Patent Description:
The present disclosure generally relates to surgical robotics, and particularly to a perfusion and suction pumping system of a medical instrument within organs of a patient's body according to the features of independent claim <NUM>.

Kidney stone is a common disease affecting men and women of all ages. The incidence of kidney stone disease is increasing about <NUM>% worldwide each year. The probability of stone formation is <NUM>% in Saudi Arabia and <NUM>% in the USA. The recurrence rate of kidney stones could be <NUM>%~<NUM>% in ten years.

Percutaneous nephrolithotomy (PCNL) is the preferred technique for the surgical treatment of large kidney stones or stones that are resistant to other forms of treatment. PCNL may also be an alternative to retrograde intrarenal surgery (RIRS) for the treatment of stones measuring between <NUM> and <NUM> due to better stone-free rates achieved by a single procedure. PCNL can also be a major option for large impacted proximal ureteric stones and symptomatic calyceal diverticular stones treatment. Percutaneous Nephrolithotomy (PCNL) is a medical procedure that allows a physician to remove a patient's kidney stones or ureter stones that are too large (over <NUM>) or too complex for other forms of stone treatment, such as shock wave lithotripsy or ureteroscopy. Kidney stones are formed in the urinary tract due to crystallization of chemical compounds in the urine, and PCNL is the standard procedure for large and complex kidney stones. During the medical procedure, a small <NUM> incision is made in the patient's flank area and a sheath is placed through the incision into the kidney under x-ray or ultrasound guidance. A small telescope called a percutaneous nephroscope is then passed through the sheath and the telescope is held by a physician throughout the operation in order to visualize the stone, break it up, and remove it from the body. If necessary, a laser or other device called a lithotripter may be used to break up the stone before it can be removed. Patients are generally anesthetized in prone or supine position during the medical procedure.

A conventional PCNL procedure typically includes a high-pressure irrigation method that allows irrigation fluid to flush the stone or stone fragments out of a patient's body and to maintain adequate visual clarity for a physician to perform the medical procedure. The pressure level of irrigation fluid is preset by the physician using a pressure pump device. Irrigation fluid is pumped by the pressure pump device and goes into a patient's kidney through the percutaneous nephroscope, and then comes out of a patient's body through the space between the percutaneous nephroscope and the sheath to an open-face waste collector. Typically, <NUM>% saline is used as irrigation fluid.

Apart from methods, e.g., high-pressure irrigation method described above, various mechanical devices may be used to help with the surgical operations. As an example, the development of various lithotripsy devices and the introduction of the holmium laser improved the efficiency of stone fragmentation and clearance. A lithotripter or a laser may be used to break up the kidney stone before it can be removed during a PCNL medical procedure.

However, previous techniques for kidney stone removal still have challenges, even when using existing methods (e.g., high-pressure irrigation method) and when employing current medical devices (e.g., lithotripsy devices and holmium laser). As one example, the high-pressure irrigation method cannot efficiently manage the inside pressure of a patient's organs because it only presets a constant pressure level outside of a patient's body with no inside pressure measurement or control during the medical procedure. PCNL is usually conducted under high pressure to keep visual clarity of a physician, and the elevated renal pelvic pressures (RPPs) caused by the high-pressure irrigation method may spread infection through pyelovenous backflow. Moreover, stone fragments may be stuck between the percutaneous nephroscope and the sheath on the way out of a patient's body and block the outflow of irrigation fluid during the medical procedure. As a result, the pressure level inside of a patient's kidney increases sharply. Due to no pressure measurement or control inside of a patient's kidney, complications such as postoperative bleeding, tissue damage, injury to nearby organs or structures, and urinary sepsis with a mortality rate <NUM>%~<NUM>% may occur. However, decreased pressures can hinder observation and increase bleeding. A physician may have to stop the medical procedure concerning about the patient's tolerance under high pressure irrigation. As a result, stone-free rate is low which leads to post-procedure kidney stone formation in the patient.

Furthermore, a physician must handhold a percutaneous nephroscope without rest throughout a PCNL procedure. Typically, the length of a PCNL procedure is three to four hours, and could be more than five hours in extreme cases when patients have large or complex kidney stones. As a result, surgery risk (e.g., complications, bleeding, and organ injury) is high due to long hours of operation, with a patient's organs under high pressure and due to the potential fatigue of the physician handholding the percutaneous nephroscope.

