Patent Description:
Minimally invasive medical techniques are intended to reduce the amount of tissue that is damaged during invasive medical procedures, thereby reducing patient recovery time, discomfort, and harmful side effects. Such minimally invasive techniques may be performed through natural orifices in a patient anatomy or through one or more surgical incisions. Through these natural orifices or incisions, clinicians may insert medical tools to reach a target tissue location. Minimally invasive medical tools include instruments such as therapeutic instruments, diagnostic instruments, and surgical instruments. Minimally invasive medical tools may also include imaging instruments such as endoscopic instruments. Imaging instruments provide a user with a field of view within the patient anatomy. Some minimally invasive medical tools and imaging instruments may be teleoperated or otherwise computer-assisted. In a teleoperational medical system, instruments may be difficult to see, whether due to small instrument size, proximity to the edge of the field of view, or obstruction by tissue. A clinician operating the teleoperational system may also have difficulty keeping track of which instruments are under which operator controls. Systems and methods are needed to provide a clinician with information about the instruments under the clinician's control to reduce the risk of clinician error.

<CIT> discloses an operator that telerobotically controls tools to perform a procedure on an object at a work site while viewing real-time images of the work site on a display. Tool information is provided in the operator's current gaze area on the display by rendering the tool information over the tool so as not to obscure objects being worked on at the time by the tool nor to require eyes of the user to refocus when looking at the tool information and the image of the tool on a stereo viewer.

<CIT> discloses an endoscope that captures images of a surgical site for display in a viewing area of a monitor. When a tool is outside the viewing area, a GUI indicates the position of the tool by positioning a symbol in a boundary area around the viewing area so as to indicate the tool position. The distance of the out-of-view tool from the viewing area may be indicated by the size, color, brightness, or blinking or oscillation frequency of the symbol. A distance number may also be displayed on the symbol. The orientation of the shaft or end effector of the tool may be indicated by an orientation indicator superimposed over the symbol, or by the orientation of the symbol itself. When the tool is inside the viewing area, but occluded by an object, the GUI superimposes a ghost tool at its current position and orientation over the occluding object.

<CIT> discloses robotic surgical systems, including robotic surgical devices having improved arm components and/or biometric sensors, contact detection systems for robotic surgical devices, gross positioning systems and devices for use in robotic surgical systems, and improved external controllers and consoles.

The present invention provides a system as defined in the appended independent claim. Optional features are defined in the appended dependent claims.

In one embodiment, a teleoperational assembly includes an operator control system and a plurality of manipulators configured to control the movement of medical instruments in a surgical environment. The manipulators are teleoperationally controlled by the operator control system. The system further includes a processing unit configured to display an image of a field of view of the surgical environment, determine association information about the manipulators and the operator control system, and display badges near the medical instruments in the image of the field of view of the surgical environment. The badges display the association information for the medical instrument they appear associated with.

In another embodiment, an image of a field of view of a surgical environment is displayed. The locations of medical instruments within the environments are determined, association information for the medical instruments and for an operator control system is determined, and badges are displayed in the image of the field of view of the surgical environment near the medical instruments. The medical instruments are attached to manipulators that are teleoperationally controlled by the operator control system. The badges display the association information for the medical instrument near which they are displayed.

It will nevertheless be understood that no limitation of the scope of the disclosure is intended. In the following detailed description of the aspects of the invention, numerous specific details are set forth in order to provide a thorough understanding of the disclosed embodiments. However, it will be obvious to one skilled in the art that the embodiments of this disclosure may be practiced without these specific details. In other instances well known methods, procedures, components, and circuits have not been described in detail so as not to unnecessarily obscure aspects of the embodiments of the invention as defined by the appended claims.

Any alterations and further modifications to the described devices, instruments, methods, and any further application of the principles of the present disclosure are fully contemplated as would normally occur to one skilled in the art to which the disclosure relates. In addition, dimensions provided herein are for specific examples and it is contemplated that different sizes, dimensions, and/or ratios may be utilized to implement the concepts of the present disclosure. To avoid needless descriptive repetition, one or more components or actions described in accordance with one illustrative embodiment can be used or omitted as applicable from other illustrative embodiments. For the sake of brevity, the numerous iterations of these combinations will not be described separately. For simplicity, in some instances the same reference numbers are used throughout the drawings to refer to the same or like parts.

The embodiments below will describe various instruments and portions of instruments in terms of their state in three-dimensional space. As used herein, the term "position" refers to the location of an object or a portion of an object in a three-dimensional space (e.g., three degrees of translational freedom along Cartesian X, Y, Z coordinates). As used herein, the term "orientation" refers to the rotational placement of an object or a portion of an object (three degrees of rotational freedom - e.g., roll, pitch, and yaw). As used herein, the term "pose" refers to the position of an object or a portion of an object in at least one degree of translational freedom and to the orientation of that object or portion of the object in at least one degree of rotational freedom (up to six total degrees of freedom). As used herein, the term "shape" refers to a set of poses, positions, or orientations measured along an object.

Referring to <FIG> of the drawings, a teleoperational medical system for use in, for example, medical procedures including diagnostic, therapeutic, or surgical procedures, is generally indicated by the reference numeral <NUM>. As will be described, the teleoperational medical systems of this disclosure are under the teleoperational control of a surgeon. In alternative embodiments, a teleoperational medical system may be under the partial control of a computer programmed to perform the procedure or sub-procedure. In still other alternative embodiments, a fully automated medical system, under the full control of a computer programmed to perform the procedure or sub-procedure, may be used to perform procedures or sub-procedures. As shown in <FIG>, the teleoperational medical system <NUM> generally includes a teleoperational assembly <NUM> mounted to or near an operating table O on which a patient P is positioned. The teleoperational assembly <NUM> may be referred to as a patient side cart. A medical instrument system <NUM> and an endoscopic imaging system <NUM> are operably coupled to the teleoperational assembly <NUM>. An operator input system <NUM> allows a surgeon or other type of clinician S to view images of or representing the surgical site and to control the operation of the medical instrument system <NUM> and/or the endoscopic imaging system <NUM>.

