Patent Description:
Minimally invasive medical techniques are intended to reduce the amount of extraneous tissue that is damaged during diagnostic or surgical procedures, thereby reducing patient recovery time, discomfort, and harmful side effects. Minimally invasive telesurgical systems have been developed to increase a surgeon's dexterity and to avoid some of the limitations on traditional minimally invasive techniques. In telesurgery, the surgeon uses some form of remote control, e.g., a servomechanism or the like, to manipulate surgical instrument movements, rather than directly holding and moving the instruments by hand. In telesurgery systems, the surgeon can be provided with an image of the surgical site at the surgical workstation. While viewing a two or three dimensional image of the surgical site on a display, the surgeon performs the surgical procedures on the patient by manipulating master control devices, which in turn control motion of the servomechanically operated instruments.

In robotically-assisted telesurgery, the surgeon typically operates a master controller to control the motion of surgical instruments at the surgical site from a location that may be remote from the patient (e.g., across the operating room, in a different room, or a completely different building from the patient). The master controller usually includes one or more hand input devices, such as hand-held wrist gimbals, joysticks, exoskeletal gloves or the like, which are operatively coupled to the surgical instruments that are releasably coupled to a patient side "slave" surgical manipulator. The configuration and motion of the master controls the instrument's position, orientation, and articulation at the surgical site via the patient side "slave" surgical manipulator. The slave is an electro-mechanical assembly which includes a plurality of arms, joints, linkages, servo motors, etc. that are connected together to support and control the surgical instruments. In a surgical procedure, the surgical instruments (including an endoscope) may be introduced directly into an open surgical site or more typically through cannulas into a body cavity.

For minimally invasive surgical procedures, the surgical instruments, controlled by the surgical manipulator, may be introduced into the body cavity through a single surgical incision site or through multiple closely spaced incision sites on the patient's body. For some minimally invasive surgical procedures, surgical instruments, particularly surgical assist tools such as probes, tissue manipulators, and retractors, may also be introduced into the surgical workspace through more remotely located surgical incisions or natural orifices. Improved systems and methods are needed for mounting and controlling these surgical instruments.

<CIT> discloses methods and systems are provided for operating various robotic systems. The methods and systems involve applications of platforms that enable multiple-input teleoperation and a high degree of immersiveness for the user. The robotic systems may include multiple arms for manipulators and retrieving information from the environment and/or the robotic system. The robotic methods may include control modification modules for detecting that an operation of a robotic device based on the control commands fails to comply with one or more operational parameters; identifying the non-compliant control command; and generating a modifier for the secondary device to adjust the non-compliant control command to comply with the set of operational parameters.

<CIT> relates to a method of controlling a medical master/slave system that is used while inserted through the body cavity to apply treatments to various in-vivo tissues.

The instruments, systems, and methods described herein may be used for non-medical purposes including industrial uses, general robotic uses, manipulation of non-tissue work pieces, and/or cosmetic improvements. Other non-surgical applications include use on tissue removed from human or animal anatomies (without return to a human or animal anatomy) or on human or animal cadavers.

The embodiments of the invention are summarized by the claims that follow below. Surgical methods described here below are not part of the claimed invention.

In one embodiment, a teleoperational medical system comprises an input device, a first manipulator arm configured to couple with and move an instrument, and a second manipulator arm configured to couple with and move an imaging instrument. The system also comprises a control system including one or more processors. In response to a determination that the instrument is inserted into an instrument workspace in a direction that is no more than <NUM> degrees from a viewing axis of the imaging instrument in the instrument workspace, the control system is configured to map movement of the input device to movement of the instrument according to a first mapping. In response to a determination that the instrument is inserted into the instrument workspace in a direction that is greater than <NUM> degrees from the viewing axis, the control system is configured to map movement of the input device to movement of the instrument according to a second mapping. The second mapping includes an inversion of the first mapping for at least one direction of motion of the instrument.

In another, not claimed aspect, a method comprises generating master control signals based on a movement of a master controller in a master workspace and determining a direction of a viewing axis of an imaging device in an instrument workspace, the imaging device being coupled to a second manipulator arm of a teleoperational system. The method also comprises determining whether a slave instrument direction for a slave instrument in the instrument workspace is corresponding to the direction of the viewing axis or is non-corresponding to the direction of the viewing axis, the slave instrument being coupled to a first manipulator arm of the teleoperational system. In response to a determination that the slave instrument direction is no more than <NUM> degrees from the direction of the viewing axis, the method comprises mapping the movement of the master controller to movement of the slave instrument according to a first mapping and generating slave instrument control signals for movement of the slave instrument in the instrument workspace based on the first mapping. In response to a determination that the slave instrument direction is greater than <NUM> degrees from the direction of the viewing axis, the method comprises mapping the movement of the master controller to movement of the slave instrument according to a second mapping and generating slave instrument control signals for movement of the slave instrument in the instrument workspace based on the second mapping. The second mapping includes an inversion of the first mapping for at least one direction of motion of the slave instrument.

In another embodiment, a teleoperational instrument system comprises a master input device in a master workspace, an actuated instrument end effector in an instrument workspace, and an actuated tissue probe in the instrument workspace. A method of operating the teleoperational instrument system comprises generating a set of master control signals in response to movement of the master input device and responsive to the set of master control signals, generating a first mapping. The first mapping maps the movement of the master input device to movement of the instrument end effector in the instrument workspace. Responsive to the set of master control signals, the method also comprises generating a second mapping. The second mapping maps the movement of the master input device to movement of the actuated tissue probe in the instrument workspace. In response to a determination that the master input device has control of the actuated instrument end effector, the method also includes generating a set of instrument control signals using the first mapping. In response to a determination that the master input device has control of the actuated tissue probe, the method comprises generating a set of instrument control signals using the second mapping. The second mapping includes an inversion of the first mapping for at least one direction of motion of the actuated tissue probe.

In the following detailed description of the embodiments 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.

Referring to <FIG> of the drawings, a teleoperational system is generally indicated by the reference numeral <NUM>. The teleoperational surgical system <NUM> includes a master console <NUM>, also referred to as a master or surgeon's console, for inputting a surgical procedure and a slave manipulator <NUM>, also referred to as a patient-side manipulator (PSM), for the teleoperational movement of surgical instruments at a surgical site within a patient. The teleoperational surgical system <NUM> is used to perform minimally invasive teleoperational surgery. One example of a teleoperational surgical system that can be used to implement the systems and techniques described in this disclosure is a da Vinci® Surgical System manufactured by Intuitive Surgical, Inc. of Sunnyvale, California. In one embodiment the slave manipulator may be free-standing (see, <FIG>). In an alternative embodiment, the slave manipulator may be mounted to other equipment in the surgical arena, including, for example, the surgical bed (see, <FIG>). In still another alternative embodiment, the slave manipulator may include both free-standing and bed-mounted components.

The teleoperational surgical system <NUM> also includes an image capture system <NUM> which includes an image capture device, such as an endoscope, and related image processing hardware and software. The teleoperational surgical system <NUM> also includes a control system <NUM> that is operatively linked to sensors, motors, actuators, components of the master console <NUM>, components of the slave manipulator <NUM> and to the image capture system <NUM>.

The system <NUM> is used by a system operator, generally a surgeon, who performs a minimally invasive surgical procedure on a patient. The system operator sees images, captured by the image capture system <NUM>, presented for viewing at the master console <NUM>. In response to the surgeon's input commands, the control system <NUM> effects servomechanical movement of surgical instruments coupled to the teleoperational slave manipulator <NUM>.

The control system <NUM> includes at least one processor and typically a plurality of processors for effecting control between the master manipulator <NUM>, the slave manipulator <NUM>, and the image capture system <NUM>. The control system <NUM> also includes software programming instructions to implement some or all of the methods described herein. While control system <NUM> is shown as a single block in the simplified schematic of <FIG>, the system may comprise a number of data processing circuits (e.g., on the surgeon's console <NUM> and/or on the slave manipulator system <NUM>), with at least a portion of the processing optionally being performed adjacent an input device, a portion being performed adjacent a manipulator, and the like. Any of a wide variety of centralized or distributed data processing architectures may be employed. Similarly, the programming code may be implemented as a number of separate programs or subroutines, or may be integrated into a number of other aspects of the teleoperational systems described herein. In one embodiment, control system <NUM> may support wireless communication protocols such as Bluetooth, IrDA, HomeRF, IEEE <NUM>, DECT, and Wireless Telemetry.