Thus, there is a need for improved techniques for pressure management inside of a patient's body during the medical procedure, and there is a need for improved techniques to remove stones more safely and efficiently.

<CIT> discloses methods and systems for administering directed fluidics during a medical procedure for removing an object according to the preamble of independent claim <NUM>.

The claimed invention includes an endoscopic surgical robotic system includes an endoscope pre-selected according to a lesion inside of an organ and including a fluid inlet channel for flowing an irrigation fluid to the organ, a sheath for guiding the endoscope, a suction channel located within the sheath for removing the irrigation fluid from the organ, a pressure measuring channel located along the sheath and connected to a pressure detector constructed to measure a pressure within the organ, and a pressure relief valve in fluid communication with the sheath such that, once the pressure reaches a threshold, the pressure relief valve opens to allow removal of the irrigation fluid in the suction channel, thereby lowering pressure within the organ. The endoscopic surgical robotic system also includes a first holder for holding the sheath and being connected to the sheath with a first latch, a second holder for holding the endoscope and being connected to the endoscope with a second latch, a robotic arm for controlling movement of the sheath and being connected to the first holder, and a holder bar for hanging the first holder and the second holder such that the first holder and the second holder are movable back and forth along the holder bar to move co-axially so as to move the endoscope in and out of the sheath, the holder bar being connected to the robotic arm via a connector.

In some embodiments, the endoscope is selected from percutaneous nephroscope, ureteroscope, cystoscope, urethroscope, hysteroscope, arthroscope, spine endoscope, ventroscope, lacrimal duct endoscope, nasopharyngeal endoscope, and/or otoscope.

In some embodiments, the endoscopic surgical robotic system can further include a puncturable cap, optionally a rubber cap, located at a distal end of the sheath through which the endoscope is inserted into the sheath.

In some embodiments, the endoscopic surgical robotic system can further include a perfusion-suction pump for continuously pumping the irrigation fluid into the organ and continuously removing the irrigation fluid.

In some embodiments, the endoscopic surgical robotic system can further include a suction pump in fluid communication with the suction channel, for pumping out and removing the irrigation fluid from the organ.

In some embodiments, the pressure measuring channel is located inside of the sheath.

In some embodiments, the pressure detector monitors pressure in real time and is optionally connected to an electrocardiograph.

In some embodiments, the threshold is pre-determined according to the lesion, the organ, the sheath and/or a flow speed of the irrigation fluid, wherein optionally the threshold is about <NUM> cml/hO.

In some embodiments, the first holder is constructed to removably hold the sheath via a first latch, and/or the second holder is constructed to removably hold the endoscope via a second latch.

In some embodiments, the robotic arm comprises a multi-degree-of-freedom actuator and a multi-degree-of-freedom control system, wherein the endoscope is fixed at an output end of the multi-degree-of-freedom actuator, and wherein a tool center point is defined on the endoscope by the multi-degree-of-freedom control system.

In some embodiments, the endoscopic surgical robotic system can further include a command console for controlling the robotic arm.

In some embodiments, the command console comprises a 3D controller and a control host, wherein a dimension of the 3D controller is matched with freedom degrees of the tool center point, wherein the control host associates dimension information from a multi-dimensional sensor of the 3D controller with freedom degree information from the tool center point.

In some embodiments, the 3D controller remotely controls the multi-degree-of-freedom actuator and endoscope.

In some embodiments, the tool center point is an entry point for incision.

In some embodiments, when the endoscope reaches the patient, the control host starts to restrict the endoscope to only move along its axial direction and rotate around the tool center point with pitch, roll, and yaw motion within a preset scope of a safety zone.

In some embodiments, the command console comprises a monitor module for displaying patient monitoring information such as electrocardiogram and blood pressure, intrarenal pressure values and curves, endoscopic images, perfusion and suction parameters, laser parameters, x-ray images and the like.

In some embodiments, the endoscopic surgical robotic system can further include a lithotripter for breaking up stones within the organ.

Also provided herein is a method for performing PCNL surgery, comprising using the endoscopic surgical robotic system disclosed herein.

Another aspect relates to a method for performing PCNL surgery, comprising:.

The figures depict embodiments of the described system (or method) for purposes of illustration only.

