CN113473938A - Surgical robotic system including robotic telemanipulator and integrated laparoscopy - Google Patents

Abstract

A surgical robotic system for remote manipulation having a robotic telemanipulator is provided. The surgical robotic system is well suited for use by surgeons, may be seamlessly integrated into an operating room, allows surgeons to work between the robot and the patient in a sterile manner throughout the surgery, is relatively low cost, and/or allows integrated laparoscopy. The system preferably includes a master console having a plurality of master links interconnected by a plurality of master joints, and a handle coupled to the master console to operate the remote manipulator. The system also includes a slave console operably coupled to the master console and having a plurality of slave links interconnected by a plurality of slave joints, the slave links moving in response to movement at the master console to allow the end effector to perform a surgical procedure.

Description

Surgical robotic system including robotic telemanipulator and integrated laparoscopy

Cross Reference to Related Applications

This application claims the benefit of priority from U.S. patent application serial No. 16/505,585 filed on 7/8/2019, which is a continuation of U.S. patent application serial No. 16/269,383 filed on 6/2/2019, U.S. patent application serial No. 16/269,383, which is now U.S. patent No. 10,413,374, which claims the benefit of priority from U.S. provisional patent application serial No. 62/788,781 filed on 5/1/2019 and U.S. provisional patent application serial No. 62/627,554 filed on 7/2/2018, each of which is incorporated herein by reference in its entirety. This application also claims PCT/IB2019/050961 filed on 6.2.2019 and disclosed as a priority claim for WO2019/155383, which PCT/IB2019/050961 claims a priority claim for U.S. provisional patent application serial No. 62/788,781 filed on 5.1.2019 and U.S. provisional patent application serial No. 62/627,554 filed on 7.2.2018, each of which is incorporated herein by reference in its entirety.

Technical Field

The present application relates generally to a remotely actuated surgical robotic system having a robotic telemanipulator.

Background

A variety of environments and applications require remote actuation with teleoperated surgical devices. These applications include the ability to perform delicate manipulations, manipulations in enclosed spaces, manipulations in hazardous or contaminated environments, in clean or sterile environments, and in surgical environments (whether open field or minimally invasive). Although these applications and parameters (such as precise tolerances and end-user skill levels) are varying, each application requires many of the same functions of the remote operating system, such as the ability to perform dexterous manipulations with high precision.

Surgical applications will be discussed in more detail in the following disclosure as an example of an application of teleoperational device systems, where there are known devices, but there are significant disadvantages in previously known systems and methods.

Open surgery remains the preferred method for many surgical procedures. It has been used for decades by the medical community and typically requires a long incision in the abdomen or other area of the body through which a conventional surgical tool is inserted. Due to this incision, this extremely invasive approach results in significant blood loss during surgery and often a lengthy and painful rest period in the hospital environment.

Laparoscopy is a minimally invasive technique that has been developed to overcome some of the disadvantages of open surgery. Instead of a large transmural incision, several small openings are made in the patient through which elongated surgical instruments and endoscopic cameras are inserted. The minimally invasive nature of the laparoscopic procedure reduces blood loss and pain and shortens hospital stays. When performed by experienced surgeons, laparoscopic techniques can achieve clinical results similar to open surgery. However, despite the above advantages, laparoscopy still requires a high degree of skill to successfully manipulate the rigid and long instruments used in such procedures. Typically, the entry incision serves as a point of rotation, reducing the freedom to position and orient the instrument within the patient. The movement of the surgeon's hand about this incision point is reversed and scaled up relative to the instrument tip ("fulcrum effect"), which reduces dexterity and sensitivity, and amplifies any tremor of the surgeon's hand. In addition, long, straight instruments force the surgeon to work in an uncomfortable posture with hands, arms, and body, which can be very tiring during long routines. Thus, due to these shortcomings of laparoscopic instruments, minimally invasive techniques are limited primarily to use in simple surgical procedures, and only a very few surgeons are able to use such instruments and methods in complex procedures.

To overcome the foregoing limitations of previously known systems, surgical robotic systems have been developed to provide an easy-to-use approach to complex minimally invasive surgery. These systems enable remote laparoscopy to be performed by means of a computerized robotic interface, in which the surgeon sits on a console, manipulating two master manipulators to perform operations through several small incisions. Like laparoscopy, robotic methods are also minimally invasive, providing the above advantages over open surgery in terms of pain relief, blood loss, and recovery time. In addition, it provides better ergonomics for the surgeon, increased flexibility, accuracy and tremor suppression, and eliminates the fulcrum effect compared to open and laparoscopic techniques. Although technically easier, robotic surgery still suffers from several drawbacks. One major drawback of previously known robotic surgical systems relates to the extremely high complexity of such systems, which include four to five robotic arms for replacing the hands of surgeons and assistants, integrated endoscopic imaging systems, and the ability to perform telesurgery, resulting in significant capital costs for acquisition and maintenance, and limiting the affordability of most surgical departments worldwide. Another disadvantage of these systems is the bulky size of previously known surgical robots, which compete for valuable space in the operating room environment and significantly increase preparation time. Thus possibly hampering patient access, which creates a safety hazard.

For example, da

A Surgical system, available from Intuitive Surgical Inc (Intuitive Surgical Inc., of sony, ca), is a robotic Surgical system that allows a surgeon to perform remote laparoscopy. However, da

Surgical systems are very complex robotic systems with a cost of approximately $ 200 million per robot per system, a maintenance cost of $ 15 million per year, and a surgical instrument cost of $ 2000 per procedure. da

Surgical systems also require a significant amount of space to be left in the operating room, making it difficult to move the surgical system in the operating room to the vicinity of the desired location, and to switch between a forward surgical workspace and a reverse surgical workspace (also referred to as multi-quadrant surgery).

In addition, since the surgeon's operating console is typically located remotely from the surgical site, the surgeon and operating console are not within the sterile field of the operating room. If the surgeon's operating console is not sterile, the surgeon is not allowed to attend to the patient without additional sterilization routines, if necessary. During certain surgical procedures, surgeons may need immediate intervention, and current cumbersome robotic systems may prevent surgeons from quickly accessing the surgical site on the patient in a life-saving manner.

WO97/43942 to Madhani, WO98/25666 to Cooper, and U.S. patent application publication No.2010/0011900 to Burbank each disclose a robotic teleoperated surgical instrument designed to replicate the movement of a surgeon's hand within a patient. Through a computerized robotic interface, the instrument is capable of performing remote laparoscopy, wherein a surgeon sitting on a console and manipulating two joysticks performs the operation through several small incisions. These systems have no self-righting or artificial intelligence and are essentially complex tools that are fully controlled by the surgeon. Control commands are transmitted between the robot master and slave parts through a complex computer controlled mechatronic system that is extremely costly to produce and maintain and requires extensive training of hospital staff.

WO2013/014621 to Beira, the entire content of which is incorporated herein by reference, describes a mechanical teleoperated device for remote manipulation comprising a master-slave arrangement comprising slave units driven by a kinematically equivalent master unit, such that each part of a slave unit mimics the movement of a corresponding part of the master unit. A typical master-slave telemanipulator provides seven degrees of freedom of movement. In particular, these degrees of freedom include three translational macro movements (e.g., inward/outward, upward/downward, and leftward/rightward degrees of freedom) and four micro movements, including one rotational degree of freedom (e.g., pronation and supination), two articulated degrees of freedom (e.g., yaw and pitch), and one actuation degree of freedom (e.g., open/close). Although the mechanical transmission system described in this publication is well suited for this device, the low friction wiring of the cable from the handle through the entire kinematic chain to the instrument is expensive, complex, cumbersome, and requires precise calibration and careful handling and maintenance.

In addition, previously known purely mechanical solutions do not provide wrist alignment, low device complexity, low mass and inertia, high surgical volume, and good tactile feedback. For example, for a purely mechanical teleoperated device, in order to perform a pure pronation/roll movement of the instrument, the surgeon typically has to perform a combined pronation/roll movement of his hand/forearm and a translational movement on a curved path with his wrist. Such movements are complicated to perform correctly and, if not performed properly, the pitch and yaw of the end effector create undesirable parasitic movements.

Furthermore, the routing of articulation and actuation degree of freedom cables through the mechanical telemanipulator may limit the flexibility of the angular range of the telemanipulator links and the various joints of the joint structure. This in turn limits the amount of surgical available for instruments that can be used in a patient. During rapid movement of the mechanical telemanipulator, the inertia of the telemanipulator may also interfere and cause target overshoot and surgeon hand fatigue. Part of this mass can be attributed to the parts and components required to route the actuation and articulation degrees of freedom.

Accordingly, it is desirable to provide a remotely actuated surgical robotic system having a robotic telemanipulator that is well suited for use by a surgeon, seamlessly integrates into an operating room, allows the surgeon to work in a sterile manner between the robot and the patient, is relatively low cost, and/or allows integrated laparoscopy.

It is further desirable to provide a remotely actuated surgical robot having a mechanical and/or electromechanical telemanipulator.

Disclosure of Invention

The present invention overcomes the disadvantages of previously known systems by providing a remotely actuated surgical robotic system having a robotic telemanipulator that is preferably well suited for use by a surgeon, can be seamlessly integrated into an operating room, allows the surgeon to work between the robot and the patient in a sterile manner throughout the surgical procedure, is relatively low cost, and/or allows for integrated laparoscopy.

It will be understood by those of ordinary skill in the art that the term "master" as used herein refers to a component controlled by a surgeon and may be referred to as a "surgeon," and the term "slave" as used herein refers to a component that interacts with a patient undergoing a surgical procedure and may be referred to as a "patient. For example, the terms "master console" and "surgeon console" are interchangeable, and the terms "slave console" and "patient console" are interchangeable, and so forth. A surgical robotic system for remote manipulation comprising: a main console having a plurality of main links; and a handle coupled to the main console such that movement imparted at the handle moves at least one of the plurality of master links. The main console may be designed to remain sterile during the surgical procedure. According to one aspect, the handle may be removably coupled to the main console such that the handle is sterile during a surgical procedure and sterilizable when removed for additional surgical procedures. For example, the handle may be removably coupled to the main console via, for example, a clamping attachment or a threaded attachment. The removable handle may be purely mechanical without electronics such as circuitry, sensors, or electrically coupled buttons to facilitate sterilization between surgical procedures when the handle is removed from the main console. In this way, the master console may be sterile (e.g., covered with sterile drapes except at the handle) during surgery, while allowing the surgeon to have tactile feedback available from the handle in direct contact with the robot.

The surgical robotic system also includes a slave console having a plurality of slave links. According to one aspect, the distal end of the slave console may be rotatable about an alpha axis of an angled slave link of the plurality of slave links such that the distal end of the slave console may be positioned in a manner that allows a user to move from the master console in order to manually perform a laparoscopic routine on a patient undergoing a surgical procedure.

Additionally, the system includes an end effector coupled to the slave console, wherein the end effector moves in response to movement applied at the handle and in response to movement at the slave console to perform the surgical procedure. For example, the slave console may include a plurality of actuators, such as motors, operably coupled to the end effector that, when activated in response to an actuation at the handle, apply translational macro movements to the plurality of slave links during the macro synchronization state but not apply translational macro movements in the out-of-sync macro state, and apply micro movements to the end effector during the micro synchronization state but not apply micro movements in the out-of-sync micro state. Further, the surgical robotic system may include an instrument having a proximal end and a distal end, the proximal end having an instrument hub designed to be coupled to the distal end of the slave console, and the distal end having an end effector.

The handle may include a telescopic piston that moves in response to actuation of the handle. Thus, the at least one sensor of the master console is designed to sense the movement of the telescoping piston to cause the plurality of actuators to make corresponding micro-movements at the end effector. According to one aspect of the invention, the slave console does not respond to movement at the master console unless at least one sensor senses at least a predetermined amount of the telescoping piston. Furthermore, the at least one sensor coupled to the handle may be designed to sense an actuation pattern of the handle that transitions the robot from the unsynchronized micro-state to the micro-synchronized state. For example, in an unsynchronized micro-state, the movement at the handle sensed by the plurality of sensors does not cause the end effector to cause a corresponding micro-movement until the robot is transitioned to a micro-synchronized state due to the at least one sensor sensing the actuation pattern of the handle.

