The systems and methods disclosed herein are directed to robotic medical systems, and more particularly to a specimen collector for robotic medical systems.
Robotic medical systems can be configured to perform a wide variety of medical procedures, including endoscopic, laparoscopic and open procedures among others. During some procedures, medical instruments can be used to remove an object, specimen, or sample from a patient. As one example, a medical instrument can be used to remove a kidney stone or kidney stone fragment during a kidney stone removal procedure.
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.
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.
The robotically-enabled medical system may be configured in a variety of ways depending on the particular procedure.
With continued reference to
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.
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.
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.
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.
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
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
With continued reference to
In some embodiments, a table base may stow and store the robotic arms when not in use.
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.
To accommodate laparoscopic procedures, the robotically-enabled table system may also tilt the platform to a desired angle.
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.
The adjustable arm support 105 can provide several degrees of freedom, including lift, lateral translation, tilt, etc. In the illustrated embodiment of
The surgical robotics system 100 in
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
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.
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.
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).
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
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
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.
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.
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.
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
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.
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.
As shown in
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, 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
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.
Robotic medical systems, such as those described above with reference to
As an example, a robotic medical system can include three robotic arms configured for use during a ureteroscopic kidney stone removal procedure. A first robotic arm can operate and control (e.g., control articulation of) a robotic ureteroscope and basketing device. A distal drive device positioned on a second robotic arm can insert and retract the ureteroscope into and out of the patient. In some embodiments, a third robotic arm can optionally be used to control a percutaneously inserted robotic laparoscope (e.g., during percutaneously assisted ureteroscopy (PAU)). The physician can control the system to capture a kidney stone with the basketing device. Then, when the robotic ureteroscope is holding the stone, the robotic ureteroscope can be retracted to remove the stone from the patient. Once positioned outside of the patient's body, the basketing device can be opened to release the stone. The robotic ureteroscope can then be reinserted into the body to retrieve further stones, if necessary. Generally, the stones are retained in order to be analyzed after the procedure.
This disclosure relates to specimen collectors that are configured for use with robotic medical systems in order to facilitate robotic medical procedures that involve removing objects, specimens, or samples from a patient. The specimen collectors can be configured such that the robotic medical system can deposit specimens therein robotically, which can minimize manual or physical interaction. During manual object removal procedures (e.g., manual kidney stone removal), objects removed from a patient are manually deposited into specimen cups, which are generally physically held by the physician or other sterile users in the operating room. Use of such manual specimen cups can be disadvantageous for use with robotic medical systems because such cups would need to be held by a clinician or have a specially designed holder, increasing cost and/or reducing the roboticization.
As will be described in more detail below, the specimen collectors described herein can be specifically configured for use with robotic medical systems so as to facilitate and/or optimize robotic procedures. For example, the specimen collectors described herein can be integrated into and/or configured to be supported by components of the robotic medical systems at positions at which the robotically controlled medical instruments can quickly and efficiently deposit specimens therein. As an initial example, a specimen collector configured for use with a robotic medical system can be integrated into a sterile drape configured to cover various robotic components of the system. The specimen collector can be positioned on the drape such that it is advantageously positioned when the drape is installed. For example, the specimen collector can be positioned at a location that is directly below a robotically controlled basketing device when the basketing device is retracted out of the patient. At this position, the basketing device can simply open to drop a retrieved object into the specimen collector. The specimen collector can be configured with at least one porous portion that allows fluid to drain therethrough while retaining objects deposited therein. The specimen collector can be configured with an opening-retaining device (e.g., pliable wires or metal strips) that are configured to hold an opening of the specimen collector open such that there is a large area for the objects to be deposited into. Further, the specimen collector can be configured such that it can be removed (e.g., torn away from) the drape, so the objects can be easily sent for analysis. In some embodiments, inclusion of the specimen collector on the drape provides a cost effective solution that provides significant benefit.
These and other features will be described in more detail below with reference to the embodiments illustrated in the figures, which are intended to illustrate certain example features and aspects of the specimen collectors described herein. The illustrated embodiments are not intended to be limiting, and those of skill in the art, upon consideration of this disclosure, will appreciate that various modifications can be made which are within the scope of this disclosure.