The methods and apparatuses disclosed herein provide improved stone removal techniques by providing a robotic endoscopic system to assist a physician to control the movement of a medical instrument such as a flexible or rigid elongated medical instrument (e.g., a percutaneous nephroscope) within organs of a patient's body. It should be noted while the present disclosure uses PCNL and in particular kidney stone removal as an example, the methods and systems disclosed herein can be readily applied to other medical procedures, as one of ordinary skill in the art would appreciate. Such other medical procedures include, without limitation, percutaneous nephroscopy, ureteroscopy, cystoscopy, urethroscopy, hysteroscopy, arthroscopy, spine endoscopy, ventroscopy, lacrimal duct endoscopy, nasopharyngeal endoscopy and otoscopy.

As one example, the apparatus is a robotic percutaneous nephroscopic tool to accurately and safely stabilize a percutaneous nephroscope of a desired anatomical site during a PCNL procedure. The robotic percutaneous nephroscopic tool includes a robotic arm system, an endoscope connector coupled to the robotic arm, a percutaneous nephroscope, a pressure management system, a command console, an energy source (e.g., a laser device) and necessary layout accessories. Controlled by a physician with a real-time 3D controller, the robotic percutaneous nephroscopic tool operates a robotic arm accurately and intuitively to move a percutaneous nephroscope during a PCNL procedure. The robotic arm system comprises a multi-degree-of-freedom robotic arm actuator and robotic arm controller. A percutaneous nephroscope is fixed at an output end of the robotic arm actuator by an endoscope connector. A tool center point is defined on the percutaneous nephroscope by the robotic arm controller, and the dimension of the 3D controller is matched with the freedom degrees of the tool center point. The command console is used for associating the dimension information from the multi-dimensional sensor of the 3D controller with the freedom degree information from the tool center point.

In some embodiments, the 3D controller remotely controls the multi-degree-of-freedom robotic arm and the percutaneous nephroscope. The robotic arm controller defines the point of entry (i.e., incision) as the tool center point. When the endoscope device reaches to the patient, the command console starts to restrict the movement of the endoscope device. During the surgery, the command console only allows the endoscope device to move along its axial direction and rotate around the tool center point with pitch, roll, and yaw motion within a preset scope which is called a safety zone. The upper computer further includes a monitor module for displaying images sent by the imaging sensor attached to the endoscope device. Robotic endoscopic system provides tremendous advantages in accurately and safely assisting the movement control of an endoscope during medical procedures. It allows for more convenient, more efficient and safer operations by the physician. It is also easy to use because it is compatible with the standard medical procedure. Exemplary robotic arm systems suitable for the present disclosure include Kuka LBR iiwa, Kuka LBR Med, Universal Robot UR5e, Franka Emika Panda, Kinova Jaco, etc..

Furthermore, the methods and apparatuses disclosed herein provide improved pressure management techniques by providing an improved pressure management system (e.g., a perfusion and suction pumping system) of a medical instrument such as a flexible or rigid elongated medical instrument (e.g., a percutaneous nephroscope) within organs of a patient's body.

As one example, the apparatus is a perfusion and suction pumping system for irrigation fluid to flush the stone fragment out of a patient's body and to maintain adequate visual clarity for surgery operation, while measuring and controlling the inside pressure of a patient's kidney during a PCNL procedure. The perfusion and suction pumping system include a pressure pump device, a pressure detector on the proximal end of a pressure measurement channel, a pressure relief valve, and a waste collector. The pressure pump device perfuses the irrigation fluid into a patient's body, the pressure sensor and pressure meter measure and display the inside-kidney pressure, and the pressure relief valve allows the irrigation fluid to be sucked out of the kidney to reduce inside-kidney pressure when it reaches a threshold. The threshold pressure may vary and can be selected based on the patient, the status of the kidney (e.g., size, swollenness, bleeding, number of stones), the size of the sheath and the flow speed of the irrigation fluid. In some embodiments, the upper threshold can be about <NUM> cmH<NUM>O, about <NUM> cmH<NUM>O, about <NUM> cmH<NUM>O, about <NUM> cmH<NUM>O, or about <NUM> cmH<NUM>O, or any number therebetween, or higher, or lower. In some embodiments, the threshold can be about <NUM>±<NUM> cmH<NUM>O for F24 sheath. In some embodiments, the inside-kidney pressure is monitored in real time. In certain embodiments, the monitoring can be achieved using electrocardiography (e.g., the pressure sensor can be connected to an electrocardiograph). The perfusion and suction pumping system allows a physician to operate the surgery safely by real time monitoring and managing the inside pressure of a patient's kidney during a PCNL procedure.

