Medical instrument with a capstan

Description

TECHNICAL FIELD

The systems and methods disclosed herein are directed to medical instrument systems, and more particularly, to medical instruments that utilize a capstan.

BACKGROUND

Medical procedures, such as endoscopy, may involve accessing and visualizing the inside of a patient's anatomy for diagnostic and/or therapeutic purposes. For example, gastroenterology, urology, and bronchology involve medical procedures that allow a physician to examine patient lumens, such as the ureter, gastrointestinal tract, and airways (bronchi and bronchioles). During these procedures, a thin, flexible tubular tool or instrument, such as an endoscope, and/or a thin, rigid tool or instrument, such as a scope, is inserted into the patient through an orifice (such as a natural orifice) and advanced towards a tissue site identified for subsequent diagnosis and/or treatment. The medical instrument can be controllable and articulable to facilitate navigation through the anatomy.

BRIEF DESCRIPTION OF THE DRAWINGS

The disclosed aspects will hereinafter be described in conjunction with the appended drawings, provided to illustrate and not to limit the disclosed aspects, wherein like designations denote like elements.

FIG. 1 illustrates an embodiment of a cart-based robotic system arranged for diagnostic and/or therapeutic bronchoscopy.

FIG. 2 depicts further aspects of the robotic system of FIG. 1.

FIG. 3 illustrates an embodiment of the robotic system of FIG. 1 arranged for ureteroscopy.

FIG. 4 illustrates an embodiment of the robotic system of FIG. 1 arranged for a vascular procedure.

FIG. 5 illustrates an embodiment of a table-based robotic system arranged for a bronchoscopic procedure.

FIG. 6 provides an alternative view of the robotic system of FIG. 5.

FIG. 7 illustrates an example system configured to stow robotic arm(s).

FIG. 8 illustrates an embodiment of a table-based robotic system configured for a ureteroscopic procedure.

FIG. 9 illustrates an embodiment of a table-based robotic system configured for a laparoscopic procedure.

FIG. 10 illustrates an embodiment of the table-based robotic system of FIGS. 5-9 with pitch or tilt adjustment.

FIG. 11 provides a detailed illustration of the interface between the table and the column of the table-based robotic system of FIGS. 5-10.

FIG. 12 illustrates an alternative embodiment of a table-based robotic system.

FIG. 13 illustrates an end view of the table-based robotic system of FIG. 12.

FIG. 14 illustrates an end view of a table-based robotic system with robotic arms attached thereto.

FIG. 15 illustrates an exemplary instrument driver.

FIG. 16 illustrates an exemplary medical instrument with a paired instrument driver.

FIG. 17 illustrates an alternative design for an instrument driver and instrument where the axes of the drive units are parallel to the axis of the elongated shaft of the instrument.

FIG. 18 illustrates an instrument having an instrument-based insertion architecture.

FIG. 19 illustrates an exemplary controller.

FIG. 20 depicts a block diagram illustrating a localization system that estimates a location of one or more elements of the robotic systems of FIGS. 1-10, such as the location of the instrument of FIGS. 16-18, in accordance to an example embodiment.

FIG. 21 illustrates a cable connected to a capstan and a pulley.

FIG. 22A illustrates a capstan connected to a drive input and a screw.

FIG. 22B illustrates the capstan of FIG. 22A with the outer surface transparent.

FIG. 23 illustrates a cable connected to a capstan and a pulley in a handle of a medical instrument.

FIG. 24 illustrates a cable connected to a capstan and an elongated shaft of a medical instrument.

FIG. 25 illustrates a cable connected to a capstan and pulley within a handle.

FIG. 26 illustrates a cable connected to a capstan within a handle with one or more drive inputs.

DETAILED DESCRIPTION
1. Overview

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

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

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

A. Robotic System—Cart.

The robotically-enabled medical system may be configured in a variety of ways depending on the particular procedure. FIG. 1 illustrates an embodiment of a cart-based robotically-enabled system 10 arranged for a diagnostic and/or therapeutic bronchoscopy. During a bronchoscopy, the system 10 may comprise a cart 11 having one or more robotic arms 12 to deliver a medical instrument, such as a steerable endoscope 13, which may be a procedure-specific bronchoscope for bronchoscopy, to a natural orifice access point (i.e., the mouth of the patient positioned on a table in the present example) to deliver diagnostic and/or therapeutic tools. As shown, the cart 11 may be positioned proximate to the patient's upper torso in order to provide access to the access point. Similarly, the robotic arms 12 may be actuated to position the bronchoscope relative to the access point. The arrangement in FIG. 1 may also be utilized when performing a gastro-intestinal (GI) procedure with a gastroscope, a specialized endoscope for GI procedures. FIG. 2 depicts an example embodiment of the cart in greater detail.

With continued reference to FIG. 1, once the cart 11 is properly positioned, the robotic arms 12 may insert the steerable endoscope 13 into the patient robotically, manually, or a combination thereof. As shown, the steerable endoscope 13 may comprise at least two telescoping parts, such as an inner leader portion and an outer sheath portion, each portion coupled to a separate instrument driver from the set of instrument drivers 28, each instrument driver coupled to the distal end of an individual robotic arm. This linear arrangement of the instrument drivers 28, which facilitates coaxially aligning the leader portion with the sheath portion, creates a “virtual rail” 29 that may be repositioned in space by manipulating the one or more robotic arms 12 into different angles and/or positions. The virtual rails described herein are depicted in the Figures using dashed lines, and accordingly the dashed lines do not depict any physical structure of the system. Translation of the instrument drivers 28 along the virtual rail 29 telescopes the inner leader portion relative to the outer sheath portion or advances or retracts the endoscope 13 from the patient. The angle of the virtual rail 29 may be adjusted, translated, and pivoted based on clinical application or physician preference. For example, in bronchoscopy, the angle and position of the virtual rail 29 as shown represents a compromise between providing physician access to the endoscope 13 while minimizing friction that results from bending the endoscope 13 into the patient's mouth.

The endoscope 13 may be directed down the patient's trachea and lungs after insertion using precise commands from the robotic system until reaching the target destination or operative site. In order to enhance navigation through the patient's lung network and/or reach the desired target, the endoscope 13 may be manipulated to telescopically extend the inner leader portion from the outer sheath portion to obtain enhanced articulation and greater bend radius. The use of separate instrument drivers 28 also allows the leader portion and sheath portion to be driven independently of each other.

For example, the endoscope 13 may be directed to deliver a biopsy needle to a target, such as, for example, a lesion or nodule within the lungs of a patient. The needle may be deployed down a working channel that runs the length of the endoscope to obtain a tissue sample to be analyzed by a pathologist. Depending on the pathology results, additional tools may be deployed down the working channel of the endoscope for additional biopsies. After identifying a nodule to be malignant, the endoscope 13 may endoscopically deliver tools to resect the potentially cancerous tissue. In some instances, diagnostic and therapeutic treatments can be delivered in separate procedures. In those circumstances, the endoscope 13 may also be used to deliver a fiducial to “mark” the location of the target nodule as well. In other instances, diagnostic and therapeutic treatments may be delivered during the same procedure.

The system 10 may also include a movable tower 30, which may be connected via support cables to the cart 11 to provide support for controls, electronics, fluidics, optics, sensors, and/or power to the cart 11. Placing such functionality in the tower 30 allows for a smaller form factor cart 11 that may be more easily adjusted and/or re-positioned by an operating physician and his/her staff. Additionally, the division of functionality between the cart/table and the support tower 30 reduces operating room clutter and facilitates improving clinical workflow. While the cart 11 may be positioned close to the patient, the tower 30 may be stowed in a remote location to stay out of the way during a procedure.

In support of the robotic systems described above, the tower 30 may include component(s) of a computer-based control system that stores computer program instructions, for example, within a non-transitory computer-readable storage medium such as a persistent magnetic storage drive, solid state drive, etc. The execution of those instructions, whether the execution occurs in the tower 30 or the cart 11, may control the entire system or sub-system(s) thereof. For example, when executed by a processor of the computer system, the instructions may cause the components of the robotics system to actuate the relevant carriages and arm mounts, actuate the robotics arms, and control the medical instruments. For example, in response to receiving the control signal, the motors in the joints of the robotics arms may position the arms into a certain posture.

The tower 30 may also include a pump, flow meter, valve control, and/or fluid access in order to provide controlled irrigation and aspiration capabilities to the system that may be deployed through the endoscope 13. These components may also be controlled using the computer system of the tower 30. In some embodiments, irrigation and aspiration capabilities may be delivered directly to the endoscope 13 through separate cable(s).

The tower 30 may include a voltage and surge protector designed to provide filtered and protected electrical power to the cart 11, thereby avoiding placement of a power transformer and other auxiliary power components in the cart 11, resulting in a smaller, more moveable cart 11.

The tower 30 may also include support equipment for the sensors deployed throughout the robotic system 10. For example, the tower 30 may include optoelectronics equipment for detecting, receiving, and processing data received from the optical sensors or cameras throughout the robotic system 10. In combination with the control system, such optoelectronics equipment may be used to generate real-time images for display in any number of consoles deployed throughout the system, including in the tower 30. Similarly, the tower 30 may also include an electronic subsystem for receiving and processing signals received from deployed electromagnetic (EM) sensors. The tower 30 may also be used to house and position an EM field generator for detection by EM sensors in or on the medical instrument.

The tower 30 may also include a console 31 in addition to other consoles available in the rest of the system, e.g., console mounted on top of the cart. The console 31 may include a user interface and a display screen, such as a touchscreen, for the physician operator. Consoles in the system 10 are generally designed to provide both robotic controls as well as preoperative and real-time information of the procedure, such as navigational and localization information of the endoscope 13. When the console 31 is not the only console available to the physician, it may be used by a second operator, such as a nurse, to monitor the health or vitals of the patient and the operation of the system 10, as well as to provide procedure-specific data, such as navigational and localization information. In other embodiments, the console 30 is housed in a body that is separate from the tower 30.

The tower 30 may be coupled to the cart 11 and endoscope 13 through one or more cables or connections (not shown). In some embodiments, the support functionality from the tower 30 may be provided through a single cable to the cart 11, simplifying and de-cluttering the operating room. In other embodiments, specific functionality may be coupled in separate cabling and connections. For example, while power may be provided through a single power cable to the cart 11, the support for controls, optics, fluidics, and/or navigation may be provided through a separate cable.

FIG. 2 provides a detailed illustration of an embodiment of the cart 11 from the cart-based robotically-enabled system shown in FIG. 1. The cart 11 generally includes an elongated support structure 14 (often referred to as a “column”), a cart base 15, and a console 16 at the top of the column 14. The column 14 may include one or more carriages, such as a carriage 17 (alternatively “arm support”) for supporting the deployment of one or more robotic arms 12 (three shown in FIG. 2). The carriage 17 may include individually configurable arm mounts that rotate along a perpendicular axis to adjust the base of the robotic arms 12 for better positioning relative to the patient. The carriage 17 also includes a carriage interface 19 that allows the carriage 17 to vertically translate along the column 14.

The carriage interface 19 is connected to the column 14 through slots, such as slot 20, that are positioned on opposite sides of the column 14 to guide the vertical translation of the carriage 17. The slot 20 contains a vertical translation interface to position and hold the carriage 17 at various vertical heights relative to the cart base 15. Vertical translation of the carriage 17 allows the cart 11 to adjust the reach of the robotic arms 12 to meet a variety of table heights, patient sizes, and physician preferences. Similarly, the individually configurable arm mounts on the carriage 17 allow the robotic arm base 21 of the robotic arms 12 to be angled in a variety of configurations.

In some embodiments, the slot 20 may be supplemented with slot covers that are flush and parallel to the slot surface to prevent dirt and fluid ingress into the internal chambers of the column 14 and the vertical translation interface as the carriage 17 vertically translates. The slot covers may be deployed through pairs of spring spools positioned near the vertical top and bottom of the slot 20. The covers are coiled within the spools until deployed to extend and retract from their coiled state as the carriage 17 vertically translates up and down. The spring-loading of the spools provides force to retract the cover into a spool when the carriage 17 translates towards the spool, while also maintaining a tight seal when the carriage 17 translates away from the spool. The covers may be connected to the carriage 17 using, for example, brackets in the carriage interface 19 to ensure proper extension and retraction of the cover as the carriage 17 translates.

The column 14 may internally comprise mechanisms, such as gears and motors, that are designed to use a vertically aligned lead screw to translate the carriage 17 in a mechanized fashion in response to control signals generated in response to user inputs, e.g., inputs from the console 16.

The robotic arms 12 may generally comprise robotic arm bases 21 and end effectors 22, separated by a series of linkages 23 that are connected by a series of joints 24, each joint comprising an independent actuator, each actuator comprising an independently controllable motor. Each independently controllable joint represents an independent degree of freedom available to the robotic arm 12. Each of the robotic arms 12 may have seven joints, and thus provide seven degrees of freedom. A multitude of joints result in a multitude of degrees of freedom, allowing for “redundant” degrees of freedom. Having redundant degrees of freedom allows the robotic arms 12 to position their respective end effectors 22 at a specific position, orientation, and trajectory in space using different linkage positions and joint angles. This allows for the system to position and direct a medical instrument from a desired point in space while allowing the physician to move the arm joints into a clinically advantageous position away from the patient to create greater access, while avoiding arm collisions.

The cart base 15 balances the weight of the column 14, carriage 17, and robotic arms 12 over the floor. Accordingly, the cart base 15 houses heavier components, such as electronics, motors, power supply, as well as components that either enable movement and/or immobilize the cart 11. For example, the cart base 15 includes rollable wheel-shaped casters 25 that allow for the cart 11 to easily move around the room prior to a procedure. After reaching the appropriate position, the casters 25 may be immobilized using wheel locks to hold the cart 11 in place during the procedure.

Positioned at the vertical end of the column 14, the console 16 allows for both a user interface for receiving user input and a display screen (or a dual-purpose device such as, for example, a touchscreen 26) to provide the physician user with both preoperative and intraoperative data. Potential preoperative data on the touchscreen 26 may include preoperative plans, navigation and mapping data derived from preoperative computerized tomography (CT) scans, and/or notes from preoperative patient interviews. Intraoperative data on display may include optical information provided from the tool, sensor and coordinate information from sensors, as well as vital patient statistics, such as respiration, heart rate, and/or pulse. The console 16 may be positioned and tilted to allow a physician to access the console 16 from the side of the column 14 opposite the carriage 17. From this position, the physician may view the console 16, robotic arms 12, and patient while operating the console 16 from behind the cart 11. As shown, the console 16 also includes a handle 27 to assist with maneuvering and stabilizing the cart 11.

FIG. 3 illustrates an embodiment of a robotically-enabled system 10 arranged for ureteroscopy. In a ureteroscopic procedure, the cart 11 may be positioned to deliver a ureteroscope 32, a procedure-specific endoscope designed to traverse a patient's urethra and ureter, to the lower abdominal area of the patient. In a ureteroscopy, it may be desirable for the ureteroscope 32 to be directly aligned with the patient's urethra to reduce friction and forces on the sensitive anatomy in the area. As shown, the cart 11 may be aligned at the foot of the table to allow the robotic arms 12 to position the ureteroscope 32 for direct linear access to the patient's urethra. From the foot of the table, the robotic arms 12 may insert the ureteroscope 32 along the virtual rail 33 directly into the patient's lower abdomen through the urethra.

After insertion into the urethra, using similar control techniques as in bronchoscopy, the ureteroscope 32 may be navigated into the bladder, ureters, and/or kidneys for diagnostic and/or therapeutic applications. For example, the ureteroscope 32 may be directed into the ureter and kidneys to break up kidney stone build up using a laser or ultrasonic lithotripsy device deployed down the working channel of the ureteroscope 32. After lithotripsy is complete, the resulting stone fragments may be removed using baskets deployed down the ureteroscope 32.