In the illustrated embodiment, the medical instrument 204 comprises a robotically controllable ureteroscope, which can be similar to the ureteroscope 32 described above with reference to
A distal end 214 of the elongated shaft 212 is configured to be inserted into the patient 202. For example, the robotic manipulator (e.g., the drive device 206 described in more detail below) can be configured to drive insertion and/or retraction of the elongated shaft 212 such that the distal end 214 of the elongated shaft 212 can be inserted into and retracted from the patient 202. In the illustrated embodiment, the medical instrument 204 is illustrated in a position wherein the distal end 214 of the elongated shaft 212 has been retracted out of the patient 202.
In the illustrated embodiment, the system 200 includes an access sheath 216. The access sheath 216 can be inserted into the patient 202 to provide a channel or conduit through which the elongated shaft 212 of the medical instrument 204 can be inserted. In the illustrated embodiment, the access sheath 216 is a ureteral access sheath inserted into the urethra of the patient 202, although other types of access sheaths, which can be inserted into other natural patient orifices or other surgical ports (e.g., laparoscopic ports) can also be used. In some embodiments, the access sheath 216 comprises a tube.
The medical instrument 204 can be configured to capture (e.g., grip, grab, hold, etc.) a specimen from within the patient. For example, in the case of a kidney stone removal procedure, the medical instrument 204 can include a basketing device configured to capture kidney stones such that the kidney stones can be removed from the patient 202. As described above, in some embodiments, the basketing device can be configured as a tool (robotically and/or manually controllable) which can be inserted through a working channel of the elongated shaft 212 of the medical instrument 204. In some embodiments, the basketing device is directly integrated into the medical instrument 204. Although examples described herein relate to kidney stone removal, the medical instrument 204 can be configured to collect and retrieve other types of objects, specimens, or samples from within the patient 202. For example, in some embodiments, the medical instrument 204 is configured to take a biopsy sample from the patient 202.
In the robotic medical system 200 illustrated in
In the illustrated embodiment, the drive device 206 is engaged with the elongated shaft 212 of the medical instrument 204 and configured to drive axial motion (e.g., insertion and/or retraction) of the distal tip 214 of the elongated shaft 212 into and out of the patient 202. For example, as shown in
As shown in
With continued reference to
While the illustrated embodiment of the system 200 includes the drive device 206 for driving axial motion of the elongated shaft 212 of the medical instrument 204, other types of robotic manipulators can be used to drive axial motion in other embodiments. For example, in some embodiments, axial motion is driven by moving a robotic arm 226 to which the base 210 of the medical instrument 204 is attached. In other embodiments, the base 210 of the medical instrument 204 is configured to drive axial motion of the elongated shaft, for example, as described above with reference to
As shown in
The robotic arms 226 can be, for example, robotic arms mounted on or extending from a cart as shown in
As shown in
As noted above, the system 200 also includes the specimen collector 300 into which specimens removed from the patient 202 using the medical instrument 204 can be deposited. As best seen in the side view of
As shown in
Further, as illustrated in
As shown in
As noted above, in the illustrated embodiment, the connector 304 is attached to the sterile drape 232. In some embodiments, the connector 304 is fixedly or permanently attached to the sterile drape 232. That is, in some embodiments, the specimen collector 300 is a component of the sterile drape 232. In these embodiments, the specimen collector 300 can positioned on the drape 232 such that, when the drape 232 is installed over the robotic medical system 200, the specimen collector 300 is positioned in an advantageous or desired position as described above. In other embodiments, the connector 304 can be configured to selectively attach to the sterile drape 232 (or other components of the robotic medical system 200). For example, the connector 304 can comprise an adhesive strip on the attachment tab. A user can then use the adhesive strip to attach the specimen collector 300 to a component of the robotic medical system 200 as desired.
