted by arrows <NUM>. In these figures, the arm <NUM> is shown transparently so that mechanisms internal to the arm <NUM> can be visualized.

In the depicted embodiment, the arcuate path <NUM> is defined by the combination of a first, fixed arcuate segment <NUM> and a second, movable arcuate segment <NUM>. The movable arcuate segment <NUM> is movably coupled to the fixed arcuate segment <NUM> so that the movable segment <NUM> telescopes distally with reference to fixed segment <NUM>. As shown, movable segment <NUM> is positioned and translates inside fixed segment <NUM>, and optionally movable segment <NUM> is positioned and translates outside fixed segment <NUM>. Such a telescoping arrangement offers advantages. For example, as shown in <FIG>, the telescopic arrangement of the arcuate segments <NUM> and <NUM> allows the overall length of the manipulator assembly <NUM> to be shorter as compared to an arm that has only a fixed arcuate portion with the same pitch range of motion). Having a shorter overall length can advantageously reduce the potential for collisions between manipulator assemblies (e.g., when two or more manipulator assemblies are used during a surgery as depicted in <FIG>). Additionally, shortening overall length of the manipulator assembly <NUM> allows for enhanced patient access by clinical personnel and more flexibility in manipulator positioning in relation to the patient.

As described above for arm <NUM>, arm <NUM> includes one or more pitch-adjustment motors <NUM> which bi-directionally, rotatably drive a leadscrew <NUM>. A nut <NUM> is threadably coupled to the leadscrew <NUM> and is rotationally constrained such that rotations of the leadscrew <NUM> result in translational movements of the nut <NUM>. The first end <NUM> of the link <NUM> is pivotably coupled to the nut <NUM>. The second end <NUM> of the link <NUM> is pivotably coupled to the pod <NUM>. Hence, as the nut <NUM> translates along the longitudinal axis of the lead screw <NUM>, the second end <NUM> of the link <NUM> drives translation of the pod coupling <NUM> to follow the curvilinear path of the pitch arc <NUM>. The sequence of <FIG> illustrate pod coupling <NUM> translating along pitch arc <NUM>, as well as movable segment <NUM> telescoping in relation to fixed segment <NUM>.

As shown in <FIG>, in a full surgical tool pitch-forward configuration the pod coupling <NUM> is located at its proximal end range of motion limit in relation to the movable arcuate segment <NUM>, and the movable arcuate segment <NUM> is located at its proximal end range of motion limit in relation to the fixed arcuate segment <NUM>. As the link <NUM> is driven distally in relation to the arm <NUM>, the pod coupling <NUM> first begins to translate distally along a curvilinear path defined by the movable arcuate segment <NUM> while the movable arcuate segment <NUM> remains stationary in relation to the fixed arcuate segment <NUM>. As shown in <FIG>, in the configuration in which the pod coupling <NUM> has reached its distal range of motion limit in relation to the movable arcuate segment <NUM>, the movable arcuate segment <NUM> begins to move distally in relation to the fixed arcuate segment <NUM>. As the link <NUM> is driven still farther distally in relation to the arm <NUM>, the movable arcuate segment <NUM>, with the pod coupling <NUM> remaining at its distal range of motion limit in relation to the movable arcuate segment <NUM>, translates distally along a curvilinear path defined by the fixed arcuate segment <NUM> until the movable arcuate segment <NUM> its distal range of motion limit in relation to the fixed arcuate segment <NUM>, as depicted in <FIG>.

A proximal retraction of the movable arcuate segment <NUM> and the pod coupling <NUM> to their proximal range of motion limits (e.g., moving from the configuration of <FIG> toward the configuration of <FIG>, and further toward the configuration of <FIG>) can take place as a reversal of the above-described sequence of distal movements. In some embodiments, the movable arcuate segment <NUM> is spring-biased towards its proximal end range of motion limit in relation to the fixed arcuate segment <NUM>. Accordingly, movable segment <NUM> remains at its proximal range of motion limit as link <NUM> drives pod coupling <NUM> through the proximal portion of pod coupling's full pitch range of motion (e.g., <FIG>). As link <NUM> drives pod coupling <NUM> beyond its distal range of motion limit within movable link <NUM> (e.g., <FIG>), the pitch-adjustment actuator overcomes the spring bias, and movable link <NUM> and pod coupling <NUM> together begin to translate distally along fixed segment <NUM> to move pod coupling <NUM> through the distal portion of pod coupling <NUM>'s full pitch range of motion (e.g., <FIG>).

During retraction, the link <NUM> is retracted proximally (starting from the configuration of <FIG>), and the spring bias keeps the movable arcuate segment <NUM> against pod coupling <NUM>. When the movable arcuate segment <NUM> reaches its proximal range of motion limit in relation to the fixed arcuate segment <NUM>, then the pod coupling <NUM> will begin to translate proximally along the curvilinear path defined by the movable arcuate segment <NUM> until the pod coupling <NUM> reaches its proximal range of motion in relation to the movable arcuate segment <NUM>.

In some embodiments, the extension and retraction movements of the movable arcuate segment <NUM> in relation to the fixed arcuate segment <NUM> can be motorized. A separate motorized linear actuator drives movable arcuate segment through its arcuate range of motions. In some embodiments, other telescoping or telescoping actuator arrangements may be used to control the movable segment's position with reference to the fixed segment as the pod coupling is moved distally and proximally with reference to the fixed and movable segments.