FIG. 4 illustrates an embodiment of a robotically-enabled system 10 similarly arranged for a vascular procedure. In a vascular procedure, the system 10 may be configured such that the cart 11 may deliver a medical instrument 34, such as a steerable catheter, to an access point in the femoral artery in the patient's leg. The femoral artery presents both a larger diameter for navigation as well as a relatively less circuitous and tortuous path to the patient's heart, which simplifies navigation. As in a ureteroscopic procedure, the cart 11 may be positioned towards the patient's legs and lower abdomen to allow the robotic arms 12 to provide a virtual rail 35 with direct linear access to the femoral artery access point in the patient's thigh/hip region. After insertion into the artery, the medical instrument 34 may be directed and inserted by translating the instrument drivers 28. Alternatively, the cart may be positioned around the patient's upper abdomen in order to reach alternative vascular access points, such as, for example, the carotid and brachial arteries near the shoulder and wrist.

B. Robotic System—Table.

Embodiments of the robotically-enabled medical system may also incorporate the patient's table. Incorporation of the table reduces the amount of capital equipment within the operating room by removing the cart, which allows greater access to the patient. FIG. 5 illustrates an embodiment of such a robotically-enabled system arranged for a bronchoscopic procedure. System 36 includes a support structure or column 37 for supporting platform 38 (shown as a “table” or “bed”) over the floor. Much like in the cart-based systems, the end effectors of the robotic arms 39 of the system 36 comprise instrument drivers 42 that are designed to manipulate an elongated medical instrument, such as a bronchoscope 40 in FIG. 5, through or along a virtual rail 41 formed from the linear alignment of the instrument drivers 42. In practice, a C-arm for providing fluoroscopic imaging may be positioned over the patient's upper abdominal area by placing the emitter and detector around the table 38.

FIG. 6 provides an alternative view of the system 36 without the patient and medical instrument for discussion purposes. As shown, the column 37 may include one or more carriages 43 shown as ring-shaped in the system 36, from which the one or more robotic arms 39 may be based. The carriages 43 may translate along a vertical column interface 44 that runs the length of the column 37 to provide different vantage points from which the robotic arms 39 may be positioned to reach the patient. The carriage(s) 43 may rotate around the column 37 using a mechanical motor positioned within the column 37 to allow the robotic arms 39 to have access to multiples sides of the table 38, such as, for example, both sides of the patient. In embodiments with multiple carriages, the carriages may be individually positioned on the column and may translate and/or rotate independently of the other carriages. While the carriages 43 need not surround the column 37 or even be circular, the ring-shape as shown facilitates rotation of the carriages 43 around the column 37 while maintaining structural balance. Rotation and translation of the carriages 43 allows the system 36 to align the medical instruments, such as endoscopes and laparoscopes, into different access points on the patient. In other embodiments (not shown), the system 36 can include a patient table or bed with adjustable arm supports in the form of bars or rails extending alongside it. One or more robotic arms 39 (e.g., via a shoulder with an elbow joint) can be attached to the adjustable arm supports, which can be vertically adjusted. By providing vertical adjustment, the robotic arms 39 are advantageously capable of being stowed compactly beneath the patient table or bed, and subsequently raised during a procedure.

The robotic arms 39 may be mounted on the carriages 43 through a set of arm mounts 45 comprising a series of joints that may individually rotate and/or telescopically extend to provide additional configurability to the robotic arms 39. Additionally, the arm mounts 45 may be positioned on the carriages 43 such that, when the carriages 43 are appropriately rotated, the arm mounts 45 may be positioned on either the same side of the table 38 (as shown in FIG. 6), on opposite sides of the table 38 (as shown in FIG. 9), or on adjacent sides of the table 38 (not shown).

The column 37 structurally provides support for the table 38, and a path for vertical translation of the carriages 43. Internally, the column 37 may be equipped with lead screws for guiding vertical translation of the carriages, and motors to mechanize the translation of the carriages 43 based the lead screws. The column 37 may also convey power and control signals to the carriages 43 and the robotic arms 39 mounted thereon.

The table base 46 serves a similar function as the cart base 15 in the cart 11 shown in FIG. 2, housing heavier components to balance the table/bed 38, the column 37, the carriages 43, and the robotic arms 39. The table base 46 may also incorporate rigid casters to provide stability during procedures. Deployed from the bottom of the table base 46, the casters may extend in opposite directions on both sides of the base 46 and retract when the system 36 needs to be moved.

With continued reference to FIG. 6, the system 36 may also include a tower (not shown) that divides the functionality of the system 36 between the table and the tower to reduce the form factor and bulk of the table. As in earlier disclosed embodiments, the tower may provide a variety of support functionalities to the table, such as processing, computing, and control capabilities, power, fluidics, and/or optical and sensor processing. The tower may also be movable to be positioned away from the patient to improve physician access and de-clutter the operating room. Additionally, placing components in the tower allows for more storage space in the table base 46 for potential stowage of the robotic arms 39. The tower may also include a master controller or console that provides both a user interface for user input, such as keyboard and/or pendant, as well as a display screen (or touchscreen) for preoperative and intraoperative information, such as real-time imaging, navigation, and tracking information. In some embodiments, the tower may also contain holders for gas tanks to be used for insufflation.

In some embodiments, a table base may stow and store the robotic arms when not in use. FIG. 7 illustrates a system 47 that stows robotic arms in an embodiment of the table-based system. In the system 47, carriages 48 may be vertically translated into base 49 to stow robotic arms 50, arm mounts 51, and the carriages 48 within the base 49. Base covers 52 may be translated and retracted open to deploy the carriages 48, arm mounts 51, and robotic arms 50 around column 53, and closed to stow to protect them when not in use. The base covers 52 may be sealed with a membrane 54 along the edges of its opening to prevent dirt and fluid ingress when closed.

FIG. 8 illustrates an embodiment of a robotically-enabled table-based system configured for a ureteroscopic procedure. In a ureteroscopy, the table 38 may include a swivel portion 55 for positioning a patient off-angle from the column 37 and table base 46. The swivel portion 55 may rotate or pivot around a pivot point (e.g., located below the patient's head) in order to position the bottom portion of the swivel portion 55 away from the column 37. For example, the pivoting of the swivel portion 55 allows a C-arm (not shown) to be positioned over the patient's lower abdomen without competing for space with the column (not shown) below table 38. By rotating the carriage 35 (not shown) around the column 37, the robotic arms 39 may directly insert a ureteroscope 56 along a virtual rail 57 into the patient's groin area to reach the urethra. In a ureteroscopy, stirrups 58 may also be fixed to the swivel portion 55 of the table 38 to support the position of the patient's legs during the procedure and allow clear access to the patient's groin area.

In a laparoscopic procedure, through small incision(s) in the patient's abdominal wall, minimally invasive instruments may be inserted into the patient's anatomy. In some embodiments, the minimally invasive instruments comprise an elongated rigid member, such as a shaft, which is used to access anatomy within the patient. After inflation of the patient's abdominal cavity, the instruments may be directed to perform surgical or medical tasks, such as grasping, cutting, ablating, suturing, etc. In some embodiments, the instruments can comprise a scope, such as a laparoscope. FIG. 9 illustrates an embodiment of a robotically-enabled table-based system configured for a laparoscopic procedure. As shown in FIG. 9, the carriages 43 of the system 36 may be rotated and vertically adjusted to position pairs of the robotic arms 39 on opposite sides of the table 38, such that instrument 59 may be positioned using the arm mounts 45 to be passed through minimal incisions on both sides of the patient to reach his/her abdominal cavity.

To accommodate laparoscopic procedures, the robotically-enabled table system may also tilt the platform to a desired angle. FIG. 10 illustrates an embodiment of the robotically-enabled medical system with pitch or tilt adjustment. As shown in FIG. 10, the system 36 may accommodate tilt of the table 38 to position one portion of the table at a greater distance from the floor than the other. Additionally, the arm mounts 45 may rotate to match the tilt such that the robotic arms 39 maintain the same planar relationship with the table 38. To accommodate steeper angles, the column 37 may also include telescoping portions 60 that allow vertical extension of the column 37 to keep the table 38 from touching the floor or colliding with the table base 46.

FIG. 11 provides a detailed illustration of the interface between the table 38 and the column 37. Pitch rotation mechanism 61 may be configured to alter the pitch angle of the table 38 relative to the column 37 in multiple degrees of freedom. The pitch rotation mechanism 61 may be enabled by the positioning of orthogonal axes 1, 2 at the column-table interface, each axis actuated by a separate motor 3, 4 responsive to an electrical pitch angle command. Rotation along one screw 5 would enable tilt adjustments in one axis 1, while rotation along the other screw 6 would enable tilt adjustments along the other axis 2. In some embodiments, a ball joint can be used to alter the pitch angle of the table 38 relative to the column 37 in multiple degrees of freedom.

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

FIGS. 12 and 13 illustrate isometric and end views of an alternative embodiment of a table-based surgical robotics system 100. The surgical robotics system 100 includes one or more adjustable arm supports 105 that can be configured to support one or more robotic arms (see, for example, FIG. 14) relative to a table 101. In the illustrated embodiment, a single adjustable arm support 105 is shown, though an additional arm support can be provided on an opposite side of the table 101. The adjustable arm support 105 can be configured so that it can move relative to the table 101 to adjust and/or vary the position of the adjustable arm support 105 and/or any robotic arms mounted thereto relative to the table 101. For example, the adjustable arm support 105 may be adjusted one or more degrees of freedom relative to the table 101. The adjustable arm support 105 provides high versatility to the system 100, including the ability to easily stow the one or more adjustable arm supports 105 and any robotics arms attached thereto beneath the table 101. The adjustable arm support 105 can be elevated from the stowed position to a position below an upper surface of the table 101. In other embodiments, the adjustable arm support 105 can be elevated from the stowed position to a position above an upper surface of the table 101.

The adjustable arm support 105 can provide several degrees of freedom, including lift, lateral translation, tilt, etc. In the illustrated embodiment of FIGS. 12 and 13, the arm support 105 is configured with four degrees of freedom, which are illustrated with arrows in FIG. 12. A first degree of freedom allows for adjustment of the adjustable arm support 105 in the z-direction (“Z-lift”). For example, the adjustable arm support 105 can include a carriage 109 configured to move up or down along or relative to a column 102 supporting the table 101. A second degree of freedom can allow the adjustable arm support 105 to tilt. For example, the adjustable arm support 105 can include a rotary joint, which can allow the adjustable arm support 105 to be aligned with the bed in a Trendelenburg position. A third degree of freedom can allow the adjustable arm support 105 to “pivot up,” which can be used to adjust a distance between a side of the table 101 and the adjustable arm support 105. A fourth degree of freedom can permit translation of the adjustable arm support 105 along a longitudinal length of the table.

The surgical robotics system 100 in FIGS. 12 and 13 can comprise a table supported by a column 102 that is mounted to a base 103. The base 103 and the column 102 support the table 101 relative to a support surface. A floor axis 131 and a support axis 133 are shown in FIG. 13.

The adjustable arm support 105 can be mounted to the column 102. In other embodiments, the arm support 105 can be mounted to the table 101 or base 103. The adjustable arm support 105 can include a carriage 109, a bar or rail connector 111 and a bar or rail 107. In some embodiments, one or more robotic arms mounted to the rail 107 can translate and move relative to one another.

The carriage 109 can be attached to the column 102 by a first joint 113, which allows the carriage 109 to move relative to the column 102 (e.g., such as up and down a first or vertical axis 123). The first joint 113 can provide the first degree of freedom (“Z-lift”) to the adjustable arm support 105. The adjustable arm support 105 can include a second joint 115, which provides the second degree of freedom (tilt) for the adjustable arm support 105. The adjustable arm support 105 can include a third joint 117, which can provide the third degree of freedom (“pivot up”) for the adjustable arm support 105. An additional joint 119 (shown in FIG. 13) can be provided that mechanically constrains the third joint 117 to maintain an orientation of the rail 107 as the rail connector 111 is rotated about a third axis 127. The adjustable arm support 105 can include a fourth joint 121, which can provide a fourth degree of freedom (translation) for the adjustable arm support 105 along a fourth axis 129.

FIG. 14 illustrates an end view of the surgical robotics system 140A with two adjustable arm supports 105A, 105B mounted on opposite sides of a table 101. A first robotic arm 142A is attached to the bar or rail 107A of the first adjustable arm support 105B. The first robotic arm 142A includes a base 144A attached to the rail 107A. The distal end of the first robotic arm 142A includes an instrument drive mechanism 146A that can attach to one or more robotic medical instruments or tools. Similarly, the second robotic arm 142B includes a base 144B attached to the rail 107B. The distal end of the second robotic arm 142B includes an instrument drive mechanism 146B. The instrument drive mechanism 146B can be configured to attach to one or more robotic medical instruments or tools.

In some embodiments, one or more of the robotic arms 142A, 142B comprises an arm with seven or more degrees of freedom. In some embodiments, one or more of the robotic arms 142A, 142B can include eight degrees of freedom, including an insertion axis (1-degree of freedom including insertion), a wrist (3-degrees of freedom including wrist pitch, yaw and roll), an elbow (1-degree of freedom including elbow pitch), a shoulder (2-degrees of freedom including shoulder pitch and yaw), and base 144A, 144B (1-degree of freedom including translation). In some embodiments, the insertion degree of freedom can be provided by the robotic arm 142A, 142B, while in other embodiments, the instrument itself provides insertion via an instrument-based insertion architecture.

C. Instrument Driver & Interface.

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

FIG. 15 illustrates an example instrument driver. Positioned at the distal end of a robotic arm, instrument driver 62 comprises one or more drive units 63 arranged with parallel axes to provide controlled torque to a medical instrument via drive shafts 64. Each drive unit 63 comprises an individual drive shaft 64 for interacting with the instrument, a gear head 65 for converting the motor shaft rotation to a desired torque, a motor 66 for generating the drive torque, an encoder 67 to measure the speed of the motor shaft and provide feedback to the control circuitry, and control circuity 68 for receiving control signals and actuating the drive unit. Each drive unit 63 being independently controlled and motorized, the instrument driver 62 may provide multiple (e.g., four as shown in FIG. 15) independent drive outputs to the medical instrument. In operation, the control circuitry 68 would receive a control signal, transmit a motor signal to the motor 66, compare the resulting motor speed as measured by the encoder 67 with the desired speed, and modulate the motor signal to generate the desired torque.

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

D. Medical Instrument.

FIG. 16 illustrates an example medical instrument with a paired instrument driver. Like other instruments designed for use with a robotic system, medical instrument 70 comprises an elongated shaft 71 (or elongate body) and an instrument base 72. The instrument base 72, also referred to as an “instrument handle” due to its intended design for manual interaction by the physician, may generally comprise rotatable drive inputs 73, e.g., receptacles, pulleys or spools, that are designed to be mated with drive outputs 74 that extend through a drive interface on instrument driver 75 at the distal end of robotic arm 76. When physically connected, latched, and/or coupled, the mated drive inputs 73 of the instrument base 72 may share axes of rotation with the drive outputs 74 in the instrument driver 75 to allow the transfer of torque from the drive outputs 74 to the drive inputs 73. In some embodiments, the drive outputs 74 may comprise splines that are designed to mate with receptacles on the drive inputs 73.