The master console may include a mechanical constraint designed to constrain movement of at least one of the plurality of master links, and may further include a clutch that, when actuated, prevents translational macro movement of the plurality of master links. The surgical robotic system may also include a display coupled to the master console that allows a user to visualize the end effector during operation of the telemanipulator. Additionally, the system may include a removable incision indicator that allows alignment from a distal end of the console with a trocar positioned within a patient undergoing a surgical procedure.

Further, the base of the slave console may be coupled to a proximal slave link of the plurality of slave links via a proximal slave joint of the plurality of slave joints such that the plurality of slave links and the joint are movable about the proximal slave joint to position the distal end of the slave console in a desired horizontal orientation prior to performing the surgical procedure while the base of the slave console remains stationary. Additionally, the base of the slave console may include an adjustable vertical post coupled to a proximal slave link of the plurality of slave links. The adjustable vertical column may adjust the height of the plurality of slave links and joints prior to operating the remote manipulator to position the distal end of the slave console in a desired vertical orientation.

According to one aspect of the application, a slave link and joint of the plurality of slave links and joints distal to a beta joint of the plurality of slave joints is designed to move relative to the beta joint to flip a distal end of the slave console between the forward surgical workspace and the reverse surgical workspace while a slave link of the plurality of slave links proximal to the beta joint and a base of the slave console remain stationary.

The surgical robotic system may also include a controller operably coupled to the plurality of actuators such that the plurality of actuators apply movement to the plurality of slave links of the slave console in response to instructions executed by the controller. For example, the controller may execute instructions to cause the plurality of actuators to move the plurality of slave links of the slave console to a home configuration in which the plurality of slave links are retracted such that the end effector is positionable within a trocar inserted into a patient undergoing a surgical procedure. In addition, the controller can execute instructions to cause the plurality of actuators to move the angulation in the plurality of slave links from the link to an angle such that the angulation slave link and a slave link in the slave console proximal to the angulation slave link remain stationary during operation of the telemanipulator. Thus, under the angle of the angled slave link, the distal end of the slave console allows the end effector to perform a surgical procedure in a hemispherical surgical workspace that is inclined at an angle that is substantially parallel to the angle of the angled slave link.

According to another aspect of the invention, the master console has a master controller and the slave console has a slave controller, such that the master controller can execute instructions based on the movement sensed at the handle and transmit signals to the slave controller based on the movement. Thus, the slave controller may receive signals and execute instructions to move at least one of the plurality of slave links and/or the end effector based on the signals transmitted from the master controller. For example, the slave console may include a right slave remote manipulator, a right slave controller, a left slave remote manipulator, and a left slave controller, and the master console may include a right master remote manipulator, a left master remote manipulator, and a master controller, such that in a forward surgical workspace configuration, the master controller communicates with the right slave controller to cause the right slave remote manipulator to move in response to movement of the right master remote manipulator, and the master controller communicates with the left slave controller to cause the left slave remote manipulator to move in response to movement of the left master remote manipulator. Additionally, according to some embodiments, in the reverse surgical workspace configuration, the master controller communicates with the left slave controller to cause the left slave remote manipulator to move in response to movement of the right master remote manipulator, and the master controller communicates with the right slave controller to cause the right slave remote manipulator to move in response to movement of the left master remote manipulator.

Accordingly, the distal end of the right slave telemanipulator may be rotated about the alpha axis of the right angled slave link of the plurality of right slave links, and the distal end of the left slave telemanipulator may be rotated about the alpha axis of the left angled slave link of the plurality of left slave links, such that the distal ends of the right and left slave telemanipulators may be positioned in a manner that allows a user to move from the master console to manually perform a laparoscopic routine on a patient undergoing a surgical procedure. Additionally, the right handle may be removably coupled to the right master remote manipulator and the left handle may be removably coupled to the left master remote manipulator.

According to yet another aspect of the present invention, a system for remote manipulation to perform a surgical procedure is provided. The system includes a patient console having a plurality of patient links coupled to a base and a surgical instrument coupled to the patient console. A distal region of a surgical instrument may be inserted into a patient at a surgical site to perform a robotic surgical procedure. The system also includes a controller that executes instructions to: in a surgical mode, at least one of the plurality of patient links is moved in response to movement applied at a handle of a surgeon console operably coupled to the patient console to move the surgical instrument to perform the robotic surgery, and the patient console is transitioned from the surgical mode to a laparoscopic mode in which the plurality of patient links are retracted from the patient while a base of the patient console remains stationary to expose the surgical site to allow the surgeon to perform the non-robotic surgery at the surgical site without interference from the plurality of patient links.

In addition, the controller may execute the instructions to determine that the surgical instrument has been removed from the patient at the surgical site, such that the controller transitions the patient console from the surgical mode to the laparoscopic mode only if the surgical instrument has been removed. For example, the controller may determine that the surgical instrument has been removed from the patient by determining that the surgical instrument has been decoupled from the patient console. Further, the controller may transition the patient console from the surgical mode to the laparoscopic mode in response to a user input received at the patient console. Further, the handle may be removably coupled to the surgeon console such that the handle is sterile during the surgical procedure and sterilizable when removed for additional surgical procedures. The system may also include a display coupled to the surgeon console to allow the surgeon to visualize the surgical instrument during operation of the system.

In addition, the controller can also execute instructions to, in a surgical mode, move at least one of the plurality of patient links in response to a movement applied at a handle of the surgeon console at the scaled degree. For example, the controller may execute instructions to cause scaled micro-movements at the surgical instrument in micro-degrees of freedom in response to corresponding movements applied at a handle of the surgeon console in the surgical mode. The micro-movements applied at the surgical instrument may be independently scalable for each of the micro-degrees of freedom such that the scaled micro-movements at the micro-degrees of freedom are at a different scale than the second scaled micro-movements at the surgical instrument at the second micro-degrees of freedom. Further, the surgeon console may include a clutch to prevent micro-movement at the surgical instrument in response to micro-movement applied at a handle of the surgeon console when the clutch is actuated.

According to another aspect of the present invention, a method for remotely performing a surgical procedure is provided. The method can comprise the following steps: coupling a surgical instrument to a patient console, the patient console including a plurality of patient links coupled to a base; inserting a distal region of a surgical instrument into a patient at a surgical site to perform a robotic surgical procedure; in a surgical mode, moving at least one of the plurality of patient links in response to movement imparted at a handle of a surgeon console operably coupled to the patient console, thereby moving the surgical instrument to perform the robotic surgical procedure; and transitioning the patient console from a surgical mode to a laparoscopic mode in which the plurality of patient links are retracted from the patient while the base of the patient console remains stationary to expose the surgical site to allow the surgeon to perform the non-robotic surgery at the surgical site without interference from the plurality of patient links.

According to yet another aspect of the present invention, another system for remote manipulation to perform a surgical procedure is provided. The system may include a patient console having an alignment joint and a plurality of patient links coupled to a base, and a surgical instrument coupled to the patient console. A distal region of a surgical instrument may be inserted into a patient at a surgical site to perform a robotic surgical procedure. The system may also include a controller that executes instructions to: setting a virtual center of motion based on the alignment of the alignment joint and the surgical site; and moving at least one of the plurality of patient links in response to movement applied at a handle of a surgeon console operably coupled to the patient console to move the surgical instrument to perform the robotic surgery, wherein movement of the surgical instrument is constrained near the virtual remote center of motion to maintain alignment of the patient joint with the surgical site during the surgical procedure.

The system may also include a cut-out indicator that may be removably coupled to the alignment joint to allow the alignment joint to be aligned with the surgical site. For example, the incision indicator may be removably coupled to the alignment joint via a magnetic attachment. In addition, the system can include a trocar positioned within the patient at the surgical site such that the virtual center of motion is set based on the alignment of the alignment joint and the trocar.

According to another aspect of the present invention, another method for remotely performing a surgical procedure is provided. The method can comprise the following steps: aligning one of a plurality of patient joints of a patient console with a trocar insertion site, the plurality of patient joints interconnected by a plurality of patient links, the patient console operably coupled to a surgeon console and configured to move in response to movement applied at a handle of the surgeon console; setting a virtual remote center of motion based on alignment of the patient joint with the trocar insertion site; and moving at least one of the plurality of patient links in response to movement applied at the handle to move a surgical instrument coupled to the patient console to perform the surgical procedure, wherein movement of the surgical instrument is constrained near the virtual remote center of motion to maintain alignment of the patient joint with the trocar insertion site during the surgical procedure.

According to yet another aspect of the present invention, another system for remote manipulation to perform a surgical procedure is provided. The system may include a patient console having an alignment joint and a plurality of patient links coupled to a base, and a surgical instrument coupled to the patient console. A distal region of a surgical instrument may be inserted into a patient at a surgical site to perform a robotic surgical procedure. The system may also include a controller that, in a surgical mode, causes scaled micro-movement at the surgical instrument in the micro-degree of freedom in response to a corresponding movement applied at the handle of the surgeon console, wherein the scaled micro-movement at the surgical instrument in the micro-degree of freedom is greater than the corresponding movement applied at the handle of the surgical console. The micro-movements applied at the surgical instrument may be independently scalable for each of the micro-degrees of freedom such that the scaled micro-movements at the first micro-degree of freedom are at a different scale than the second scaled micro-movements at the surgical instrument at the second micro-degree of freedom.

Further, the surgeon console may include a clutch that, when actuated, prevents micro-movement at the surgical instrument in response to micro-movement applied at a handle of the surgeon console. For example, the surgeon may articulate the instrument end effector via the handle to a certain position (e.g., using roll, pitch, and/or yaw degrees of freedom of the end effector), then actuate the clutch, move the handle back to a more ergonomic position while the instrument end effector remains stationary, and then release the clutch to continue relative micro-movement from the handle to the instrument end effector.

Drawings

FIG. 1 illustrates an exemplary remotely actuated surgical robotic system having a robotic telemanipulator constructed in accordance with the principles of the present invention.

FIG. 2A illustrates an exemplary host console constructed in accordance with the principles of the present invention.

Fig. 2B illustrates an exemplary display constructed in accordance with the principles of the present invention.

FIG. 2C illustrates another exemplary host console constructed in accordance with the principles of the present invention.

Fig. 3A shows the main console of fig. 2A in a seated configuration, and fig. 3B and 3C show the main console of fig. 2A in a standing configuration.

FIG. 4 illustrates an exemplary master console handle constructed in accordance with the principles of the present invention.

FIG. 5A illustrates an exemplary handle grip constructed in accordance with the principles of the present invention. Fig. 5B and 5C illustrate the handle grip of fig. 5A removably coupled with the main console handle of fig. 4A, according to principles of the present disclosure.

Fig. 5D-5F illustrate an exemplary handle grip removably coupled with a main console handle via a clamping attachment in accordance with the principles of the present disclosure.

Fig. 5G illustrates an exemplary sterile drape cover coupled to a main console handle in accordance with the principles of the present invention.

FIG. 6 illustrates an exemplary handle grip removably coupled with a main console handle via a threaded attachment in accordance with the principles of the present disclosure.

7A-7C illustrate actuation steps of the handle grip of FIG. 5A in accordance with the principles of the present invention.

Fig. 7D and 7E are cross-sectional views of the handle grip of fig. 5A coupled to a main console handle.

FIG. 8A illustrates another exemplary master console handle constructed in accordance with the principles of the present invention.

Fig. 8B and 8C illustrate movement of the handle grip of the main console handle of fig. 8A in accordance with the principles of the present invention.

Fig. 8D and 8E are internal views of the console handle of fig. 8A.

Fig. 8F and 8G illustrate an exemplary sterile drape interface according to principles of the present invention.

Fig. 9A-9C illustrate the handle grip of fig. 8A removably coupled with the main console handle of fig. 8A in accordance with the principles of the present disclosure.

Fig. 9D-9F illustrate the handle grip of fig. 8A decoupled from the main console handle of fig. 8A in accordance with the principles of the present disclosure.

Fig. 10A-10C illustrate yet another exemplary master console handle constructed in accordance with the principles of the present invention.

Fig. 11A and 11B illustrate an exemplary slave console constructed in accordance with the principles of the present invention.

Fig. 12 illustrates a left slave console constructed in accordance with the principles of the present invention.

Fig. 13A illustrates an exemplary controller of a remotely actuated surgical robotic system.

Fig. 13B illustrates another example controller of a remotely actuated surgical robotic system.

Fig. 14A-14E illustrate Scara (scakara) movement from a console according to the principles of the present invention.