The operator input system <NUM> may be located at a surgeon's console, which is usually located in the same room as operating table O. It should be understood, however, that the surgeon S can be located in a different room or a completely different building from the patient P. Operator input system <NUM> generally includes one or more input control device(s) for controlling the medical instrument system <NUM>. The input control device(s) may include one or more of any number of a variety of devices, such as hand grips, joysticks, trackballs, data gloves, trigger-guns, hand-operated controllers, voice recognition devices, touch screens, pedals, body motion or presence sensors, eye-gaze tracking devices and the like. In some embodiments, the control device(s) will be provided with the same degrees of freedom as the medical instruments of the teleoperational assembly to provide the surgeon with telepresence, the perception that the control device(s) are integral with the instruments so that the surgeon has a strong sense of directly controlling instruments as if present at the surgical site. In other embodiments, the control device(s) may have more or fewer degrees of freedom than the associated medical instruments and still provide the surgeon with telepresence. In some embodiments, the control device(s) are manual input devices which move with six degrees of freedom, and which may also include an actuatable handle for actuating instruments (for example, for closing grasping jaws, applying an electrical potential to an electrode, delivering a medicinal treatment, and the like).

The teleoperational assembly <NUM> supports and manipulates the medical instrument system <NUM> while the surgeon S views the surgical site through the console <NUM>. An image of the surgical site can be obtained by the endoscopic imaging system <NUM>, such as a stereoscopic endoscope, which can be manipulated by the teleoperational assembly <NUM> to orient the endoscope <NUM>. Optionally, an electronics cart <NUM> can be used to process the images of the surgical site for subsequent display to the surgeon S through the surgeon's console <NUM>. The number of medical instrument systems <NUM> used at one time will generally depend on the diagnostic or surgical procedure and the space constraints within the operating room among other factors. The teleoperational assembly <NUM> may include a kinematic structure of one or more non-servo controlled links (e.g., one or more links that may be manually positioned and locked in place, generally referred to as a set-up structure) and a teleoperational manipulator. The teleoperational assembly <NUM> includes a plurality of motors that drive inputs on the medical instrument system <NUM>. These motors move in response to commands from the control system (e.g., control system <NUM>). The motors include drive systems which when coupled to the medical instrument system <NUM> may advance the medical instrument into a naturally or surgically created anatomical orifice. Other motorized drive systems may move the distal end of the medical instrument in multiple degrees of freedom, which may include three degrees of linear motion (e.g., linear motion along the X, Y, Z Cartesian axes) and in three degrees of rotational motion (e.g., rotation about the X, Y, Z Cartesian axes). Additionally, the motors can be used to actuate an articulable end effector of the instrument for grasping tissue in the jaws of a biopsy device or the like.

The teleoperational medical system <NUM> also includes a control system <NUM>. The control system <NUM> includes at least one memory and at least one processor (not shown), and typically a plurality of processors, for effecting control between the medical instrument system <NUM>, the operator input system <NUM>, and an electronics system <NUM>. The control system <NUM> also includes programmed instructions (e.g., a computer-readable medium storing the instructions) to implement some or all of the methods described in accordance with aspects disclosed herein. While control system <NUM> is shown as a single block in the simplified schematic of <FIG>, the system may include two or more data processing circuits with one portion of the processing optionally being performed on or adjacent the teleoperational assembly <NUM>, another portion of the processing being performed at the operator input system <NUM>, and the like. Any of a wide variety of centralized or distributed data processing architectures may be employed. Similarly, the programmed instructions may be implemented as a number of separate programs or subroutines, or they may be integrated into a number of other aspects of the teleoperational systems described herein. In one embodiment, control system <NUM> supports wireless communication protocols such as Bluetooth, IrDA, HomeRF, IEEE <NUM>, DECT, and Wireless Telemetry.

In some embodiments, control system <NUM> may include one or more servo controllers that receive force and/or torque feedback from the medical instrument system <NUM>. Responsive to the feedback, the servo controllers transmit signals to the operator input system <NUM>. The servo controller(s) may also transmit signals instructing teleoperational assembly <NUM> to move the medical instrument system(s) <NUM> and/ or endoscopic imaging system <NUM> which extend into an internal surgical site within the patient body via openings in the body. Any suitable conventional or specialized servo controller may be used. A servo controller may be separate from, or integrated with, teleoperational assembly <NUM>. In some embodiments, the servo controller and teleoperational assembly are provided as part of a teleoperational arm cart positioned adjacent to the patient's body.

The teleoperational medical system <NUM> may further include optional operation and support systems (not shown) such as illumination systems, steering control systems, irrigation systems, and/or suction systems. In alternative embodiments, the teleoperational system may include more than one teleoperational assembly and/or more than one operator input system. The exact number of manipulator assemblies will depend on the surgical procedure and the space constraints within the operating room, among other factors. The operator input systems may be collocated, or they may be positioned in separate locations. Multiple operator input systems allow more than one operator to control one or more manipulator assemblies in various combinations.

<FIG> is a perspective view of the surgeon's console <NUM>. The surgeon's console <NUM> includes a left eye display <NUM> and a right eye display <NUM> for presenting the surgeon S with a coordinated stereo view of the surgical site that enables depth perception. The console <NUM> further includes one or more input control devices <NUM>, which in turn cause the teleoperational assembly <NUM> to manipulate one or more instruments or the endoscopic imaging system. The input control devices <NUM> can provide the same degrees of freedom as their associated instruments <NUM> to provide the surgeon S with telepresence, or the perception that the input control devices <NUM> are integral with the instruments <NUM> so that the surgeon has a strong sense of directly controlling the instruments <NUM>. To this end, position, force, and tactile feedback sensors (not shown) may be employed to transmit position, force, and tactile sensations from the instruments <NUM> back to the surgeon's hands through the input control devices <NUM>.