<FIG> is a front elevation view of the patient-side manipulator <NUM> according to one embodiment of the teleoperational surgical system <NUM>. The patient-side manipulator <NUM> includes a base <NUM> that rests on the floor, a support tower <NUM> that is mounted on the base <NUM>, and several arms that support surgical tools (including portions of the image capture system <NUM>). As shown in <FIG>, arms 124a, 124b are instrument arms that support and move the surgical instruments used to manipulate tissue, and arm <NUM> is a camera arm that supports and moves the endoscope. <FIG> also shows an optional third instrument arm 124c that is supported on the back side of support tower <NUM> and that can be positioned to either the left or right side of the patient-side manipulator as necessary to conduct a surgical procedure. <FIG> further shows interchangeable surgical instruments 128a, 128b, 128c mounted on the instrument arms 124a, 124b, 124c, respectively, and it shows endoscope <NUM> mounted on the camera arm <NUM>. Knowledgeable persons will appreciate that the arms that support the instruments and the camera may also be supported by a base platform (fixed or moveable) mounted to a ceiling or wall, or in some instances to another piece of equipment in the operating room (e.g., the operating table). Likewise, they will appreciate that two or more separate bases may be used (e.g., one base supporting each arm). The surgical instruments 128a, 128b include end effectors 129a, 129b, respectively. (See <FIG>).

<FIG> is a front elevation view of a master console <NUM> component according to one embodiment of the teleoperational surgical system <NUM>. The master console <NUM> is equipped with left and right multiple DOF master tool manipulators (MTM's) 132a, 132b, which are kinematic chains that are used to control the surgical tools (which include the endoscope and various cannulas). The MTM's <NUM> may be referred to simply as "master," and their associated arms <NUM> and surgical instruments <NUM> may be referred to simply as "slave. " The surgeon grasps a pincher assembly 134a, 134b on each MTM <NUM>, typically with the thumb and forefinger, and can move the pincher assembly to various positions and orientations. Each MTM 132a, 132b will generally allow movement within the master workspace with a plurality of degrees of freedom, typically with six degrees of freedom, three rotational degrees of freedom and three translational degrees of freedom.

When a tool control mode is selected, each MTM <NUM> is coupled to control a corresponding instrument arm <NUM> for the patient-side manipulator <NUM>. For example, left MTM 132a may be coupled to control instrument arm 124a and instrument 128a, and right MTM 132b may be coupled to control instrument arm 124b and instrument 128b. If the third instrument arm 124c is used during a surgical procedure and is positioned on the left side, then left MTM 132a can be switched between controlling arm 124a and instrument 128a to controlling arm 124c and instrument 128c. Likewise, if the third instrument arm 124c is used during a surgical procedure and is positioned on the right side, then right MTM 132a can be switched between controlling arm 124b and instrument 128b to controlling arm 124c and instrument 128c. In alternative embodiments, the third instrument arm may be controlled by either the left or right MTM to accommodate surgical convenience. In some instances, control assignments between MTM's 132a, 132b and arm 124a/instrument 128a combination and arm 124b/instrument 128b combination may also be exchanged. This may be done, for example, if the endoscope is rolled <NUM> degrees, so that the instrument moving in the endoscope's field of view appears to be on the same side as the MTM the surgeon is moving.

Surgeon's console <NUM> also includes a stereoscopic image display system <NUM>. Left side and right side images captured by the stereoscopic endoscope <NUM> are output on corresponding left and right displays, which the surgeon perceives as a three-dimensional image on display system <NUM>. In one configuration, the MTM's <NUM> are positioned below display system <NUM> so that the images of the surgical tools shown in the display appear to be co-located with the surgeon's hands below the display. This feature allows the surgeon to intuitively control the various surgical tools in the three-dimensional display as if watching the hands directly. Accordingly, the MTM servo control of the associated instrument arm and instrument is based on the endoscopic image reference frame.

The endoscopic image reference frame (i.e., "the image frame" or the "first instrument frame") is also used if the MTM's are switched to a camera control mode. For example, if the camera control mode is selected, the surgeon may move the distal end of the endoscope by moving one or both of the MTM's together (portions of the two MTM's may be servomechanically coupled so that the two MTM portions appear to move together as a unit). The surgeon may then intuitively move (e.g., pan, tilt, zoom) the displayed stereoscopic image by moving the MTM's as if holding the image in the hands.

The surgeon's console <NUM> is typically located in the same operating room as the patient-side manipulator <NUM>, although it is positioned so that the surgeon operating the console is outside the sterile field. One or more assistants typically assist the surgeon by working within the sterile surgical field (e.g., to change tools on the patient side cart, to perform manual retraction, etc.). Accordingly, the surgeon operates remote from the sterile field, and so the console may be located in a separate room or building from the operating room. In some implementations, two consoles <NUM> (either co-located or remote from one another) may be networked together so that two surgeons can simultaneously view and control tools at the surgical site.

<FIG> illustrates the slave manipulator <NUM> with a patient P positioned for surgery. In this embodiment, the slave manipulator <NUM> is free-standing and the surgical instruments and the uterine elevator are all mounted to the free-standing base <NUM> and support tower <NUM>. For clarity, some of the instrument arms and instruments have been omitted.

<FIG> is a perspective view of a portion of the control arm 124c with the mounted surgical instrument 128c. Sterile drapes and associated mechanisms that are normally used during surgery are omitted for clarity. The manipulator <NUM> includes a yaw servo actuator <NUM>, a pitch servo actuator <NUM>, and an insertion and withdrawal ("I/O") actuator <NUM>. The surgical instrument 128c is shown mounted at an instrument spar <NUM> including a mounting carriage <NUM>. An illustrative straight cannula <NUM> is shown mounted to cannula mount <NUM>. Shaft <NUM> of instrument 128c extends through cannula <NUM>. Manipulator <NUM> is mechanically constrained so that it moves instrument 128c around a stationary remote center of motion <NUM> (also called "remote center <NUM>") located along the instrument shaft. Yaw actuator <NUM> provides yaw motion <NUM> around remote center <NUM>, pitch actuator <NUM> provides pitch motion <NUM> around remote center <NUM>, and I/O actuator <NUM> provides insertion and withdrawal motion <NUM> through remote center <NUM>. Typically the remote center of motion <NUM> is locked at the incision in the patient's body wall during surgery and to allow for sufficient yaw and pitch motion to be available to carry out the intended surgical task. Alternatively, the remote center of motion may be located outside of the body to allow a greater range of motion without contacting the patient. Knowledgeable persons will understand that motion around a remote center of motion may be constrained by the use of software or by a physical constraint defined by a mechanical assembly.

Matching force transmission disks in mounting carriage <NUM> and instrument force transmission assembly <NUM> couple actuation forces from actuators in manipulator <NUM> to move various parts of instrument 128c in order to position and orient a tissue probe <NUM> mounted at the distal end of the curved shaft <NUM>. Such actuation forces may typically roll instrument shaft <NUM> (thus providing another DOF through the remote center <NUM>). Embodiments of force transmission assemblies are provided in <CIT>; disclosing "Surgical Robotic Tools, Data Architecture, and Use") and <CIT>; disclosing "Mechanical Actuator Interface System for Robotic Surgical Tools") In alternative embodiments, the instrument 128c may include a wrist at the distal end of the shaft that provides additional yaw and pitch DOF's. The tissue probe <NUM> may be, for example, a general tissue manipulator, a tissue elevator, or a tissue retractor. In alternative embodiments, the instrument 128c may include an imaging component.