Fig. 15A-15C illustrate vertical adjustment of the slave console according to the principles of the present invention.

FIG. 16 illustrates the slave console in a home configuration in accordance with the principles of the present invention.

Fig. 17A-17D illustrate movement of an exemplary translating instrument interface coupled to a slave console in a forward configuration during zero degree angulation of the slave console.

Fig. 18A-18D illustrate the forward surgical workspace of fig. 17A-17D.

Fig. 18E is a rear view of the slave console forward surgical workspace of fig. 18A-18D.

Fig. 19A-19C illustrate a forward surgical workspace of an exemplary instrument coupled to a slave console in a forward configuration during a twenty degree angulation of the slave console.

Fig. 20A-20C illustrate a forward surgical workspace of an exemplary instrument coupled to a slave console in a forward configuration during a forty degree angulation of the slave console.

Fig. 21A-21J illustrate flipping of a slave console between a forward configuration and a reverse configuration in accordance with the principles of the present invention.

Fig. 21K and 21L are schematic diagrams of a master console and a slave console during a forward configuration and a reverse configuration, respectively, in accordance with the principles of the present invention.

Fig. 22A-22C illustrate example translating instrument interfaces coupled to a slave console in a reverse configuration during zero, twenty, and forty degree angulations of the slave console, respectively.

Fig. 23A-23C illustrate the reverse surgical workspace of fig. 22A-22C.

FIGS. 24A-24D illustrate slave console adjustment for integrated laparoscopy according to the principles of the present invention.

Fig. 25 is a flow chart illustrating use of the remotely actuated surgical robotic system of fig. 1 in accordance with the principles of the present invention.

FIG. 26 is a flowchart illustrating the surgeon console positioning step of FIG. 25 in accordance with the principles of the present invention.

Fig. 27 is a flowchart illustrating the preparation steps of fig. 25 in accordance with the principles of the present invention.

Fig. 28 is a flow chart illustrating the instrument preparation steps of fig. 25 in accordance with the principles of the present invention.

Fig. 29 is a flowchart illustrating preliminary steps of the operation of fig. 25 in accordance with the principles of the present invention.

Fig. 30 is a flowchart illustrating the operational steps of fig. 25 in accordance with the principles of the present invention.

Fig. 31A and 31B illustrate an exemplary remotely actuated surgical robotic system having a hybrid telemanipulator constructed in accordance with the principles of the present invention.

Fig. 32A and 32B illustrate partially exploded perspective views of the surgical robotic system of fig. 31A and 31B.

FIG. 33 illustrates a partially exploded top view of an exemplary mechanical transmission system constructed in accordance with the principles of the present invention.

Fig. 34A and 34B illustrate side perspective views of an exemplary master unit constructed in accordance with the principles of the present invention.

Fig. 34C and 34D show an alternative embodiment of a handle suitable for use with the main unit depicted in fig. 34A and 34B.

Fig. 35A and 35B illustrate side perspective views of an exemplary slave unit constructed in accordance with the principles of the present invention.

Fig. 36A and 36B show an exemplary cross-sectional end view and a side internal perspective view of the hub, respectively.

Fig. 36C and 36D are a side perspective view of the instrument and a detailed interior view of the end effector, respectively, constructed in accordance with the principles of the present invention.

Fig. 36E is a detailed view of an alternative embodiment of an exemplary end effector.

Fig. 37 shows a flowchart illustrating exemplary method steps for identifying kinematics of a selected end effector.

Fig. 38 illustrates an alternative exemplary embodiment of a remotely actuated surgical robotic system of the present invention.

Fig. 39 shows an inside perspective view of the main unit of the remotely actuated surgical robotic system of fig. 38.

Fig. 40A and 40B are front and rear perspective views of the slave unit of the remotely actuated surgical robotic system of fig. 38.

Fig. 40C and 40D illustrate another exemplary incision indicator constructed in accordance with the principles of the present invention.

Fig. 41A and 41B are alternative schematic views of a control system suitable for use in the surgical robotic system of the present invention.

Fig. 1, an exemplary remotely actuated surgical robotic system 10 having a robotic telemanipulator is depicted. The surgical robotic system 10 includes a master console 20, the master console 20 being electrically and operatively coupled to a slave console 50 via, for example, a cable. As described in further detail below, the surgical robotic system 10 includes a macro-synchronization state in which a plurality of actuators (e.g., preferably motors) coupled to the slave console 50 apply translational macro movements to the end effector of the slave console 50 in response to movements applied at the master console 20 via a processor-driven control system, and a micro-synchronization state in which a plurality of actuators (e.g., preferably motors) coupled to the slave console 50 apply micro movements to the end effector of the slave console 50 in response to movements applied at the handle of the master console 20 via a processor-driven control system.

The control system may include a master controller 2 operatively coupled to right and left master remote manipulators 22a and 22b of the master console 20, and slave controllers 4a and 4b operatively coupled to right and left slave remote manipulators 51a and 51b, respectively, of the slave console 50. For example, the host controller 2 may include a non-transitory computer-readable medium, such as a memory, having instructions stored thereon that, when executed by one or more processors of the host controller 2, enable operation of the host console 20. Similarly, the slave controllers 4a and 4b may each include a non-transitory computer readable medium, such as a memory, having stored thereon instructions that, when executed by one or more processors of the respective slave controllers 4a, 4b, enable operation of the slave console 50. The master controller 2 is operatively coupled to the slave controllers 4a and 4b via a communication link such as a cable (as shown) or via wireless communication means.

The master controller 2 may be operatively coupled to one or more sensors of the master console 20, and the slave controllers 4a, 4b may be operatively coupled to one or more actuators of the slave console 50, such that the master controller 2 may receive signals indicative of movement imparted at the master console 20 through the one or more sensors of the master console 20 and execute instructions stored thereon to perform the coordinate transformations necessary to activate the one or more actuators of the slave console 50, send the processed signals to the respective slave controllers 4a, 4b, the slave controllers 4a, 4b execute the instructions stored thereon to move the slave console 50 in a manner corresponding to the movement of the master console 20 based on the processed signals. For example, the one or more actuators may include one or more motors. Alternatively, the master controller 2 may receive signals from one or more sensors of the master console 20, process the signals, and transmit the processed signals to the respective slave controllers 4a, 4b, the slave controllers 4a, 4b execute instructions stored thereon to perform coordinate transformation based on the processed signals, and execute instructions to activate one or more actuators of the slave console 50 to move the slave console 50 in a manner corresponding to the movement of the master console 20 based on the transformed processed signals. Preferably, the slave links and joints of the slave console 50 move in a manner such that the end effector/instrument tip replicates the movement imposed at the handle of the master console 20 without being offset from the remote center of motion during operation of the surgical robotic system 10, as described in further detail below. Thus, translational degrees of freedom (e.g., left/right, up/down, inward/outward), articulation degrees of freedom (e.g., pitch and yaw), actuation degrees of freedom (e.g., open/close), and rotational degrees of freedom (e.g., pronation and supination) are replicated electromechanically via sensors, actuators, and control systems, as described in further detail below.

According to one aspect of the present invention, the slave links and joints of the slave console 50 may be moved in a manner responsive to movements applied at the handle of the master console 20 such that the surgical instrument reproduces the movements applied at the handle of the master console 20 at a scaled degree. For example, the master controller 2 may receive signals from one or more sensors of the master console 20, process the signals, and transmit the processed signals to the respective slave controllers 4a, 4b, the slave controllers 4a, 4b execute instructions stored thereon to perform coordinate transformations based on the processed signals to generate signals indicative of correspondingly scaled movements, and execute instructions to activate one or more actuators of the slave console 50 to move the slave console 50 in a scaled manner corresponding to the movements of the master console 20 based on the transformed scaled processed signals. Thus, the surgeon may apply, for example, 30 degrees of micro-roll movement to the handle of the master console 20 such that the actuators of the slave console 50 cause the surgical instruments of the slave console 50 to perform micro-roll movements at a scaled degree of, for example, 60 degrees, resulting in scaled movements (e.g., 1:2) of the slave console 50 in response to the movement at the master console 20. Preferably, the micro-scaling causes greater micro-movement at the end effector than occurs at the handle. Each of the macro degrees of freedom (e.g., translation) and each of the micro degrees of freedom (e.g., articulation, actuation, and rotation) may be independently scaled such that corresponding movements at the slave console 50 in a given degree of freedom are selectably scaled as compared to movements applied by the surgeon at the master console 20. For example, a rotational micro degree of freedom may be programmed with correspondingly scaled movements between master and slave at a first scale (1:2), while an actuation and/or articulation micro degree of freedom may be programmed with correspondingly scaled movements between master and slave at a second scale (2:3) different from the first scale. A third scaling may be used for a third micro degree of freedom. As one of ordinary skill in the art will appreciate, the ratio of scaling may be, for example, 3:1, 2.5:1, 2:1, 1.5:1, 1:1.5, 1:2, 1:2.5, or 1:3, and may vary by degree of freedom. Advantageously, when micro-scaling requires a more scaled movement at the end effector than at the handle, the surgeon does not need to apply large movements on the handle of master console 20 to achieve the desired large movements made from the surgical instruments of console 50. This allows for more efficient aspects of robotic surgery (e.g., suturing) with reduced burden on the surgeon's hands/wrists/arms.

The master console 20 may be positioned in an operating room (in which a user, such as a surgeon, may be located) and close to the slave console 50 (at which the patient undergoing surgery may be located, such as a sterile field), so that the user may quickly move between the master console 20 and the slave console 50 during surgery to manually perform laparoscopy, if necessary. Thus, the slave console 50 is designed to effectively retract to a configuration that allows the surgeon to access the surgical site on the patient, as described in further detail below. The master console 20 may be covered with sterile drapes and may include a removable handle that can be removed and sterilized between surgeries such that the handle is sterile during the surgeries and there are no physical barriers between the handle and the surgeon's hands, thus improving surgeon control and performance. The removable handle may be purely mechanical without electronics such as circuitry, sensors, or electrically coupled buttons, so that the removable handle may be easily sterilized between surgeries. In this way, the master console can be sterile during surgery, while allowing the surgeon to have tactile feedback available from the handle that directly contacts the robot.

As shown in fig. 1, the main console 20 includes a right main remote manipulator 22a and a left main remote manipulator 22 b. The right master remote manipulator 22a and the left master remote manipulator 22b may be positioned on a single master console such that when the surgeon is located at the master console 20, the right master remote manipulator 22a may be manipulated by the surgeon's right hand and the left master remote manipulator 22b may be manipulated by the surgeon's left hand. Thus, master console 20 may include wheels for mobility within the operating room, as well as wheel locks that may be actuated to lock the remote manipulators in place (e.g., during storage or during use by the surgeon during surgery). In addition, the right master remote manipulator 22a and the left master remote manipulator 22b may be operated simultaneously and independently of each other, for example, by the right and left hands of the surgeon. Preferably, the surgical robotic system 10 is preferably used in a surgical procedure.

As further shown in fig. 1, the slave console 50 includes a right slave remote manipulator 51a operatively coupled to the right master remote manipulator 22a, and a left slave remote manipulator 51b operatively coupled to the left master remote manipulator 22 b. The right slave telemanipulator 51a and the left slave telemanipulator 51b may be located on separate consoles, such that the right slave telemanipulator 51a may be located on the right side of the patient undergoing the surgical procedure and the left slave telemanipulator may be located on the left side of the patient. Thus, left slave remote manipulator 51a and right slave remote manipulator 51b may each include wheels for mobility within the operating room, and floor latches that may be actuated to lock the remote manipulators in place (e.g., during storage) or to the vicinity of the patient (during surgery). In addition, the left slave remote manipulator 51a and the right slave remote manipulator 51b may each include a pull rod for pushing and pulling the remote manipulators in the operating room.

Further, the camera system may be used with the surgical robotic system 10. For example, a camera (e.g., an endoscope) manipulated by an assistant located at the slave console 50 may be operated and/or held in place at the slave console 50. Accordingly, the camera system may include a display 21, the display 21 being mounted on the master console 20 in a position that is easily viewed by the surgeon during the surgical routine. Display 21 may display status information on surgical robotic system 10 and/or display the surgical site captured by the endoscopic camera to the surgeon in real-time.

Referring now to FIG. 2A, an exemplary host console 20 is depicted. As described above, the main console 20 includes the right master remote manipulator 22a and the left master remote manipulator 22 b. Since left master remote manipulator 22b may be a structural mirror image version of right master remote manipulator 22a as shown, the following description of right master remote manipulator 22a also applies to left master remote manipulator 22 b.