<FIG> is a perspective view of the electronics cart <NUM>. The electronics cart <NUM> can be coupled with the endoscope <NUM> and can include a processor to process captured images for subsequent display, such as to a surgeon on the surgeon's console, or on another suitable display located locally and/or remotely. For example, where a stereoscopic endoscope is used, the electronics cart <NUM> can process the captured images to present the surgeon with coordinated stereo images of the surgical site. Such coordination can include alignment between the opposing images and can include adjusting the stereo working distance of the stereoscopic endoscope. As another example, image processing can include the use of previously determined camera calibration parameters to compensate for imaging errors of the image capture device, such as optical aberrations. The electronics cart <NUM> may also include a display monitor and components of the control system <NUM>.

<FIG> is a perspective view of one embodiment of a teleoperational assembly <NUM> which may be referred to as a patient side cart. The patient side cart <NUM> shown provides for the manipulation of three surgical tools 26a, 26b, 26c (e.g., instrument systems <NUM>) and an imaging device <NUM> (e.g., endoscopic imaging system <NUM>), such as a stereoscopic endoscope used for the capture of images of the site of the procedure. The imaging device may transmit signals over a cable <NUM> to the electronics cart <NUM>. Manipulation is provided by teleoperative mechanisms having a number of joints. The imaging device <NUM> and the surgical tools 26a, 26b, 26c can be positioned and manipulated through incisions in the patient so that a kinematic remote center is maintained at the incision to minimize the size of the incision. Images of the surgical site can include images of the distal ends of the surgical tools <NUM> when they are positioned within the field-of-view of the imaging device <NUM>. The teleoperational assembly <NUM> is located in a world coordinate system or frame FW. The distal tip of each medical instrument 26a, 26b, 26c defines a respective instrument coordinate system or frame FI. The distal tip of the imaging device <NUM> defines a coordinate system or frame FE.

The patient side cart <NUM> includes a drivable base <NUM>. The drivable base <NUM> is connected to a telescoping column <NUM>, which allows for adjustment of the height of arms 54a, 54b, 54c, and 54d. Arm 54a may be known and/or labeled in the surgical environment as "Arm <NUM>. " Arm 54b may be known and/or labeled in the surgical environment as "Arm <NUM>. " Arm 54c may be known and/or labeled in the surgical environment as "Arm <NUM>. " Arm 54d may be known and/or labeled in the surgical environment as "Arm <NUM>. " The arms 54a may include a rotating joint <NUM> that both rotates and moves up and down. Arm 54a connects to a manipulator arm portion <NUM>. The manipulator arm portions <NUM> may connect directly to the medical instrument 26a via a manipulator spar <NUM>. Each of the other arms 54b, 54c, 54d may have a similar configuration to arm 54a. Each of the arms 54a, 54b, 54c, 54d may be connected to an orienting platform <NUM>. The orienting platform <NUM> may be capable of <NUM> degrees of rotation. The patient side cart <NUM> may also include a telescoping horizontal cantilever <NUM> for moving the orienting platform <NUM> in a horizontal direction. The manipulator arm portion <NUM> may be teleoperable. The arms 54a, 54b, 54c, 54d may be teleoperable or not. In embodiments in which the arm <NUM> is not teleoperable but the manipulator arm is, the arm <NUM> is positioned as desired before the surgeon begins operation with the system <NUM>. Note that while arms <NUM> (and associated manipulator arm portions <NUM>) are depicted and described as being part of a single patient side cart <NUM> for examplary purposes, in various other embodiments, arms <NUM> and/or manipulator arm portions <NUM> (or additional arms <NUM> and/or manipulator arm portions <NUM>) can be discrete structures (e.g., separate table-, ceiling-, and/or floor-mounted arms).

Endoscopic imaging systems (e.g., systems <NUM>, <NUM>) may be provided in a variety of configurations including rigid or flexible endoscopes. Rigid endoscopes include a rigid tube housing a relay lens system for transmitting an image from a distal end to a proximal end of the endoscope. Flexible endoscopes transmit images using one or more flexible optical fibers. Endoscopes may be provided with different viewing angles including a <NUM>° viewing angle for forward axial viewing or viewing angles between <NUM>°-<NUM>° for forward oblique viewing. Digital image based endoscopes have a "chip on the tip" design in which a distal digital sensor such as a one or more charge-coupled device (CCD) or a complementary metal oxide semiconductor (CMOS) device store image data. Endoscopic imaging systems may provide two- or three-dimensional images to the viewer. Two-dimensional images may provide limited depth perception. Three-dimensional stereo endoscopic images may provide the viewer with more accurate depth perception. Stereo endoscopic instruments employ stereo cameras to capture stereo images of the patient anatomy in the camera's field of view.

The stereo images of the imaging system field of view may be seen by a clinician through the eye displays <NUM>, <NUM>. In addition to the patient tissue, the field of view may also include the distal ends of the medical instruments and any accessories used in performing the surgical procedure. To perform the procedure, a clinician recognizes an association between an instrument in the field of view and the input control device controlling that instrument from the control console. The clinician may make this association by, for example, referring to alphanumeric text, symbols, or other information located at the periphery of the viewed image. To view this information, however, the clinician's focus must move away from the central portion of the display and distal tips of the instruments to the periphery of the image. Alternatively, the clinician may make the association by moving an input control device and observing the corresponding instrument movement in the image. This may be time consuming and disruptive to the flow of the surgical procedure. To aid the clinician in associating the input control devices <NUM> with the instruments visible in the field of view, information about an input control device may be presented in graphical form and co-located with the instrument it controls. Co-locating the association information with the instrument allows the clinician to quickly associate control devices with instruments while maintaining focus on the surgical area of interest.