In some embodiments, a small (e.g., <NUM>) incision is made in the patient's flank area and a sheath is placed through the incision into the kidney. A percutaneous nephroscope is then passed through the sheath in order to visualize the stone, break it up, and remove it from the body. Through the percutaneous nephroscope, irrigation fluid is pumped into a patient's kidney by a pressure pump device, and is pumped out of a patient's kidney together with the stone fragments through the perfusion and suction pumping system. The irrigation fluid can be an isotonic solution, optionally <NUM>% saline. All waste fluid goes into a waste collector.

In one embodiment, a pressure measurement channel is placed between the sheath and the percutaneous nephroscope. A pressure detector is connected by a pressure measurement catheter that goes through the pressure measurement channel. The pressure detector includes a pressure sensor that collects real-time inside pressure information is fixed at one end of the catheter inside of the patient's kidney. The pressure detector that allows a physician to read the real-time inside pressure is located outside of the patient's body on the other end of the catheter. When the pressure reaches the physician's preset threshold level, a pressure relief valve can be used to reduce the inside pressure and to suck the irrigation fluid outside of the patient's body, which allows for visual clarity and safe operations by the physician. The system is easy to use and compatible with current medical devices to perform PCNL procedure.

For convenience, certain terms employed in the specification, examples, and appended claims are collected here. Unless defined otherwise, all technical and scientific terms used herein have the same meaning as commonly understood by one of ordinary skill in the art to which this disclosure belongs.

The use of the word "a" or "an" when used in conjunction with the term "comprising" in the claims and/or the specification may mean "one," but it is also consistent with the meaning of "one or more," "at least one," and "one or more than one.

Throughout this application, the term "about" is used to indicate that a value includes the inherent variation of error for the method/device being employed to determine the value, or the variation that exists among the study subjects. Typically, the term is meant to encompass approximately or less than <NUM>%, <NUM>%, <NUM>%, <NUM>%, <NUM>%, <NUM>%, <NUM>%, <NUM>%, <NUM>%, <NUM>%, <NUM>%, <NUM>%, <NUM>%, <NUM>%, <NUM>%, <NUM>%, <NUM>%, <NUM>%, <NUM>% or <NUM>% variability depending on the situation.

The use of the term "or" in the claims is used to mean "and/or" unless explicitly indicated to refer only to alternatives or the alternatives are mutually exclusive, although the disclosure supports a definition that refers to only alternatives and "and/or.

As used in this specification and claim(s), the terms "comprising" (and any form of comprising, such as "comprise" and "comprises"), "having" (and any form of having, such as "have" and "has"), "including" (and any form of including, such as "includes" and "include") or "containing" (and any form of containing, such as "contains" and "contain") are inclusive or openended and do not exclude additional, unrecited, elements or method steps. It is contemplated that any embodiment discussed in this specification can be implemented with respect to any method, system, host cells, expression vectors, and/or composition of the invention. Furthermore, compositions, systems, host cells, and/or vectors of the invention can be used to achieve methods and proteins of the invention.

As used herein the term "consisting essentially of" refers to those elements required for a given embodiment. The term permits the presence of additional elements that do not materially affect the basic and novel or functional characteristic(s) of that embodiment of the disclosure.

The term "consisting of" refers to compositions, methods, and respective components thereof as described herein, which are exclusive of any element not recited in that description of the embodiment.

The use of the term "for example" and its corresponding abbreviation "e.g." (whether italicized or not) means that the specific terms recited are representative examples and embodiments of the invention that are not intended to be limited to the specific examples referenced or cited unless explicitly stated otherwise.

<FIG> shows an exemplary surgical robotic system <NUM>, according to one embodiment. The surgical robotic system <NUM> includes a base <NUM> coupled to one robotic arm, e.g., robotic arm <NUM>. The base <NUM> is communicatively coupled to a command console, which is further described with reference to <FIG> below. The base <NUM> can be positioned such that the robotic arm <NUM> has access to perform a surgical procedure on a patient, while a user such as a physician may control the surgical robotic system <NUM> from the comfort of the command console. Though not shown in <FIG> for ease of view, the base <NUM> may include subsystems such as power sources and the like. The robotic arm <NUM> includes several arm links <NUM> coupled at joints <NUM>, which provides the robotic arm <NUM> multiple degrees of freedom, e.g., seven degrees of freedom corresponding to seven arm links. The robotic arm controller <NUM> in the base <NUM> may also process and transmit control signals communicated from the command console.