The elongated shaft 71 is designed to be delivered through either an anatomical opening or lumen, e.g., as in endoscopy, or a minimally invasive incision, e.g., as in laparoscopy. The elongated shaft 71 may be either flexible (e.g., having properties similar to an endoscope) or rigid (e.g., having properties similar to a laparoscope) or contain a customized combination of both flexible and rigid portions. When designed for laparoscopy, the distal end of a rigid elongated shaft may be connected to an end effector extending from a jointed wrist formed from a clevis with at least one degree of freedom and a surgical tool or medical instrument, such as, for example, a grasper or scissors, that may be actuated based on force from the tendons as the drive inputs rotate in response to torque received from the drive outputs 74 of the instrument driver 75. When designed for endoscopy, the distal end of a flexible elongated shaft may include a steerable or controllable bending section that may be articulated and bent based on torque received from the drive outputs 74 of the instrument driver 75.

Torque from the instrument driver 75 is transmitted down the elongated shaft 71 using tendons along the elongated shaft 71. These individual tendons, such as pull wires, may be individually anchored to individual drive inputs 73 within the instrument handle 72. From the handle 72, the tendons are directed down one or more pull lumens along the elongated shaft 71 and anchored at the distal portion of the elongated shaft 71, or in the wrist at the distal portion of the elongated shaft. During a surgical procedure, such as a laparoscopic, endoscopic or hybrid procedure, these tendons may be coupled to a distally mounted end effector, such as a wrist, grasper, or scissor. Under such an arrangement, torque exerted on drive inputs 73 would transfer tension to the tendon, thereby causing the end effector to actuate in some way. In some embodiments, during a surgical procedure, the tendon may cause a joint to rotate about an axis, thereby causing the end effector to move in one direction or another. Alternatively, the tendon may be connected to one or more jaws of a grasper at the distal end of the elongated shaft 71, where tension from the tendon causes the grasper to close.

In endoscopy, the tendons may be coupled to a bending or articulating section positioned along the elongated shaft 71 (e.g., at the distal end) via adhesive, control ring, or other mechanical fixation. When fixedly attached to the distal end of a bending section, torque exerted on the drive inputs 73 would be transmitted down the tendons, causing the softer, bending section (sometimes referred to as the articulable section or region) to bend or articulate. Along the non-bending sections, it may be advantageous to spiral or helix the individual pull lumens that direct the individual tendons along (or inside) the walls of the endoscope shaft to balance the radial forces that result from tension in the pull wires. The angle of the spiraling and/or spacing therebetween may be altered or engineered for specific purposes, wherein tighter spiraling exhibits lesser shaft compression under load forces, while lower amounts of spiraling results in greater shaft compression under load forces, but limits bending. On the other end of the spectrum, the pull lumens may be directed parallel to the longitudinal axis of the elongated shaft 71 to allow for controlled articulation in the desired bending or articulable sections.

In endoscopy, the elongated shaft 71 houses a number of components to assist with the robotic procedure. The shaft 71 may comprise a working channel for deploying surgical tools (or medical instruments), irrigation, and/or aspiration to the operative region at the distal end of the shaft 71. The shaft 71 may also accommodate wires and/or optical fibers to transfer signals to/from an optical assembly at the distal tip, which may include an optical camera. The shaft 71 may also accommodate optical fibers to carry light from proximally-located light sources, such as light emitting diodes, to the distal end of the shaft 71.

At the distal end of the instrument 70, the distal tip may also comprise the opening of a working channel for delivering tools for diagnostic and/or therapy, irrigation, and aspiration to an operative site. The distal tip may also include a port for a camera, such as a fiberscope or a digital camera, to capture images of an internal anatomical space. Relatedly, the distal tip may also include ports for light sources for illuminating the anatomical space when using the camera.

In the example of FIG. 16, the drive shaft axes, and thus the drive input axes, are orthogonal to the axis of the elongated shaft 71. This arrangement, however, complicates roll capabilities for the elongated shaft 71. Rolling the elongated shaft 71 along its axis while keeping the drive inputs 73 static results in undesirable tangling of the tendons as they extend off the drive inputs 73 and enter pull lumens within the elongated shaft 71. The resulting entanglement of such tendons may disrupt any control algorithms intended to predict movement of the flexible elongated shaft 71 during an endoscopic procedure.

FIG. 17 illustrates an alternative design for an instrument driver and instrument where the axes of the drive units are parallel to the axis of the elongated shaft of the instrument. As shown, a circular instrument driver 80 comprises four drive units with their drive outputs 81 aligned in parallel at the end of a robotic arm 82. The drive units, and their respective drive outputs 81, are housed in a rotational assembly 83 of the instrument driver 80 that is driven by one of the drive units within the assembly 83. In response to torque provided by the rotational drive unit, the rotational assembly 83 rotates along a circular bearing that connects the rotational assembly 83 to the non-rotational portion 84 of the instrument driver 80. Power and controls signals may be communicated from the non-rotational portion 84 of the instrument driver 80 to the rotational assembly 83 through electrical contacts that may be maintained through rotation by a brushed slip ring connection (not shown). In other embodiments, the rotational assembly 83 may be responsive to a separate drive unit that is integrated into the non-rotatable portion 84, and thus not in parallel to the other drive units. The rotational mechanism 83 allows the instrument driver 80 to rotate the drive units, and their respective drive outputs 81, as a single unit around an instrument driver axis 85.

Like earlier disclosed embodiments, an instrument 86 may comprise an elongated shaft portion 88 and an instrument base 87 (shown with a transparent external skin for discussion purposes) comprising a plurality of drive inputs 89 (such as receptacles, pulleys, and spools) that are configured to receive the drive outputs 81 in the instrument driver 80. Unlike prior disclosed embodiments, the instrument shaft 88 extends from the center of the instrument base 87 with an axis substantially parallel to the axes of the drive inputs 89, rather than orthogonal as in the design of FIG. 16.

When coupled to the rotational assembly 83 of the instrument driver 80, the medical instrument 86, comprising instrument base 87 and instrument shaft 88, rotates in combination with the rotational assembly 83 about the instrument driver axis 85. Since the instrument shaft 88 is positioned at the center of instrument base 87, the instrument shaft 88 is coaxial with instrument driver axis 85 when attached. Thus, rotation of the rotational assembly 83 causes the instrument shaft 88 to rotate about its own longitudinal axis. Moreover, as the instrument base 87 rotates with the instrument shaft 88, any tendons connected to the drive inputs 89 in the instrument base 87 are not tangled during rotation. Accordingly, the parallelism of the axes of the drive outputs 81, drive inputs 89, and instrument shaft 88 allows for the shaft rotation without tangling any control tendons.

FIG. 18 illustrates an instrument having an instrument based insertion architecture in accordance with some embodiments. The instrument 150 can be coupled to any of the instrument drivers discussed above. The instrument 150 comprises an elongated shaft 152, an end effector 162 connected to the shaft 152, and a handle 170 coupled to the shaft 152. The elongated shaft 152 comprises a tubular member having a proximal portion 154 and a distal portion 156. The elongated shaft 152 comprises one or more channels or grooves 158 along its outer surface. The grooves 158 are configured to receive one or more wires or cables 180 therethrough. One or more cables 180 thus run along an outer surface of the elongated shaft 152. In other embodiments, cables 180 can also run through the elongated shaft 152. Manipulation of the one or more cables 180 (e.g., via an instrument driver) results in actuation of the end effector 162.

The instrument handle 170, which may also be referred to as an instrument base, may generally comprise an attachment interface 172 having one or more mechanical inputs 174, e.g., receptacles, pulleys or spools, that are designed to be reciprocally mated with one or more torque couplers on an attachment surface of an instrument driver.

In some embodiments, the instrument 150 comprises a series of pulleys or cables that enable the elongated shaft 152 to translate relative to the handle 170. In other words, the instrument 150 itself comprises an instrument-based insertion architecture that accommodates insertion of the instrument, thereby minimizing the reliance on a robot arm to provide insertion of the instrument 150. In other embodiments, a robotic arm can be largely responsible for instrument insertion.

E. Controller.

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

FIG. 19 is a perspective view of an embodiment of a controller 182. In the present embodiment, the controller 182 comprises a hybrid controller that can have both impedance and admittance control. In other embodiments, the controller 182 can utilize just impedance or passive control. In other embodiments, the controller 182 can utilize just admittance control. By being a hybrid controller, the controller 182 advantageously can have a lower perceived inertia while in use.

In the illustrated embodiment, the controller 182 is configured to allow manipulation of two medical instruments, and includes two handles 184. Each of the handles 184 is connected to a gimbal 186. Each gimbal 186 is connected to a positioning platform 188.

As shown in FIG. 19, each positioning platform 188 includes a SCARA arm (selective compliance assembly robot arm) 198 coupled to a column 194 by a prismatic joint 196. The prismatic joints 196 are configured to translate along the column 194 (e.g., along rails 197) to allow each of the handles 184 to be translated in the z-direction, providing a first degree of freedom. The SCARA arm 198 is configured to allow motion of the handle 184 in an x-y plane, providing two additional degrees of freedom.

In some embodiments, one or more load cells are positioned in the controller. For example, in some embodiments, a load cell (not shown) is positioned in the body of each of the gimbals 186. By providing a load cell, portions of the controller 182 are capable of operating under admittance control, thereby advantageously reducing the perceived inertia of the controller while in use. In some embodiments, the positioning platform 188 is configured for admittance control, while the gimbal 186 is configured for impedance control. In other embodiments, the gimbal 186 is configured for admittance control, while the positioning platform 188 is configured for impedance control. Accordingly, for some embodiments, the translational or positional degrees of freedom of the positioning platform 188 can rely on admittance control, while the rotational degrees of freedom of the gimbal 186 rely on impedance control.

F. Navigation and Control.

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

FIG. 20 is a block diagram illustrating a localization system 90 that estimates a location of one or more elements of the robotic system, such as the location of the instrument, in accordance to an example embodiment. The localization system 90 may be a set of one or more computer devices configured to execute one or more instructions. The computer devices may be embodied by a processor (or processors) and computer-readable memory in one or more components discussed above. By way of example and not limitation, the computer devices may be in the tower 30 shown in FIG. 1, the cart 11 shown in FIGS. 1-4, the beds shown in FIGS. 5-14, etc.

As shown in FIG. 20, the localization system 90 may include a localization module 95 that processes input data 91-94 to generate location data 96 for the distal tip of a medical instrument. The location data 96 may be data or logic that represents a location and/or orientation of the distal end of the instrument relative to a frame of reference. The frame of reference can be a frame of reference relative to the anatomy of the patient or to a known object, such as an EM field generator (see discussion below for the EM field generator).

The various input data 91-94 are now described in greater detail. Preoperative mapping may be accomplished through the use of the collection of low dose CT scans. Preoperative CT scans are reconstructed into three-dimensional images, which are visualized, e.g. as “slices” of a cutaway view of the patient's internal anatomy. When analyzed in the aggregate, image-based models for anatomical cavities, spaces and structures of the patient's anatomy, such as a patient lung network, may be generated. Techniques such as center-line geometry may be determined and approximated from the CT images to develop a three-dimensional volume of the patient's anatomy, referred to as model data 91 (also referred to as “preoperative model data” when generated using only preoperative CT scans). The use of center-line geometry is discussed in U.S. patent application Ser. No. 14/523,760, issued as U.S. Pat. No. 9,763,741 on Sep. 19, 2017, the contents of which are herein incorporated in its entirety. Network topological models may also be derived from the CT-images, and are particularly appropriate for bronchoscopy.

In some embodiments, the instrument may be equipped with a camera to provide vision data (or image data) 92. The localization module 95 may process the vision data 92 to enable one or more vision-based (or image-based) location tracking modules or features. For example, the preoperative model data 91 may be used in conjunction with the vision data 92 to enable computer vision-based tracking of the medical instrument (e.g., an endoscope or an instrument advance through a working channel of the endoscope). For example, using the preoperative model data 91, the robotic system may generate a library of expected endoscopic images from the model based on the expected path of travel of the endoscope, each image linked to a location within the model. Intraoperatively, this library may be referenced by the robotic system in order to compare real-time images captured at the camera (e.g., a camera at a distal end of the endoscope) to those in the image library to assist localization.

Other computer vision-based tracking techniques use feature tracking to determine motion of the camera, and thus the endoscope. Some features of the localization module 95 may identify circular geometries in the preoperative model data 91 that correspond to anatomical lumens and track the change of those geometries to determine which anatomical lumen was selected, as well as the relative rotational and/or translational motion of the camera. Use of a topological map may further enhance vision-based algorithms or techniques.

Optical flow, another computer vision-based technique, may analyze the displacement and translation of image pixels in a video sequence in the vision data 92 to infer camera movement. Examples of optical flow techniques may include motion detection, object segmentation calculations, luminance, motion compensated encoding, stereo disparity measurement, etc. Through the comparison of multiple frames over multiple iterations, movement and location of the camera (and thus the endoscope) may be determined.

The localization module 95 may use real-time EM tracking to generate a real-time location of the endoscope in a global coordinate system that may be registered to the patient's anatomy, represented by the preoperative model. In EM tracking, an EM sensor (or tracker) comprising one or more sensor coils embedded in one or more locations and orientations in a medical instrument (e.g., an endoscopic tool) measures the variation in the EM field created by one or more static EM field generators positioned at a known location. The location information detected by the EM sensors is stored as EM data 93. The EM field generator (or transmitter), may be placed close to the patient to create a low intensity magnetic field that the embedded sensor may detect. The magnetic field induces small currents in the sensor coils of the EM sensor, which may be analyzed to determine the distance and angle between the EM sensor and the EM field generator. These distances and orientations may be intraoperatively “registered” to the patient anatomy (e.g., the preoperative model) in order to determine the geometric transformation that aligns a single location in the coordinate system with a position in the preoperative model of the patient's anatomy. Once registered, an embedded EM tracker in one or more positions of the medical instrument (e.g., the distal tip of an endoscope) may provide real-time indications of the progression of the medical instrument through the patient's anatomy.

Robotic command and kinematics data 94 may also be used by the localization module 95 to provide localization data 96 for the robotic system. Device pitch and yaw resulting from articulation commands may be determined during preoperative calibration. Intraoperatively, these calibration measurements may be used in combination with known insertion depth information to estimate the position of the instrument. Alternatively, these calculations may be analyzed in combination with EM, vision, and/or topological modeling to estimate the position of the medical instrument within the network.

As FIG. 20 shows, a number of other input data can be used by the localization module 95. For example, although not shown in FIG. 20, an instrument utilizing shape-sensing fiber can provide shape data that the localization module 95 can use to determine the location and shape of the instrument.

The localization module 95 may use the input data 91-94 in combination(s). In some cases, such a combination may use a probabilistic approach where the localization module 95 assigns a confidence weight to the location determined from each of the input data 91-94. Thus, where the EM data may not be reliable (as may be the case where there is EM interference) the confidence of the location determined by the EM data 93 can be decrease and the localization module 95 may rely more heavily on the vision data 92 and/or the robotic command and kinematics data 94.

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

2. Controlled Fleet Angle Capstan

Examples of the disclosure relate to systems and techniques for manual and/or robotic controllable medical instruments. The controllable medical instruments can be used, in some aspects, with robotically-enabled medical systems, such as those described above with reference to FIGS. 1-20. Examples of medical instruments can include a robotic arm or an instrument configured to be controlled by a robotic arm such as a flexible endoscope. In some aspects, the medical instrument can include a medical tool actuated with a wrist, a camera (e.g., with an optical fiber), a basketing tool, a blade tool, a laser tool (e.g., with an optical fiber), and/or other instruments described herein. In some aspects, the medical instruments can be configured for endoscopic procedures. For example, the medical instruments can be configured for uroscopy, ureteroscopy, gastroscopy, bronchoscopy, or other endoscopic procedures. In some examples, the medical instruments can be configured for laparoscopic procedures or other types of medical procedures (e.g., open procedures).