The master remote manipulator 22a includes a plurality of master links, e.g., a first master link 26, a second master link 28, a third master link 30, and a fourth master link (e.g.,a guided master link) 32 interconnected by a plurality of master joints, such as a first master joint 25, a second master joint 27, a third master joint 29, a fourth master joint 31, and a fifth master joint 34. As shown in fig. 1, the handle portion 35 is connected to the master remote manipulator 22a via a joint 34, and includes a plurality of handle links interconnected by a plurality of handle joints for operating the master remote manipulator 22 a. In addition, the master remote manipulator 22a includes a base portion having telescoping bases 23a and 23b, and a base cover 24 secured atop the telescoping bases 23a and 23 b. The link 26 is rotatably coupled to the base cover 24 via a joint 25. Thus, link 26, and correspondingly all the primary joints and links distal to link 26, may be at joint 25 about axis δ relative to base cover 24₁And (4) rotating. As shown in FIG. 1, link 28, and correspondingly all of the primary joints and links distal to link 28, may be at joint 27 about axis δ relative to link 26₂Rotation, link 30 and correspondingly all the primary joints and links distal to link 30 may be about axis δ relative to link 28 at joint 29₃Rotates, and the pilot master link 32 and correspondingly all master joints and links distal to the pilot master link 32 may be at joint 31 about axis δ relative to link 30₄And (4) rotating.

The master console 20 includes a plurality of sensors positioned within the master remote manipulator 22a so that any movement applied to any master links and joints can be sensed and transmitted to the control system, which will then execute instructions to cause one or more actuators coupled to the slave console 50 to replicate the movement on the corresponding slave links and joints of the slave remote manipulator 51a, as described in more detail below with reference to fig. 12.

Still referring to fig. 2A, the master remote manipulator 22A includes a mechanical constraint 33 comprising an opening in the link 26 sized and shaped to allow the guide master link 32 to be positioned therethrough, thereby constraining movement of the master remote manipulator 22A about a pivot point at the master remote manipulator 22A. For example, the mechanical constraint 33 ensures that the master link 32 is guided along the longitudinal axis δ when the master remote manipulator 22a is actuated₅And (4) translating. Furthermore, the mechanical constraint 33 enables the guiding master links 32 to be wound around each otherVertical axis delta₁And delta₆Rotate to create a plane with the stationary pivot point P and the longitudinal axis δ₅Intersecting regardless of the orientation of the pilot master link 32. As a result, corresponding movement is generated from the remote manipulator, effectively maintaining the pivot point of the master remote manipulator at, for example, a fixed incision point on the patient where the trocar enters the patient's abdomen.

When the surgical robotic system 10 is positioned such that the remote center of motion V is aligned with the patient incision, the translational movement imparted to the handle portion 35 is replicated by the end effector disposed within the patient. This arrangement advantageously eliminates the fulcrum effect between the handle and the end effector because the end effector replicates the movement imparted to the handle portion 35.

In addition, the master console 20 may include an arm support 12, for example, coupled to the base cover 24, the arm support 12 being sized and shaped to allow a surgeon to rest a surgeon's arm on the arm support during operation of the master console 20. Accordingly, the arm support 12 remains stationary during operation of the master remote manipulator 22 a. The master console 20 may also include a clutch 11, such as a foot pedal, which clutch 11, when actuated, prevents macro-synchronization and/or micro-synchronization of the surgical robotic system 10, as described in further detail below. Thus, the main console 20 allows macro clutching and micro clutching.

Referring now to FIG. 2B, display 21 is depicted. The display 21 may have a simple design that does not use text, but only utilizes visible graphical elements and LEDs (e.g., white, yellow, and red). For example, a white light indicates that the component is functioning properly, a yellow light indicates that the surgeon has taken inappropriate action, and a red light indicates that the component is faulty. As shown in fig. 2B, the display 21 graphically displays various components of the slave console 50 and their states. Icon 21a corresponds to the start of the system, icon 21b corresponds to the system warning, icon 21h corresponds to the working limit that has been reached, and icon 21j corresponds to whether the respective slave telemanipulator of slave console 50 is in the forward surgical workspace or the reverse surgical workspace, all of which may not be visible when not lit, while all other icons have visible graphical elements even when not lit. Icon 21c corresponds to a homing of the slave console 50, e.g. in-situ configuration, icon 21d corresponds to the status of the instrument 82, icon 21e corresponds to translating the sterile interface of the instrument interface 81, icon 21f corresponds to macro-synchronization, icon 21g corresponds to micro-synchronization, and icon 21i corresponds to whether the wheels of the slave console 50 are locked or unlocked, the function of all of which will be described in further detail below. As will be appreciated by one of ordinary skill in the art, the display 21 may be any display known in the art that can convey information to a surgeon.

Fig. 2C shows another exemplary master console similar to that shown in fig. 2A, except that the master console 20 in fig. 2C also includes an additional clutch 11', such as an additional foot pedal. In this manner, actuation of the clutch 11 allows the master/slave to transition between one type of synchronization/desynchronization (e.g., for macro movement), and actuation of the clutch 11' allows the master/slave to transition between another type of synchronization/desynchronization (e.g., for micro movement, for both micro and macro movement), as described in further detail below. Thus, independently actuatable macro and micro clutching are allowed. Alternatively or additionally, different predetermined actuation patterns at clutch 11 and/or clutch 11' (e.g., pressing the pedal multiple times over a predetermined time versus pressing the pedal once over a predetermined time) may be used for independently actuatable macro and micro clutching.

Referring now to fig. 3A-3C, master control station 20 may be adjusted between a seated configuration and a standing configuration via telescoping bases 23A and 23 b. For example, as shown in fig. 3A, master console 20 may be adjusted to a seated configuration such that telescoping bases 23A and 23b have a vertical height D₁. In this seated configuration, the surgeon may sit down during operation of master console 20. As shown in fig. 3B and 3C, master control station 20 may be adjusted to a standing configuration such that telescoping bases 23a and 23B have a vertical height D₂. In this configuration, the surgeon may stand during operation of master console 20. In addition to this, the present invention is,the vertical height of the telescopic bases 23a and 23b may be adjusted via an actuator positioned on the main console 20 (e.g., on the master link 26). For example, the actuator may comprise an up button and a down button which, when actuated, respectively increase or decrease the vertical height of the telescopic bases 23a and 23 b. As will be appreciated by those of ordinary skill in the art, the vertical height of the telescoping bases 23a and 23b may be adjusted to D as desired by the surgeon₁And D₂Any vertical height in between.

Referring now to FIG. 4, the main console handle portion 35 is depicted. The main console handle portion 35 includes a plurality of handle links, such as handle link 36 and handle link 38, interconnected by a plurality of handle joints, such as handle joint 37 and handle joint 39. As shown in fig. 4, handle link 36 is rotatably coupled to guide master link 32 via joint 34, and thus may be about axis δ relative to guide master link 32₇And (4) rotating. In addition, handle link 38 is rotatably coupled to handle link 36 via handle joint 37, and thus may be about axis δ relative to handle link 36₈And (4) rotating. Further, the handle grip 40 may be removably coupled to the main console handle portion 35 at a joint 39 such that the handle grip 40 may be about an axis δ relative to the handle link 37₉And (4) rotating. As shown in fig. 4, the handle grip 40 may include finger bands 41 for engaging the surgeon's fingers (e.g., thumb and forefinger).

The inward/outward movement of the handle portion 35 guides the main link 32 along the longitudinal axis δ₅Inward/outward movement, movement of the pilot master link 32 is sensed by one or more sensors coupled to the master remote manipulator 22a and transmitted to the control system, which then executes instructions to cause one or more actuators coupled to the slave remote manipulator 51a to cause the corresponding slave link to replicate about the virtual longitudinal axis ω₉Inward/outward movement. Similarly, upward/downward movement of the handle portion 35 causes the guide master link to be oriented along the longitudinal axis δ₆Move up/down, the movement of the pilot master link is sensed by one or more sensors coupled to the master remote manipulator 22a and transmitted to the control system, which thenExecuting instructions to cause one or more actuators coupled to the slave remote manipulator 51a to cause corresponding slave link replicas about the virtual longitudinal axis ω₁₀Up/down movement of the slide. Finally, the leftward/rightward movement of the handle portion 35 causes the guided main link to move along the longitudinal axis δ₁To the left/right, the movement of the pilot master link is sensed by one or more sensors coupled to the master remote manipulator 22a and transmitted to the control system, which then executes instructions to cause one or more actuators coupled to the slave remote manipulator 51a to cause the corresponding slave link to replicate about the virtual longitudinal axis ω₅To the left/right.

Still referring to fig. 4, the movements imparted at the handle portion 35 of the master remote manipulator 22a electromechanically actuate articulation degrees of freedom (e.g., pitch and yaw), actuation degrees of freedom (e.g., open/close), and rotation degrees of freedom (e.g., pronation and supination) via the sensors, actuators, and control system. The master remote manipulator 22a preferably includes one or more sensors coupled to the handle portion 35 to detect movement of the handle portion 35. It will be appreciated that the sensor may be any sensor designed to detect rotational movement, such as a magnetic-based rotation sensor comprising a magnet on one side and a sensor on the other side to measure rotation by measuring angle and position. The sensors are coupled to the control system for generating signals indicative of the rotation measured by the sensors and transmitting the signals to one or more actuators coupled to the slave console 50 that can reproduce the movements imparted on the handle portion 35 to the end effector. For example, a cable may extend from the handle portion 35 to a control system, e.g., a unit containing control electronics and additional cables may extend from the control system to one or more actuators coupled to the slave console 50.

As shown in fig. 5A, the handle grip 40 includes triggers 41a, 41b, the triggers 41a, 41b being biased toward an open configuration. Thus, the triggers 41a, 41b may be actuated to generate signals that are transmitted via a control system that executes instructions that cause actuators coupled to the slave console 50 to actuate the end effector on/off.

Referring again to FIG. 4, the handle grip 40 may be about a handle axis δ₉Rotation such that rotation of the handle grip 40 is detected by a sensor that generates a signal and transmits the signal via a control system that executes instructions that cause an actuator coupled to the slave console 50 to cause rotation of the end effector in a pronation and supination degree of freedom.

The handle portion 35 also being about the handle axis delta₈Rotatable so as to be about a handle axis delta₈Is detected by a sensor that generates a signal and transmits the signal via a control system that executes instructions that cause an actuator coupled to the slave console 50 to cause movement of the end effector in a yaw degree of freedom. In addition, the handle portion 35 may be about a handle axis δ₇Rotated so that the handle portion 35 is about the handle axis delta₇Is detected by a sensor that generates a signal and transmits the signal via a control system that executes instructions that cause an actuator coupled to the slave console 50 to cause movement of the end effector in a pitch degree of freedom.

As shown in fig. 5B and 5C, the handle grip 40 may be removably coupled to the handle portion 35 of the master remote manipulator 22a via a joint 39. Thus, the handle grip 40 may be removed for sterilization between surgeries and the handle grip 40 reconnected to the master telemanipulator 22a just prior to one surgery. Thus, since the entire main console 20 may be covered by sterile drape during operation of the surgical robotic system 10, the handle grip 40 will be sterile and may be connected to the main console 20 outside of the sterile drape. This allows the surgeon to directly contact the handle grip 40 without a physical barrier between the two, thereby improving tactile feedback and overall performance.

Referring now to fig. 5D-5F, the handle grip 40 may be removably coupled to the handle portion 35 of the main console 20 via a grip attachment. As shown in fig. 5D-5F, a spring 43 may be connected to the knuckle 39 of the handle portion 35 and the grip portion 42 of the handle grip 40 to preload the attachment to eliminate fixed play.