<FIG> depicts an exploded schematic view of a two-piece surgical instrument <NUM> that may be mounted to the manipulator <NUM> of <FIG>. In this embodiment, the straight cannula <NUM> is mounted to the instrument spar <NUM>. The instrument <NUM> includes a force transmission assembly <NUM>, a shaft <NUM>, and a tissue probe <NUM>. In this embodiment, the shaft <NUM> is a rigid rod with a curved portion <NUM>. In alternative embodiments, the shaft may be cannulated and/or flexible. The shaft <NUM> may be sterilizable and may include a back-loadable tissue probe or vaginal fornices delineator such as a KOH Cup produced by Cooper Surgical, Inc. of Trumbull, CT. The tissue probe <NUM> may be integrated with the shaft or may be removable and disposable. The instrument <NUM> is assembled by loading the shaft <NUM> through a distal end <NUM> of the cannula <NUM> and into engagement with the force transmission assembly <NUM>. With the described configuration, any instrument insertion or removal motion may be along the instrument axis associated with spar <NUM>. The curved nature of the shaft allows the instrument the versatility to manipulate tissue that is difficult to reach with a straight instrument. In one embodiment, the tissue probe <NUM> may be a uterine elevator tip for intrauterine manipulation, but other instruments such as a vaginal fornices delineator, retractors, actuated instruments, non-actuated instruments, or imaging devices may also be used for uterine procedures or surgical procedures at other anatomical locations.

<FIG> depicts an exploded schematic view of a two-piece surgical instrument <NUM> that may be mounted to the manipulator <NUM> of <FIG>. In this embodiment, a curved cannula <NUM> is mounted to the instrument spar <NUM>. The instrument <NUM> includes a force transmission assembly <NUM>, a shaft <NUM>, and a tissue probe <NUM>. In this embodiment, the shaft <NUM> is a flexible rod. In one embodiment, the tissue probe <NUM> may be a uterine elevator tip for intrauterine manipulation, but other instruments such as vaginal fornices delineator, retractors, actuated instruments, non-actuated instruments, or imaging devices may also be used for uterine procedures or surgical procedures at other anatomical locations. The tissue probe <NUM> may be integrated with the shaft or may be removable and disposable. The instrument <NUM> is assembled by loading the shaft <NUM> through a distal end <NUM> of the curved cannula <NUM> and into engagement with the force transmission assembly <NUM>. The flexible nature of the shaft allows it to bend for insertion through the curved cannula.

<FIG> depicts a schematic view of a one-piece surgical instrument <NUM> that may be mounted to the manipulator <NUM> of <FIG>. In this embodiment, the instrument <NUM> includes a tissue probe <NUM>, a curved shaft segment <NUM>, and straight shaft segment <NUM> that can be mounted directly to spar <NUM> instead of a cannula. In this embodiment, the shaft <NUM> is a rigid rod with a rigid curved segment <NUM>. In one embodiment, the tissue probe <NUM> may be a uterine elevator tip for intrauterine manipulation, but other instruments such as a vaginal fornices delineator, retractors, actuated instruments, non-actuated instruments, or imaging devices may also be used for uterine procedures or surgical procedures at other anatomical locations. To accommodate actuated instruments, the shaft may be cannulated and/or non-rigid. The tissue probe <NUM> may be integrated with the shaft or may removable and disposable. Instead of the force transmission assembly <NUM> of <FIG>, a "dummy" force transmission assembly <NUM> is shown attached to spar <NUM>. The instrument <NUM> is assembled by attaching the shaft <NUM> directly to spar <NUM> in place of a cannula. The "dummy" force transmission assembly can be installed during operation to allow the system to recognize the type of instrument being attached via an electronic identification mechanism built into the force transmission <NUM> housing. The "dummy" force transmission assembly can thus signal that the tissue probe is ready for use in a following mode. Further description of a "dummy" or "mock" instrument is provided in <CIT>; disclosing "Systems and Methods for Controlling a Robotic Surgical System"). In another alternative, shaft <NUM> may include a stop feature to prevent random rotation relative to the spar <NUM>. Alternatively, shaft <NUM> may have the capability of being rotationally indexed on the axis of the shaft. Alternatively, the force transmission assembly may include a marker for determining the rotational position of the shaft <NUM> to aid in calculating the tissue probe <NUM> location.

Another embodiment of a surgical instrument is disclosed in <FIG>. In this embodiment, a tissue probe is attachable to a distal end of a cannulated shaft that is mountable to an I/O insertion spar as previously described. Specifically, <FIG> depicts a curved cannulated shaft <NUM> and a tip fastener <NUM> sized for insertion into a distal end <NUM> of the curved cannulated shaft. The tip fastener <NUM> may be mechanically coupled to the curved cannula <NUM> via, for example, a threaded coupling, a snap coupling, a friction coupling, or other known mechanical coupling. Suitable cannulated shafts may include, for example, <NUM> or <NUM> cannulated shafts. Larger or smaller cannulated shafts may also be suitable within the anatomical constraints of the patient. As shown in <FIG>, a tissue probe <NUM> is mechanically coupled to the tip fastener <NUM>. The tissue probe <NUM> includes distal openings <NUM> connected to tubing <NUM>. The tubing <NUM> is used to irrigate and suction a surgical site via the tissue probe <NUM>. In alternative embodiments where I/O motion is not required, tissue probes may be mounted directly to cannulas mounted to the insertion spar as (such as the cannulas shown in <FIG> and 6a).

In the above described embodiments, the cannulas and the instrument shafts may be formed of rigid materials such as stainless steel or glass-epoxy composite. Alternatively, they may be formed of flexible materials such as a high modulus of elasticity plastic like Polyether ether ketone (PEEK), glass or carbon filled Polyether ether ketone (PEEK), or a glass-fiber-epoxy or a carbon-fiber-epoxy composite construction. The inside and outside diameters and physical construction of the shaft or cannula are chosen uniquely for each material choice to limit the magnitude of forces that can be applied to the body during use or allow the structure to bend sufficiently to follow a curved guide path within the instrument or cannula during use. Additional information about the cannulas and instrument shafts, including information about material composition and flexibility, is provided in detail in <CIT>; disclosing "Curved Cannula Instrument").

<FIG> schematically illustrates the master console <NUM>. <FIG> schematically illustrates components (including instruments <NUM>, 128a, 128b, 128c) of the slave manipulator <NUM>. As shown in <FIG>, the surgeon views an instrument workspace <NUM> through the viewer of the display system <NUM>. The tissue probe <NUM> carried on the instrument spar <NUM> is caused to perform positional and orientational movements within the instrument workspace <NUM> in response to movement and action inputs on an associated master control in a master workspace <NUM> (also "master space <NUM>"). As previously described, the instrument arm 124c may be controlled by either the MTM 132a or the MTM 132b. In this illustrative embodiment, the instrument arm 124c with the surgical instrument 128c including the tissue probe <NUM> will be controlled by the left MTM 132a. A different master frame of reference (X<NUM>, Y<NUM>, Z<NUM>) is associated with each one of the MTMs. It is understood that other frames of reference may be defined within the master workspace. For example, a viewer frame of reference (X<NUM>, Y<NUM>, Z<NUM>) may be associated with the viewer of display system <NUM>. The relationships between the frames of reference in the master workspace may be established by fixed kinematic relationships, by sensors, or other known relationships.

As shown in <FIG>, during the surgical set-up procedure, the surgical instrument 128c is positioned within a body cavity <NUM> and the tissue probe <NUM> is positioned against a tissue wall <NUM> of the body cavity <NUM>. The body cavity may be any surgically created or naturally formed body cavity. In one embodiment, for example, the body cavity is the uterus of a patient and the instrument is inserted through the cervix, into the uterus, and into contact with the uterine wall. During gynecological procedures, the tissue probe, which may be a uterine elevator, serves to elevate and move the uterine tissue wall so that it will be properly positioned for access by the end effectors associated with the surgical instruments. <FIG> is a view of the tissue probe <NUM> positioned against the tissue wall <NUM> from within the body cavity <NUM>. This view from a position at a proximal end of the tissue probe <NUM> will also be described as the "probe frame" or "second instrument frame" (X<NUM>, Y<NUM>, Z<NUM>) within the instrument workspace <NUM>. The instrument frame may also be defined at other locations within the body cavity or at other locations along the shaft of the instrument 128c.

During a surgical procedure, images of the end effectors 129a, 129b and the surrounding instrument workspace are captured by the endoscope <NUM> having a field of view <NUM>. These images from the viewpoint or field of view <NUM> of the endoscope are displayed on the display system <NUM> so that the surgeon sees the responsive movements and actions of the end effectors 129a, 129b as he or she controls such movements and actions by means of the MTM's 132a, 132b, respectively.