In some embodiments, the base <NUM> includes wheels <NUM> to transport the surgical robotic system <NUM>. During procedures, a user may control the robotic arm <NUM> using control devices such as the command console. Mobility of the surgical robotic system <NUM> allows efficient use of space in an operation room, and allows the robotic arm <NUM> to not interfere with people or other equipment during procedures.

Robotic arm <NUM> is coupled to an endoscope <NUM> using a connector <NUM>. The endoscope <NUM> can be removed and replaced with a different type of endoscope, for example, nephroscope or hysteroscope. The connector <NUM> is interchangeable based on the type of endoscope and can be customized for a certain type of surgical procedure. The robotic arm <NUM> can include a joint level torque sensing.

<FIG> show various perspective views of the surgical robotic system <NUM> coupled to a surgical bed <NUM>, according to various embodiments. Specifically, FIG. IB shows a side view of the surgical robotic system <NUM> with the robotic arm <NUM> manipulating the endoscope <NUM> to insert the endoscope inside a patient's body, and the patient is lying on the surgical bed <NUM>.

<FIG> shows a top view of the surgical robotic system <NUM> and the surgical bed <NUM>, and the endoscope <NUM> manipulated by the robotic arm is inserted inside the patient's body.

<FIG> shows one example of connector <NUM>, coupling the robotic arm <NUM> to hold and move an endoscope (e.g., percutaneous nephroscope) <NUM>. The connector <NUM> includes a front screw <NUM> and a rear screw <NUM> to stabilize the position of the percutaneous nephroscope <NUM>. The percutaneous nephroscope <NUM> is further described with reference to <FIG> below.

<FIG> shows an exemplary command console <NUM> for surgical robotic system <NUM>, according to one embodiment. The command console <NUM> includes a console base <NUM>, display modules <NUM>, e.g., monitors, and control modules, e.g., a keyboard <NUM> and 3D controller <NUM>. A user <NUM>, e.g., a physician, remotely controls the surgical robotic system <NUM> from an ergonomic position using the command console <NUM>.

The console base <NUM> may interprets and process signals such as camera imagery, e.g., from the endoscope <NUM> shown in <FIG>. The console base <NUM> may also process commands and instructions provided by the user <NUM> through the control modules <NUM> and <NUM>. In addition to the keyboard <NUM> and 3D controller <NUM> shown in <FIG>, the control modules may include other devices, for example, computer mice and control pads.

The user <NUM> can control a surgical instrument such as the endoscope <NUM> using the command console <NUM> in a velocity mode. A tool center point is defined on the endoscope <NUM> by the robotic arm controller, and the dimension of the 3D controller is matched with the freedom degrees of the tool center point. In velocity mode, the user <NUM> remotely controls <NUM> freedom degrees motions of the endoscope <NUM> based on direct manual control using the 3D controller <NUM>. The 3D controller <NUM> can provide haptic feedback to the user. For example, the 3D controller <NUM> vibrates to indicate the endoscope is touching the boundary of organ, must stop moving or rotating in current direction. The command console can also use a 3D image map of a patient to determine the safe zone, once the operation exceeds the boundary of organ or the safe zone, the alarm system and automatic protection program will be triggered to warn or stop or correct surgeons' operation, which will largely optimize the accuracy of the surgeons' operation, and improve patients' safety during surgeries.

Specifically, the robotic arm controller defines the point of entry (i.e., incision) as the tool center point. When the endoscope <NUM> approaches to the patients, the command console starts to restrict the movement of the endoscope <NUM>. During the surgery, the command console only allows the endoscope <NUM> to move along its axial direction and rotate around the tool center point with pitch, roll, and yaw motion within a preset scope which is called a safety zone.

In some embodiments, user <NUM> can manually manipulate robotic arm <NUM> of the surgical robotic system <NUM> without using the command console <NUM>. During setup in a surgical operating room, the robotic arm <NUM> may be configured in teach-show mode. Then the user <NUM> may move robotic arm <NUM>, endoscope <NUM>, and other surgical equipment to access a patient. The surgical robotic system <NUM> may rely on force feedback and inertia control from the user <NUM> to determine appropriate configuration of the robotic arm <NUM> and equipment. Specially, the user <NUM> can use the surgical robotic system <NUM> with such manual-manipulate mode even during the procedure, which allows more flexibility and better safety control.