<FIG> illustrates a surgical environment <NUM> within the patient P. An imaging instrument (e.g., imaging instrument <NUM>) is used to display an image <NUM> of the imaging instrument's field of view within the surgical environment <NUM>. The image <NUM> may be a three dimensional image obtained by a stereoscopic endoscope and generated as a composite image of the images visible to a user through right and left eye displays. The field of view includes a distal end portion of instrument 26a, a distal end portion of instrument 26b, and a distal end portion of instrument 26c. The image <NUM> also includes information fields <NUM> located at the periphery of the image which may include instructions to the clinician, warnings, instrument identification information, status information, or other information relevant to the surgical procedure. To assist the clinician in performing the surgical procedure using the system <NUM>, various pieces of information are superimposed on the image <NUM>. In this embodiment, a badge <NUM> contains association information related to the medical instrument 26b, such as a numerical identifier of the arm 54b (e.g. Arm "<NUM>") to which the instrument is coupled. The badge <NUM> is displayed proximate to the medical instrument <NUM> so that the clinician can easily tell that the association information pertains to the medical instrument 26b. In some embodiments, the badge may also include association information including the type of medical instrument, the state of the medical instrument (e.g. cauterizer charging/ready) or the like. Methods for creating and displaying the badge <NUM> are described in further detail below, with reference to <FIG>. In various embodiments, the badge may be circular, oval, square or any suitable shape. In various embodiments, a badge may have colors, outlines, shapes, or other features to identify or distinguish badges from one another.

The distal end portion of the medical instrument 26b visible in the field of view includes an end effector tip <NUM>, a shaft <NUM>, and a joint region <NUM> between the shaft and end effector tip. In some embodiments, a default location for placement of the badge <NUM> is superimposed over the joint region <NUM>. In other embodiments, the default location for placement of the badge <NUM> may be on the end effector tip <NUM> or the shaft <NUM>. In other embodiments, the badge <NUM> is displayed adjacent to the distal end portion. The default location for the badge may depend upon the size of the distal end portion of the medical instrument 26b in the field of view. For example, if the image is closely zoomed in (e.g., <FIG>), and the end effector occupies a large portion of the image, the badge may be located on a proximal portion of one of the end effector jaws without obstructing the view at the distal end of the jaws. If, however, the image is zoomed out and the end effector jaws are relatively small in the image, the badge may be located on the joint region or the shaft to avoid obscuring the jaws. The placement of the badge <NUM> allows the clinician to receive the association information while remaining focused on the instruments and the tissue manipulated by the instruments. The placement of the badge <NUM> also avoids obscuring objects in the field of view that need to be observed by the clinician.

In some embodiments the badge <NUM> has a central portion <NUM> as well as an orbiting portion <NUM>. The central portion <NUM> and orbiting portion <NUM> may contain different pieces of association information. For example, as shown in <FIG>, the central portion <NUM> includes a number indicating the arm 54b (e.g. Arm "<NUM>") to which the medical instrument 26b is attached. In various embodiments, orbiting portion <NUM> contains association information related to the control device used by the clinician to control the medical instrument 26b. This association information may be, for example, an indication of whether a right (e.g., "R") or left (e.g., "L") hand-operated input control device is currently in control of the medical instrument 26b to which badge <NUM> is associated.

The orbiting portion <NUM> of the badge <NUM> may move circumferentially relative to the central portion <NUM> of badge. The circumferential location of the orbiting portion <NUM> indicates the rotational position of the control device, letting the clinician know where their hand on the control device is positioned relative to the medical instrument 26b which they are controlling. The function of the orbiting portion <NUM> is shown in greater detail in <FIG>.

A badge <NUM> is located proximate to the instrument 26a and has similar features and attributes as badge <NUM>. Badge <NUM> contains association information related to the medical instrument 26a, such as a numerical identifier of the arm 54a (e.g. Arm "<NUM>") to which the instrument is coupled. In this embodiment and at this phase of the surgical procedure, instrument 26c is not presently under control of an input control device. Therefore, a badge is not located proximate to the instrument 26c. In alternative embodiments, badge information may be provided for the instrument 26c indicating the numerical identifier of the arm 54c (e.g., Arm "<NUM>"), but the fact that the instrument is not presently under control of an input device may be indicated by color, symbol, or other indication.

<FIG> illustrates a method <NUM> of operating a teleoperational system to perform a surgical procedure. At a process <NUM>, the method comprises displaying an image <NUM> of a field of view of a surgical environment. At a process <NUM>, a location of a medical instrument 26a in the surgical environment is determined. At a process <NUM>, association information for the medical instrument 26a is determined. The association information includes information about the teleoperational manipulator to which the medical instrument 26a is coupled and/or about the operator input control that controls the medical instrument. At a process <NUM>, a badge is displayed proximate to an image of the medical instrument 26a in the image <NUM> of the field of view. The badge includes the association information.