The receptacle portion 302 can be attached to the attachment tab or connector 304 in a removable manner such that the receptacle portion 302 can be removed from the connector 304. In some embodiments, once specimens are deposited into the receptacle portion 302, the receptacle portion 302 can be removed from the connector 304 while retaining the specimens therein. The receptacle portion 302 can then be sent for analysis of the specimens. As will be described below, in some embodiments, the specimen collector 300 comprises a perforation between the attachment tab or connector 304 and the receptacle portion 302 configured such that the receptacle portion 302 can be torn from the attachment tab or connector 304. Other methods for removing the receptacle portion 302 from the connector 304 are also possible as described below.
In some embodiments, at least a portion of the receptacle portion 302 is porous and configured to allow fluid to drain from the receptacle portion 302 while retaining the specimen. During some medical procedures, a fluid, such as an irrigant used during the procedure or a patient fluid, can get into the receptacle portion 302. The porous portion of the receptacle portion 302 can allow this fluid to drain. In some embodiments, the specimen collector 300 can include a drainage port that can be connected to a fluidics system which can actively or passively collect such fluid from the receptacle portion 302. The porosity of the porous portion can be configure such that fluid drains therethrough, while collected specimens are retained within the receptacle portion.
At block 252, the method 248 can include collecting the specimen from within the patient 202 using the medical instrument 204. In some embodiments, the physician can navigate and control the distal tip 214 of the medical instrument 204 within the patient 202 using the controller 244, allowing the physician to locate and collect the sample. As noted above, in the case of a kidney stone removal procedure, collecting the sample can comprise capturing a kidney stone within a basketing device inserted through a working channel of the elongated shaft 212 of the medical instrument 204.
With the sample collected, the method 248 moves to block 254, at which the distal end 214 and collected sample is retracted from the patient 202. Retraction can be commanded, for example, by the physician using the controller 244. Retraction can be provided using the same mechanisms as described above with regards to insertion. For example, retraction can be driven by the drive device 206, by moving a robotic arm 226, and/or with an instrument-based insertion architecture that drives retraction of the elongated shaft 212 relative to the instrument base 210. At block 254, the distal tip 214 of the medical instrument 204 can be retracted to a position at which the specimen can be deposited into the specimen collector 300. For example, the distal tip 214 can be retracted to a position above the specimen collector 300 as shown in
At block 256, the method 248 can include depositing the specimen into the receptacle portion 302 of the specimen collector 300. In the illustrated embodiment of the system 200, depositing the specimen into the receptacle portion 302 of the specimen collector 300 can include releasing the specimen from the distal tip 214 of the medical instrument 204 such that the specimen falls under the force of gravity into the receptacle portion 302 of the specimen collector 300. In other embodiments, depositing can be accomplished by articulating the elongated shaft 212 of the medical instrument 204 to insert the specimen into the specimen collector 300. In some embodiments, depositing the specimen into the specimen collector 300 can occur automatically after receipt of a deposit command provided with the controller 244. For example, upon receipt of the command, the system 200 can automatically move the distal end 214 of the medical instrument 204 into a depositing position and robotically deposit the specimen into the receptacle portion 302 of the specimen collector 300. In some embodiments, the system 200 is aware of the location of the specimen collector 300 such that movement to and depositing into the specimen collector 300 can be automatically performed by the system 200 (e.g., automatically performed upon receipt of a user command). That is, in some embodiments, the physician need not navigate the distal end 214 to the specimen collector 300; instead, such navigation can occur automatically.
As best shown in the exploded view of
The connector 304 can comprise an attachment tab formed by a portion of the first layer 312 that extends from the first upper edge 312A. As shown in
In some embodiments, the connector 304 or attachment tab can be permanently connected to another structure, such as the sterile drape 232 or sterile adapter 230, such that the specimen collector 300 is a component of that structure. The connector 304 can be connected to that structure such that the specimen collector 300 is advantageously positioned at a desired location when that structure is installed on the robotic system. In other embodiments, the connector 304 or attachment tab is configured to selectively attach to the robotic system. For example, the connector 304 or attachment tab can include an adhesive backing on at least a first side of thereof such that the specimen collector 300 can be adhesively attached to the robotic medical system 200 at a desired location.