In some aspects, the medical instrument can be flexible tubular tool or instrument, such as an endoscope, and/or a rigid tool or instrument, such as a scope. In some aspects, the medical instrument can include a rigid tool with a wrist and the wrist can be actuated to control and manipulate the tool. In some aspects, the medical instrument includes a flexible elongate shaft that can be deflected in various directions. In some aspects, the medical instrument can include an instrument handle, which can include one or more rotational drive inputs or drive shafts. The drive shafts may actuate one or more pullwires with one or more capstans and/or pulleys. The one or more pullwires may be actuated to articulate an elongated shaft or the wrist of the tool. The one or more pullwires may also be actuated to deflect, rotate, or translate an elongate shaft relative to the instrument handle. Controlling the articulation of the elongated shaft can include linearly translating the elongated shaft, deflecting or bending an articulable portion of the elongated shaft and in certain embodiments the roll or rotation of the elongated shaft about a longitudinal axis of the shaft. In some aspects, the articulable portion can be a distal portion of the elongated shaft. The articulable portion may be articulable in one or more degrees of freedom. Degrees of freedom may be linear or rotational. Actuation of the elongated shaft may be controlled at the instrument base with the use of one or more capstans and/or pulleys.

An instrument base or handle can be connected to the elongate shaft, such as at the proximal portion or distal portion of the shaft. The instrument base can include one or more rotational drive inputs. The rotational drive inputs may also be called drive inputs, inputs, drive shafts, rotational drive shafts, or shafts. The drive inputs may be located in a handle of the medical instrument. The elongate shaft can be coupled to the drive input to control articulation of one or more portions of the elongate shaft. The elongated shaft can include one or more pull wires which extend along the length of the elongate shaft. The one or more pull wires can be actuable to articulate the elongated shaft. The one or more drive inputs, coupled to one or more pull wires with one or more capstans/pulleys, can be configured to translate the shaft or bend the shaft in various directions.

As described above (for example, with reference to FIGS. 15-18), in some aspects, the medical instrument can include one or more pull wires extending on or through the elongated shaft. The pull wires can be attached to actuation mechanisms, such as one or more pulleys and/or capstans, within the instrument handle. The actuation mechanism can, in turn, be connected to the drive inputs such that actuation of the drive inputs operates the actuation mechanisms to pull on the pull wires to cause articulation of the elongated shaft. In some aspects, one or more of the drive inputs are each connected to the same actuation mechanism (e.g., pulley, capstan, and/or capstan assembly) within the instrument handle such that the drive input can be used to actuate the same actuation mechanism.

The physician may control the medical instrument by controlling or operating drive inputs or drive shafts of the medical device. Various tools or instruments can attach to the device driver. Insertion of an instrument (e.g., towards a surgical site) can be facilitated by the design and architecture of the instrument. For example, in some aspects, wherein an instrument includes an elongated shaft and a handle, the use of a capstan and/or pulleys can actuate the elongated shaft to translate relative to the handle along an axis of insertion. In some aspects, the use of a capstan and/or pulleys enables deflection of an elongated shaft or articulation of a wrist of a surgical tool (e.g. a cutter, a gripper, or any other tool).

It can be advantageous to route and control one or more wires or cable on a capstan. The one or more cables on the capstan can then be connected to one or pulleys. The capstan and/or the one or more pulleys may be rotated by one or more drive shafts.

FIG. 21 illustrates a cable or wire 250 connected to a capstan 200 and a pulley 260. The capstan 200 can be supported about a rotational axis. The capstan 200 may also be considered a pulley or spool. The cable 250 can be wrapped around the capstan 200 one or more times around the outer surface 202 of the capstan 200. The capstan 200 may be generally cylindrical and have a first side 206 and a second side 208. The first side 206 of the capstan 200 may be considered the top side, proximal side, first end, top end, or proximal end. The second side 208 of the capstan 200 may be considered a bottom side, distal side, second end, bottom end, or distal end.

The cable 250 may extend from the capstan 200 to the pulley 260, which may be considered a redirect pulley. The cable 250 may then extend from the pulley 260 and connect to an elongate shaft or wrist or any other component of the medical instrument.

The capstan 200 may have a center hole 204 that can be supported by or mounted on a rod 210 (which can also be called a shaft, pole, or elongate portion) that may extend at least partially through the capstan 200. In some embodiments, the rod 210 can extend from a first side 206 of the capstan 200 to a second side 208 of the capstan 200. The rod 210 may be positioned along a rotational axis 212 of the capstan 200. The rotational axis 212 can also be considered a longitudinal axis.

The capstan 200 may rotate about the rotational axis 212. The capstan 200 can rotate about the rod 210 positioned along the rotational axis 212 of the capstan 200. As the capstan 200 rotates, the cable 250 wraps on or off about the outer surface 202 of the capstan 200. The cable 250 then extends to be received in the groove or redirect surface 262 of the pulley 260. The redirect surface 262 of the pulley 260 can be rotating, such that the redirect surface 262 moves or rotates as the pulley 260 rotates, such as rotating with movement of the cable 250 received therein. The redirect surface 262 can also be static, such that the redirect surface 262 and the pulley 260 do not move or rotate as the cable 250 moves along the redirect surface 262. Although the pulley 260 and redirect surface 262 are illustrated as circular, the pulley 260 or the redirect surface 262 can have other shapes. For example, the redirect surface 262 may form a u-shape or another curved surface that receives the cable 250 and changes the direction of the cable 250. The fleet angle (“α”) is the angle at which the cable 250 extends from the capstan 200 to the pulley 260. The fleet angle α can be measured from a centerline or normal from the outer surface 202 of capstan 200 as shown. The fleet angle α can change due to the cable 250 wrapping on and off the capstan 200. The position of the pulley 260 can be stationary relative to the position of the capstan 200. As the capstan 200 rotates, the cable 250 can unwrap off or wrap around the outer surface 202 of the capstan 200 at different points along the length of the capstan 200, which can change the fleet angle α of the cable 250 between the capstan 200 and the pulley 260. The change in fleet angle α can change the length of the cable 250 and change tension in the cable 250. Therefore, controlling the fleet angle α to minimize the change in fleet angle α can be desirable to control tension in the system. While the change in fleet angle α can be minimized by increasing the distance between the capstan 200 and the pulley 260, this can cause complexity in arranging the various components in the instrument and can also cause an undesirable increase in size of the instrument. Additionally, maximizing the distance of the cable 250 between the capstan 200 and the pulley 260 can change tension in the system. While in several embodiments, the fleet angle is described as being minimized, it several embodiments, it can be desirable to control the or maintain the fleet angle at a constant desired angle. It can also be desirable to control or change the fleet angle at any desired angle, including maximizing or increasing the fleet angle such as to compensate for another function in the system. In some aspects, it can also be desirable to intentionally vary the fleet angle in a controlled manner.

Therefore, to control the fleet angle α, the capstan 200 can also translate relative to the rod 210, along the length of the rod 210. The capstan 200 can translate relative to the pulley along the rotational axis 212 of the capstan 200. The capstan 200 can simultaneously translate linearly along the rotational axis 212 and rotate about the rotational axis 212. This axial motion of the capstan 200 can minimize the change of fleet angle α, conserve or minimize space within the medical instrument, and gives full control over the cable 250 path length.

FIG. 22A illustrates a capstan 300 connected to a drive input 440 and a supporting rod 400. The capstan 300 may be generally cylindrical and have a first end 306 and a second end 308. The capstan 300 can include a groove 302 with an outer surface 310. A cable can be wrapped around the capstan 300 one or more times around the outer surface 310 of the capstan 300. The outer surface 310 can be generally smooth to allow the cable to wrap around the outer surface 310. The first and second ends 306, 308 of the outer surface 310 can be raised relative to the middle portion of the outer surface 310 to retain the cable on the capstan 300 and prevent the cable 250 from sliding or slipping off the ends of the outer surface 310. In some examples, the outer surface 310 can be considered a single large groove that is capable of receiving a cable wrapped around the outer surface 310 several times. The capstan 300 can include an anchor groove 312 to receive and secure one end of the cable. The anchor groove 312 can be positioned on the second side 308 of the capstan 300. In some examples, an anchor groove 312 can be positioned alternatively or additionally on the first side 306 of the capstan 300. As shown in FIG. 22B, the capstan 300 includes a first anchor groove 314 on the first side 306 and a second anchor groove 312 on the second side 308. This can allow a cable to be secured to the capstan 300 at one or more locations.

The drive input 440 can extend along the rotational axis 212 of the capstan 200. The drive input 440 is coupled to at least one side 308 of the capstan 200. The drive input 440 can actuate rotational motion of the capstan 300. The capstan 300 on the second side 308 can have a hole to receive and engage with the drive input 440.

The capstan 300 can also include a supporting rod 400 extending along the rotational axis 212 of the capstan 300. The supporting rod 400 can extend along the rotational axis 212 and partially through the capstan 300. The supporting rod 400 actuates axial motion of the capstan 300 as the capstan 300 rotates. The supporting rod 400 can include a top portion 402 and a bottom portion 404. The bottom portion 404 can be threaded. The supporting rod 400 can include a thread 404 coupled to the opposite side 306 of the capstan 300. The supporting rod 400 can also be considered a screw or a threaded portion itself or have a threaded portion. The capstan 300 can have a center hole 304 on the first side 306 to receive at least a portion of the bottom portion 404 of the supporting rod 400. In some aspects, the center hole 304 can extend from the first end 306 to the second end 308 of the capstan 300. In some aspects, the center hole 304 can extend from the first side 306 and partially into the capstan 300. In some aspects, the second side 308 can have a center hole (not shown) that can extend from the second side 308 and partially into the capstan 300 to receive and engage with the drive input 440.

Although the supporting rod 400 is shown coupled to the first side 306 and the drive input 440 is shown coupled to the second side 308 in FIG. 22A, the support rod 400 can also be coupled to the second side 308 and the drive input 440 can be coupled to the first side 306. In some aspects, the supporting rod 400 can extend at least from the first side 306 of the capstan to the second side 308 of the capstan 300. The supporting rod 400 can extend partially at least from the first side 306 of the capstan and partially into the capstan 300.

As described, the capstan 300 can be rotated by the drive input 440. Rotation of the capstan 300 by the drive input 440 can also cause rotation of the capstan 300 with respect to the threaded portion 404 of the supporting rod 400. As the capstan 300 rotates relative to the threaded portion 404, the capstan 300 will axially translate the capstan 300 along the threaded portion 404.

FIG. 22B illustrates the capstan 300 of FIG. 22A with the outer surface of the capstan 300 transparent to illustrate the inner components. The capstan 300 can have a spline 422 and a nut 412 positioned internally within the capstan 300. In some aspects, the spline 422 or the nut 412 can be integral with the capstan 300 and be considered part of the capstan 300. In some aspects, the spline 422 or the nut 412 can be separate components from the capstan 300, but received within a corresponding hole or groove 304 of the capstan 300. The spline 422 can extend along the rotational axis 212 of the capstan 300. The spline 422 can be coupled to at least the second side 308 of the capstan 300. In some examples, the spline 422 can be alternatively or additionally coupled to the first side 306 of the capstan 300. The spline 422 can actuate rotational motion of the capstan 300. The spline 422 can be configured to engage with or receive at least a portion of the drive input 440. The nut 412 can be configured to engage with and receive at least a part of the threaded portion 404. FIG. 22B illustrates the spline 422 positioned within the hole 304 that can be shaped to receive the spline 422. The spline 422 can engage with or connect to the drive input 440, such that rotation of the drive input 440 will rotate the spline 422, which will in turn rotate the capstan 300.

The capstan 300 can be configured to move longitudinally along the rotational axis 212 of the capstan 300. As the capstan 300 is rotated, actuated by the drive input 440 and spline 422, the capstan 300 can translate axially relative to the supporting rod 400 received in the nut 412. As the capstan 300 is rotated by the drive input 440, the nut 412 positioned within the capstan 300 will rotate relative to the threaded portion 404 and thus will axially translate relative to the threaded portion 404 based on the pitch of the threaded portion 404.

Although the bottom portion 404 of the supporting rod 400 is shown as threaded to be received within the female threads of the nut 412, in a modified arrangement the threaded arrangement can be reversed. For example, in modified arrangement, the capstan 300 can include an attached or integrated threaded rod which is received within corresponding female threads in a surrounding housing (external from the capstan). As with the illustrated embodiment, rotation of the capstan would cause axial movement as coupled or integrated threaded rod of the capstan rotates within the female threads of the surrounding housing.

Although the bottom portion 404 of the supporting rod 400 is shown as threaded, the supporting rod 210 can also be smooth and allow the capstan 200 to slide axially relative to the rod 210. As the drive input 440 actuates rotation of the capstan 300, the cable 250 can wrap on and off the capstan 300 and the capstan 300 can axially slide along the rod 210. The axial motion of the capstan 300 can be actuated by a screw (not shown) positioned off-axis from the capstan 300.

FIG. 23 illustrates a cable 250 connected to a capstan 350 and a pulley 260 in a handle of a medical instrument. The capstan 350 may be similar to the capstan 300 as described in FIGS. 22A and 22B. The capstan 350 can connect to the supporting rod or screw 400 similar to FIGS. 22A and 22B.

The spline 450 may extend from the capstan 350. In some aspects, the spline 450 may be considered separate from the capstan 350 and can be configured to attach to the capstan 350. The spline 450 may be received within a hole or groove (not shown) of the capstan 350. The spline 450 may be positioned internally within this hole or groove of the capstan 350 and also extend externally from the capstan 350. In some aspects, the spline 450 may be integral with the capstan 350 such that it is considered part of the capstan 300. The spline 450 may engage with or be coupled to a drive input. In some aspects, the spline 450 may extend from the capstan 350 and be received within a groove or recess of a separate piece (not shown) to receive the spline 450. The separate piece may then connect to and be driven by a drive input.

The cable 250 can wrap around the outer surface 354 of the capstan 350. One end of the cable 250 can extend from the outer surface 354 of the capstan 350 to a first pulley 260 while the other end of the cable 250 can extend from the outer surface 354 of the capstan 350 to a second pulley 270. The first and second pulleys 260, 270 can also be positioned in the handle of the medical instrument. The capstan 350 can include an anchor groove 352 to receive and secure one end of the cable 250. This can allow one end of the cable 250 to be secured to the capstan 300.

The capstan 350 can have a helical groove 352 on an outer surface 354 of the capstan 350. The helical groove 352 can receive the cable 250 as the cable 250 is wrapped around the capstan 350. The helical groove 352 can advantageously help with the cable life and assembly.

The pitch of the threaded portion 404 of the supporting rod or screw 400 matches a pitch of a helical groove 352 of the capstan 350. The capstan 350 is configured to move longitudinally along the rotational axis 212 of the capstan 350 as the capstan 350 is rotated (as actuated by the spline 450). The pitch of the threaded portion 404 of the screw 400 matching the pitch of the helical groove 352 of the capstan 350 allows the capstan 350 to rotate about the rotational axis 212 at the same rate the capstan 350 linearly translates along the rotational axis 212. The coordinated rotational and translational motion of the capstan 350 can control the fleet angle of the cable 250 between the capstan 350 and the pulley 260. Rotational motion of the capstan 350 can cause the capstan 350 to axially move on the screw 400 as the capstan 350 is rotated.