<FIG> illustrates a clinician's right hand <NUM> controlling an input control device <NUM> (i.e., an input control device <NUM>). The input control device <NUM> controls the medical instrument 26c. As shown in <FIG>, from the clinician's perspective, the input control device <NUM> extends toward the right. Hand association information including hand identity (right or left) and the orientation of the hand may be conveyed to the clinician via the badge. Although this control association information is described in terms of a human hand, similar association information may be provided where control is delivered by foot pedals, eye gaze trackers, voice commands, or other clinician controls. As shown in <FIG>, hand association information about the control device <NUM> of <FIG> is conveyed visually to the clinician in the image <NUM> by orienting an orbiting portion <NUM> of a badge <NUM> to the right (e.g. at about a <NUM> o'clock position) relative to the central portion <NUM> of the badge. The orbiting portion <NUM> displays an "R" to indicate that the right-hand control device <NUM> is being used to control the medical device 26c. As shown in <FIG>, from the clinician's perspective, the input control device extends upward, approximately <NUM> degrees from the position in <FIG>. As shown in <FIG>, this orientation information about the control device <NUM> of <FIG> is conveyed visually to the clinician in the image <NUM> by orienting the orbiting portion <NUM> of the badge <NUM> upward (e.g. at about a <NUM> o'clock position) relative to the central portion <NUM> of the badge. As shown in <FIG>, from the clinician's perspective, the input control device extends downward, approximately <NUM> degrees from the position in <FIG>. As shown in <FIG>, this orientation information about the control device <NUM> of <FIG> is conveyed visually to the clinician in the image <NUM> by orienting the orbiting portion <NUM> of the badge <NUM> downward (e.g. at about a <NUM> o'clock position) relative to the central portion <NUM> of the badge.

In some alternative embodiments, hand association information may be provided as the an illustration or 3D model of a hand. The illustration or model portrays a left or right hand according to whether a left-hand or right-hand control device is being used to control the associated medical device. Similar to the orbiting portion <NUM> in <FIG>, as the orientation of the control device changes the position of the illustration or model changes accordingly to visually convey information about the new orientation of the control device to the clinician. The properties and features described for any of the badges in this disclosure may apply to any of the other badges in this disclosure.

Referring now to <FIG>, there is shown further behavior of the badge <NUM> as the imaging device is moved or zoomed within the surgical environment. In an embodiment shown in <FIG>, the imaging instrument is moved or zoomed in toward the medical instruments 26a, 26b, 26c. As the medical instruments 26a, 26b, 26c appear larger in the field of view and the image <NUM>, the badges <NUM>, <NUM> become larger, changing size to appear as if they are located at the same depth in the field of view as the distal end portions of the instruments. In <FIG>, as the imaging instrument is moved further away or zoomed out from the medical instruments 26a, 26b, 26c, the badges <NUM>, <NUM> become smaller, again changing to appear as if they are located at the same depth in the field of view as the distal end portions of the instruments. In some embodiments there is a limit on the maximum and minimum size of the badges <NUM>, <NUM> to prevent them from becoming unreadable. Further detail about the badge positions and sizes are provided below in the description for <FIG>. The size of the badges <NUM>, <NUM> may also impart additional information to the clinician such as a distance between the medical instruments 26a, 26b and the imaging device. This may be helpful because different types of medical instruments vary in size, and a small instrument close to the imaging device could appear to be the same size as a large instrument far away from the imaging device.

Since the badges <NUM>, <NUM> are superimposed on the image <NUM>, they may appear on the display even if the view of the medical instruments 26a, 26b is obstructed by tissue, other instruments, or the like. As shown in <FIG> badge <NUM> remains visible even as the associated instrument 26b is hidden behind tissue. The presence of the badge <NUM> substantially offset from and at a different apparent size and depth than other instruments 26a, 26c visible in the field of view indicates to the clinician that the instrument 26b associated with the badge is occluded. The badge <NUM> allows the occluded instrument 26b to be found as shown in <FIG>. In <FIG> the tissue has been moved and the medical instrument 26b to which badge <NUM> is attached have become visible in the field of view.

The teleoperational medical system <NUM> may have multiple operational states for each instrument. These may include an active state, wherein a medical instrument is under the control of an input control device such that the clinician is actively controlling the medical instrument. In a disengaged state, a medical instrument is not under the control of an input control device and remains stationary, locked in place by the manipulator arm to which it is coupled. The system may also have an engagement state in which the user is prompted to engage or take control of the medical instrument via the associated input control device. In some embodiments, the badges are displayed when the teleoperational medical system is in the engagement state for a particular instrument. For example, in <FIG>, instruments 26a and 26b are in an engagement state in which the user is prompted by the badge information to take control of instrument 26a on Arm <NUM> with the left ("L") input control device and to take control of instrument 26b on Arm <NUM> with the right ("R") input control device. Instrument 26c is in a disengaged state and thus, a badge is not presented for the instrument. During the active state, the badges may remain visible in the image or may be removed to avoid distraction to the clinician. Presenting the badges in the engagement state allows the clinician to recognize the association information and location of each instrument within the field of view <NUM> before taking control of any of the medical instruments. For example, the location of the badge may be used to determine if any medical instruments are obstructed from view by tissue before taking control of the instrument. Additionally, the association information contained within the badge may give the clinician information that allows him to choose which medical instrument to take control of to perform a desired procedure. Further, the information given by the orbiting portion of the badge may tell the clinician how to position the input control device to match position with the orientation of the medical instrument before taking control. In some embodiments, the system may require the clinician to match this position before allowing a change of state from engagement to active.