As shown in fig. 5G, the sterile drape cover 13 may be removably coupled to the main console handle portion 35 in accordance with the principles of the present invention. As described above, master console 20 may be covered with sterile drape 14 during a surgical procedure while allowing the surgeon to obtain tactile feedback through direct contact with the robotic handle. Sterile drape interface 14 includes a sterile drape ring 14a defining an opening 14b within sterile drape interface 14, and a sterile drape 14c coupled to sterile drape ring 14 a. When the handle grip is not attached to the main console 20, such as during sterilization and/or cleaning, the sterile drape cover 13 may be temporarily coupled to the sterile drape ring 14a and the main console handle portion 35 to avoid inadvertent contact by the clinician with the interior of the main console handle interface. For example, the sterile drape cover 13 may fit over the main console handle portion 35 and be held in place via methods known in the art (including but not limited to magnets, friction, velcro surfaces, mating geometries, hooks, etc. systems). When the handle grip is ready to be coupled to the main console handle portion 35, the sterile drape cover 13 may be removed and discarded. The sterile drape ring 14a is preferably formed of a rigid material (e.g., metal) and is designed to be sandwiched between the main console 20 (e.g., at the main console handle portion 35) and the handle grip when the handle grip is coupled to the main console. This provides for securely coupling sterile drape 14c to the main console using a removable handle. Furthermore, when the handle grip is removed for sterilization for further surgery, sterile drape interface 14 may be easily removed from the main console. Opening 14b of sterile drape interface 14 allows components of the handle to move into the main console in response to actuation by the surgeon through opening 14b of sterile drape interface 14 without disturbing sterile drape 14 c. This ensures sterile surgery while allowing interaction between the removable handle and the main console.

According to another aspect of the present disclosure, as shown in FIG. 6, the handle grip 40 'may be removably coupled to the handle portion 35' of the main console 20 via a threaded attachment. As shown in FIG. 6, the threaded portion 42 'of the handle grip 40' having an inner threaded portion 44a may engage the outer threaded portion 44b at the joint 39 'of the handle portion 35' such that the handle grip 40 'is threaded onto the handle portion 35'.

Referring now to fig. 7A-7C, the actuation steps of the handle grip 40 are described. As shown in fig. 7B and 7C, the handle grip 40 includes a telescoping piston 45 positioned within a central cavity of the handle grip 40. The telescoping piston 45 is mechanically coupled to the triggers 41a, 41b of the handle grip 40 via connectors 46a, 46b, respectively. As shown in fig. 7A, when the triggers 41a, 41b are in a relaxed state, e.g., biased toward an open configuration, the telescoping piston 45 is entirely within the central cavity of the handle grip 40. As shown in fig. 7B and 7C, when the handle grip 40 is actuated, e.g., the triggers 41a, 41B are pressed toward each other, the connectors 46a, 46B extend the telescoping piston 45 out of the central cavity of the handle grip 40. Movement of the telescoping piston 45 beyond the central cavity of the handle grip 40 may be sensed by sensors within the handle portion 35.

For example, as shown in fig. 7D and 7E, a portion of the main console near where the handle grip 40 is removably coupled to the handle portion 35 may include one or more sensors 47 for sensing movement at the handle portion 35. Accordingly, the one or more sensors 47 may transmit signals indicative of the movement of the telescoping piston 45 to the control system, and the control system may execute instructions to cause the one or more actuators to cause movement by the end effector. This may be used as a fail-safe (fail-safe) because without sensor 47 sensing movement of telescoping piston 45, the control system would not instruct the actuator to cause movement by the end effector. For example, when the triggers 41a, 41b of the handle grip 40 are in a relaxed state, no movement is sensed due to small incidental movements of the triggers 41a, 41b until the triggers 41a, 41b are purposefully actuated by the surgeon. Thus, the triggers 41a, 41b may have to be actuated at least a predetermined amount to extend the telescoping piston 45 beyond the central lumen of the handle grip 40. Further, as shown in fig. 7D and 7E, the handle portion 35 may include a spring 48 for urging against the telescopic piston 45 to bias the triggers 41a, 41b in the open configuration via the connectors 46a, 46 b.

Referring now to fig. 8A-8G, another exemplary handle grip is provided. The handle grip 71 is configured to couple to the main console handle portion 35 at the sterile drape interface 14 (e.g., by sandwiching the sterile drape ring 14a between the main console handle portion 35 and the movable outer flange to clamp the components together). The handle grip 71 includes triggers 72a and 72b that are biased into an open configuration. For example, as shown in FIG. 8B, the triggers 72a, 72B may be biased to be separated by, for example, 150 degrees and 160 degrees, or preferably 155 degrees, when the clinician is not applying any force to the triggers 72a, 72B. At any time, when the clinician releases the trigger 72a, 72b, the trigger 72a, 72b will return to the predetermined open configuration. The triggers 72a, 72b may be biased to the open configuration via a spring, as described above with reference to triggers 41a, 41 b. As with the handle grip 40, the triggers 72a, 72b of the handle grip 71 may have to be pressed apart from each other by a first predetermined angle before the control system executes instructions to cause the one or more actuators to cause movement at the surgical instrument. For example, as shown in fig. 8C, the actuator will not cause movement of the plurality of slave links and slave joints or end effectors until the triggers 72a, 72b are depressed such that the triggers 71a, 72b are within a first predetermined angle, e.g., 90 degrees or less apart. This may serve as a failsafe to prevent small incidental movements of the triggers 72a, 72b from being replicated by the end effector until the triggers 72a, 72b are purposefully actuated by the surgeon. For example, the triggers 72a, 72b must be pressed within 90 degrees of each other (or another preset angle) before the plurality of slave links and slave joints move in response to movement of at least one of the plurality of master links and master joints. If the surgeon releases the triggers 72a, 72b, the slave console will cease moving in response to movement at the master console. In this manner, the surgeon may readjust multiple master links and master joints to different desired configurations without causing corresponding movement at any slave links or joints. This allows the surgeon to readjust the master console to a more comfortable position without moving the slave console. Once the triggers 72a, 72b are reengaged to the first predetermined angle or less, the controller will cause corresponding movement from the console in response to movement at the handle. The handle grip 71 also includes a palm extension 72c that extends from the trigger in the direction of the surgeon's palm so that the surgeon's palm may contact the palm extension 72c when performing the surgical procedure for ergonomic purposes.

Further, although the controller will not cause movement at the slave console unless the surgeon engages the handle in a predetermined manner (e.g., the triggers 72a, 72b move toward each other within a first predetermined angle or less), the controller will also not cause micromotion at the end effector unless the surgeon engages the handle in a second predetermined manner. For example, the second predetermined manner may be to move the triggers 72a, 72b toward each other by a second predetermined angle (e.g., 30 degrees apart) or less, wherein the second predetermined angle is less than the first predetermined angle. In this manner, the slave console will not move in response to movement at the handle/master console unless the controller senses a first actuation pattern at the handle (e.g., the triggers 72a, 72b move toward each other within a first predetermined angle or less), and the end effector will not open/close unless the controller senses a second actuation pattern at the handle (e.g., the triggers 72a, 72b move toward each other within a second predetermined angle or less).

Referring now to fig. 8D and 8E, the internal components of the handle grip 71 are described. As shown in fig. 8D and 8E, the handle grip 71 has a release grip 76 coupled to the coaxial retraction tube 74 such that retraction of the release grip 76 causes the retraction tube 74 to retract 11. The retraction tube 74 has a plurality of apertures 75 corresponding to the plurality of hooks 73 such that each hook 73 protrudes through each aperture 75 when the release grip 76 and the retraction tube 74 are in a relaxed state. For example, the handle grip 71 may have one, two, three, or four hooks. The hook 73 has an angled surface, e.g., angled away from the direction in which the handle grip 71 is coupled to the main console, such that when the retraction tube 74 is retracted via the release grip 76, the edge of the aperture 75 moves over the angled surface of the hook 73, causing the hook 73 to bend radially inward toward the central axis of the retraction tube 74. When the release handle 76 is released, both the release handle 76 and the retraction tube 74 return to their relaxed state, allowing the aperture 75 to realign with the hook 73 such that the hook 73 protrudes through the aperture 75.

The main console handle portion 35 includes an angular orientation constraint 80b having a geometry corresponding to the angular orientation constraint 80a of the handle grip 71 such that the retraction tube 74 can be inserted into the lumen of the angular orientation constraint 80b in a particular rotational orientation. As shown in fig. 8E, the angular orientation constraint 80b includes one or more grooves 77 on its inner surface having a geometry corresponding to the hooks 73 such that when the tube is retracted into the cavity of the angular orientation constraint 80b and the hooks 73 protrude through the apertures 75, the hooks 73 will engage the grooves 77. There may be a plurality of grooves corresponding to the plurality of hooks 73, or the groove 77 may extend completely circumferentially along the inner surface of the angular orientation constraint 80 b. In addition, the handle grip 71 may include an actuation rod 78, the actuation rod 78 sized to fit within the cavity of the preload spacer 86 and interact with the actuation rod 79 of the main console. For example, the actuation rod 79 may extend a predetermined distance within the preload spacer 86 to push against the actuation rod 78 of the handle grip 71 for biasing the triggers 72a, 72b in the open configuration, as described above.

The preload spacer 86 may be coupled to the preload spring 85 such that when the handle grip 71 is engaged with the main console handle portion 35, the preload spacer pushes against the handle grip 71. Thus, when the hook 73 engages the groove 77, the preload spacer 86 pushes against the handle grip 71 to keep the hook 73 positioned within the groove 77 and eliminate any gaps. Specifically, the rear edge of the hook 73 is pushed against the rear edge of the groove 77 to prevent lateral movement of the handle grip 71 relative to the main console handle portion 35 when the handle grip 71 is engaged.

As shown in fig. 8F, the release grip 76 may have a textured surface so that the release grip 76 is easily retracted by the clinician when coupling and decoupling the handle grip 71 from the main console handle portion 35. As shown in fig. 8F and 8G, when the handle grip 71 is engaged with the main console handle portion 35, the release grip 76 is engaged with the sterile drape interface 14 so that the handle grip 71 may still rotate freely. As shown in fig. 8F, sterile drape ring 14a of sterile drape interface 14 (which has sterile drape 14c coupled to sterile drape ring 14 a) is snapped onto main console handle portion 35 so that sterile drape 14c maintains the sterility of the main console during operation.

Referring now to fig. 9A-9C, steps of coupling the handle grip 71 to the main console are shown. Fig. 9A shows the release grip 76 of the handle grip 71 in a relaxed state with the hook 73 protruding through the aperture 75 of the retraction tube 74. Fig. 9B illustrates retraction of the release grip 76 when the edge of the aperture 75 moves the hook 73 radially inward so that the retraction tube 74 may be inserted into the lumen of the angular orientation constraint 80B. When the retraction tube 74 is fully inserted into the lumen of the angular orientation constraint 80b, the release grip 76 may be released, as shown in fig. 9C, to allow the hook 73 to protrude through the aperture 75 of the retraction tube 74 and engage the groove 77 in the relaxed state. Fig. 9C shows the handle grip 71 coupled to the main console handle portion 35.

Referring now to fig. 9D-9F, the steps of decoupling the handle grip 71 from the main console are shown. Fig. 9D shows the release handle 76 retracted such that the edge of the aperture 75 moves the hook 73 radially inward and out of engagement with the groove 77. Once disengaged, the handle grip 71 may be removed from the main console as shown in fig. 9E. When the handle grip 71 is decoupled from the main console, the release grip 71 may be released and returned to its relaxed state with the hook 73 protruding through the aperture 75 of the retraction tube 74.

In accordance with another aspect of the present invention, as shown in fig. 10A-10C, the handle grip 40 "may be removably coupled to the handle portion 35 of the master remote manipulator 22 a. For example, the handle grip 40 "may have a pistol shape including a handle and a trigger 49 for performing a desired surgical task. As one of ordinary skill in the art will appreciate, various shaped handle grips may be removably coupled to the master telemanipulator to actuate a desired movement by an end effector of the slave telemanipulator. Thus, the handle grip may have an integrated identifier element, such as an RFID tag, so that the control system detects the identifier element and identifies whether the handle grip is authorized for use with the surgical robotic system 10.

Referring now to fig. 11A and 11B, the slave console 50 is described. As shown in fig. 11A, the slave console 50 includes a right slave remote manipulator 51A and a left slave remote manipulator 51 b. Since the left slave remote manipulator 51b may be a structural mirror image version of the right slave remote manipulator 51a as shown, the following description of the right slave remote manipulator 51a also applies to the left slave remote manipulator 51 b.