The bearing arrangements used to movably couple the pod coupling <NUM> with the movable arcuate segment <NUM>, and to movably couple the movable arcuate segment <NUM> with the fixed arcuate segment <NUM>, are analogous to the bearing arrangements used to movably couple the pod coupling <NUM> with the arm <NUM> as described above in reference to the manipulator assembly <NUM> (see, e.g., <FIG>). That is, a first group of multiple bearings (e.g., four bearings) are affixed to pod coupling <NUM> and travel in the arcuate grooves defined in movable segment <NUM>, and a second group of multiple bearings (e.g., four bearings) are affixed to movable segment <NUM> and travel in the arcuate grooves defined in fixed segment <NUM>. Likewise, a first group of lateral bearings (e.g., four bearings) are affixed to pod coupling <NUM> and bear against one or more inner planar surfaces of movable segment <NUM>, and a second group of lateral bearings (e.g., four) are affixed to movable segment <NUM> and bear against one or more inner planar surfaces of fixed segment <NUM>. Such bearing arrangements can advantageously provide structural stability and rigidity of the pod coupling <NUM> in relation to the movable arcuate segment <NUM>, and of the movable arcuate segment <NUM> in relation to the fixed arcuate segment <NUM> (as described above in reference to the bearing arrangements between the pod coupling <NUM> and the arm <NUM>).

As described above for manipulator assembly <NUM>, other arcuate mechanisms that include two or more arcuate grooves, or one or more arcuate rails, or one or more arcuate rods, etc. may be used in other embodiments.

In the depicted embodiment, the manipulator device <NUM> can adjust through a range of about <NUM>° of pitch motion. That is, the pod coupling <NUM> can translate in relation to the arm <NUM> along the pitch arc <NUM> through about <NUM>° of travel. In some embodiments, the manipulator device <NUM> is configured to facilitate a range of pitch motion of about <NUM>° to about <NUM>°, about <NUM>° to about <NUM>°, about <NUM>° to about <NUM>°, about <NUM>° to about <NUM>°, about <NUM>° to about <NUM>°, or about <NUM>° to about <NUM>°.

As described previously, the nut <NUM> is constrained from rotating. One mechanism by which the nut <NUM> is so constrained also advantageously helps prevent or reduce the exertion of undesirable lateral forces to the leadscrew <NUM>. In particular, the arm <NUM> defines two elongate linear channels that extend parallel to the leadscrew <NUM> on opposite sides of the leadscrew <NUM>. Two bearings <NUM> are movably engaged within the two elongate linear channels <NUM>. The two bearings <NUM> can be rotatably coupled with the nut <NUM> or with the first end <NUM> of the link <NUM>. This arrangement will transfer forces from the link <NUM> (that would otherwise be exerted laterally to the leadscrew <NUM>) to the elongate linear channels of the arm <NUM> via the bearings <NUM>.

Referring again to <FIG>, it can be seen that the depicted manipulator <NUM> does not explicitly show a pod roll motor analogous to motor <NUM> shown for example in <FIG> above. Although not explicitly shown, an analogous pod roll motor may be implemented in some embodiments. And in some embodiments with both fixed and telescoping pitch arcs, an internal pod roll motor may be used. For example, when pod <NUM> is mounted to pod coupling <NUM> (or pod <NUM> to pod coupling <NUM>), the internal pod roll motor rolls the pod around insertion axis.

In some embodiments, the manipulator device <NUM> may include electronic sensors and the like for various advantageous purposes. For example, encoders may be coupled to the drive trains of the motorized pitch, roll, and/or yaw adjustment mechanisms. In some embodiments, position sensors may be used that can positively identify the locations of the movable components of the manipulator device <NUM>.

Moreover, the separation of various system modules and components in the embodiments described herein should not be understood as requiring such separation in all embodiments, and it should be understood that the described program components and systems can generally be integrated together in a single product or packaged into multiple products.

Claim 1:
A teleoperated manipulator system (<NUM>) comprising:
a mounting base (<NUM>);
an arm (<NUM>) comprising a distal pitch arc portion, a pitch-adjustment actuator (<NUM>), a yaw-adjustment motor (<NUM>), and a movable link (<NUM>), the arm (<NUM>) being rotatably coupled to the mounting base (<NUM>) and driven by actuation of the yaw-adjustment motor (<NUM>) to rotate around a yaw axis (<NUM>), the movable link (<NUM>) having a proximal end and a distal end, the proximal end of the movable link (<NUM>) being coupled to the pitch-adjustment actuator (<NUM>), the pitch-adjustment actuator (<NUM>) comprising a linear actuator, the pitch arc portion defining a pitch arc (<NUM>) having a center;
a tool actuator assembly coupling (<NUM>) coupled to translate on a curvilinear path in the pitch arc portion of the arm (<NUM>), the distal end of the movable link (<NUM>) of the arm (<NUM>) being pivotably coupled to the tool actuator assembly coupling (<NUM>); and
a tool actuator assembly (<NUM>) defining a space configured to receive a surgical tool, the tool actuator assembly (<NUM>) removably coupled to the tool actuator assembly coupling (<NUM>), a long axis of the tool actuator assembly (<NUM>) defining a tool insertion axis (<NUM>);
wherein the yaw axis (<NUM>), the center of the pitch arc, and the tool insertion axis (<NUM>) are coincident and define a remote center of motion (<NUM>) of the manipulator system (<NUM>); and
wherein the tool actuator assembly coupling (<NUM>) comprises a roll-adjustment actuator (<NUM>) coupled to drive the tool actuator assembly (<NUM>) to rotate around the tool insertion axis (<NUM>).