The field of view <NUM> captured by the endoscope <NUM> has an endoscopic frame of reference (X<NUM>, Y<NUM>, Z<NUM>) within the instrument workspace <NUM>. In this field of view, visualization of the tissue probe <NUM> is obstructed by the tissue wall <NUM>. However, protrusion of the tissue wall <NUM> and movement of the protrusion due to movement of the tissue <NUM> on the opposite side of the tissue wall may be visualized in the field of view <NUM> of endoscope <NUM>. The control system <NUM> is arranged to cause orientational and positional movement of the tissue probe <NUM>, as viewed in the image at the viewer of the display system <NUM> to be mapped by orientational and positional movement of MTM 132a of the master manipulator <NUM> as will be described in greater detail below.

The probe frame, the endoscopic frame, frames of reference for each of the end effectors 129a, 129b, and any other frames of reference defined within the instrument workspace <NUM> may have known relationships established by fixed kinematic connections or by sensors.

In the description which follows, the control system will be described with reference to MTM 132a and instrument arm 124c with surgical instrument 128c. Control between master and slave movement is achieved by comparing master position and orientation in the master workspace <NUM> having a master Cartesian coordinate reference system with slave position and orientation in an instrument workspace <NUM> having a surgical Cartesian coordinate reference system. For ease of understanding and economy of words, the term "Cartesian coordinate reference system" will simply be referred to as "frame" in the rest of this specification. Accordingly, the control system <NUM> serves to compare the slave position and orientation within the endoscopic frame with the master position and orientation in the master frame (and/or viewer frame) and will actuate the slave to into a position and/or orientation in the endoscopic frame that corresponds with the position and/or orientation of the master in the master frame (and/or viewer frame). As an MTM is translated and rotated in three dimensional space, the master frame of reference translates and rotates correspondingly. These master frame translations and rotations may be sensed, and they may transformed (also "mapped") to the frames of reference in the instrument workspace, including the probe frame, to provide a control relationship between the MTM and coupled instruments and/or probe in the workspace by using well known kinematic calculations. As the master frame position and orientation is changed, the frame of the coupled instrument is changed correspondingly, so that the coupled instrument movement is slaved to the MTM movement.

As previously described, the control system <NUM> includes at least one, and typically a plurality, of processors which compute new corresponding positions and orientations of the slave in response to master movement input commands on a continual basis determined by the processing cycle rate of the control system.

As shown in <FIG>, The Z<NUM>-axis of the master frame through the master workspace moves with the MTM 132a. Naturally, the X<NUM> and Y<NUM>-axes extend perpendicularly from the Z<NUM>-axis. Also as shown in <FIG>, the Z<NUM>-axis of the viewer frame through the master workspace extends along (or parallel to) a line of sight of the surgeon, indicated by axis <NUM>, when viewing the surgical site through the viewer of the display system <NUM>. Naturally, the X<NUM> and Y<NUM>-axes extend perpendicularly from the Z<NUM>-axis. Conveniently, the Y<NUM> axis is chosen to extend generally vertically relative to the viewer of the display system <NUM> and the X<NUM> axis is chosen to extend generally horizontally relative to the viewer.

As shown in <FIG>, the Z<NUM>-axis of the endoscopic frame extends axially along (or parallel to) a viewing axis <NUM> of the endoscope <NUM>. Although in <FIG>, the viewing axis <NUM> is shown in coaxial alignment with a shaft axis of the endoscope <NUM>, it is to be appreciated that the viewing axis can be angled relative thereto. Thus, the endoscope can be in the form of a straight or angled-tip scope. The X<NUM> and Y<NUM>-axes are positioned in a plane perpendicular to the Z<NUM>-axis. Also shown in <FIG>, the Z<NUM>-axis of a probe frame extends axially along (or parallel to) a longitudinal axis of the instrument 128c. The X<NUM> and Y<NUM>-axes are positioned in a plane perpendicular to the Z<NUM>-axis.

Additional information about a referenced control system, including information about the mapping of the position and orientation of the master in the master workspace with the instrument in the instrument workspace, is provided in detail in U. Patent No. <CIT>; disclosing "Camera Referenced Control in a Minimally Invasive Surgical Apparatus"). Generally, a surgical teleoperational mapping method includes moving a MTM in a master workspace by articulating a plurality of master joints. Master control signals, corresponding to the position, orientation, and velocity of the MTM are transmitted to the control system. In general, the control system will generate corresponding slave motor signals to map the Cartesian position of the master in the master workspace with the Cartesian position of the end effector or tissue probe in the instrument workspace according to a transformation. The control system may derive the transformation in response to state variable signals provided from the image capture system so that an image of the end effector or tissue probe in the display system appears substantially connected to the MTM. Additionally, position and velocity in the master workspace are transformed into position and velocity in the instrument workspace using scale and offset converters. Further details of the transformation are provided in <CIT>. A surgical tissue probe or end effector is moved in the instrument workspace by articulating a plurality of slave joints in response to slave motor signals. The slave motor signals are generated by the control system in response to moving the master so that an image of the end effector or tissue probe in the display appears substantially connected with the MTM in the master workspace.

Because the surgeon has a distal end-on view of the tissue probe <NUM> through the display system <NUM>, conventional mapping of the master to the slave would require the MTM 132a to be twisted to point back at the surgeon in an ergonomically awkward position and orientation. Therefore, a method of inverting the mapping of the master to the slave along at least one of the coordinates will allow the surgeon to control the tissue probe <NUM> as though the instrument 128c was extending from the tissue probe back toward the surgeon. In other words, as will be described in detail below, the movement of the MTM <NUM> is mapped to the tissue probe <NUM> in a reversed direction along at least one coordinate of the probe frame.

In a conventional mapping technique, movement of the MTM 132a in a +X<NUM> direction results in a corresponding movement (including scaling and offset factors) of instrument 128a in a +X<NUM> direction in the instrument workspace in the endoscopic frame. If the user wishes to relinquish control of instrument 128a and initiate control of instrument 128c using MTM 132a, the user registers the indication with the control system <NUM> and the control of MTM 132a is transferred to instrument 128c.

<FIG> provides one example of a process <NUM> for controlling a surgical instrument 128c, such a uterine elevator instrument, using an inverted mapping technique. Prior to implementation of the inverted mapping technique, the control system <NUM> will be informed that an inverted mapping technique, rather than a conventional mapping technique is required. This information may be based, for example, on a user input, sensor input, or other feedback identifying the slave instrument or slave arm as arranged in a configuration, such as an end-on view, in which an inverted mapping technique provides more comfortable manipulation for the user. As previously described, an MTM <NUM> within the master workspace <NUM> typically has six degrees of freedom, three rotational degrees of freedom and three translational degrees of freedom. The process <NUM> may be performed with all six degrees of freedom enabled. In an alternative embodiment, the position of the tip of the tissue probe may be mapped without similarly mapping the orientation of the probe. In other words, the rotational/ orientation mapping is rendered inoperable. More specifically, the rotational degrees of freedom (yaw, pitch, and roll) may be freed to create an interface that allows the surgeon to perceive that the MTM 132a is dragging the tissue probe. Thus, the tissue probe would appear to translate through the three dimensional coordinate system, but rotational capability would be disabled, wherein the rotation of the MTM is locked out. Alternatively, the master rotation may be allowed to float, wherein the rotation is ignored in the transformation of the tissue probe manipulation. In still another alternative, translation is mapped with less than all of the rotational degrees of freedom. For example, translation of the MTM may be mapped with rotation about a Z-axis, without mapping the movement about the X- and Y- axes. Any error between the master and probe with respect to non-active axes may be omitted from display to avoid the need for remapping of the MTM.

At a process <NUM>, movement of a master input device, namely MTM 132a, in a first direction in the master workspace <NUM> is detected. At a process <NUM>, the movement of the MTM 132a results in the generation of master control signals. At a process <NUM>, the movement of the MTM 132a in the master workspace <NUM> is mapped to the tissue probe <NUM> in the instrument workspace. At a process <NUM>, slave control signals are generated to move the tissue probe <NUM> in the instrument workspace, in an inverted first direction. An inverted direction is reversed or opposite in magnitude along at least one axis of the Cartesian coordinate system. The scale of movement, velocity, and size of the workspace may be controlled based upon the tissue probe used. Limits on the motion of the tissue, e.g. the uterus, may be predetermined and set by the system or by the surgeon's visual cues.