FIG. 24 illustrates one or more cables 252 connected to a capstan 300 and an elongated shaft 500 of a medical instrument. The elongate shaft 500 can be operatively coupled to the capstan 300 and the first pulley 260 and a second pulley 270. The elongate shaft 500 can include a proximal portion 502 and a distal portion 504. The elongate shaft 500 can include an end effector (not shown), which may be connected to the distal portion of the elongate shaft 500. The rotation of the capstan 300 and corresponding shortening or lengthening of the one or more cables 252 can actuate the end effector. The rotation of the capstan 300 and corresponding shortening or lengthening of the one or more cables can also actuate linear translation of the elongate shaft 500.

A first end of the one or more cables 252 can terminate at the proximal portion 502 of the shaft 500 and a second end of the one or more cables 252 can terminate at the distal portion 504 of the shaft 500. In some embodiments, the one or more cables 252 can be a single cable that terminates at the proximal portion 502 of the shaft 500 and connects to and wraps around the capstan 300 and also terminates at the distal portion 504 of the shaft 500. The one or more cables 252 can connect on a distal side 308 of the capstan 300 and can connect on a proximal side 306 of the capstan 300.

The one or more cables 252 can also be connected to the first pulley 260 and the second pulley 270. The one or more cables 252 can wrap around the proximal side 306 of the capstan 300, about the first pulley 260, and extend to the proximal portion 502 of the elongate shaft 500. In some embodiments, the one or more cables 252 can wrap around the proximal side 306 of the capstan 300 and extend from the middle portion of the capstan 300 to the first pulley, as shown in FIG. 24. In other embodiments, the one or more cables 252 can wrap around the proximal side 306 of the capstan 300 and extend from the proximal side 306 of the capstan 300 to the first pulley 260. The one or more cables 252 can also wrap around the distal side 308 of the capstan 300, about the second pulley 270, and extend to the distal portion 504 of the elongate shaft 500. In some embodiments, the one or more cables 252 can wrap around the distal side 308 of the capstan 300 and extend from the middle portion of the capstan 300 to the second pulley 270, as shown in FIG. 24. In other embodiments, the one or more cables 252 can wrap around the distal side 308 of the capstan 300 and extend from the distal side 308 of the capstan 300 to the second pulley 270.

Rotation of the capstan 300 can cause shortening of the one or more cable 250 at the distal side 308 of the capstan and a corresponding lengthening of the cable at the proximal side 306 of the capstan 300. Rotation of the capstan 300 causes linear translation of the shaft 500 relative to the position of the capstan 300 of the medical instrument or device.

The one or more cables 252 can wrap on and off the capstan 300 actuated by rotation of the capstan 300. When the one or more cables 252 is wound about the capstan 300 at the distal side 308 of the capstan 300 during linear translation of the shaft 500 in a first direction. The first direction may be a linear direction parallel to the length of the elongate shaft 500. When the one or more cables 252 is unwound from the capstan 300 at the proximal side 306 of the capstan 350 during linear translation of the shaft 500 in a second direction. The second direction can be a linear direction parallel to the length of the elongate shaft and can be opposite from the first direction.

In some embodiments, the one or more cables 252 can include at least two cables. One end of the first cable 252a can attach and terminate to the proximal portion 502 of the shaft 500. The first cable 252a can wrap around a first end 306 of the capstan 300. The second end of the first cable 252a can terminate on the first side 306 of the capstan 300. The second cable 252b of the at least two cables can attach to and terminate on the distal portion 504 of the elongate shaft 500. The second cable 252b can wrap around the second end 308 of the capstan 300.

The first cable 252a can be connected to the first pulley 260 and the second cable 252b can be connected to the second pulley 270. The first cable 252a can extend from the proximal side 306 of the capstan 300, about the first pulley 260, and extend to the proximal portion 502 of the elongate shaft 500. The second cable 252b can also extend from the distal side 308 of the capstan 300, about the second pulley 270, and extend to the distal portion 504 of the elongate shaft 500.

The second end of the second cable 252b can terminate on the second end 308 of the capstan 300. The capstan 300 can be rotated in a first rotational direction to cause winding of the first cable 252a around the capstan 300 and a corresponding unwinding of the second cable 252b from the capstan 300. The first rotational direction can be a rotational direction, such as clockwise. The capstan 300 can be rotated in a second rotational direction to cause unwinding of the first cable 252a around the capstan 300 and a corresponding winding of the second cable 252b from the capstan 300. The second rotational direction can be a rotational direction opposite from the first rotational direction, such as counterclockwise. Winding of the first cable 252a around the capstan 300 and unwinding of the second cable 252b from the capstan 300 can cause linear translation of the shaft 500 in a first linear direction. Unwinding of the first cable 252a around the capstan 300 and winding of the second cable 252b from the capstan 300 can cause linear translation of the shaft in a second linear direction.

Rotating the capstan 300 in a first rotational direction about a rotational axis can impart movement to a pull wire 252 extending around a pulley 260 in a first direction. The distal end 504 of the medical device can be moved in a first direction via movement of the pull wire 252. In some embodiments, the distal end 504 can be actuated to move the shaft 500 of the medical device in a first linear direction via movement of the pull wire 252. In some embodiments, the distal end 504 can be deflected in any direction.

The capstan 300 can be translated along the rotational axis in concert with rotating the capstan 300 in the first rotational direction to control a fleet angle of the pull wire 252 between the capstan 300 and the pulley 260. The pull wire 252 can wrap on the capstan 300 as the capstan 300 rotates in a first rotational direction. The pull wire 252 can wrap off the capstan 300 as the capstan 300 rotates in a second rotational direction. The fleet angle can be the angle the pull wire 252 wraps on and off the capstan 300. The change in the fleet angle can be maintained within an angle range between 0-45 degrees, such as between 0-1 degrees, 0-2 degrees, 0-5 degrees, 0-10 degrees, 0-15 degrees, 0-20 degrees, 0-25 degrees, 0-30 degrees, 0-40 degrees, 5-10 degrees, or 5-15. Optionally, the second pulley 270 can similarly actuate movement of the same pull wire or a different pull wire to connect to and actuate the proximal portion 502 of the elongate shaft 500.

FIG. 25 illustrates a cable 250 connected to the capstan 300 and connected to a pulley 260 within the handle 600 of a medical device. The cable 250 can then extend from the pulley 260 to the elongate shaft 500. FIG. 26 illustrates a cable 250 connected to the capstan 350 within a handle 600 with one or more drive inputs 612. The elongate shaft 500 can be coupled to a handle 600.

Rotation of the capstan 350 can cause linear translation of the shaft 500 relative to the handle 600 of the medical device. Rotational motion of the capstan 350 can cause the capstan 350 to axially move on a screw 400 fixed to the handle 600 as the capstan 350 is rotated. Rotational motion of the capstan 350 can cause the capstan 350 to axially move on the screw 400 fixed to the handle 600 as the capstan 350 is rotated. A cable 250 can be wrapped around the capstan 350. The cable 250 can extend from the capstan 350 to the pulley 260 at a fleet angle.

The medical instrument can be attached to an instrument drive mechanism or instrument driver that is positioned on the end of a robotic arm or other instrument positioning device. The instrument drive mechanism can include one or more robotic drive outputs that engage one or more robotic drive inputs or drive shafts 612 to robotically control the medical instrument. In some aspects, the medical instrument can include the instrument handle 600, which can include one or more rotational drive inputs or drive shafts 612. The one or more pullwires 250 may be actuated to articulate an elongated shaft 500 or the wrist of the tool. The one or more pullwires 250 may also be actuated to translate an elongate shaft 500 relative to the instrument handle 600. The drive inputs 612 of the handle 600 can be driven by an instrument driver with one or more drive outputs, similar to the instrument driver shown in FIG. 17. The drive inputs 612 can receive the drive outputs (similar to the drive outputs 81 as shown in FIG. 17).

The spline 450 can be coupled to and driven by a drive input 612 of the handle 600. The capstan 350 can be rotated by the spline 450, as described herein. The drive inputs 612 can then be rotated by the drive outputs of the instrument driver to actuate rotational movement of the capstan 350 through the connected spline 450. The other drive inputs 612 may be used for other types of articulation and actuation. The handle 600 can include other spools or pulleys and pull wires for other types of articulation or actuation.

The spline 450 can be connected to the capstan 350 as described herein. The instrument driver can be configured to control the fleet angle of the cable 252 by urging translation of the capstan 350 as the capstan 350 rotates. The instrument driver can control the fleet angle by moving the capstan 350 longitudinally along a rotational axis of the capstan 350 in concert with rotation of the capstan 350 about the rotational axis of the capstan 350. The capstan 350 can be mounted on the screw 400 and configured to move the capstan 350 axially relative to the screw 400 as the capstan 350 rotates. Axial movement of the capstan 350 can be configured to control the fleet angle of the first cable 250 wrapping on or off the capstan 350.

3. Implementing Systems and Terminology

Implementations disclosed herein provide systems, methods and apparatus related to capstans for robotically controllable medical instruments.

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

The specific computer-implemented functions described herein may be stored as one or more instructions on a processor-readable or computer-readable medium. The term “computer-readable medium” refers to any available medium that can be accessed by a computer or processor. By way of example, and not limitation, such a medium may comprise random access memory (RAM), read-only memory (ROM), electrically erasable programmable read-only memory (EEPROM), flash memory, compact disc read-only memory (CD-ROM) or other optical disk storage, magnetic disk storage or other magnetic storage devices, or any other medium that can be used to store desired program code in the form of instructions or data structures and that can be accessed by a computer. It should be noted that a computer-readable medium may be tangible and non-transitory. As used herein, the term “code” may refer to software, instructions, code or data that is/are executable by a computing device or processor.

The methods disclosed herein comprise one or more steps or actions for achieving the described method. The method steps and/or actions may be interchanged with one another without departing from the scope of the claims. In other words, unless a specific order of steps or actions is required for proper operation of the method that is being described, the order and/or use of specific steps and/or actions may be modified without departing from the scope of the claims.

As used herein, the term “plurality” denotes two or more. For example, a plurality of components indicates two or more components. The term “determining” encompasses a wide variety of actions and, therefore, “determining” can include calculating, computing, processing, deriving, investigating, looking up (e.g., looking up in a table, a database or another data structure), ascertaining and the like. Also, “determining” can include receiving (e.g., receiving information), accessing (e.g., accessing data in a memory) and the like. Also, “determining” can include resolving, selecting, choosing, establishing and the like.

The phrase “based on” does not mean “based only on,” unless expressly specified otherwise. In other words, the phrase “based on” describes both “based only on” and “based at least on.”

The previous description of the disclosed implementations is provided to enable any person skilled in the art to make or use the present invention. Various modifications to these implementations will be readily apparent to those skilled in the art, and the generic principles defined herein may be applied to other implementations without departing from the scope of the invention. For example, it will be appreciated that one of ordinary skill in the art will be able to employ a number corresponding alternative and equivalent structural details, such as equivalent ways of fastening, mounting, coupling, or engaging tool components, equivalent mechanisms for producing particular actuation motions, and equivalent mechanisms for delivering electrical energy. Thus, the present invention is not intended to be limited to the implementations shown herein but is to be accorded the widest scope consistent with the principles and novel features disclosed herein.

Claims

1. A medical device comprising: a redirect surface;a capstan supported for rotation about a rotational axis and translation along the rotational axis;a cable wrapped around the capstan and extending from the capstan to the redirect surface;a shaft comprising a proximal portion and a distal portion, wherein a first end of the cable terminates at the proximal portion of the shaft and a second end of the cable terminates at the distal portion of the shaft; anda handle coupled to the shaft,wherein rotation of the capstan causes linear translation of the shaft relative to the handle of the medical device and the capstan is configured to translate relative to the redirect surface along the rotational axis as the capstan rotates about the rotational axis.
2. The medical device of claim 1, further comprising a supporting rod extending along the rotational axis of the capstan, wherein the supporting rod comprises a thread coupled to a first side of the capstan, wherein the supporting rod actuates axial motion of the capstan as the capstan rotates.
3. The medical device of claim 1, further comprising a threaded portion extending along the rotational axis and partially through the capstan, wherein rotation of the capstan with respect to the threaded portion causes axial translation of the capstan along the threaded portion.
4. The medical device of claim 3, further comprising a helical groove of an outer surface of the capstan, the helical groove configured to receive the cable as the cable is wrapped around the capstan, wherein a pitch of the threaded portion matches a pitch of a helical groove.
5. The medical device of claim 1, further comprising a spline extending along the rotational axis of the capstan, wherein the spline is coupled to at least a second side of the capstan, wherein the spline actuates rotational motion of the capstan.
6. The medical device of claim 1, further comprising a support rod extending along the rotational axis of the capstan, the supporting rod extending at least from a first side of the capstan to a second side of the capstan, wherein the capstan is configured to slide axially relative to the supporting rod.
7. The medical device of claim 1, wherein the capstan is configured to move longitudinally along the rotational axis of the capstan to control a fleet angle between the capstan and the redirect surface.
8. The medical device of claim 1, wherein:the cable connects on a distal side of the capstan and connects on a proximal side of the capstan,rotation of the capstan causes shortening of the cable at the distal side of the capstan and a corresponding lengthening of the cable at the proximal side of the capstan,the cable is wound about the capstan at the distal side of the capstan during linear translation of the shaft relative to the handle in a first direction, andthe cable is unwound from the capstan at the proximal side of the capstan during linear translation of the shaft relative to the handle in a second direction, wherein the second direction is opposite from the first direction.
9. The medical device of claim 1, wherein the capstan is rotated by a spline, wherein the spline is coupled to and driven by a drive input of the handle.
10. The medical device of claim 1, wherein rotational motion of the capstan causes the capstan to axially move on a screw fixed to the handle as the capstan is rotated.
11. The medical device of claim 1, further comprising an end effector connected to the distal portion of the shaft.
12. The medical device of claim 1, wherein the redirect surface is a pulley.
13. A robotic medical system comprising: a pulley;a capstan;a cable wrapped around the capstan, the cable extending from the capstan to the pulley at a fleet angle;a shaft comprising a proximal portion and a distal portion, wherein a first end of the cable terminates at the proximal portion of the shaft and a second end of the cable terminates at the distal portion of the shaft; andan instrument driver configured to control the fleet angle of the cable by urging translation of the capstan as the capstan rotates, wherein rotation of the capstan causes linear translation of the shaft.
14. The robotic medical system of claim 13, wherein the instrument driver controls the fleet angle by moving the capstan longitudinally along a rotational axis of the capstan in concert with rotation of the capstan about the rotational axis of the capstan.
15. The robotic medical system of claim 13, wherein the capstan is mounted on a screw configured to move the capstan axially relative to the screw as the capstan rotates, wherein axial movement of the capstan is configured to control the fleet angle of the cable wrapping on or off the capstan.
16. The robotic medical system of claim 15, wherein a change in the fleet angle is maintained within an angle range between 0 degrees to 10 degrees.
17. The robotic medical system of claim 13, wherein: the cable connects on a distal side of the capstan and connects on a proximal side of the capstan,rotation of the capstan causes shortening of the cable at the distal side of the capstan and a corresponding lengthening of the cable at the proximal side of the capstan,the cable is wound about the capstan at the distal side of the capstan during linear translation of the shaft in a first direction, andthe cable is unwound from the capstan at the proximal side of the capstan during linear translation of the shaft in a second direction, wherein the second direction is opposite from the first direction.
18. A method of operating a medical device comprising: rotating a capstan in a first rotational direction about a rotational axis to impart movement to a pull wire extending around a pulley in a first direction;moving a distal end of the medical device via movement of the pull wire;translating the capstan along the rotational axis in concert with rotating the capstan in the first rotational direction to control a fleet angle of the pull wire between the capstan and the pulley; andmoving a shaft of the medical device in a first linear direction via movement of the pull wire.
19. The method of claim 18, wherein a change in the fleet angle is maintained within an angle range between 0 degrees to 10 degrees.
20. The method of claim 18, further comprising: wrapping the pull wire on the capstan as the capstan rotates in a first rotational direction; and unwrapping the pull wire off the capstan as the capstan rotates in a second rotational direction.
21. The method of claim 18, further comprising: winding the pull wire about the capstan at a distal side of the capstan during linear translation of the shaft in a first direction.
22. The method of claim 21, further comprising: unwinding the pull wire from the capstan at a proximal side of the capstan during linear translation of the shaft in a second direction, wherein the second direction is opposite from the first direction.
23. A medical device comprising: a shaft comprising a proximal portion and a distal portion;a redirect surface;a capstan supported for rotation about a rotational axis and translation along the rotational axis;a cable wrapped around the capstan and extending from the capstan to the redirect surface; anda second cable wrapped around the capstan, wherein:a first end of the cable terminates at the proximal portion of the shaft and a second end of the cable terminates at a first side of the capstan,a first end of the second cable terminates at the distal portion of the shaft and a second end of the second cable terminates at a second side of the capstan,rotation of the capstan in a first rotational direction causes winding of the cable around the capstan and a corresponding unwinding of the second cable from the capstan,rotation of the capstan in a second rotational direction causes unwinding of the cable around the capstan and a corresponding winding of the second cable from the capstan,winding of the cable around the capstan and unwinding of the second cable from the capstan causes linear translation of the shaft in a first linear direction,unwinding of the cable around the capstan and winding of the second cable from the capstan causes linear translation of the shaft in a second linear direction, andthe capstan is configured to translate relative to the redirect surface along the rotational axis as the capstan rotates about the rotational axis.