As shown in fig. 12, the slave telemanipulator 51a includes a plurality of slave links, e.g., a first slave link 55, a second slave link 57, a third slave link 59, a fourth slave link (e.g., an angulation link) 61, a fifth slave link 63, a sixth slave link 65, a seventh slave link 67, and an eighth slave link (e.g., a slave hub) 69 interconnected by a plurality of slave joints, e.g., a first slave joint (e.g., a proximal Scara joint) 54, a second slave joint (e.g., a medial Scara joint) 56, a third slave joint (e.g., a distal Scara joint) 58, a fourth slave joint (e.g., an angulation joint) 60, a fifth slave joint (e.g., an alpha joint) 62, a sixth slave joint (e.g., a beta joint) 64, a seventh slave joint (e.g., a gamma joint) 66, and an eighth slave joint (e.g., a west tower joint 68). As shown in fig. 12, the translating instrument interface 81 is coupled to the slave telemanipulator 51a via the theta joint 68.

The translation instrument interface 81 may be constructed as described in U.S. patent application publication No.2018/0353252 to chaplot, assigned to the assignee of the present application, the disclosure of which is incorporated herein by reference in its entirety. For example, translating instrument interface 81 includes slave hub 69 and a surgical instrument. As shown in fig. 11B, a slave hub 69 may be fixed to the link 67 of the slave telemanipulator 51 a. The surgical instrument includes an end effector disposed at a distal end of a shaft of the surgical instrument and may be coupled to a slave hub 69. For example, the end effector may be removably coupled to the slave hub 69. A sterile interface may be positioned between the slave hub 69 and the surgical instrument. In addition, translating instrument interface 81 includes a translation transmission system that extends from one or more actuators positioned within hub 69 to components of the end effector. For example, the end effector includes a plurality of end effector links interconnected by a plurality of end effector joints coupled to a translation drive system of the translation instrument interface 81 such that actuation of the translation drive system by one or more actuators causes movement of the end effector via the plurality of end effector links and joints.

In addition, the slave remote manipulator 51a includes a base portion 52 having an adjustable post and a slave support 53 fixed on top of the adjustable post. The link 55 is rotatably coupled to the slave support 53 via a proximal Scara joint 54. Thus, the link 55 and correspondingly all slave joints distal to the link 55 and the link may be at the proximal Scara joint 54 about the axis ω relative to the slave support 53₁And (4) rotating. As shown in FIG. 12, link 57, and correspondingly all slave joints and links distal to link 57, may be at a meso Scara joint 56 about axis ω with respect to link 55₂Rotation, link 59 and correspondingly all slave joints and links distal to link 59 may be about axis ω with respect to link 57 at distal Scara joint 58₃Rotation, the angled link 61 and, correspondingly, all slave joints and links distal to the angled link 61 can be at the angled joint 60 about the axis ω with respect to the link 59₄In rotation, link 63, and accordingly all slave joints and links distal to link 63, may be at alpha joint 62 about alpha axis ω with respect to angled link 61₅Rotation, link 65 and correspondingly all slave joints and links distal to link 65 may be about beta axis ω relative to link 63 at beta joint 64₆Rotation, link 67 and correspondingly all slave joints and links distal to link 67 may be about gamma axis ω relative to link 65 at gamma joint 66₇Rotating, and correspondingly translating instrument interface 81, from hub 69 (when translating instrument interface 81 is coupled to hub 69) may be about theta axis ω with respect to link 67 at theta joint 68₈And (4) rotating.

The column integrated into the slave support 53 contains an actuator, for example an electric motor, which allows to extend and retract the column, thus adjusting the height of all the links distal to the slave support 53 with respect to the ground. Alternatively, instead of a post integrated into the slave support 53, the slave support 53 may include a mechanical linear guide system with a counterweight based counterbalance system and an electric brake to resist vertical movement. Thus, when the electric brake is released, the vertical height of all the links on the far side from the support 53 with respect to the ground can be adjusted. Proximal Scara joint 54, median Scara joint 56, and distal Scara joint 58 each contain an electric brake that can prevent movement of the corresponding joint when the corresponding brake is engaged, and that allows manual movement of the corresponding joint when the corresponding brake is released. The angled joint 60 includes an actuator, such as an electromagnetic motor, that allows adjustment of the angular position of the link 61 about the link 59. The alpha joint 62, beta joint 64, gamma joint 66, and theta joint 68 are each linked to a dedicated pair of electromagnetic motors and brakes so that the control system can adjust the angular position of each joint by applying position commands to the respective motors and stop any movement of the joints by activating the respective brakes.

As will be appreciated by those of ordinary skill in the art, the slave console 50 may include a plurality of sensors and the master console 20 may include a plurality of actuators such that movement imparted at the slave console 50 may cause movement imparted at the master console 20, thereby providing haptic feedback.

Referring now to fig. 13A, the controller 70 is depicted. Controller 70 may be a remote controller or graphical user interface operatively coupled to the control system of surgical robotic system 10, or a series of actuators integrated into left and right telemanipulators 51a and 51b, respectively. Thus, the controller 70 may include multiple actuators, such as buttons or a touch screen interface, whereby a user may select multiple options via touch. For example, the controller 70 may provide the user with an option to select at least one of the following commands: scara brake engagement and release 70a, park position configuration 70b, tip-over from forward gear to reverse gear or reverse gear to forward gear 70c, vertical adjustment from console 70d, vertical post brake release 70e, laparoscope configuration 70f, home configuration 70g, and increase and decrease forward angulation 70 h. The controller 70 is operably coupled to one or both of the slave controllers and/or the master controller. As shown in fig. 13A, the controller 70 may be integrated into the linkage of the slave console itself. For example, the controller 70 is integrated into the third slave link 59' of the left slave remote manipulator 51b to control a certain function of the slave remote manipulator in response to a user input, and the second controller having the same function is integrated into the slave link (e.g., the third slave link) to control a certain function of the slave remote manipulator (e.g., the right slave remote manipulator 51a) in response to a user input.

For example, when the user actuates the Scara brake engage and release 70a interface, the controller will transition the Scara brake from engaged to released and vice versa. When the user actuates the parking position configuration 70b interface, the controller will cause the slave remote manipulator to move to a position suitable for transport and storage. When the user actuates the reverse gear to reverse gear or reverse gear to forward gear 70c, the controller will move the slave telemanipulator between the forward surgical workspace and the reverse surgical workspace. When the user actuates the vertical adjustment 70d of the slave console, the controller will cause vertical adjustment of the slave telemanipulator. When the user actuates the vertical column brake release 70e, the controller will transition the vertical column brake from engaged to released and vice versa to respectively prevent or allow vertical adjustment from the remote manipulator. When the user actuates the laparoscopic configuration 70f, the in situ configuration 70g, the controller will move the slave hub away from the patient undergoing the surgical procedure so that the surgeon can quickly and safely move from the master console to the surgical site of the patient to manually perform the laparoscopic routine on the patient. When the user actuates to increase and decrease the forward angulation 70h, the controller will cause an adjustment of the forward angulation from the remote manipulator. In response to user input at the controller 70, the corresponding slave controller executes instructions stored thereon to execute the command(s) input by the user as explained below. Each slave console may include its own dedicated controller 70, or a common controller 70 may be used for both slave consoles.

Referring now to fig. 13B, a controller 70' is depicted. The controller 70 'is configured similarly to the controller 70, except that the controller 70' is a remote controller that is separate from the console and powered by a wired or wireless connection. Thus, the controller 70' may be removed and operated at a distance away from the console for the convenience of the clinician and/or operator.

For example, as shown in fig. 14A-14E, the controller 70 may allow the user to release the brakes in the proximal Scara joint 54, the median Scara joint 56, and the distal Scara joint 56 so that the surgeon may manually reposition the slave arm horizontally by grasping, holding, and pushing/pulling the slave arm link distal to the proximal Scara joint 54 while the slave support 53 of the slave telemanipulator remains stationary. In particular, during Scara movement, the slave links 55, 57, 59 may be allowed to rotate about the axis ω at joints 54, 56, and 58₁、ω₂、ω₃While the slave support 53 of the slave telemanipulator remains stationary and while the slave joint distal to the slave link 59 and the link are fixed relative to the slave link 59. Thus, the user may adjust the distal end of the slave telemanipulator (e.g., from hub 69) to a desired position over the patient undergoing the surgical procedure.

As shown in fig. 15A-15C, the controller 70 may allow the user to select the vertical adjustment commanded from the console, whereby the control system will execute instructions to extend or retract an actuator (e.g., a motor) coupled to a post in the slave support 53. Specifically, during vertical adjustment of the slave telemanipulator, the relative distance between the slave link 55 and the top surface of the base portion 52 of the slave telemanipulator may be adjusted. For example, as shown in fig. 15A, the vertical distance between the slave link 55 and the top surface of the base portion 52 of the slave telemanipulator is H₁As shown in fig. 15B, the vertical distance between the slave link 55 and the top surface of the base portion 52 of the slave manipulator is H₂And as shown in fig. 15C, the vertical distance between the slave link 55 and the top surface of the base portion 52 of the slave manipulator is H₃. Thus, the user can adjust the relative distance between the slave link 55 and the top surface of the base portion 52 of the slave telemanipulator to a desired height above the patient undergoing the surgical procedure. In embodiments where the slave console includes a mechanical linear guide system with a counterweight-based counterbalance system, the controller 70 may allow the user to select the vertical adjustment commanded from the console, whereby the control system will execute instructions to cause the electricity in the column to be electricityThe brake will be released so that the mechanical counter-balance linear guide system can be moved up or down, thereby adjusting the relative distance between the slave link 55 and the top surface of the base portion 52 of the slave telemanipulator to a desired height above the patient undergoing the surgical procedure.

As shown in fig. 16, the controller 70 may allow the user to select an in-situ configuration command whereby the control system will execute instructions to cause the actuators coupled to the beta joint 64, gamma joint 66, and theta joint 68 to move the slave links and joints to a retracted position such that the slave hub 69 from the telemanipulator is in a desired position to position the shaft of the translating instrument interface 81 within a trocar within a patient undergoing a surgical procedure. In the home position, the slave hub 69 will be positioned relative to a trocar within the patient such that the instrument 82 can be inserted and coupled to the slave hub 69 such that the instrument tip 84 will slide into but not through the trocar, thus allowing the surgeon to insert the instrument safely without having to inspect the distal end of the trocar with the aid of an endoscope.

Additionally, the controller 70 may allow the user to select an angulation command whereby the control system will execute instructions such that an actuator coupled to the angulation joint 60 will cause the angulation link 61 to articulate the angulation link 61 about axis ω at the angulation joint 60₄Is adjusted to a desired angle of angulation relative to the base 52 from the remote manipulator 51a, for example between 0 and 45 degrees. Specifically, when an angulation command is actuated, the angulation link 61, and accordingly all slave links and joints distal to the angulation link 61, will be at the angulation joint 60 about axis ω₄Rotate while the slave link 59 and all slave links and joints proximal to the slave link 59 and the base portion 52 of the slave telemanipulator remain stationary. By adjusting the angle of angulation from the telemanipulator, the angle of the surgical workspace from the telemanipulator will be adjusted, thereby providing more access for the surgeon to the patient via the translating instrument interface 81.

For example, fig. 17A-17D illustrate movement of the translating instrument interface 81 coupled to the slave telemanipulator 51a during zero degree angulation from the console. As shown in fig. 17A-17D, the angled link 61 and the corresponding angled axis ω₅And a base 5 of a slave remote manipulator 51a2 are parallel to the longitudinal axis and perpendicular to the floor of the ground. During operation of the slave telemanipulator 51a, the control system executes only instructions to cause actuators coupled to the slave console 20 to impart movement to slave links and joints distal of the angulation link 61. Thus, as shown in fig. 18A-18D, translating instrument interface 81 from remote manipulator 51a has a forward surgical workspace FSW, e.g., the extent to which translating instrument interface 81 can reach in a forward configuration during zero degrees of angulation from the console. Fig. 18E is a rear view of the forward surgical workspace FSW of fig. 18A-18D from the console.

Fig. 19A-19C illustrate movement of the translating instrument interface 81 coupled to the slave telemanipulator 51a during a 20 degree angulation from the console. As shown in FIG. 19A, the angled link 61 and the corresponding angled axis ω₅Is adjusted to a 20 degree angle with respect to the longitudinal axis of the base 52 of the slave telemanipulator 51 a. During operation of the slave telemanipulator 51a, the control system executes only instructions to cause actuators coupled to the slave console 20 to impart movement to slave links and joints distal of the angulation link 61. Thus, as shown in fig. 19B, translating instrument interface 81 from remote manipulator 51a has a forward surgical workspace FSW, e.g., the extent to which translating instrument interface 81 can reach in a forward configuration during 20 degrees of angulation from the console. Fig. 19C is a rear view of the forward surgical workspace FSW of fig. 19B from the console during a 20 degree angulation of the console.