As explained further in the detailed examples provided in <FIG>, the movement of the master input device in the master workspace may be mapped to instruments in the instrument workspace based upon a determination of the slave instrument insertion direction. For example, if the slave instrument is inserted into the instrument workspace in a direction that corresponds with the direction of the field of view, a mapping associated with the direction of the field of view may be used. Alternatively, if the slave instrument is inserted into the instrument workspace in a direction that is non-corresponding with the direction of the field of view, a different mapping, such as one including an inversion for at least one direction of the slave instrument motion may be used.

A slave instrument insertion direction may be considered "corresponding" based on a geometric relationship between the viewing axis of the imaging instrument and the slave instrument as determined by known kinematic relationship or sensor feedback. A corresponding slave instrument direction may be any direction that is less than or equal to ninety degrees (or, in other embodiments, less than ninety degrees) from the viewing axis (e.g. axis <NUM>). In <FIG>, instruments 128a and 128b may be considered to be inserted in a corresponding direction because of their direction relative to the viewing axis <NUM>. A slave instrument direction may also be considered "non-corresponding" based on a geometric relationship between the viewing axis of the imaging instrument and the slave instrument. A non-corresponding slave instrument direction may be any direction that is greater than ninety degrees (or, in other embodiments, no less than ninety degrees) from the viewing axis. In <FIG>, instrument 128c may be considered to be inserted in a non-corresponding direction because of it has an insertion direction approximately <NUM>° from the viewing angle <NUM> and is not extending between the viewing angle <NUM> and a plane perpendicular to the distal tip of the imaging instrument <NUM>. Thus in <FIG>, instruments 128a, 128b may have a corresponding mapping that corresponds to the field of view along the viewing axis <NUM>, and instrument 128c may have a mapping that includes an inversion of the corresponding mapping in at least one direction of motion (e.g., the X<NUM> direction) for the instrument 128c. The inversion may be, for example an opposite or <NUM>° change in direction from the corresponding mapping.

Referring now to <FIG>, the view of the instrument workspace <NUM> through the endoscope <NUM>, i.e., the endoscopic frame, allows the user at the master console <NUM> to visualize the section of tissue wall <NUM>, the instrument 128a with end effector 129a, and the instrument 128b with end effector 129b. Although the tissue probe <NUM> in the workspace may not be directly visualized due to the intervening tissue <NUM>, the general location of the tip may be identified by a protrusion, distension, or other quality associated with an area of the tissue <NUM> that has been elevated by the tip. In one embodiment, an overlay image may be displayed to indicate the location of the tip. This overlay may be triggered when control is switched to the tissue probe. If an imaging probe is used, the tissue may be visualized directly, providing an internal view of the patient anatomy. In this example frame, the +X<NUM> direction is to the right of the page, the -X<NUM> direction is to the left of the page, the +Y<NUM> direction is to the top of the page, the -Y<NUM> direction is to the bottom of the page, the +Z<NUM> direction is out of the page, and the -Z<NUM> direction is into the page. In an alternative embodiment, the surgeon may be primarily interested in the amount of tissue stretch achieved by the probe and will move the probe until the image in the endoscopic frame indicates that the tissue of interest is stretched to the surgeon's specifications.

Referring now to <FIG>, the probe frame of the instrument workspace <NUM> from the opposite side of the tissue wall <NUM> (e.g., from a proximal end of the instrument 128c, as viewed from the cervix into the uterus) inverts the X and Z axes as compared to the endoscopic frame (X<NUM>, Y<NUM>, Z<NUM>). Specifically, in this example frame, the -X<NUM> direction is to the left of the page, the +X<NUM> direction is to the right of the page, the +Y<NUM> direction is to the top of the page, the -Y<NUM> direction is to the bottom of the page, the -Z<NUM> direction is into the page, and the +Z<NUM> direction is out of the page.

If the MTM 132a is coupled to move the tissue probe <NUM>, and the surgeon wishes to move the tissue probe <NUM> toward the location of the end effector 129b, as shown in <FIG>, he or she moves the MTM 132a in the +X<NUM> direction (toward the MTM 132b in the master space <NUM>). Because of the inverted position (non-corresponding direction) of the instrument 128c, under a conventional, non-inverted mapping scheme, movement of the MTM 132a to the right toward the MTM 132b in the master space <NUM> would cause the tissue probe <NUM> in the view of <FIG> to also move to the right -- in the +X<NUM> direction toward the end effector 129a. To avoid this reversed outcome and to move the tissue probe <NUM> toward the intended end effector 129b, the mapping of the MTM 132a is inverted. Thus, as shown in <FIG>, movement of the MTM 132a in the +X<NUM> direction in the master workspace <NUM> is inverted in the probe frame, causing the tissue probe <NUM> to move in the -X<NUM> direction (i.e. opposite the +X<NUM> direction), toward the end effector 129b in the endoscopic frame.

More specifically, the control system <NUM> may be configured to determine if the MTM 132a is communicatively coupled with a slave instrument in a corresponding direction such as an instrument 128a, 128b, <NUM> (i.e. an instrument other than the tissue probe <NUM>), and if so movement of the MTM 132a in the viewer frame is mapped to movement of the slave instrument in the endoscopic frame according to a first mapping. The first mapping translates movement in a first direction (e.g., to the viewer's right, +X<NUM>) in the viewer frame to movement in the first direction (e.g., to the endoscope's right, +X<NUM>) in the endoscopic frame. If the MTM 132a is communicatively coupled with a slave instrument in a non-corresponding direction, such as the inverted instrument 128c that includes the tissue probe <NUM>, movement of the MTM 132a in the viewer frame is mapped to movement of the inverted instrument in the probe frame according to a second mapping. The second mapping translates the movement in the first direction (e.g. to the viewer's right, +X<NUM>) in the viewer frame to movement in an inverted first direction (e.g. to the tissue probe's left, -X<NUM>, as viewed from a proximal location along the shaft of instrument 128c) in the probe frame. The inverted first direction (e.g. -X<NUM>) in the probe frame is opposite the first direction (e.g., +X<NUM>) in the viewer frame and in the endoscopic frame. In this embodiment, movement of the instrument 128c in the inverted first direction of the probe frame is in the same direction in the instrument workspace as the first direction of the instrument 128a in the endoscopic frame. In other words, in the instrument workspace <NUM>, the first direction +X<NUM> in the endoscopic frame is the same as the inverted first direction -X<NUM> in the probe frame.

Referring now to <FIG>, in another example, a starting position of the tissue probe <NUM> as in <FIG> is assumed. If the surgeon wishes to move the tissue probe <NUM> up, he or she moves the MTM 132a in the +Y<NUM> direction (out of the page in the master space <NUM> of <FIG>). In this example, a conventional mapping scheme may be used because an upward movement of the MTM 132a in the master space <NUM> would cause the tissue probe <NUM> in the view of <FIG> to also move up-- in the +Y<NUM> direction. In other words, the "up" movement is the same in both the endoscopic view of <FIG> and in the instrument view of <FIG>. Thus, conventional mapping will result in movement of the tissue probe <NUM> in the +Y<NUM> direction and the +Y<NUM> direction when the MTM 132a is moved in the +Y<NUM> direction.

More specifically, the control system <NUM> may be configured to determine if the MTM 132a is communicatively coupled with a slave instrument in a corresponding direction such as an instrument 128a, 128b, <NUM> (i.e. an instrument other than the tissue probe <NUM>), and if so movement of the MTM 132a in the viewer frame is mapped to movement of the first slave instrument in the endoscopic frame according to a first mapping. The first mapping translates movement in a first direction (e.g., to the viewer's up, +Y<NUM>) in the viewer frame to movement in the first direction (e.g., to the endoscope's up, +Y<NUM>) in the endoscopic frame. If the MTM 132a is communicatively coupled with a slave instrument in a non-corresponding direction, such as the instrument 128c that includes the tissue probe <NUM>, movement of the MTM 132a in the viewer frame is mapped to movement of the slave instrument in the probe frame according to a second mapping. The second transformation also translates the movement in the first direction (e.g. to the viewer's up, +Y<NUM>) in the viewer frame to movement in a first direction (e.g. to the tissue probe's up, +Y<NUM>, as viewed from a proximal location along the shaft of instrument 128c) in the probe frame. The first direction (e.g. +Y<NUM>) in the probe frame is the same as the first direction (e.g., +Y<NUM>) in the viewer frame. In this embodiment, movement of the instrument 128c in the first direction of the probe frame is in the same direction in the instrument workspace as the first direction of the instrument 128a in the endoscopic frame. In other words, in the instrument workspace <NUM>, the first direction +Y<NUM> in the endoscopic frame is the same as the inverted first direction +Y<NUM> in the probe frame.