CROSS-REFERENCE TO RELATED APPLICATION(S)

This application claims the benefit of U.S. Provisional Application No. 62/908,446, filed Sep. 30, 2019, which is hereby incorporated by reference in its entirety.

US Referenced Citations (816)

Number	Name	Date	Kind
2556601	Schofield	Jun 1951	A
2566183	Forss	Aug 1951	A
2623175	Finke	Dec 1952	A
2730699	Gratian	Jan 1956	A
2884808	Mueller	May 1959	A
3294183	Riley et al.	Dec 1966	A
3472083	Schnepel	Oct 1969	A
3513724	Box	May 1970	A
3595074	Johnson	Jul 1971	A
3734207	Fishbein	May 1973	A
3739923	Totsuka	Jun 1973	A
3763860	Clarke	Oct 1973	A
3784031	Nitu	Jan 1974	A
3790002	Guilbaud et al.	Feb 1974	A
3921536	Savage	Nov 1975	A
3926386	Stahmann	Dec 1975	A
4040413	Ohshiro	Aug 1977	A
4141245	Brandstetter	Feb 1979	A
4198960	Utsugi	Apr 1980	A
4241884	Lynch	Dec 1980	A
4243034	Brandt	Jan 1981	A
4351493	Sonnek	Sep 1982	A
4357843	Peck et al.	Nov 1982	A
4384493	Grunbaum	May 1983	A
4470407	Hussein	Sep 1984	A
4507026	Lund	Mar 1985	A
4530471	Inoue	Jul 1985	A
4532935	Wang et al.	Aug 1985	A
4555960	King	Dec 1985	A
4685458	Leckrone	Aug 1987	A
4688555	Wardle	Aug 1987	A
4745908	Wardle	May 1988	A
4747405	Leckrone	May 1988	A
4784150	Voorhies et al.	Nov 1988	A
4854301	Nakajima	Aug 1989	A
4857058	Payton	Aug 1989	A
4898574	Uchiyama et al.	Feb 1990	A
4907168	Boggs	Mar 1990	A
4945790	Golden	Aug 1990	A
4983165	Loiterman	Jan 1991	A
5029574	Shimamura et al.	Jul 1991	A
5085659	Rydell	Feb 1992	A
5150452	Pollack et al.	Sep 1992	A
5196023	Martin	Mar 1993	A
5207128	Albright	May 1993	A
5217465	Steppe	Jun 1993	A
5234428	Kaufman	Aug 1993	A
5256150	Quiachon et al.	Oct 1993	A
5277085	Tanimura et al.	Jan 1994	A
5308323	Sogawa et al.	May 1994	A
5318589	Lichtman	Jun 1994	A
5325848	Adams et al.	Jul 1994	A
5342381	Tidemand	Aug 1994	A
5344395	Whalen et al.	Sep 1994	A
5350101	Godlewski	Sep 1994	A
5353783	Nakao et al.	Oct 1994	A
5370609	Drasler et al.	Dec 1994	A
5372124	Takayama et al.	Dec 1994	A
5411016	Kume	May 1995	A
5426687	Goodall et al.	Jun 1995	A
5431649	Mulier et al.	Jul 1995	A
5441485	Peters	Aug 1995	A
5449356	Walbrink	Sep 1995	A
5450843	Moll et al.	Sep 1995	A
5472426	Bonati et al.	Dec 1995	A
5496267	Drasler	Mar 1996	A
5501667	Verduin, Jr.	Mar 1996	A
5507725	Savage et al.	Apr 1996	A
5520684	Imran	May 1996	A
5524180	Wang et al.	Jun 1996	A
5545170	Hart	Aug 1996	A
5559294	Hoium et al.	Sep 1996	A
5562239	Boiarski et al.	Oct 1996	A
5562648	Peterson	Oct 1996	A
5562678	Booker	Oct 1996	A
5572999	Funda et al.	Nov 1996	A
5573535	Viklund	Nov 1996	A
5613973	Jackson et al.	Mar 1997	A
5645083	Essig et al.	Jul 1997	A
5653374	Young et al.	Aug 1997	A
5658311	Baden	Aug 1997	A
5695500	Taylor et al.	Dec 1997	A
5697949	Giurtino et al.	Dec 1997	A
5709661	Van Egmond	Jan 1998	A
5710870	Ohm	Jan 1998	A
5716325	Bonutti	Feb 1998	A
5737500	Seraji et al.	Apr 1998	A
5767840	Selker	Jun 1998	A
5779623	Bonnell	Jul 1998	A
5788667	Stoller	Aug 1998	A
5792135	Madhani et al.	Aug 1998	A
5792165	Klieman	Aug 1998	A
5797900	Madhani	Aug 1998	A
5798627	Gilliland	Aug 1998	A
5810770	Chin et al.	Sep 1998	A
5842390	Bouligny	Dec 1998	A
5855583	Wang et al.	Jan 1999	A
5893869	Barhart	Apr 1999	A
5897491	Kastenbauer et al.	Apr 1999	A
5921968	Lampropoulos et al.	Jul 1999	A
5924175	Lippitt	Jul 1999	A
5943056	Sato	Aug 1999	A
5967934	Ishida et al.	Oct 1999	A
5989230	Frassica	Nov 1999	A
6071281	Burnside et al.	Jun 2000	A
6077219	Viebach	Jun 2000	A
6084371	Kress et al.	Jul 2000	A
6093157	Chandrasekaran	Jul 2000	A
6110171	Rydell	Aug 2000	A
6120476	Fung et al.	Sep 2000	A
6120498	Jani et al.	Sep 2000	A
6154000	Rastegar et al.	Nov 2000	A
6156030	Neev	Dec 2000	A
6171234	White et al.	Jan 2001	B1
6174318	Bates et al.	Jan 2001	B1
6183435	Bumbalough et al.	Feb 2001	B1
6185478	Koakutsu et al.	Feb 2001	B1
6206903	Ramans	Mar 2001	B1
6236906	Muller	May 2001	B1
6272371	Shlomo	Aug 2001	B1
6289579	Viza et al.	Sep 2001	B1
6322557	Nikolaevich	Nov 2001	B1
6375635	Moutafis	Apr 2002	B1
6394998	Wallace et al.	May 2002	B1
6401572	Provost	Jun 2002	B1
6405078	Moaddeb et al.	Jun 2002	B1
6436107	Wang et al.	Aug 2002	B1
6440061	Wenner et al.	Aug 2002	B1
6487940	Hart et al.	Dec 2002	B2
6491701	Tierney et al.	Dec 2002	B2
6508823	Gonon	Jan 2003	B1
6522906	Salisbury et al.	Feb 2003	B1
6577891	Jaross et al.	Jun 2003	B1
6676668	Mercereau et al.	Jan 2004	B2
6685698	Morley et al.	Feb 2004	B2
6695818	Wollschlager	Feb 2004	B2
6706050	Giannadakis	Mar 2004	B1
6726675	Beyar	Apr 2004	B1
6786896	Madhani et al.	Sep 2004	B1
6827712	Tovey et al.	Dec 2004	B2
7044936	Harding	May 2006	B2
7172580	Hruska et al.	Feb 2007	B2
7248944	Green	Jul 2007	B2
7276044	Ferry et al.	Oct 2007	B2
7282055	Tsuruta	Oct 2007	B2
7559934	Teague et al.	Jul 2009	B2
7615042	Beyar et al.	Nov 2009	B2
7635342	Ferry et al.	Dec 2009	B2
7736356	Cooper et al.	Jun 2010	B2
7766856	Ferry et al.	Aug 2010	B2
7882841	Aljuri	Feb 2011	B2
7938809	Lampropoulos et al.	May 2011	B2
7963911	Turliuc	Jun 2011	B2
7972298	Wallace et al.	Jul 2011	B2
7974674	Hauck et al.	Jul 2011	B2
7987046	Peterman	Jul 2011	B1
7998020	Kidd et al.	Aug 2011	B2
8002713	Heske	Aug 2011	B2
8004229	Nowlin et al.	Aug 2011	B2
8038598	Khachi	Oct 2011	B2
8052636	Moll et al.	Nov 2011	B2
8092397	Wallace et al.	Jan 2012	B2
8157308	Pedersen	Apr 2012	B2
8182415	Larkin et al.	May 2012	B2
8187173	Miyoshi	May 2012	B2
8257303	Moll et al.	Sep 2012	B2
8277417	Fedinec et al.	Oct 2012	B2
8291791	Light et al.	Oct 2012	B2
8414505	Weitzner	Apr 2013	B1
8425465	Nagano	Apr 2013	B2
8480595	Speeg	Jul 2013	B2
8523762	Miyamoto et al.	Sep 2013	B2
8540748	Murphy et al.	Sep 2013	B2
8541970	Nowlin	Sep 2013	B2
8671817	Bogusky	Mar 2014	B1
8720448	Reis et al.	May 2014	B2
8746252	McGrogan et al.	Jun 2014	B2
8749190	Nowlin et al.	Jun 2014	B2
8786241	Nowlin et al.	Jul 2014	B2
8820603	Shelton et al.	Sep 2014	B2
8821480	Burbank	Sep 2014	B2
8870815	Bhat et al.	Oct 2014	B2
8882660	Phee et al.	Nov 2014	B2
8945163	Voegele et al.	Feb 2015	B2
8956280	Eversull et al.	Feb 2015	B2
8961533	Stahler et al.	Feb 2015	B2
8968333	Yu et al.	Mar 2015	B2
8992542	Hagag et al.	Mar 2015	B2
9173713	Hart et al.	Nov 2015	B2
9179979	Jinno	Nov 2015	B2
9204933	Reis et al.	Dec 2015	B2
9259280	Au	Feb 2016	B2
9259281	Griffiths et al.	Feb 2016	B2
9259282	Azizian	Feb 2016	B2
9296104	Swarup et al.	Mar 2016	B2
9326822	Lewis et al.	May 2016	B2
9345456	Tsonton et al.	May 2016	B2
9345544	Hourtash et al.	May 2016	B2
9375284	Hourtash	Jun 2016	B2
9408669	Kokish et al.	Aug 2016	B2
9415510	Hourtash et al.	Aug 2016	B2
9446177	Millman et al.	Sep 2016	B2
9452018	Yu	Sep 2016	B2
9457168	Moll et al.	Oct 2016	B2
9460536	Hasegawa et al.	Oct 2016	B2
9480534	Bowling	Nov 2016	B2
9498601	Tanner et al.	Nov 2016	B2
9504604	Alvarez	Nov 2016	B2
9510911	Hourtash	Dec 2016	B2
9517106	Hourtash et al.	Dec 2016	B2
9561083	Yu et al.	Feb 2017	B2
9566125	Bowling	Feb 2017	B2
9592042	Titus	Mar 2017	B2
9597152	Schaeffer	Mar 2017	B2
9622827	Yu et al.	Apr 2017	B2
9636184	Lee et al.	May 2017	B2
9636483	Hart et al.	May 2017	B2
9668814	Kokish	Jun 2017	B2
9675422	Hourtash et al.	Jun 2017	B2
9687310	Nowlin et al.	Jun 2017	B2
9713509	Schuh et al.	Jul 2017	B2
9727963	Mintz et al.	Aug 2017	B2
9730757	Brudniok	Aug 2017	B2
9737371	Romo et al.	Aug 2017	B2
9737373	Schuh	Aug 2017	B2
9744335	Jiang	Aug 2017	B2
9763741	Alvarez et al.	Sep 2017	B2
9788910	Schuh	Oct 2017	B2
9844412	Bogusky et al.	Dec 2017	B2
9867635	Alvarez et al.	Jan 2018	B2
9918659	Chopra	Mar 2018	B2
9918681	Wallace et al.	Mar 2018	B2
9931025	Graetzel et al.	Apr 2018	B1
9943962	Sattler et al.	Apr 2018	B2
9949749	Noonan et al.	Apr 2018	B2
9955986	Shah	May 2018	B2
9962228	Schuh et al.	May 2018	B2
9980785	Schuh	May 2018	B2
9993313	Schuh et al.	Jun 2018	B2
9993614	Pacheco	Jun 2018	B2
10016900	Meyer et al.	Jul 2018	B1
10022192	Ummalaneni	Jul 2018	B1
10029367	Hourtash	Jul 2018	B2
10046140	Kokish et al.	Aug 2018	B2
10071479	Swarup et al.	Sep 2018	B2
10080576	Romo et al.	Sep 2018	B2
10117713	Moctezuma de la Barrera	Nov 2018	B2
10130429	Weir	Nov 2018	B1
10136949	Felder et al.	Nov 2018	B2
10136959	Mintz et al.	Nov 2018	B2
10143360	Roelle et al.	Dec 2018	B2
10145747	Lin et al.	Dec 2018	B1
10149720	Romo	Dec 2018	B2
10154822	Henderson	Dec 2018	B2
10159532	Ummalaneni et al.	Dec 2018	B1
10159533	Moll et al.	Dec 2018	B2
10169875	Mintz et al.	Jan 2019	B2
10213264	Tanner et al.	Feb 2019	B2
10219868	Weir	Mar 2019	B2
10219874	Yu et al.	Mar 2019	B2
10231793	Romo	Mar 2019	B2
10231867	Alvarez et al.	Mar 2019	B2
10244926	Noonan et al.	Apr 2019	B2
10258285	Hauck	Apr 2019	B2
10285574	Landey et al.	May 2019	B2
10299870	Connolly et al.	May 2019	B2
10314463	Agrawal et al.	Jun 2019	B2
10314661	Bowling	Jun 2019	B2
10327855	Hourtash et al.	Jun 2019	B2
10350017	Bowling	Jul 2019	B2
10350390	Moll et al.	Jul 2019	B2
10383765	Alvarez et al.	Aug 2019	B2
10398518	Yu et al.	Sep 2019	B2
10405939	Romo et al.	Sep 2019	B2
10405940	Romo	Sep 2019	B2
10426559	Graetzel et al.	Oct 2019	B2
10426661	Kintz	Oct 2019	B2
10434660	Meyer	Oct 2019	B2
10454347	Covington et al.	Oct 2019	B2
10463440	Bowling	Nov 2019	B2
10464209	Ho et al.	Nov 2019	B2
10470830	Hill	Nov 2019	B2
10478595	Kokish	Nov 2019	B2
10482599	Mintz et al.	Nov 2019	B2
10493239	Hart et al.	Dec 2019	B2
10493241	Jiang	Dec 2019	B2
10500001	Yu et al.	Dec 2019	B2
10517692	Eyre et al.	Dec 2019	B2
10524866	Srinivasan	Jan 2020	B2
10524867	Kokish et al.	Jan 2020	B2
10539478	Lin	Jan 2020	B2
10543047	Yu	Jan 2020	B2
10543048	Noonan et al.	Jan 2020	B2
10555778	Ummalaneni et al.	Feb 2020	B2
10556092	Yu et al.	Feb 2020	B2
10569052	Kokish et al.	Feb 2020	B2
10631949	Schuh et al.	Apr 2020	B2
10639108	Romo et al.	May 2020	B2
10639109	Bovay et al.	May 2020	B2
10639114	Schuh	May 2020	B2
10667871	Romo et al.	Jun 2020	B2
10667875	DeFonzo	Jun 2020	B2
10682189	Schuh et al.	Jun 2020	B2
10687903	Lewis et al.	Jun 2020	B2
10695536	Weitzner et al.	Jun 2020	B2
10702348	Moll et al.	Jul 2020	B2
10716461	Jenkins	Jul 2020	B2
10743751	Landey et al.	Aug 2020	B2
10744035	Alvarez et al.	Aug 2020	B2
10751140	Wallace et al.	Aug 2020	B2
10765303	Graetzel et al.	Sep 2020	B2
10765487	Ho	Sep 2020	B2
10779898	Hill	Sep 2020	B2
10786329	Schuh et al.	Sep 2020	B2
10786432	Jornitz et al.	Sep 2020	B2
10792112	Kokish et al.	Oct 2020	B2
10792464	Romo et al.	Oct 2020	B2
10792466	Landey et al.	Oct 2020	B2
10813539	Graetzel et al.	Oct 2020	B2
10814101	Jiang	Oct 2020	B2
10820947	Julian	Nov 2020	B2
10820952	Yu	Nov 2020	B2
10820954	Marsot et al.	Nov 2020	B2
10827913	Ummalaneni et al.	Nov 2020	B2
10828118	Schuh et al.	Nov 2020	B2
10835153	Rafii-Tari et al.	Nov 2020	B2
10850013	Hsu	Dec 2020	B2
10881280	Baez	Jan 2021	B2
20010042643	Krueger et al.	Nov 2001	A1
20020019644	Hastings	Feb 2002	A1
20020045905	Gerbi et al.	Apr 2002	A1
20020098938	Milbourne et al.	Jul 2002	A1
20020100254	Dharssi	Aug 2002	A1
20020107573	Steinberg	Aug 2002	A1
20020111608	Baerveldt	Aug 2002	A1
20020111621	Wallace et al.	Aug 2002	A1
20020117017	Bernhardt et al.	Aug 2002	A1
20020161355	Wollschlager	Oct 2002	A1
20020161426	Lancea	Oct 2002	A1
20020177789	Ferry et al.	Nov 2002	A1
20030004455	Kadziauskas	Jan 2003	A1
20030040681	Ng et al.	Feb 2003	A1
20030056561	Butscher et al.	Mar 2003	A1
20030065358	Frecker	Apr 2003	A1
20030100892	Morley et al.	May 2003	A1
20030109780	Coste-Maniere et al.	Jun 2003	A1
20030109877	Morley	Jun 2003	A1
20030109889	Mercereau	Jun 2003	A1
20030158545	Hovda et al.	Aug 2003	A1
20030167623	Lorenz	Sep 2003	A1
20030208189	Payman	Nov 2003	A1
20030212308	Bendall	Nov 2003	A1
20040015053	Bieger	Jan 2004	A1
20040143253	Vanney	Jul 2004	A1
20040152972	Hunter	Aug 2004	A1
20040153093	Donovan	Aug 2004	A1
20040158261	Vu	Aug 2004	A1
20040186349	Ewers	Sep 2004	A1
20040193146	Lee et al.	Sep 2004	A1
20040210116	Nakao	Oct 2004	A1
20040243147	Lipow	Dec 2004	A1
20040253079	Sanchez	Dec 2004	A1
20040254566	Plicchi	Dec 2004	A1
20050004579	Schneider et al.	Jan 2005	A1
20050033270	Ramans et al.	Feb 2005	A1
20050054900	Mawn	Mar 2005	A1
20050159645	Bertolero	Jul 2005	A1
20050177026	Hoeg et al.	Aug 2005	A1
20050183532	Najaf et al.	Aug 2005	A1
20050222554	Wallace et al.	Oct 2005	A1
20050240178	Morley et al.	Oct 2005	A1
20050261705	Gist	Nov 2005	A1
20060015133	Grayzel	Jan 2006	A1
20060041245	Ferry	Feb 2006	A1
20060058813	Teague	Mar 2006	A1
20060111692	Hlavka et al.	May 2006	A1
20060116693	Weisenburgh	Jun 2006	A1
20060135963	Kick	Jun 2006	A1
20060142657	Quaid	Jun 2006	A1
20060146010	Schneider	Jul 2006	A1
20060156875	McRury et al.	Jul 2006	A1
20060161137	Orban et al.	Jul 2006	A1
20060189891	Waxman et al.	Aug 2006	A1
20060201688	Jenner et al.	Sep 2006	A1
20060229587	Beyar et al.	Oct 2006	A1
20060237205	Sia et al.	Oct 2006	A1
20070000498	Glynn et al.	Jan 2007	A1
20070013336	Nowlin et al.	Jan 2007	A1
20070016164	Dudney et al.	Jan 2007	A1
20070027443	Rose	Feb 2007	A1
20070027534	Bergheim	Feb 2007	A1
20070032906	Sutherland et al.	Feb 2007	A1
20070060879	Weitzner et al.	Mar 2007	A1
20070100201	Komiya et al.	May 2007	A1
20070100254	Murakami	May 2007	A1
20070106304	Hammack	May 2007	A1
20070112355	Salahieh	May 2007	A1
20070119274	Devengenzo et al.	May 2007	A1
20070123355	Morley et al.	May 2007	A1
20070135803	Belson	Jun 2007	A1
20070149946	Viswanathan	Jun 2007	A1
20070185485	Hauck et al.	Aug 2007	A1
20070191177	Nagai et al.	Aug 2007	A1
20070208375	Nishizawa	Sep 2007	A1
20070213668	Spitz	Sep 2007	A1
20070239028	Houser	Oct 2007	A1
20070239178	Weitzner et al.	Oct 2007	A1
20070245175	Zheng et al.	Oct 2007	A1
20070250111	Lu	Oct 2007	A1
20070299427	Yeung et al.	Dec 2007	A1
20080009838	Schena	Jan 2008	A1
20080015566	Livneh	Jan 2008	A1
20080021440	Solomon	Jan 2008	A1
20080033467	Miyamoto et al.	Feb 2008	A1
20080039255	Jinno et al.	Feb 2008	A1
20080045981	Margolin et al.	Feb 2008	A1
20080046122	Manzo et al.	Feb 2008	A1
20080065103	Cooper et al.	Mar 2008	A1
20080065111	Blumenkranz	Mar 2008	A1
20080065112	Tovey et al.	Mar 2008	A1
20080125698	Greg et al.	May 2008	A1