Referring now to <FIG>, the distal end portion of the medical instrument 26a visible in the field of view includes an end effector tip <NUM>, a shaft <NUM>, and a joint region <NUM> between the shaft and end effector tip. The distal end portion of the medical instrument 26c visible in the field of view includes an end effector tip <NUM>, a shaft <NUM>, and a joint region <NUM> between the shaft and end effector tip. As shown in <FIG> and previously described, a default location for placement of the badge <NUM> is superimposed over the joint region <NUM>. A default location for placement of the badge <NUM> is superimposed over the joint region <NUM>. In <FIG>, the instrument distal end portions are spaced apart and easily distinguishable from each other, consequently, the badges <NUM> and <NUM> are clearly readable and clearly associated with medical instruments 26a and 26c, respectively. <FIG> illustrates the case where the distal end portions of instruments 26a and 26c are overlapping or in very close proximity in the image <NUM>. If allowed to remain in their default locations, the badges <NUM>, <NUM> would overlap or appear adjacent or superimposed upon more than one instrument, thus causing confusion to the clinician. As shown in <FIG>, to remedy this issue, the badge <NUM> is moved a shift distance from its default location near the distal end of the joint region <NUM> along a longitudinal axis A1 of the instrument 26a. In this embodiment, the badge <NUM> is relocated to a distal end of the shaft <NUM> of the instrument 26a. Similarly, the badge <NUM> is moved a shift distance from its default location near the distal end of the joint region <NUM> along a longitudinal axis A2 of the instrument 26c. In this embodiment, the badge <NUM> is relocated to a distal end of the shaft <NUM> of the instrument 26c. The shift distance may correspond to the position of the badge relative to a calibrated kinematic model of the instrument as coupled to the arm and spar and/or may correspond to the size of the instrument distal end portions in the field of view <NUM>. For example, the calibrated kinematic model (based, for example, on knowledge of the manipulator joint positions, kinematic sensors, size of components in the kinematic chain) provides the position and orientation of the joint region <NUM> of the instrument 26a in the surgical environment. An uncertainty factor is associated with the determined position orientation of the joint region <NUM> due to uncertainty in the kinematic model. Based on the kinematic model, the kinematic uncertainty factors for all of the instruments in the field of view, and the default locations for the badges, the teleoperational system may determine a proximity factor (e.g. a center-to-center or edge-to-edge distance, a percentage of overlap) indicating whether the badges overlap or are sufficiently close to each other as to create ambiguity to a clinician if the badges remain in the default locations. If the proximity factor is less than a predetermined interference distance, the badges are adjusted as needed to raise the proximity factor above the predetermined interference distance. For example, in some embodiments, the badges can be moved along or across the axis of the instruments by at least a minimum shift distance. In other embodiments, the badges can be resized or reshaped to maintain an acceptable interference distance while still providing the desired informational content. In this way, the badges <NUM>, <NUM> remain clearly associated with their respective medical instruments 26a, 26c and also remain clearly readable.

Referring now to <FIG>, a badge with its association information may be particularly useful when a medical instrument approaches a boundary of the image <NUM> of the field of view or moves out of the image <NUM>. <FIG> illustrates the displayed image <NUM> of a field of view of the imaging instrument in the surgical environment <NUM>. The displayed image has a boundary <NUM>. The distal end portion of medical instrument 26c, particularly the end effector tip <NUM>, is within the boundary <NUM> and is visible in the displayed image <NUM>. The determination of whether the instrument 26c is inside or outside of the field of view of the imaging instrument may be based upon the calculated location of the end effector tips <NUM>. Because of small error factors associated with the teleoperational system, the instrument, and/or the imaging system, the determination of the location of the tips <NUM> with respect to the imaging instrument has an associated cumulative error factor. To avoid providing false-positive out-of-view indicators to a clinician, the determination of whether an instrument tip is out of the imaging system field of view may be biased by estimating the range of possible locations for the distal tip and suppressing an out-of-view indicator if any or a designated percentage of the estimated possible locations for the distal tip are within the field of view. The sensitivity of the bias may be adjusted based upon the clinician's tolerance for false-positive out-of-view indicators. A set of error bounding volumes <NUM> is associated with the tip <NUM>. The bounding volumes <NUM> may be displayed graphically in the image <NUM> or may be associated with the tip <NUM> without being displayed. The error bounding volumes may represent the predicted locations of the distal and proximal ends of the tip portions to within a high degree of certainty such as <NUM>-<NUM>%. The error bounding volume <NUM> represents the predicted locations of the tip <NUM> of the instrument 26c. Further description of the error calculation and bounding volumes is provided in <CIT>, disclosing "Systems and methods for offscreen indication of instruments in a teleoperational medical system,".

As shown in <FIG>, the bounding volumes <NUM> are within the field of view bounded by the boundary <NUM>. The bounding volumes <NUM> may or may not be rendered in the image <NUM>, but their location relative to the boundary may be determined by the system regardless of whether they are displayed. Since the medical instrument 26c is visible in the display and the bounding volumes are within the boundary <NUM>, the badge <NUM> is accordingly displayed on the image <NUM> of the field of view. In order to maintain visibility and readability, the badge <NUM> remains completely inside the boundary <NUM>, even if the distal end portion of the instrument 26c, to which the badge <NUM> is attached, is partially outside the boundary <NUM>, as shown here. This allows the clinician to clearly locate the medical instrument 26c even if it is only barely visible within the image <NUM>. In <FIG> the medical instrument 26c is not visible in the displayed image <NUM>. In some embodiments, the system may terminate display of the badge <NUM> when the associated medical instrument 26c is not visible in the image <NUM>. Because the medical instrument <NUM> may be teleoperationally controlled without being visible in the field of view to a clinician, inadvertent movement of an instrument outside of the field of view creates a safety risk. Additionally, clinicians may lose track of instruments that are located outside of the field of view. To minimize these risks, out-of-view instrument indicators may be visually or audibly presented to increase the clinician's awareness of the location of instruments not visible within the field of view. However, in <FIG> the bounding volumes <NUM> for medical instrument 26c are within the boundary <NUM> indicating that the location of the tip <NUM> relative to the boundary <NUM> is uncertain. Therefore, while the bounding volumes <NUM> remain within the boundary <NUM>, the badge <NUM> remains on the image <NUM> even if the image <NUM> does not appear to include the tip <NUM>.