The display modules <NUM> may display patient monitoring information such as electrocardiogram and blood pressure, intrarenal pressure values and curves, endoscopic images, perfusion and suction parameters, laser parameters, x-ray images and the like.

Various endoscopes can be adapted into the system described herein, depending on the medical procedure to be performed. A matching endoscope can be selected according to the location and size of the lesion inside of the organ. For example, percutaneous nephroscope, ureteroscope, cystoscope, urethroscope, hysteroscope, arthroscope, spine endoscope, ventroscope, lacrimal duct endoscope, nasopharyngeal endoscope, otoscope and the like can be used depending on the organ, the lesion, and so on. In various embodiments, an endoscope can comprise a fluid inlet channel, a light source, a light conductor (e.g., fibers) and prisms.

<FIG> shows a side view of an exemplary endoscope <NUM>, according to one embodiment. The endoscope <NUM> is an optical instrument which allows one to inspect the renal cavitary system and to perform different therapeutic procedures under direct visual control. The endoscope <NUM> can be used to remove stones up to about <NUM>, stone fragments and small tumors. Endoscope <NUM> contains a sheath <NUM>, an optical system and a working channel <NUM>.

The optical system includes a light port <NUM>, a fiber optic entrance <NUM>, and an eyepiece <NUM>. The fiber optic light port <NUM> is incorporated with working channel <NUM>. During the medical procedure, light source goes through light port <NUM> and allows the fiber optic <NUM> that goes through the fiber optic entrance <NUM> and located in the central axis <NUM> of the working channel <NUM> to collect real-time images inside a patient's kidney. The real-time images can be visualized by a physician from the eyepiece <NUM>. The optical system of an endoscope <NUM> ensure a clear visibility to assist a physician to perform the medical procedure.

The working channel <NUM> allows the insertion of a wide range of rigid accessories, such as lithothripter or different working elements (stone forceps, extraction probe, etc.), that are necessary to the medical procedure. The nephroscope tip <NUM> of the working channel <NUM> will be inserted into a patient's kidney and allows a physician to perform the medical procedure. Irrigation fluid is used to keep a clear vision and flush out the stone fragments. The same axial channel also ensures the irrigation fluid's flow that comes from the inflow connection <NUM>. The outflow of the irrigation fluid is through the space between the working channel <NUM> and a sheath <NUM>. The sheath <NUM> is further described with reference to the pumping system below.

<FIG> shows a surgery operation view of the endoscope shown in <FIG>, according to one embodiment. During the medical procedure, a small (e.g., <NUM>) incision <NUM> is made in the patient's flank area and a sheath <NUM> is placed through the incision into the kidney under x-ray or ultrasound guidance. An endoscope (i.e., percutaneous nephroscope) <NUM> is then passed through the sheath <NUM> and inserted into the patient's kidney <NUM> for a physician to visualize the kidney stone <NUM>. A medical device (e.g., laser device) can break up the stone in to fragments.

A system can be used to continuously pumping the irrigation fluid through the system. In some embodiments, a perfusion-suction pump can be included in the system to achieve continuous pumping.

<FIG> shows an PCNL system, according to one embodiment. A perfusion-suction system is shown which allows irrigation fluid to remove the kidney stone and to maintain adequate visual clarity for a physician to perform the medical procedure with real time pressure management. The perfusion-suction pumping system includes a perfusion-suction pump <NUM>, a pressure detector <NUM> with a pressure sensor inside, a sheath <NUM> with a suction channel <NUM>, a rubber cap <NUM> at the rear end of the sheath <NUM>. A pressure measuring channel <NUM> running along the sheath <NUM>. The suction channel <NUM> is connected with a suction pump <NUM> through a connecting pipe <NUM>. The water inlet channel <NUM> of endoscope <NUM> is connected with the perfusion pump <NUM> by a connecting pipe <NUM>. During the operation, the endoscope <NUM> is inserted into the sheath <NUM> from the center of the rubber cap <NUM> at the rear end of the sheath <NUM>. A pressure relief valve <NUM> that allows real time pressure release is located on the sheath <NUM>.