20080147011	Urmey	Jun 2008	A1
20080177285	Brock et al.	Jul 2008	A1
20080187101	Gertner	Aug 2008	A1
20080196533	Bergamasco	Aug 2008	A1
20080214925	Wilson et al.	Sep 2008	A1
20080228104	Uber et al.	Sep 2008	A1
20080243064	Stahler et al.	Oct 2008	A1
20080249536	Stahler et al.	Oct 2008	A1
20080253108	Yu et al.	Oct 2008	A1
20080262301	Gibbons et al.	Oct 2008	A1
20080287963	Rogers et al.	Nov 2008	A1
20080302200	Tobey	Dec 2008	A1
20090005768	Sharareh	Jan 2009	A1
20090012507	Culbertson et al.	Jan 2009	A1
20090030446	Measamer	Jan 2009	A1
20090036900	Moll	Feb 2009	A1
20090043305	Brodbeck	Feb 2009	A1
20090082634	Kathrani et al.	Mar 2009	A1
20090082722	Munger et al.	Mar 2009	A1
20090088774	Swarup et al.	Apr 2009	A1
20090098971	Ho et al.	Apr 2009	A1
20090105645	Kidd et al.	Apr 2009	A1
20090105723	Dillinger	Apr 2009	A1
20090131885	Akahoshi	May 2009	A1
20090161827	Gertner et al.	Jun 2009	A1
20090163948	Sunaoshi	Jun 2009	A1
20090171371	Nixon	Jul 2009	A1
20090192524	Ltkowitz	Jul 2009	A1
20090227998	Aljuri	Sep 2009	A1
20090247944	Kirschenman et al.	Oct 2009	A1
20090248039	Cooper et al.	Oct 2009	A1
20090248041	Williams et al.	Oct 2009	A1
20090248043	Tiemey et al.	Oct 2009	A1
20090264878	Carmel et al.	Oct 2009	A1
20090270760	Leimbach et al.	Oct 2009	A1
20090287188	Golden et al.	Nov 2009	A1
20090299352	Zerfas	Dec 2009	A1
20090312773	Cabrera et al.	Dec 2009	A1
20100004642	Lumpkin	Jan 2010	A1
20100010504	Simaan et al.	Jan 2010	A1
20100011900	Burbank	Jan 2010	A1
20100011901	Burbank	Jan 2010	A1
20100016852	Manzo et al.	Jan 2010	A1
20100016853	Burbank	Jan 2010	A1
20100030023	Yoshie	Feb 2010	A1
20100069833	Wenderow et al.	Mar 2010	A1
20100073150	Olson et al.	Mar 2010	A1
20100081965	Mugan et al.	Apr 2010	A1
20100082017	Zickler	Apr 2010	A1
20100082041	Prisco	Apr 2010	A1
20100130923	Cleary et al.	May 2010	A1
20100130987	Wenderow et al.	May 2010	A1
20100175701	Reis et al.	Jul 2010	A1
20100179632	Bruszewski et al.	Jul 2010	A1
20100204605	Blakley	Aug 2010	A1
20100204646	Plicchi et al.	Aug 2010	A1
20100210923	Li et al.	Aug 2010	A1
20100217235	Thorstenson	Aug 2010	A1
20100225209	Goldberg	Sep 2010	A1
20100228249	Mohr	Sep 2010	A1
20100248177	Mangelberger et al.	Sep 2010	A1
20100249506	Prisco et al.	Sep 2010	A1
20100268211	Manwaring et al.	Oct 2010	A1
20100274078	Kim et al.	Oct 2010	A1
20100312141	Keast et al.	Dec 2010	A1
20100331858	Simaan et al.	Dec 2010	A1
20100332033	Diolaiti	Dec 2010	A1
20110009863	Stanislaw	Jan 2011	A1
20110015483	Barbagli	Jan 2011	A1
20110015484	Alvarez et al.	Jan 2011	A1
20110015648	Alvarez et al.	Jan 2011	A1
20110015650	Choi et al.	Jan 2011	A1
20110028790	Farr et al.	Feb 2011	A1
20110028991	Ikeda et al.	Feb 2011	A1
20110071541	Prisco et al.	Mar 2011	A1
20110071543	Prisco et al.	Mar 2011	A1
20110106146	Jeong	May 2011	A1
20110125165	Simaan et al.	May 2011	A1
20110130718	Kidd et al.	Jun 2011	A1
20110147030	Blum et al.	Jun 2011	A1
20110152880	Alvarez et al.	Jun 2011	A1
20110160713	Neuberger	Jun 2011	A1
20110160745	Fielding	Jun 2011	A1
20110167611	Williams	Jul 2011	A1
20110184391	Aljuri	Jul 2011	A1
20110208211	Whitfield et al.	Aug 2011	A1
20110213362	Cunningham	Sep 2011	A1
20110224660	Neuberger et al.	Sep 2011	A1
20110238064	Williams et al.	Sep 2011	A1
20110238083	Moll et al.	Sep 2011	A1
20110257641	Hastings et al.	Oct 2011	A1
20110261183	Ma et al.	Oct 2011	A1
20110276085	Krzyzanowski	Nov 2011	A1
20110277775	Holop et al.	Nov 2011	A1
20110288573	Yates et al.	Nov 2011	A1
20110306836	Ohline et al.	Dec 2011	A1
20110313343	Milutinovic et al.	Dec 2011	A1
20120048759	Disch et al.	Mar 2012	A1
20120069167	Liu et al.	Mar 2012	A1
20120071821	Yu	Mar 2012	A1
20120071894	Tanner et al.	Mar 2012	A1
20120071895	Stahler et al.	Mar 2012	A1
20120132018	Tang	May 2012	A1
20120136419	Zarembo et al.	May 2012	A1
20120138586	Webster et al.	Jun 2012	A1
20120138660	Shelton, IV et al.	Jun 2012	A1
20120143226	Belson et al.	Jun 2012	A1
20120150154	Brisson et al.	Jun 2012	A1
20120186194	Schlieper	Jul 2012	A1
20120191107	Tanner et al.	Jul 2012	A1
20120209315	Amat	Aug 2012	A1
20120217457	Schena et al.	Aug 2012	A1
20120232342	Reydel	Sep 2012	A1
20120232476	Bhat et al.	Sep 2012	A1
20120239012	Laurent et al.	Sep 2012	A1
20120253277	Tah et al.	Oct 2012	A1
20120253332	Moll	Oct 2012	A1
20120259320	Loesel et al.	Oct 2012	A1
20120277730	Salahieh	Nov 2012	A1
20120283747	Popovic	Nov 2012	A1
20120296318	Wellhofer et al.	Nov 2012	A1
20130006144	Clancy	Jan 2013	A1
20130018400	Milton et al.	Jan 2013	A1
20130035537	Wallace et al.	Feb 2013	A1
20130053877	BenMaamer	Feb 2013	A1
20130066136	Palese et al.	Mar 2013	A1
20130066335	Barwinkel	Mar 2013	A1
20130085442	Shtul et al.	Apr 2013	A1
20130085486	Boutoussov et al.	Apr 2013	A1
20130096422	Boctor	Apr 2013	A1
20130096574	Kang et al.	Apr 2013	A1
20130110042	Humphreys	May 2013	A1
20130110107	Smith	May 2013	A1
20130116716	Bahls et al.	May 2013	A1
20130144116	Cooper et al.	Jun 2013	A1
20130144274	Stefanchik et al.	Jun 2013	A1
20130144395	Stefanchik	Jun 2013	A1
20130190796	Tilson et al.	Jul 2013	A1
20130204124	Duindam	Aug 2013	A1
20130225997	Dillard et al.	Aug 2013	A1
20130226151	Suehara	Aug 2013	A1
20130226161	Hickenbotham	Aug 2013	A1
20130231678	Wenderow	Sep 2013	A1
20130233908	Knodel	Sep 2013	A1
20130253267	Collins	Sep 2013	A1
20130303876	Gelfand et al.	Nov 2013	A1
20130304084	Beira et al.	Nov 2013	A1
20130310819	Neuberger et al.	Nov 2013	A1
20130317519	Romo et al.	Nov 2013	A1
20130334281	Williams	Dec 2013	A1
20130345519	Piskun et al.	Dec 2013	A1
20130345686	Brown	Dec 2013	A1
20140000411	Shelton, IV et al.	Jan 2014	A1
20140005681	Gee et al.	Jan 2014	A1
20140039517	Bowling	Feb 2014	A1
20140039681	Bowling	Feb 2014	A1
20140046308	Bischoff	Feb 2014	A1
20140051985	Fan et al.	Feb 2014	A1
20140058365	Bille	Feb 2014	A1
20140058404	Hammack	Feb 2014	A1
20140058428	Christopher	Feb 2014	A1
20140066944	Taylor et al.	Mar 2014	A1
20140069437	Reis et al.	Mar 2014	A1
20140100445	Stenzel	Apr 2014	A1
20140142591	Alvarez et al.	May 2014	A1
20140163318	Swanstrom	Jun 2014	A1
20140163736	Azizian	Jun 2014	A1
20140166023	Kishi	Jun 2014	A1
20140171778	Tsusaka	Jun 2014	A1
20140180063	Zhao	Jun 2014	A1
20140194859	Ianchulev	Jul 2014	A1
20140194905	Kappel	Jul 2014	A1
20140222019	Brudnick	Aug 2014	A1
20140222207	Bowling et al.	Aug 2014	A1
20140243849	Saglam et al.	Aug 2014	A1
20140246473	Auld	Sep 2014	A1
20140257333	Blumenkranz	Sep 2014	A1
20140275956	Fan	Sep 2014	A1
20140276233	Murphy	Sep 2014	A1
20140276389	Walker	Sep 2014	A1
20140276394	Wong et al.	Sep 2014	A1
20140276594	Tanner et al.	Sep 2014	A1
20140276723	Parihar	Sep 2014	A1
20140276935	Yu	Sep 2014	A1
20140276936	Kokish et al.	Sep 2014	A1
20140276956	Crainich	Sep 2014	A1
20140277334	Yu et al.	Sep 2014	A1
20140309655	Gal et al.	Oct 2014	A1
20140316203	Carroux et al.	Oct 2014	A1
20140357984	Wallace et al.	Dec 2014	A1
20140375784	Massetti	Dec 2014	A1
20150012134	Robinson	Jan 2015	A1
20150073439	Dannaher	Mar 2015	A1
20150080879	Trees	Mar 2015	A1
20150090063	Lantermann et al.	Apr 2015	A1
20150127045	Prestel	May 2015	A1
20150133960	Lohmeier	May 2015	A1
20150133963	Barbagli	May 2015	A1
20150142013	Tanner et al.	May 2015	A1
20150144514	Brennan et al.	May 2015	A1
20150148600	Ashinuma et al.	May 2015	A1
20150150635	Kilroy	Jun 2015	A1
20150164522	Budiman	Jun 2015	A1
20150182250	Conlon et al.	Jul 2015	A1
20150190204	Popovi	Jul 2015	A1
20150201917	Snow	Jul 2015	A1
20150202085	Lemonis	Jul 2015	A1
20150231364	Blanchard	Aug 2015	A1
20150314110	Park	Nov 2015	A1
20150366629	Bowling	Dec 2015	A1
20150374445	Gombert et al.	Dec 2015	A1
20150374446	Malackowski	Dec 2015	A1
20160000512	Gombert et al.	Jan 2016	A1
20160022466	Pedtke	Jan 2016	A1
20160030073	Lsakov	Feb 2016	A1
20160045208	Ciulla	Feb 2016	A1
20160051220	Wan	Feb 2016	A1
20160051318	Manzo et al.	Feb 2016	A1
20160066935	Nguyen et al.	Mar 2016	A1
20160157945	Madhani	Jun 2016	A1
20160158490	Leeflang	Jun 2016	A1
20160166234	Zhang	Jun 2016	A1
20160183841	Duindam et al.	Jun 2016	A1
20160192860	Allenby	Jul 2016	A1
20160199984	Lohmeier et al.	Jul 2016	A1
20160206389	Miller	Jul 2016	A1
20160213435	Hourtash	Jul 2016	A1
20160235495	Wallace et al.	Aug 2016	A1
20160242858	Moctezuma de la Barrera et al.	Aug 2016	A1
20160249932	Rogers et al.	Sep 2016	A1
20160270865	Landey et al.	Sep 2016	A1
20160287279	Bovay et al.	Oct 2016	A1
20160302871	Gregerson et al.	Oct 2016	A1
20160303743	Rockrohr	Oct 2016	A1
20160310146	Levy et al.	Oct 2016	A1
20160331358	Gordon	Nov 2016	A1
20160338783	Romo et al.	Nov 2016	A1
20160346049	Allen et al.	Dec 2016	A1
20160367324	Sato et al.	Dec 2016	A1
20170000577	Bowling	Jan 2017	A1
20170007337	Dan	Jan 2017	A1
20170020615	Koenig et al.	Jan 2017	A1
20170049471	Gaffney et al.	Feb 2017	A1
20170055995	Weier	Mar 2017	A1
20170065227	Marrs	Mar 2017	A1
20170071584	Suigetsu et al.	Mar 2017	A1
20170086934	Devengenzo et al.	Mar 2017	A1
20170095234	Prisco et al.	Apr 2017	A1
20170095295	Overmyer	Apr 2017	A1
20170135706	Frey	May 2017	A1
20170151028	Ogawa et al.	Jun 2017	A1
20170151416	Kutikov	Jun 2017	A1
20170165009	Chaplin et al.	Jun 2017	A1
20170172553	Chaplin	Jun 2017	A1
20170172680	Bowling	Jun 2017	A1
20170202627	Sramek et al.	Jul 2017	A1
20170209073	Sramek et al.	Jul 2017	A1
20170252096	Felder	Sep 2017	A1
20170258534	Hourtash et al.	Sep 2017	A1
20170265923	Privitera	Sep 2017	A1
20170265954	Burbank	Sep 2017	A1
20170281049	Yamamoto	Oct 2017	A1
20170290631	Lee et al.	Oct 2017	A1
20170319289	Neff et al.	Nov 2017	A1
20170325932	Hoelzle	Nov 2017	A1
20170333147	Bernstein	Nov 2017	A1
20180000563	Shanjani et al.	Jan 2018	A1
20180025666	Ho et al.	Jan 2018	A1
20180042464	Arai	Feb 2018	A1
20180042686	Peine	Feb 2018	A1
20180049792	Eckert	Feb 2018	A1
20180049824	Harris	Feb 2018	A1
20180056044	Choi et al.	Mar 2018	A1
20180079090	Koenig et al.	Mar 2018	A1
20180080841	Cordoba	Mar 2018	A1
20180104820	Troy et al.	Apr 2018	A1
20180116735	Tierney et al.	May 2018	A1
20180140371	Hares et al.	May 2018	A1
20180193049	Heck et al.	Jul 2018	A1
20180206927	Prisco et al.	Jul 2018	A1
20180206931	Scheib	Jul 2018	A1
20180221038	Noonan et al.	Aug 2018	A1
20180221039	Shah	Aug 2018	A1
20180243048	Shan	Aug 2018	A1
20180250085	Simi	Sep 2018	A1
20180279852	Rafii-Tari et al.	Oct 2018	A1
20180289431	Draper et al.	Oct 2018	A1
20180296285	Simi et al.	Oct 2018	A1
20180296299	Iceman	Oct 2018	A1
20180303566	Soundararajan	Oct 2018	A1
20180325499	Landey et al.	Nov 2018	A1
20180326181	Kokish et al.	Nov 2018	A1
20180360435	Romo	Dec 2018	A1
20190000559	Berman et al.	Jan 2019	A1
20190000560	Berman et al.	Jan 2019	A1
20190000576	Mintz et al.	Jan 2019	A1
20190015166	Mahoney	Jan 2019	A1
20190069962	Tabandeh et al.	Mar 2019	A1
20190099231	Bruehwiler	Apr 2019	A1
20190099232	Soto et al.	Apr 2019	A1
20190110839	Rafii-Tari et al.	Apr 2019	A1
20190117320	Shoham et al.	Apr 2019	A1
20190117324	Hibner	Apr 2019	A1
20190151148	Alvarez et al.	Apr 2019	A1
20190125465	Evans et al.	May 2019	A1
20190142537	Covington et al.	May 2019	A1
20190167366	Ummalaneni	Jun 2019	A1
20190175009	Mintz	Jun 2019	A1
20190175287	Hill	Jun 2019	A1
20190183585	Rafii-Tari et al.	Jun 2019	A1
20190183587	Rafii-Tari et al.	Jun 2019	A1
20190192249	Bowling	Jun 2019	A1
20190216548	Ummalaneni	Jul 2019	A1
20190216576	Eyre	Jul 2019	A1
20190223967	Abbott	Jul 2019	A1
20190223974	Romo	Jul 2019	A1
20190231458	DiMaio	Aug 2019	A1
20190231460	DiMaio	Aug 2019	A1
20190239890	Stokes	Aug 2019	A1
20190262086	Connolly et al.	Aug 2019	A1
20190269468	Hsu et al.	Sep 2019	A1
20190274764	Romo	Sep 2019	A1
20190290109	Agrawal et al.	Sep 2019	A1
20190298460	Al-Jadda	Oct 2019	A1
20190298464	Abbott	Oct 2019	A1
20190298465	Chin	Oct 2019	A1
20190298469	Ramstad et al.	Oct 2019	A1
20190314616	Moll et al.	Oct 2019	A1
20190336238	Yu	Nov 2019	A1
20190365201	Noonan et al.	Dec 2019	A1
20190365209	Ye et al.	Dec 2019	A1
20190365479	Rafii-Tari	Dec 2019	A1
20190365486	Srinivasan et al.	Dec 2019	A1
20190375383	Alvarez	Dec 2019	A1
20190380787	Ye	Dec 2019	A1
20190380797	Yu	Dec 2019	A1
20200000533	Schuh	Jan 2020	A1
20200008874	Barbagli et al.	Jan 2020	A1
20200030046	Bowling	Jan 2020	A1
20200038123	Graetzel	Feb 2020	A1
20200039086	Meyer	Feb 2020	A1
20200046434	Graetzel	Feb 2020	A1
20200085516	DeFonzo	Mar 2020	A1
20200086087	Hart et al.	Mar 2020	A1
20200091799	Covington et al.	Mar 2020	A1
20200093549	Chin	Mar 2020	A1
20200093554	Schuh	Mar 2020	A1
20200100855	Leparmentier	Apr 2020	A1
20200107894	Wallace	Apr 2020	A1
20200121502	Kintz	Apr 2020	A1
20200129252	Kokish	Apr 2020	A1
20200138531	Chaplin	May 2020	A1
20200146769	Eyre	May 2020	A1
20200155245	Yu	May 2020	A1
20200155801	Kokish	May 2020	A1
20200163726	Tanner	May 2020	A1
20200170720	Ummalaneni	Jun 2020	A1
20200171660	Ho	Jun 2020	A1
20200188043	Yu	Jun 2020	A1
20200197109	Chaplin	Jun 2020	A1
20200197112	Chin	Jun 2020	A1
20200206472	Ma	Jul 2020	A1
20200217733	Lin	Jul 2020	A1
20200222134	Schuh	Jul 2020	A1
20200230360	Yu	Jul 2020	A1
20200237458	DeFonzo	Jul 2020	A1
20200261172	Romo	Aug 2020	A1
20200268459	Noonan et al.	Aug 2020	A1
20200268460	Tse	Aug 2020	A1
20200281787	Ruiz	Sep 2020	A1
20200297437	Schuh	Sep 2020	A1
20200297444	Camarillo	Sep 2020	A1
20200305983	Yampolsky	Oct 2020	A1
20200305989	Schuh	Oct 2020	A1
20200305992	Schuh	Oct 2020	A1
20200315717	Bovay	Oct 2020	A1
20200315723	Hassan	Oct 2020	A1
20200323596	Moll	Oct 2020	A1
20200330167	Romo	Oct 2020	A1
20200345216	Jenkins	Nov 2020	A1
20200352420	Graetzel	Nov 2020	A1
20200360183	Alvarez	Nov 2020	A1
20200367726	Landey et al.	Nov 2020	A1
20200367981	Ho et al.	Nov 2020	A1
20200375678	Wallace	Dec 2020	A1
20200383735	Lewis	Dec 2020	A1
20200405317	Wallace	Dec 2020	A1
20200405411	Draper et al.	Dec 2020	A1
20200405413	Kokish	Dec 2020	A1
20200405419	Mao	Dec 2020	A1
20200405420	Purohit	Dec 2020	A1
20200405423	Schuh	Dec 2020	A1
20200405424	Schuh	Dec 2020	A1
20200405434	Schuh	Dec 2020	A1
20200406002	Romo	Dec 2020	A1