Referring now to <FIG>, in another example, a starting position of the tissue probe <NUM> as in <FIG> is assumed. If the MTM 132a is coupled to move the tissue probe <NUM> and the surgeon wishes to move the tissue probe <NUM> away from the tissue wall <NUM>, he or she moves the MTM 132a along the -Z<NUM> direction and away from the viewer of the display system <NUM> in <FIG>. Because of the inverted position (non-corresponding direction) of the instrument 128c, under a conventional mapping scheme, movement of the MTM 132a away from the surgeon in the -Z<NUM> direction in the master space <NUM> would cause the tissue probe <NUM> in the view of <FIG> to move into the page -- in the -Z<NUM> direction further into the tissue wall <NUM>. To avoid this reversed outcome and to move the tissue probe <NUM>, as intended, away from the tissue wall <NUM>, the mapping of the MTM 132a is inverted. Thus, as shown in <FIG>, movement of the MTM 132a in the -Z<NUM> direction in the master workspace <NUM> is inverted, causing the tissue probe <NUM> to move in the +Z<NUM> direction (i.e. opposite the -Z<NUM> direction), out of the page and away from the tissue wall <NUM> (toward the cervix in the probe frame).

More specifically, the control system <NUM> may be configured to determine if the MTM 132a is communicatively coupled with a slave instrument in a corresponding direction such as an instrument 128a, 128b, <NUM> (i.e. an instrument other than the tissue probe <NUM>), and if so movement of the MTM 132a in the viewer frame is mapped to movement of the first slave instrument in the endoscopic frame according to a first mapping. The first mapping translates movement in a first direction (e.g., away from the viewer, -Z<NUM>) in the viewer frame to movement in the first direction (e.g., away from the endoscope, -Z<NUM>) in the endoscopic frame. If the MTM 132a is communicatively coupled with a slave instrument in a non-corresponding direction, such as the instrument 128c that includes the tissue probe <NUM>, movement of the MTM 132a in the viewer frame is mapped to movement of the second slave instrument in the probe frame according to a second mapping. The second mapping translates the movement in the first direction (e.g. away from the viewer, -Z<NUM>) in the viewer frame to movement in an inverted first direction (e.g. away from the tissue wall <NUM>, +Z<NUM>, as viewed from a proximal location along the shaft of instrument 128c) in the probe frame. The inverted first direction (e.g. +Z<NUM>) in the probe frame is opposite the first direction (e.g., -Z<NUM>) in the viewer frame and the endoscopic frame. In this embodiment, movement of the instrument 128c in the inverted first direction of the probe frame is in the same direction in the instrument workspace as the first direction of the instrument 128a in the endoscopic frame. In other words, in the instrument workspace <NUM>, the first direction -Z<NUM> in the endoscopic frame is the same as the inverted first direction +Z<NUM> in the probe frame.

Although the examples provided describe linear movements along X, Y, or Z axes, it is understood that angular movements of the MTM 132a in the three dimensional workspace <NUM> may also be mapped to the three dimensional instrument workspace such that the mapping is inverted as to one or more of the coordinate axes and conventional as to one or more of the coordinate axes. For example, a movement +X<NUM>, +Y<NUM>, in the viewer and endoscopic frames, may be mapped to correspond to a movement -X<NUM>, +Y<NUM>, in a probe frame.

The embodiment of <FIG> illustrates an alternative slave manipulator system <NUM>. The system <NUM> includes separate teleoperated manipulator component <NUM> and manipulator component <NUM>. Both components <NUM>, <NUM> may be operated via a common master manipulator and control system. Alternatively, they may be operated by different master manipulators, direct manipulators, and/or control systems. Manipulator component <NUM> is substantially similar to the patient-side manipulator described for <FIG>, including the surgical instruments that operate under master control. Manipulator component <NUM> is a separate servo-operated manipulator and includes a mounted instrument <NUM> with tissue probe <NUM>, similar to any of the embodiments described above. In this embodiment, the manipulator component <NUM> is mounted to a bed rail <NUM> of a patient bed <NUM>. The initial positioning of the manipulator component <NUM> may be performed manually. For example, the manipulator component <NUM> may be moved along the bed rail <NUM> and locked in place with a friction locking mechanism. After being locked in place, the manipulator component <NUM> may be placed under the control of the master manipulator and central control system. With the component <NUM> locked in position, the mounted instrument <NUM> with tissue probe <NUM> may be operated as described for earlier embodiments. In other alternative embodiments, the manipulator component may be mounted on any side of the patient bed or on another movable or stationary component in the surgical arena.

<FIG> illustrate an assisting medical instrument <NUM>, such as a uterine elevator, according to another embodiment. For use with teleoperational control, the instrument <NUM> may be attached to the instrument spar <NUM> of <FIG>. The instrument <NUM> has a proximal end <NUM> and a distal end <NUM>. The proximal end includes a handle <NUM> that may be used to manually manipulate the instrument when disconnected from the instrument spar <NUM>. The handle <NUM> has an ergonomic grip to allow a user to grasp and manipulate the instrument when not under teleoperational control. The instrument <NUM> further includes a mounting portion <NUM> sized and shaped to mate with the cannula mount <NUM>. The mounting portion <NUM> includes a recessed surface <NUM> that provides identification information indicating characteristics of the instrument such as size and shape. In alternative embodiments, the identification information may be located on a different portion of the instrument. In still other alternative embodiments, the identification information may be read or otherwise sensed at the instrument spar <NUM> and electronically communicated from the instrument to the control system <NUM>.

The instrument <NUM> further includes a fixed curved shaft portion <NUM> having an approximately <NUM>° arc and a fixed radius of curvature. In this embodiment, the curved portion has an arc length. The curved portion <NUM> and other portions of the instrument <NUM> may be formed of a rigid material including metals such as stainless steel or titanium, polymers such polyetheretherketone (PEEK), or ceramics. Suitable materials may be light weight but have sufficient strength to resist substantial bending or breaking when a force is applied to the instrument to manipulate tissue in a patient anatomy. The curved portion <NUM> has a solid shaft but in alternative embodiments may be cannulated to reduce weight or to provide passage for fluid flow or other medical tools.

The distal end <NUM> of the instrument <NUM> includes a tip fastener <NUM> and the curved shaft portion <NUM> includes channels, grooves, fasteners and other mating features <NUM>. The fastener <NUM> and mating features <NUM> are sized and shaped to mate with a medical accessory <NUM>. The medical accessory <NUM> include a tissue probe <NUM>. The tissue probe <NUM> may be rounded, flexible, inflatable, and/or have other atraumatic tip characteristics that allow the probe to engage and apply force to tissue without tearing, abrading, or otherwise damaging the tissue. Various medical accessories suitable for use with the instrument <NUM> are available from CooperSurgical, Inc. of Trumbull, CT and may include uterine manipulator accessories from the RUMI® and Koh product lines.

When attached to the instrument spar <NUM>, the instrument <NUM> may be controlled to pivot about a center of rotation C1 disposed along an axis A1 (perpendicular to the page in <FIG>) which does not intersect the instrument <NUM>. The instrument <NUM> may be constrained to single rotational degree of freedom (e.g. pitch). Typically the center of rotation C1 is locked at the patient orifice during surgery and allows for sufficient pitch motion to be available to carry out the intended surgical manipulation. Alternatively, the center of rotation may be located outside of the body to allow a greater range of motion without contacting the patient. Knowledgeable persons will understand that motion around a center of rotation may be constrained by the use of software or by a physical constraint defined by a mechanical assembly.