Fig. 20A-20C illustrate movement of the translating instrument interface 81 coupled to the slave telemanipulator 51a during a 40 degree angulation from the console. As shown in FIG. 20A, the angled link 61 and the corresponding angled axis ω₅Is adjusted to an angle of 40 degrees with respect to the longitudinal axis of the base 52 of the slave telemanipulator 51 a. During operation of the slave telemanipulator 51a, the control system executes only instructions to cause actuators coupled to the slave console 20 to impart movement to slave links and joints distal of the angulation link 61. Thus, as shown in fig. 20B, translating instrument interface 81 from remote manipulator 51a has a forward surgical workspace FSW, e.g., during 40 degree angulation from the console, translating instrument interface 81 may be in a forward configurationTo the extent that it is achieved. Fig. 20C is a rear view of the forward surgical workspace FSW of fig. 19B from the console during a 40 degree angulation of the console.

As shown in fig. 21A-21J, controller 70 may allow the user to select a flip command whereby the control system will execute instructions to cause a plurality of actuators coupled to the slave console to move the slave telemanipulator 51A between the forward surgical workspace and the reverse surgical workspace. For example, the control system may cause a plurality of actuators coupled to the slave console to invert the slave telemanipulator 51a from the forward surgical workspace to the reverse surgical workspace, and vice versa. Specifically, during actuation of the flipping command, link 65, and accordingly all slave links and slave joints distal to link 65, rotate about beta joint 64 of slave telemanipulator 51 a. In addition, as link 65 rotates about beta joint 64, link 67 rotates relative to link 65 at gamma joint 66 and from hub 69 rotates relative to link 67 about theta joint 68 until slave telemanipulator 51a is in the reverse surgical workspace configuration. As shown in fig. 22B-22H, prior to actuation of the tumble command, translating instrument interface 81 is removed from hub 69 to prevent translating instrument interface 81 from injuring the patient. Since the slave telemanipulator 51a can be flipped between the forward surgical workspace and the reverse surgical workspace by simply removing the translating instrument interface 81 and actuating the flip command without unlocking the slave telemanipulator 51a and moving it around the operating room, and without actuating the Scara brake release command or the vertical adjustment command of the slave console, the user will save a lot of time and be able to quickly continue operating the patient in the different surgical workspaces.

Referring now to fig. 21K and 21L, schematic illustrations of master and slave consoles with forward and reverse surgical workspaces, respectively, are provided. As shown in fig. 21K, when the telemanipulator of the slave console 50 has a forward surgical work space, the master controller 2 of the master console 20 is programmed so that the right master telemanipulator 22a communicates with the right slave telemanipulator 51a and the left master telemanipulator 22b communicates with the left slave telemanipulator 51 b. Thus, the master controller 2 may receive signals indicative of movements imposed at the right master remote manipulator 22a through one or more sensors of the master console 20 and execute instructions stored thereon to perform coordinate transformations necessary to activate one or more actuators of the slave console 50, send processed signals to the respective slave controllers 4a, execute the instructions stored thereon from the slave controllers 4a to move the right slave remote manipulator 51a in a manner corresponding to the movements of the right master remote manipulator 22a based on the processed signals. Similarly, master controller 2 may receive signals indicative of movements imposed at left master remote manipulator 22b through one or more sensors of master console 20 and execute instructions stored thereon to perform coordinate transformations necessary to activate one or more actuators of slave console 50, send processed signals to respective slave controllers 4b, execute instructions stored thereon from slave controllers 4b to move left slave remote manipulator 51b in a manner corresponding to the movements of left master remote manipulator 22b based on the processed signals.

As shown in fig. 21L, when the telemanipulator of the slave console 50 has a reverse surgical work space, the master controller 2 of the master console 20 functions as an exchange board and is programmed so that the right master telemanipulator 22a communicates with the left slave telemanipulator 51b, and the left master telemanipulator 22b communicates with the right slave telemanipulator 51 a. This is necessary so that a surgeon positioned at master console 20 and viewing the surgical site via display 21 can operate the telemanipulator that the surgeon appears to be a "right" slave telemanipulator (left slave telemanipulator 51b in the inverse surgical workspace) with right master telemanipulator 22a and the telemanipulator that the surgeon appears to be a "left" slave telemanipulator (right slave telemanipulator 51a in the inverse surgical workspace) with left master telemanipulator 22 a. Thus, the master controller 2 may receive signals indicative of movements imposed at the right master remote manipulator 22a through one or more sensors of the master console 20 and execute instructions stored thereon to perform coordinate transformations necessary to activate one or more actuators of the slave console 50, send processed signals to the respective slave controllers 4b, execute instructions stored thereon from the slave controllers 4b to move the left slave remote manipulator 51b in a manner corresponding to the movements of the right master remote manipulator 22a based on the processed signals. Similarly, the master controller 2 may receive signals representative of movements imposed at the left master remote manipulator 22b through one or more sensors of the master console 20 and execute instructions stored thereon to perform coordinate transformations necessary to activate one or more actuators of the slave console 50, send processed signals to the respective slave controllers 4a, execute the instructions stored thereon from the slave controllers 4a to move the right slave remote manipulator 51a in a manner corresponding to the movements of the left master remote manipulator 22b based on the processed signals.

Thus, in the forward surgical workspace configuration, the master controller 2 communicates with the right slave controller 4a to cause the right slave remote manipulator 51a to move in response to movement at the right master remote manipulator 22a, and the master controller 2 communicates with the left slave controller 4b to cause the left slave remote manipulator 51b to move in response to movement at the left master remote manipulator 22 b. In addition, in the reverse surgical workspace configuration, the master controller 2 communicates with the left slave controller 4b to cause the left slave remote manipulator 51b to move in response to movement of the right master remote manipulator 22a, and the master controller 2 communicates with the right slave controller 4a to cause the right slave remote manipulator 51a to move in response to movement at the left master remote manipulator 22 b.

Fig. 22A shows the slave remote manipulator 51a in a reversed configuration during a zero degree angulation of the slave console, fig. 22B shows the slave remote manipulator 51a in a reversed configuration during a 20 degree angulation of the slave console, and fig. 22C shows the slave remote manipulator 51a in a reversed configuration during a 40 degree angulation of the slave console. Further, as shown in fig. 23A-23C, the translating instrument interface 81 from the remote manipulator 51a has a reversed surgical workspace RSW, e.g., the extent to which the translating instrument interface 81 can reach in a reversed configuration during zero, 20, and 40 degrees angulations from the console, respectively.

As shown in FIGS. 24A-24D, the controller 70 may allowThe user selects the laparoscopic configuration commands whereby the control system will execute instructions to cause the plurality of actuators coupled to the slave console to move the slave hub 69 from a surgical mode, in which the plurality of slave links move in response to movements applied at the handle of the master console to move the surgical instrument to perform the robotic surgery, to a laparoscopic mode, in which the slave hub 69 is positioned away from the patient undergoing the surgery so that the surgeon can quickly and safely move from the master console 20 to the surgical site on the patient to perform laparoscopic tasks on the patient. Thus, in the laparoscopic mode, the plurality of slave links proximal to the slave hub 69 are retracted from the patient while the base 52 of the slave console 50 remains stationary to expose the surgical site to allow the surgeon to perform non-robotic surgery at the surgical site without interference from the plurality of slave links and the slave hub 69. In particular, actuation of the laparoscopic configuration commands causes link 63, and correspondingly all slave links and joints distal to link 63, to pivot about the alpha axis ω at joint 62₅Rotate while the angulation link 61 and, correspondingly, all slave links and joints proximal to the angulation link 61 (including the base 52 of the slave telemanipulator 51a) remain stationary until back toward the patient from the hub 69, as shown in figure 24D.

Thus, in a preferred embodiment, the longitudinal axis of at least one link (e.g., angled link 61 and/or link 63) from the console remains aligned with the remote center of motion in both the surgical mode and the laparoscopic mode to allow seamless transitions back and forth between the modes. For example, during the transition from the surgical mode to the laparoscopic mode, the alpha axis ω₅May remain aligned with the remote center of motion of the slave console 50. Advantageously, this allows the surgeon to move the slave console 50 between the surgical mode and the laparoscopic mode, thereby eliminating the need to move the angled link 61 and the alpha axis ω back to the surgical mode₅Realigns with the remote center of motion of the slave console 50 (and thus, the incision point of the patient's body). According to another aspect of the invention, the laparoscopic configuration command is actuated after the laparoscopic configuration command is actuatedThe distal slave link of the slave console 50 may be about a de-alpha axis ω₅The outer axis is retracted from the patient while the base 52 of the slave console 50 remains stationary to expose the surgical site so that the alpha axis ω is during the transition from the surgical mode to the laparoscopic mode₅Not remaining aligned with the remote center of motion of the slave console 50. For example, a distal slave link of the slave console 50 may be about, for example, axis ω₄Axis omega₃Axis omega₂Or axis ω₁Rotate while the base 52 from the console 50 remains stationary to expose the surgical site.

Further, the control system will execute instructions to determine whether the translating instrument interface 81 has been decoupled from the slave hub 69 of the slave console 50, and thus decoupled from the patient at the surgical site, such that the laparoscopic configuration commands cannot be actuated unless the control system determines that the translating instrument interface 81 is not coupled to the slave hub 69. Therefore, before laparoscopic configuration commands are actuated by the user transitioning the slave console from surgical mode to laparoscopic mode, translating instrument interface 81 must be removed from hub 69.

Referring now to fig. 25-30, an exemplary method 90 for using the surgical robotic system 10 via a control system is described. As will be appreciated by those skilled in the art, the steps of the methods described herein can be performed by one or more processors of the control system (e.g., at the master controller, the first slave controller, and/or the second slave controller) that execute instructions stored in one or more memory components in response to user input. As shown in fig. 25, at step 91, system 10 is powered on. At step 92, the slave console 50 is prepared in preparation for performing an operation on the patient undergoing the surgical procedure, as further shown in fig. 27, and at step 93, the master console 20 is positioned during the operation to the surgeon's desired configuration, as further shown in fig. 26.

For example, FIG. 26 shows step 93 of positioning the master console 20 to the surgeon's desired configuration. When the wheels are unlocked, the master console 20 can be moved around the operating room via the wheels at its base. Once the desired orientation within the operating room is reached, the wheel locks are activated to hold the master console 20 in place. As shown in fig. 26, at step 93A, the primary telemanipulator is stationary and the telescopic pedestals 23A, 23b have an initial height. Then, at step 93B, a controller (e.g., a button) operably coupled to the master console 20 may be actuated to adjust the height of the telescoping seatings 23a, 23B, e.g., to increase or decrease the height of the telescoping seatings 23a, 23B, until the master console 20 is at the desired height for the surgeon. For example, master console 20 may be adjusted to a sitting configuration, in which the surgeon may sit during operation of master console 20, or a standing configuration, in which the surgeon may stand during operation of master console 20. Thus, the controller can be actuated to return the main console 20 to an initial height, for example for storage purposes.

Referring now to FIG. 27, a step 92 of preparing the slave console 50 is described. As shown in fig. 27, at step 92A, the wheel locks of the slave telemanipulator are disengaged so that the slave console 50 can be moved around the operating room to a desired orientation relative to the patient. The wheel lock can only be disengaged when the instrument 82 is not inserted into the slave hub 69 to avoid injury to the patient. Since multiple slave telemanipulators may be used, each slave telemanipulator is positioned during step 92A. When the slave console 50 is in the desired position within the operating room adjacent the patient undergoing the surgical procedure, the wheel lock of the slave console 50 is activated at step 92B such that the slave console 50 is prevented from further movement around the operating room via its wheels. Thus, if it is desired to move the slave console 50 to a different desired location, the wheel lock can be disengaged again at step 92A.