Once the medical instrument <NUM> is far enough outside the boundary <NUM> that the bounding volumes <NUM> are also outside of the boundary, an out-of-view instrument indicator <NUM> is provided along the boundary <NUM> of the image <NUM> of the field of view, as shown in <FIG>, to indicate that medical instrument 26c is located out of the field of view in the general direction of the indicator. In this embodiment, the indicator <NUM> is a graphical bar, but in other embodiments may be a series of dots, or an icon, an alpha-numeric indicator. In addition to or alternative to the visual indicator <NUM>, an audible out-of-view indicator such as a beeping sound or a language-based instruction may alert the clinician that the medical instrument <NUM> is out of the field of view. The audible cue may pan between left and right speakers of the surgeon's console to reinforce the instrument position relative to the view. Alternatively, the audible cue may emit from the left or right speaker in correspondence with the left or right hand control associated with the instrument. In addition to or alternative to the visual indicator <NUM>, textual information <NUM> related to the out-of view instrument may be provided to alert the clinician and/or to provide identifying information about the instrument or an instruction to visualize the instrument. In various embodiments, the out-of-view indicator <NUM> is mutually exclusive with the badge <NUM>. When the badge <NUM> is displayed the out-of-view indicator <NUM> is not displayed, and vice versa. This provides the clinician with constant knowledge of the location of the medical instrument 26c.

In various embodiments, the use of an out-of-view indicator may be limited to avoid becoming a distraction to the clinician. The use of the out-of-view indicator may be context-sensitive such that the out-of-view indicator may only be displayed during certain states of operation of the teleoperational system. For example, the out-of-view indicator may be displayed during a state of the system in which the operator controls movement of the imaging system, a state which may be known as a camera control state. As another example, the out-of-view indicator may be displayed while the system awaits input from the operator to take control of an associated instrument, described above as the disengaged state. As another example, the out-of-view indicator may be displayed for a few seconds after initiating a state of the system in which the operator controls movement of the instruments, described above as the engaged state. In still other alternative embodiments, the out-of-view indicator may be disabled or selectively enabled when the clinician wants to learn about the location of out-of-view instruments. In some embodiments, the clinician must provide an acknowledgement that the instrument tip is outside of the field of view before operation of the out of view instrument is enabled. Additional warnings or acknowledgements may be used for energy emitting devices, sharp devices, or devices that provide an increased patient risk if used without visualization. Further description of an out-of-view indicator system is provided in <CIT>.

As explained above, the badges may be positioned and sized to correspond with the images of the instrument distal ends with which they are associated. <FIG> provide further detail for preserving this physical correspondence. <FIG> illustrates a method <NUM> of rendering badges within image <NUM>. At process <NUM> the locations of medical instrument distal end portions are projected into a coordinate space of the image <NUM>. <FIG> illustrates a method <NUM> for performing the process <NUM>. At process <NUM>, the forward kinematics of the teleoperational assembly are evaluated to determine the position and orientation of the medical instruments (including the imaging device) within a world coordinate system (e.g., a surgical environment coordinate space FW). More specifically, the kinematics associated with the respective set of links and teleoperational manipulator for each medical instrument is determined in the world coordinate system. The world coordinate system is a set of Cartesian coordinates that is established with reference to the surgical environment within which the teleoperational system is located.

At process <NUM> the position and orientation of the distal end portion of each medical instrument (e.g. in the instrument coordinate space FI) is mapped to an endoscope coordinate system (e.g. imaging device coordinate space FE). The endoscope coordinate system is a set of Cartesian coordinates that is established with its origin at the distal tip of the endoscope. By using the forward kinematics of the endoscope and the forward kinematics of each medical instrument in the world coordinate system, as determined at process <NUM>, the medical instrument distal end position and orientation relative to the endoscope tip position and orientation may be computed in the endoscope coordinate system. Generally, the default location for the badges may be at or near a kinematic endpoint of the medical instrument.

At process <NUM> a calibrated camera model is obtained for the endoscope. The calibrated camera model is a mapping from endoscope coordinate space to the right and left eye image coordinate spaces. In one embodiment, the mapping is accomplished with a series of three transforms. First, a modelview transform maps from the endoscope coordinate space (at the distal tip of the endoscope) into an eye coordinate space for the endoscope, accounting for interocular separation of the stereoscopic cameras in the imaging system and for differences in coordinate system conventions. Second, a perspective projection transform maps from the eye coordinate space to normalized coordinates (e.g., -<NUM>, +<NUM>) and accounts for perspective of the endoscope field of view and convergence distance. Third, a viewport bounds transform maps from the normalized eye coordinates to the right and left eye image coordinate spaces. In one embodiment, these three transforms can be combined into one 4x4 homogenous transform for each of the right and left eye images.

At process <NUM> the calibrated camera model is used to project points and vectors from endoscope coordinate space to the image coordinate space for each eye. More specifically the calibrated camera model projects the medical instrument distal end position and orientation to a right eye image coordinate space and a left eye image coordinate space to provide a stereoscopic 3D image to the clinician.

At process <NUM>, uncertainties in the kinematic model of the teleoperational system, which result in corresponding uncertainties in the position of the distal end portion of the associated medical instrument, are estimated with respect to the endoscope tip. At process <NUM> these uncertainties are mapped to the right and left eye image coordinate spaces from which the clinician views the three dimensional image <NUM>.

At process <NUM>, using the forward kinematics determined at process <NUM>, the kinematic remote center (e.g., the incision site about which the instruments pivot) is mapped to the endoscope coordinate space. At process <NUM>, the calibrated camera model is used to project the remote center to the image coordinate systems for each eye in a similar manner as described in process <NUM>.

The processes <NUM>-<NUM> may be repeated for each medical instrument in the teleoperational system so that all medical instruments are properly projected into the stereoscopic 3D image <NUM>. The processes may be performed in sequence or in parallel, and one or more process may be updated while the others are not.