A location feature <NUM> is provided on the mounting portion <NUM> to indicate to a user the direction of the instrument curvature when the curved portion of the instrument is located inside of a patient anatomy and thus is not visible to the user. The location feature <NUM> may also serve to prevent the instrument <NUM> from rotating about an axis A2 extending through the mounting portion <NUM>, thus maintaining the center of rotation C1 in a fixed position relative to the instrument spar <NUM>. In this embodiment, the location feature <NUM> is a projection, but in alternative embodiments may be a marking, a recessed portion or other indicating feature.

During an initial surgical set-up procedure, the instrument <NUM> is attached to the cannula mount <NUM>. As previously described, instead of a force transmission assembly, a "dummy" force transmission assembly (<FIG>) can be installed to allow the system to recognize the type of medical instrument attached to the instrument spar. The medical accessory <NUM> is mated with the curved shaft portion <NUM> and is coupled to the distal end <NUM>. The assembled instrument <NUM> is positioned within a body cavity with the tissue probe <NUM> positioned against a tissue wall of the body cavity. The tissue probe may be, for example, expanded by inflation with a fluid. In an alternative embodiment, the instrument may be positioned through a patient orifice first and then may be coupled to the manipulator after the instrument is in position. As previously described, in various embodiments, the manipulator <NUM> may be attached to the patient bed, to a movable support structure, or to another fixed or movable component in the surgical area.

In this embodiment, movement of the instrument <NUM> along the X<NUM> axis (perpendicular to the page in <FIG>) is restricted and movement of the instrument in the Y<NUM> and Z<NUM> directions is coupled due to the constrained rotational movement of the instrument <NUM> about the center of rotation C1. For example, as the distal end <NUM> of the instrument <NUM> is pivoted forward (clockwise in <FIG>) about the center of rotation C1 (i.e. a pitch motion about axis A1), the distal end <NUM> moves in a +Y<NUM>, -Z<NUM> direction. As the distal end <NUM> is pivoted in reverse (counter-clockwise in <FIG>) about the center of rotation C1, the distal end <NUM> moves in a-Y<NUM>, +Z<NUM> direction. The movement of the MTM 132a that controls the motion of the tissue probe may likewise be coupled in the Y<NUM> and Z<NUM> directions. Alternatively, the movement of the MTM 132a that controls the motion of the tissue probe may be decoupled in the Y1 and Z1 directions. When the movement of the MTM 132a is decoupled, the decoupled movement of the MTM 132a is mapped to approximate MTM movement while accommodating the coupled movement of the instrument.

As an example, if the surgeon wishes to move the tissue probe <NUM> in the +Y<NUM> direction, he or she moves the MTM 132a along the +Y<NUM> direction (out of the page in the master space <NUM> of <FIG>). In this example, a conventional mapping scheme may be used because an upward movement of the MTM 132a in the master space <NUM> would cause the tissue probe <NUM> to also move up-- in the +Y<NUM> direction. In other words, the "up" movement is the same in both the endoscopic view and in the instrument view. Thus, conventional mapping will result in movement of the tissue probe <NUM> in the +Y<NUM> direction when the MTM 132a is moved in the +Y<NUM> direction. If the surgeon wishes to move the tissue probe <NUM> away from the tissue wall <NUM> (<FIG>), he or she moves the MTM 132a along the -Z<NUM> direction and away from the surgeon in <FIG>. Because of the inverted position of the instrument 128c, under a conventional mapping scheme, movement of the MTM 132a away from the surgeon in the -Z<NUM> direction in the master space <NUM> would cause the tissue probe <NUM> to move in the -Z<NUM> direction further into the tissue wall. To avoid this reversed outcome and to move the tissue probe <NUM>, as intended, away from the tissue wall <NUM>, the mapping of the MTM 132a is inverted. Thus, movement of the MTM 132a in the +Z<NUM> direction in the master workspace <NUM> is inverted, causing the tissue probe <NUM> to move in the +Z<NUM> direction, away from the tissue wall <NUM> (toward the cervix in the probe frame).

<FIG> illustrate an assisting medical instrument <NUM>, such as a uterine elevator, according to another embodiment. The medical instrument <NUM> may be similar in configuration and operation to the instrument <NUM>, with a few distinguishing features as will be described. The medical instrument <NUM> includes a proximal end <NUM>, a distal end <NUM>, and a curved shaft portion <NUM> extending between the proximal and distal ends. In this embodiment, a straight shaft portion <NUM> extends between the proximal end <NUM> and the curved shaft portion <NUM>. When attached to the instrument spar <NUM>, the instrument <NUM> may pivot about a center of rotation C2. The straight shaft portion extends the center of rotation C2 away from the spar <NUM> as compared to the instrument <NUM>. Selection of the proper instrument for use in a particular procedure may be based upon the patient size and the distance between the tissue to be manipulated and natural or surgically created orifice through which the instrument is inserted.

<FIG> is a schematic view of an assisting medical instrument <NUM> that may be mounted to the manipulator <NUM> of <FIG> in a configuration that provides additional degrees of freedom of motion for the tissue probe. In this embodiment, the instrument <NUM> has a proximal end <NUM>, a distal end <NUM>, a curved shaft portion <NUM>, and a straight shaft portion <NUM>. A tissue probe <NUM> is mounted to the distal end <NUM>. An axis A3 extends through the straight shaft portion <NUM>. The instrument spar <NUM> of the manipulator <NUM> includes an instrument anchor <NUM>. The instrument anchor <NUM> includes a passageway sized to receive the straight shaft portion <NUM> to couple instrument <NUM> to the instrument spar <NUM>. The instrument anchor <NUM> may be an accessory clamp as described in greater detail in <CIT>; disclosing "Surgical Accessory Clamp and Method"). The instrument anchor <NUM> may serve as a bearing which permits linear translation of the instrument <NUM> along the axis A3 and rotational motion of the instrument about the axis A3, while constraining translational motion perpendicular to the axis A3.

A force transmission assembly <NUM> (substantially similar to force transmission assembly <NUM> described above) couples actuation forces from actuators in manipulator <NUM> to move various parts of instrument <NUM> in order to position and orient the tissue probe <NUM> mounted at the distal end of the curved shaft <NUM>. A joint <NUM>, such as a quick disconnect mechanism, extends between the proximal and distal ends of the instrument <NUM>. In this embodiment, the joint <NUM> is between the instrument anchor <NUM> and the force transmission assembly <NUM>. Alternatively, the joint may extend between the proximal end of the instrument and the force transmission assembly. The joint <NUM> allows for rotation of the tissue probe <NUM> about the axis A3 at the j oint. The j oint <NUM> may also or alternatively allow for translation of the tissue probe along the axis A3 from the joint. Additionally, the joint <NUM> permits quick exchange of the distal end of the instrument <NUM> and the tissue probe <NUM>. For example, joint <NUM> allows a non-sterile end effector or tissue probe on a distal end of the instrument to be removed from the sterile proximal end portions of the instrument. Furthermore, the joint <NUM> allows for set-up of the instrument <NUM> and tissue probe <NUM> within the patient anatomy without the encumbrance of an attached manipulator. For example, the instrument <NUM> and tissue probe <NUM> may be positioned and arranged within the patient body cavity. After this initial set-up activity is complete, the instrument spar <NUM> with force transmission assembly <NUM> is introduced to the instrument <NUM>. The straight shaft portion <NUM> is loaded into the instrument anchor <NUM>, for example, through a distal opening in the instrument anchor or through an opening between pivoting clamp arms. The force transmission assembly <NUM> may then be operatively coupled to the straight shaft portion via the joint <NUM>. After the instrument <NUM> is connected to the joint <NUM>, the force transmission assembly <NUM> is operable to control the rotational movement of the tissue probe <NUM> about the axis A3 and to control the translation of the tissue probe along the axis A3. In one embodiment, to permit translation of the straight shaft portion <NUM> relative to the joint, <NUM>, the straight shaft portion between the joint and the curved shaft portion may have a smaller diameter than the straight shaft portion between the joint and the force transmission assembly to permit telescoping motion. The instrument anchor <NUM> may operate as a bearing to support the rotational and translational motion of the straight portion of the shaft.