As shown in
The specimen collector 300 can also include an open-retaining device 320. The open-retaining device 320 can be configured to retain the opening of the receptacle portion 302 in an open configuration so as to facilitate depositing of specimens into the receptacle portion 302. In some embodiments, for example, as illustrated, the open-retaining device 320 can be positioned at the opening of the receptacle portion 302. In the illustrated embodiment, the open-retaining device 320 comprises a formable metal strips 322. In the illustrated embodiment, the formable metal strips 322 are attached on a first side to the first layer 312 with an attachment pad 324 and attached on a second side to the second layer 314 with an attachment pad 324. The formable metal strips 322 can be bent into a configuration that holds the opening of the receptacle portion 302 open. Other mechanisms for the open-retaining device 320 are also possible, such as formable, shape retaining wires that can be embedded in the opening. In some embodiments, the open-retaining device 320 can be omitted.
As noted above, the specimen collector 300 can include a porous portion for allowing fluid to drain from the receptacle portion 302. In some embodiments, one or both of the first layer 312 and the second layer 314 can be porous. In some embodiments, a portion of one or both of the first layer 312 and the second layer 314 can be porous.
At block 404, the method 400 includes manipulating the medical instrument 204 with a robotic manipulator to capture a specimen within the patient. In some embodiments, the base 210 of the medical instrument 204 is engaged with the instrument drive mechanism 228 such that drive outputs of the instrument drive mechanism 228 actuate drive inputs in the base 210 to cause articulation of the elongated shaft 212. The physician or other operator can control articulation and/or insertion and retraction of the elongated shaft 212 to capture the specimen with the distal end 214 of the medical instrument 204. Navigation within the patient can be facilitated by the navigation and localization system described above with reference to
At block 406, the method 400 includes robotically retracting the elongated shaft 212 of the medical instrument 204 to withdraw the distal end 214 and the specimen from the patient. In some embodiments, the robotic manipulator comprises the drive device 206 configured to engage with and drive insertion and retraction of the elongated shaft 212 of the medical instrument 204. Retraction can be driven by the drive device 206. In some embodiments, the robotic manipulator comprises a robotic arm 226 and an instrument drive mechanism 228 positioned at a distal end of the robotic arm 226. The instrument drive mechanism 228 can be configured to attach to the base 210 of the medical instrument 204 to operate the medical instrument 204. In some embodiments, robotically retracting the elongated shaft 212 of a medical instrument 204 comprises moving the robotic arm 226. In some embodiments, robotically retracting the elongated body 212 of the medical instrument 204 comprises driving a retraction mechanism of the base 210 with the instrument drive mechanism 228 to cause the elongated shaft 212 to be retracted relative to the base 210.
At block 408, the method 400 includes robotically depositing the specimen into the specimen collector 300. As described with reference to
The method 400 may also include draping a robotic medical system with a sterile barrier 232 to separate a sterile field containing at least the medical instrument 204 and the specimen collector 300 from a non-sterile field containing at least the robotic manipulator. In some embodiments, the specimen collector 300 is attached to the sterile barrier 232 at a location at which the medical instrument can robotically deposit the specimen.
In some embodiments, the method 400 also includes adhesively attaching the specimen collector 300 to the sterile barrier 232. In some embodiments, the receptacle portion 302 of the specimen collector 300 is removable from the connector 304, and the method 400 further comprises detaching the receptacle portion 302 from the connector 304. The method 400 may further include draining fluid through a porous portion of the receptacle portion 302 while retaining the specimen within the receptacle portion 302. In some embodiments, the method 400 also includes positioning an opening of the specimen collector in an open position using an open-retaining device 320 of the specimen collector 300.
In the illustrated embodiment, specimen collectors 300 are positioned at the distal ends of each of the flexible tubes 253 so as to be positioned in an advantageous position (as described above) when the drape 232 is installed.
Implementations disclosed herein provide systems, methods and apparatus for specimen collectors configured for use with robotic medical systems.
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 phrases referencing specific computer-implemented processes/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.
This application claims priority to U.S. Provisional Application No. 62/955,050, filed Dec. 30, 2019, which is incorporated herein by reference. Any and all applications for which a foreign or domestic priority claim is identified in the Application Data Sheet as filed with the present application are hereby incorporated by reference under 37 CFR 1.57.
Number | Date | Country | |
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62955050 | Dec 2019 | US |