Referring again to <FIG>, the rendering of badge graphics is based upon a consideration of multiple display factors including, for example, the default locations at or near the distal tip of the distal ends of the medical instruments, the potential ambiguity associated with overlapping or indeterminate badge placement, the constraints imposed by the endoscope viewport, and the system rules for hidden instruments. The position of the badge graphics may be determined in image coordinate space for each eye. At a process <NUM>, potential overlap of badges is checked for and resolved to reduce the likelihood that a badge is spatially associated with the wrong instrument. <FIG> illustrates a method <NUM> for performing the process <NUM> of <FIG>. In this embodiment, at least two medical instruments are positioned in the surgical space. As described above, the default location for rendering the badge is at the distal end portion of a medical instrument. At process <NUM>, the distance in image space coordinates between the distal end portions of two medical instruments is calculated. At process <NUM>, a threshold for minimum allowed inter-badge distance is calculated. The threshold for minimum allowed inter-badge distance is the maximum of the sum of the projected radii (or, if the badge is not circular, another maximum dimension from the center of the badge) of the badges plus the maximum of the sum of the projected uncertainty of badge positions. At process <NUM>, the image space distance between the two distal end portions is compared to the calculated threshold distance to determine whether their associated badges overlap or may be perceived to overlap. If overlap is detected, at process <NUM> a direction to move the badge to resolve the overlap is computed. The direction to move the badge is determined by the unit vector between the instrument distal end portion and the remote center projected into image coordinate space (as determined in processes <NUM> and <NUM>). Further if overlap is detected, at process <NUM> a distance to translate the badge to resolve overlap is determined. The distance that the badges are offset is computed as the difference between the minimum allowed inter-badge distance and the current distance between the distal end portions. The offset prevents badge graphics from overlapping and provides badge positions that are sufficiently spaced to avoid uncertainty in instrument association.

Referring again to <FIG>, at a process <NUM> badges are constrained to the viewable space of image <NUM>, which corresponds to the boundaries of the endoscope viewport at the distal tip of the endoscope. This process may place the badge graphics within the boundaries of the image <NUM> without clipping any of the graphics. This process may also control the perceived depth of the badge by preventing modification to the horizontal disparity if the badges are shifted to avoid the image boundaries or to prevent ambiguity. <FIG> illustrates a method <NUM> for performing the process <NUM> of <FIG>. At process <NUM>, the right eye boundary of the viewable space of image <NUM>, corresponding to the endoscope viewport, is determined. At process <NUM> the projected radius of the badge graphic is determined for the right eye. At process <NUM>, for the right eye, the boundary is inset by the projected badge radius to create an inset boundary. At process <NUM> the Y position of the center of the badge is adjusted to remain within the inset boundary for the right eye. At process <NUM> the offset of the X position of the center of the badge which is necessary to keep the badge completely within the inset boundary is computed. Processes <NUM> through <NUM> are repeated for the left eye images. To maintain the proper apparent depth in stereoscopic 3D, the badge must be adjusted the same amount in both the right and left eye images. This maintains the horizontal disparity required for the proper perceived depth of the badge. At process <NUM>, the X offset which was computed at process <NUM> for one of the right or left eye images is applied to the X position of the badge in both the right and left eye images. In some embodiments, the larger X offset value is chosen to prevent the possibility that the badge graphic will be even partially outside of the boundary <NUM>.

Referring again to <FIG>, at process <NUM>, the badges are rendered within the left and right eye displays to form the image <NUM> based on the calculations made in processes <NUM>, <NUM> and <NUM>.

One or more elements in embodiments of the invention may be implemented in software to execute on a processor of a computer system such as control processing system. When implemented in software, the elements of the embodiments of the invention are essentially the code segments to perform the necessary tasks. The program or code segments can be stored in a processor readable storage medium or device that may have been downloaded by way of a computer data signal embodied in a carrier wave over a transmission medium or a communication link. The processor readable storage device may include any medium that can store information including an optical medium, semiconductor medium, and magnetic medium. Processor readable storage device examples include an electronic circuit; a semiconductor device, a semiconductor memory device, a read only memory (ROM), a flash memory, an erasable programmable read only memory (EPROM); a floppy diskette, a CD-ROM, an optical disk, a hard disk, or other storage device, The code segments may be downloaded via computer networks such as the Internet, Intranet, etc..

Claim 1:
A system (<NUM>) comprising:
a teleoperational assembly (<NUM>) including an operator control system (<NUM>) and a plurality of manipulators (<NUM>) configured for teleoperation by the operator control system (<NUM>), wherein a first manipulator of the plurality of manipulators (<NUM>) is configured to control movement of a first medical instrument (26a), and wherein a second manipulator of the plurality of manipulators (<NUM>) is configured to control movement of a second medical instrument (26c); and
a processing unit including one or more processors, wherein the processing unit is configured to:
display an image (<NUM>) of a field of view of a surgical environment (<NUM>);
display a first badge (<NUM>) at a default location, wherein the default location is proximate to an image of the first medical instrument (26a) in the image (<NUM>) of the field of view, the first badge (<NUM>) including first association information for the first medical instrument (26a);
display a second badge (<NUM>) proximate to an image of the second medical instrument (26c) in the image (<NUM>) of the field of view, the second badge (<NUM>) including second association information for the second medical instrument (26c);
determine a display factor associated with the first badge (<NUM>), characterized in that
determining the display factor includes:
determining a distance between the first badge (<NUM>) and the second badge (<NUM>); and
recognizing that the determined distance is less than a predetermined interference distance, wherein the determined distance is less than the predetermined interference distance at least before the first badge (<NUM>) and the second badge (<NUM>) overlap;
when the determined distance is less than the predetermined interference distance, determine a shift distance between the default location and a shifted location or determine a revised size for the first badge (<NUM>); and
display the first badge (<NUM>) at the revised size or at the shifted location which is along a longitudinal axis (A1) of the first medical instrument (26a).