Foreign Referenced Citations (52)

Number	Date	Country
101161426	Apr 2008	CN
101443069	May 2009	CN
100515347	Jul 2009	CN
103037799	Apr 2011	CN
201884596	Jun 2011	CN
102316817	Jan 2012	CN
102327118	Jan 2012	CN
102458295	May 2012	CN
102665590	Sep 2012	CN
102834043	Dec 2012	CN
102973317	Mar 2013	CN
102015759	Apr 2013	CN
103298414	Sep 2013	CN
103735313	Apr 2014	CN
104619281	May 2015	CN
105147393	Dec 2015	CN
105559850	May 2016	CN
105559886	May 2016	CN
205729413	Nov 2016	CN
19649082	Jan 1998	DE
102004020465	Sep 2005	DE
1321 106	Jun 2003	EP
1 442 720	Aug 2004	EP
1 849 423	Oct 2007	EP
2 567 670	Mar 2013	EP
3 025 630	Jun 2016	EP
07-136173	May 1995	JP
2005-270464	Oct 2005	JP
2009-139187	Jun 2009	JP
2010-046384	Mar 2010	JP
2014-159071	Sep 2014	JP
2015-181495	Oct 2015	JP
WO 9414494	Jul 1994	WO
WO 9622591	Jul 1996	WO
WO 0274178	Sep 2002	WO
WO 07146987	Dec 2007	WO
WO 09092059	Jul 2009	WO
WO 10133982	Nov 2010	WO
WO 11005335	Jan 2011	WO
WO 11161218	Dec 2011	WO
WO 12037506	Mar 2012	WO
WO 13107468	Jul 2013	WO
WO 13179600	Dec 2013	WO
WO 15127231	Aug 2015	WO
WO 15153174	Oct 2015	WO
WO 16137612	Sep 2016	WO
WO 17059412	Apr 2017	WO
WO 17114855	Jul 2017	WO
WO 17151993	Sep 2017	WO
WO 18069679	Apr 2018	WO
WO 18094191	May 2018	WO
WO 18189722	Oct 2018	WO

Non-Patent Literature Citations (4)

Entry
Ramezanifard et al, 2007, A Novel Modeling Approach for Collision Avoidance in Robotic Surgery, 2007 Science Publications, American Journal of Applied Sciences 4(9):693-699.
International search report and written opinion dated Jan. 6, 2021 in application No. PCT/IB2020/059010.
Hernansanz et al, 2015, A multi-robot cooperation strategy for dexterous task oriented teleoperation, 2015, Elsevier, Robotics and Autonomous Systems, 68(205):156-172.
Mayo Clinic, Robotic Surgery, https://www.mayoclinic.org/tests-procedures/robotic-surgery/about/pac-20394974?p=1, downloaded from the internet on Jul. 12, 2018, 2 pp.

Related Publications (1)

	Number	Date	Country
	20210093408 A1	Apr 2021	US

Provisional Applications (1)

	Number	Date	Country
	62908446	Sep 2019	US

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