<FIG> is a schematic view of an assisting medical instrument <NUM> that may be mounted to the manipulator <NUM> of <FIG> in a configuration that provides additional degrees of freedom of motion for the tissue probe. In this embodiment, the instrument <NUM> may be substantially similar to the instrument <NUM> and configuration of <FIG> with the differences to be described. In this embodiment, the instrument <NUM> has a proximal end <NUM>, a distal end <NUM>, a curved shaft portion <NUM>, a straight shaft portion <NUM>, and a tissue probe <NUM>. In this embodiment, a joint <NUM>, such as a quick disconnect j oint, is engaged between the distal end <NUM> and the instrument anchor <NUM>. The joint <NUM> allows for rotation of the tissue probe <NUM> and curved portion <NUM> about the axis A4 at the joint. The joint <NUM> also allows for translation of the tissue probe along the axis A4 from the joint. Additionally, the joint <NUM> permits quick exchange of the distal end <NUM> of the instrument and the tissue probe <NUM>. Furthermore, the joint <NUM> allows for set-up of the instrument <NUM> and tissue probe <NUM> within the patient anatomy without the encumbrance of an attached manipulator. In this embodiment, assembly of the instrument <NUM> may be less cumbersome that the assembly of the instrument <NUM> (<FIG>) because the straight shaft portion may be connected to the joint without the need to feed the straight shaft portion through the instrument anchor. Because the joint <NUM> is distal of the instrument anchor, the joint should be selected to withstand the tissue probing forces without deformation. With a sufficiently robust joint, the straight shaft portions on either side of the joint may remain generally collinear and aligned with the axis A4. For example, the joint may be capable of withstanding loads of up to approximately <NUM>,<NUM> (<NUM> lbs).

<FIG> is a schematic view of an assisting medical instrument <NUM> that may be mounted to the manipulator <NUM> of <FIG> in a configuration that provides additional degrees of freedom of motion for the tissue probe. In this embodiment, the instrument <NUM> may be substantially similar to the instrument <NUM> and configuration of <FIG> with the differences to be described. In this embodiment rather than a quick disconnect joint <NUM>, the instrument <NUM> has a proximal end <NUM>, a distal end <NUM>, a curved shaft portion <NUM>, a straight shaft portion <NUM>, and a tissue probe <NUM>. In this embodiment, a joint <NUM>, such as a multi-dimensional wrist joint, is between the distal end <NUM> and the instrument anchor <NUM>. An example of various multi-dimensional wrist joints are described in greater detail in <CIT>; disclosing "Surgical Tool Having Positively Positionable Tendon Actuated Multi-Disk Wrist Joint"). The joint <NUM> allows for multi-dimensional movement of the tissue probe <NUM> and curved portion <NUM>. Because the joint <NUM> is distal of the instrument anchor, the joint should be selected to withstand the tissue probing forces without deformation. With a sufficiently robust j oint, the straight shaft portions on either side of the joint remain generally collinear and aligned with the axis A4. For example, the joint may be capable of withstanding loads of up to approximately <NUM>,<NUM> (<NUM> lbs).

<FIG> illustrates an assisting medical instrument <NUM> including a passive illumination source. The medical instrument <NUM> may be, for example, a uterine elevator similar to any of the embodiments previously described. For use with teleoperational control, the instrument <NUM> may be attached to the instrument spar <NUM> of <FIG>. The instrument <NUM> includes a probe portion <NUM> coupled to a distal end of a shaft portion <NUM>. The probe portion <NUM> and or the shaft portion <NUM> may include one or more illumination fiducial markers <NUM>. The illumination fiducial markers <NUM> may be passive illumination fiducial markers that operate without connection to a power mains or to an energy storage device such as a battery. Passive illumination fiducial markers receive incident light from a light source and in response, emit light. In one alternative, a passive illumination fiducial marker may include a passive light emitting diode (LED) system. A passive LED system may include a photosensor coupled to an LED. The photosensor receives excitation light and generates current to illuminate the LED. In another alternative, a passive illumination fiducial marker may include a well, a channel, a recess, or other cavity or container for containing a fluorescent dye such as indocyanine green (ICG) dye. When the ICG dye is illuminated with light at an excitation wavelength (e.g., about <NUM> to <NUM>) it may be observed directly or imaged at a longer observation wavelength (e.g., over <NUM>).

Light received from an external source, such as light delivered by an optical fiber to a surgical area, may illuminate the passive marker either directly or through occluding tissue. For example, with reference to <FIG>, if the passive marker is located on the probe <NUM> within the body cavity <NUM> (e.g., a uterus), light emitted from the endoscope <NUM> may pass through the tissue wall to excite the passive marker on the probe. The excited passive marker emits light that may be visible to a user via the endoscope. Thus, the location of the probe may be recognized, through the occluding tissue, from the light of the passive marker. In alternative embodiments, the excitation light may be supplied by a light source on either the probe side or the end effector side of the tissue wall. In alternative embodiments, the markers may be active illumination fiducial markers, including a battery or other power supply to power an LED or other light source.

<FIG> illustrate another example of a medical implement that may be fitted with passive illumination markers. In this embodiment, a colpotomizer cup <NUM> includes passive illumination markers <NUM>. When used in a medical procedure such as a hysterectomy, the colpotomizer cup <NUM> may be positioned at the base of a uterus <NUM>. Light from an endoscope <NUM> or other light source may pass through a wall <NUM> of the uterus <NUM> to excite one or more of the markers <NUM>. Light emitted from the excited markers <NUM> may then be visible through the wall <NUM> via the endoscope <NUM>. The excited markers <NUM> may thus serve as a guide for the medical instrument <NUM> to perform a medical procedure such as an ablation or an incision. For example, if the markers <NUM> are placed radially around a lip of the cup <NUM>, the ring of markers may serve as a guide for cutting the tissue adjacent to the lip of the cup. Passive markers <NUM> may also be located on a uterine probe <NUM>, including on an inflatable portion of the probe. Such markers may aid in defining the endometrium and fibroid tumors to allow for safer myomectomy procedures.

Passive markers, such as those described, may be used in a variety of medical procedures to identify instruments, implants, target locations, or leave-behind guides or indicators where occluding tissue would otherwise obstruct direct visualization by an image capture system, a visualization system, or the naked eye.

Although the above described systems and methods are useful for elevating or retracting tissue through natural or surgically created opening in a variety of surgical procedures, they are particularly useful for uterine manipulation. Uterine manipulation may be used in a hysterectomy procedure or in the treatment of endometriosis to provide constant stable tension to enable precise dissection. Teleoperational control of uterine manipulation may also be particularly useful in cases in which the manual manipulation of a large uterus would lead to user fatigue. In addition to providing tissue tension, uterine manipulators may be used to move the transaction place away from vital structures such as ureters.

Teleoperational uterine manipulation is also useful for improving the surgical autonomy of the console surgeon. The surgeon controls the position exactly to their liking without interacting with or waiting for the patient side assistant. Also, the patient side assistant may be providing surgical assistance instead of holding the manipulator. Teleoperational uterine manipulation may also avoid the patient side assistant from becoming contaminated due to movement between the equipment arms.

Any reference to surgical instruments and surgical methods is non-limiting as the instruments and methods described herein may be used for animals, human cadavers, animal cadavers, portions of human or animal anatomy, non-surgical diagnosis, industrial systems, and general robotic or teleoperational systems.

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 system <NUM>. 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 teleoperational system (<NUM>) comprising:
an input device (<NUM>);
a first manipulator arm (<NUM>) configured to couple with and move an instrument (<NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>);
a second manipulator arm (<NUM>) configured to couple with and move an imaging instrument (<NUM>);
a control system (<NUM>) including one or more processors, wherein the control system (<NUM>) is configured to:
in response to a determination that the instrument (<NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>) is inserted into an instrument workspace (<NUM>) in a direction that is no more than <NUM> degrees from a viewing axis (<NUM>) of the imaging instrument (<NUM>) in the instrument workspace (<NUM>), map movement of the input device (<NUM>) to movement of the instrument (<NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>) according to a first mapping, and
in response to a determination that the instrument (<NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>) is inserted into the instrument workspace (<NUM>) in a direction that is greater than <NUM> degrees from the viewing axis (<NUM>), map movement of the input device (<NUM>) to movement of the instrument (<NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>) according to a second mapping, wherein the second mapping includes an inversion of the first mapping for at least one direction of motion of the instrument (<NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>, <NUM>).