At the beginning of the PCNL procedure, a physician turns on the perfusion-suction pump <NUM>. A small <NUM> incision is made in the patient's flank area and a sheath <NUM> is placed through the incision into the kidney under x-ray or ultrasound guidance. The endoscope <NUM> is inserted into the sheath <NUM> from the center of the rubber cap <NUM> at the rear end of the sheath to reach into the kidney. The perfusion pump <NUM> pumps irrigation fluid <NUM> into the endoscope <NUM> and then into the kidney. Then the suction pump <NUM> pumps the irrigation fluid <NUM> (containing fragmented kidney stones) out of the patient's body through the space between the endoscope <NUM> and the sheath <NUM>. Then the irrigation fluid <NUM> will flow into the suction channel <NUM>, and goes into a waste collector <NUM>.

The sheath <NUM> has an intrarenal pressure measurement channel <NUM>. A pressure measurement catheter <NUM> is placed inside of the pressure measurement channel <NUM>. The distal end of the pressure measurement catheter <NUM> is placed inside of the kidney, and the proximal end of the pressure measurement catheter <NUM> is connected to the outside pressure detector <NUM>. The pressure level of the perfusion-suction pump <NUM> can be adjusted automatically by the command console <NUM> or manually by a physician according to the real-time pressure measurement results. When the sheath <NUM> is blocked and the pressure in the kidney exceeds the safe pressure range, which can be <NUM>-<NUM> cmFhO, the pressure relief valve <NUM> will be functioning to relieve the inside pressure of the kidney.

<FIG> shows the top view of an endoscope for use in connection with the system of <FIG>, according to one embodiment. The sheath <NUM> allows the endoscope <NUM> to reach into a patient's kidney. The pressure measuring channel <NUM> is on one side of the sheath <NUM> between the space of the sheath <NUM> and the endoscope <NUM>.

<FIG> shows the side view of an endoscope and sheath design in connection with the system of <FIG>, according to one embodiment. The robotic arm <NUM> is connected to holder bar <NUM> via connector <NUM>. The distal holder <NUM> of the holder bar <NUM> is connected to the sheath <NUM> with the sheath latch <NUM>. The proximal holder <NUM> of the holder bar <NUM> is connected with the endoscope <NUM> with the endoscope latch <NUM>. During the procedure, the distal holder <NUM> and the proximal holder <NUM> move in a coaxial motion. The distal holder <NUM> controls the depth and angle of the sheath <NUM> in the kidney, while the proximal holder <NUM> controls the endoscope <NUM> to move back and forth within the sheath <NUM>.

Claim 1:
An endoscopic surgical robotic system (<NUM>), comprising:
an endoscope (<NUM>) pre-selected according to a lesion inside of an organ,
wherein the endoscope (<NUM>) comprises a fluid inlet channel (<NUM>) for flowing an irrigation fluid to the organ;
a sheath (<NUM>, <NUM>) for guiding the endoscope (<NUM>);
a suction channel (<NUM>) located within the sheath (<NUM>, <NUM>) for removing the irrigation fluid from the organ;
a pressure measuring channel (<NUM>) located along the sheath (<NUM>, <NUM>), and connected to a pressure detector (<NUM>) constructed to measure a pressure within the organ;
a pressure relief valve (<NUM>) in fluid communication with the sheath (<NUM>, <NUM>), wherein once the pressure reaches a threshold, the pressure relief valve (<NUM>) opens to allow removal of the irrigation fluid in the suction channel (<NUM>), thereby lowering pressure within the organ;
wherein the endoscopic surgical robotic system (<NUM>) is characterized in that the endoscopic surgical robotic system (<NUM>) comprises:
a first holder for holding the sheath (<NUM>, <NUM>), wherein the first holder (<NUM>) is connected to the sheath (<NUM>, <NUM>) with a first latch (<NUM>);
a second holder for holding the endoscope (<NUM>), wherein the second holder (<NUM>) is connected to the endoscope (<NUM>) with a second latch (<NUM>), and wherein the first holder and the second holder are designed to move co-axially so as to move the endoscope (<NUM>) in and out of the sheath (<NUM>, <NUM>);
a robotic arm (<NUM>) for controlling a movement of the sheath (<NUM>, <NUM>),
wherein the robotic arm (<NUM>) is connected to the first holder (<NUM>); and
a holder bar (<NUM>) for hanging the first holder (<NUM>) and the second holder (<NUM>) such that the first holder (<NUM>) and the second holder (<NUM>) are movable back and forth along the holder bar (<NUM>) to move co-axially, wherein the robotic arm (<NUM>) is connected to the holder bar (<NUM>) via a connector (<NUM>).