At step 92C, the Scara brake release command has not been actuated and the Scara brake of the slave console 50 is on. At step 92D, the user may actuate the Scara brake release command to position the distal end of the slave telemanipulator (e.g., the slave link distal to link 59) at a desired location above the patient undergoing the surgical procedure. In particular, upon actuation of the Scara brake release command, the slave links 55, 57, 59 are allowed to rotate about the axis ω at the joints 54, 56 and 58₁、ω₂、ω₃Moves while the slave support 53 of the slave telemanipulator remains stationary and the slave link distal to the slave link 59 is fixed relative to the slave link 59. When the distal end of the slave telemanipulator is at the desired position above the patient, actuation of the Scara brake release command is stopped at step 92C. In addition, as described above with reference to fig. 15A-15C, the vertical height of the slave telemanipulator may be adjusted such that the distal end of the slave telemanipulator is at a desired height relative to the trocar within the patient. The Scara brake release command can only be activated if there is no instrument 82 from the hub 69 to avoid injury to the patient.

Referring again to fig. 27, at step 92E, the angled link 61 of the slave telemanipulator is stationary relative to the slave link 59. For example, there may initially be a zero degree angle of angulation from the remote manipulator. At step 92F, the angulation command may be actuated to position the angulation link 61 at the angulation joint 60 about the axis ω₄Is adjusted to a desired angle of angulation relative to the base 52 from the remote manipulator 51a, for example between zero and 45 degrees. Specifically, upon actuation of the angulation command, the angulation link 61, and accordingly all slave links and joints distal to the angulation link 61, will be at the angulation joint 60 about axis ω₄Rotate while the slave link 59 and all slave links and joints proximal to the slave link 59 and the base portion 52 of the slave telemanipulator remain stationary. When the desired angulation angle from the remote manipulator is achieved, actuation of the angulation command is stopped at step 92E, such that angulation link 61 of the slave remote manipulator is stationary with respect to slave link 59. The angulation command may have two buttons, one increasing the angulation and the other decreasing the angulation.

At step 92G, the slave telemanipulator has a forward surgical workspace, or alternatively, at step 92H, the slave telemanipulator has a reverse surgical workspace. During both steps 92G and 92H, the instrument 82 cannot be in the slave hub 69. If the slave telemanipulator has a forward surgical workspace at step 92G and the user desires a reverse surgical workspace, a flip command may be actuated to invert the slave telemanipulator 51a from the forward surgical workspace to the reverse surgical workspace. Specifically, upon actuation of the flipping command, link 65, and accordingly all slave links and slave joints distal to link 65, rotate about beta joint 64 of slave telemanipulator 51 a. In addition, as link 65 rotates about beta joint 64, link 67 rotates relative to link 65 at gamma joint 66 and from hub 69 rotates relative to link 67 about theta joint 68 until slave telemanipulator 51a is in the reverse surgical workspace configuration. Similarly, if the slave telemanipulator has a reverse surgical workspace at step 92H, and the user desires a forward surgical workspace, the flip command may be actuated to invert the slave telemanipulator 51a from the forward surgical workspace to the reverse surgical workspace.

At step 92I, translating instrument interface 81 is not coupled to slave hub 69 of the slave telemanipulator. At step 92J, a temporary incision indicator may be removably coupled to the slave telemanipulator. For example, the temporary cut indicator may be removably coupled to the slave telemanipulator such that it points to lie on axis ω₅The virtual remote center of motion V at the predetermined point on the upper surface makes it possible to make the virtual remote center of motion V coincide with the surgical incision point, reducing trauma to the patient and improving the cosmetic effect of the surgical operation. If desired, the temporary incision indicator may be removed prior to installation of the translating instrument interface 81. During the preparation step 92, the instrument 82 should not be coupled to the slave hub 69 of the slave telemanipulator. Thus, if the instrument 82 is coupled to the slave hub 69 of the slave telemanipulator, the control system will prevent further action until the translating instrument interface 81 is removed at step 92K.

At step 92L, the slave link and the joint distal from the link 61 of the remote manipulator may be in any position. Thus, at step 92M, the home configuration command may be actuated to move the slave links and joints to the retracted position such that the slave hub 69 of the slave telemanipulator is in a desired position to position the instrument tip 84 within a trocar within a patient undergoing a surgical procedure. At step 92N, the slave telemanipulator is in a home position with the slave hub 69 positioned relative to the trocar within the patient such that the instrument 82 can be inserted and coupled to the slave hub 69 and the instrument tip 84 will slide into but not through the trocar.

At step 92O, the laparoscopic configuration commands may be actuated to move the slave hub 69 away from the patient undergoing the surgical procedure so that the surgeon may quickly and safely move from the master console 20 to the surgical site on the patient to manually perform laparoscopic tasks on the patient. Specifically, upon actuation of the laparoscopic configuration command, link 63, and accordingly all slave links and joints distal to link 63, are at joint 62 about alpha axis ω₅Rotate while the angulation link 61 and, correspondingly, all slave links and joints proximal to the angulation link 61 (including the base 52 of the slave telemanipulator 51a) remain stationary until back toward the patient from the hub 69. At step 92P, the slave hub 69 is in the retracted position.

At step 92Q, the sterile interface of the translating instrument interface 81 is not coupled to the slave hub 69 of the slave telemanipulator. At step 92R, the sterile interface is coupled to the slave hub, and the control system determines whether the sterile interface is identified, for example, by reading an RFID tag integrated into the sterile interface. If the sterile interface is not identified, at step 92S, the control system waits for removal of the sterile interface until the sterile interface is decoupled from the hub 69 at step 92Q. If a sterile interface is identified, the sterile interface is successfully installed at step 92T.

At step 92U, the park position command may be actuated to move the slave remote manipulator 51b to a position suitable for transport and storage. Specifically, upon actuation of the parking position command, the vertical post in support 53 is retracted to a minimum height, the Scara brake is released to fold the Scara arm to the collapsed position, the angulation returns to a zero degree angulation, and the joint distal to joint 62 moves to fold the slave arm to the compact position. If desired, the surgical robotic system 10 may be powered down after step 92.

If the surgical robotic system 10 is not powered down after step 92, the control system determines whether the sterile interface has been successfully installed and the floor lock is activated at step 94. If it is determined that the sterile interface has not been successfully installed or the floor lock is disengaged, the surgical robotic system 10 must return to the preparation step 92 to correct the above. If it is determined at step 94 that the sterile interface has been successfully installed and the floor lock is activated, the surgical robotic system 10 may proceed to step 95.

At step 95, the surgical robotic system prepares the instrument 82, as shown in fig. 28. For example, at step 95A, the control system of the slave console 50 waits for the instrument 82 until the instrument 82 is coupled to the slave hub 69 of the slave telemanipulator. Thus, the instrument 82 is selected and inserted into the slave hub 69. To ensure that the instrument does not fall out of the hub, the user can mechanically lock the instrument in the hub 69 by rotating the proximal end of the instrument. The slave hub 69 has an integrated sensor to detect if the instrument is locked. At step 95B, an identifier element, such as an RFID tag, integrated with the selected instrument is read out from a sensor positioned within hub 69, where the RFID tag contains identification information of the selected instrument. At step 95C, the control system determines whether the selected instrument is authorized based on the detection of the RFID tag. If the selected instrument is not authorized, the control system waits until it is removed at step 95D. When the unauthorized instrument is removed, step 95D returns to step 95A. If the selected instrument is authorized and locked within the slave hub 69 of the slave telemanipulator at step 95E, the method 90 may proceed to step 96. If at any time during step 95, the sterile interface is removed, the floor lock is disengaged, the tumble command is actuated, the Scara brake release command is actuated, the home configuration command is actuated, or the cut indicator is inserted, the method 90 may return to the preparation step 92.

At step 96, the surgical robotic system 10 is prepared for operation. As shown in fig. 29, at step 96A, the control system verifies whether the instrument 82 is coupled to the slave hub 69 of the slave telemanipulator. At step 96B, the control system detects when the surgeon grasps the handle grip 40 of the handle portion 35. As shown in fig. 9A and 9B, a sensor in the handle can detect that the surgeon has grasped the handle. At step 96C, the clutch 11 is actuated to prepare the control system for macro synchronization, as depicted at step 97A.

As shown in fig. 30, the surgical robotic system 10 may now be operated. For example, at step 97A, the surgical robotic system 10 is in a macro-sync state, but not a micro-sync state. In the macro-synchronous state, translational macro-movements imparted at the master console 20 will be sensed and transmitted to the control system, which instructs the actuators coupled to the slave console 50 to move the corresponding slave links and joints in a manner such that macro-movements (i.e., up/down, left/right, in/out) of the instrument tip 84 correspond to macro-movements of the handles on the master console 20. However, in the out-of-sync macro state, the control system does not cause macro movements imposed at the master console 20 to be performed at the slave console 50 in a corresponding manner. For example, in an out-of-sync macro state, macro movement at the master console 20, whether intentional or unintentional, will allow master link movement of the master console 20, but will not result in any corresponding movement at the slave console 50.

In the micro-synchronized state, micro-movements imparted at the handle portion 35 of the master console 20 will be sensed and transmitted to the control system, which instructs the actuators coupled to the slave console 50 to move the instrument tip 84 in a manner corresponding to those micro-movements imparted at the handle portion 35 of the master console 20. However, in an unsynchronized micro-state, the control system does not cause micro-movements applied at the master console 20/handle portion 35 to be performed at the slave console 50/end effector in a corresponding manner. Thus, at step 97A, the panning macro movements are copied, but the micro movements are not synchronized. At step 97B, the clutch 11 may be actuated to transition the surgical robotic system 10 to an unsynchronized macro state in which the master console 20 may prevent translational macro movement and, thus, the slave console 50 cannot replicate the translational macro movement. For example, the clutch 11 may be a foot pedal that, when stepped on, maintains the surgical robotic system 10 in an out-of-sync macro state. After releasing the clutch 11, the surgical robotic system 10 returns to the macro-synchronization state at step 97A. Thus, for example, the surgeon may apply macro movement to the handle portion 35 in a synchronized macro state, e.g., moving the handle portion 35 inward/outward, causing inward/outward movement on the surgical instrument, then actuate the clutch 11 to transition the surgical system from the synchronized macro state to the unsynchronized macro state, move the handle portion back to its original position or other more comfortable position that will not result in macro movement of the surgical instrument, release the clutch 11 to transition the surgical system from the unsynchronized macro state to the synchronized macro state, and continue to apply additional macro movement to the handle portion 35 that will result in corresponding macro movement at the surgical instrument. Advantageously, this will allow the surgeon to readjust the master console 20 for comfort while the slave console 50 remains in the desired position. In another example, actuation of the clutch 11 transitions the surgical system between a synchronized state and an unsynchronized state for both macro and micro movements.

Further, the control system may be programmed to detect an actuation pattern of the handle portion 35 such that the end effector does not replicate micro-movement at the handle portion 35 unless the control system detects the actuation pattern. For example, the actuation mode may include a rapid dual actuation of the handle grip 40. Thus, when the user repeatedly presses the handle grip 40 twice at step 97C, the control system detects the actuation pattern and the surgical robotic system 10 is in a micro-synchronized state in which micro-movements at the handle portion 35 will be replicated by the end effector. When transitioning from the unsynchronized micro-state to the micro-synchronized state, the control system executes instructions to cause the micro-position of the instrument tip 84 to have the same spatial orientation relative to the instrument shaft 82 as the spatial orientation of the handle portion 35 relative to the corresponding link 32 of the master remote manipulator 22 a. At step 97D, the surgical robotic system 10 is fully in the macro-synchronized state and the micro-synchronized state, e.g., when the end effector is in the target position for operation, and the surgeon may perform the surgical task using the surgical robotic system 10. After actuating the clutch 11, the surgical robotic system 10 is in a microsynchronized state, but in an unsynchronized macro state at step 97E.

According to another aspect of the present invention, as shown in fig. 2C, the master console 20 may have a second clutch 11' for use in conjunction with the clutch 11 to actuate the macro and/or micro synchronization states of the surgical robotic system 10. For example, actuation of the clutch 11 may transition the surgical robotic system 10 between a synchronous macro state and an asynchronous macro state, and actuation of the clutch 11' may transition the surgical robotic system 10 between a synchronous micro state and an asynchronous micro state. Thus, for example, a surgeon may apply micromovements to the handle portion 35 in a synchronized macro state, e.g., rolling the handle portion 35 to cause a rolling movement on the surgical instrument, then actuate the clutch 11 'to transition the surgical system from the synchronized micro state to the unsynchronized micro state, move the handle portion back to its original position or other more comfortable position, which will not result in micromovements of the surgical instrument, but if the surgical system is in the synchronized macro state, may result in macro movements of the surgical instrument, release the clutch 11' to transition the surgical system from the unsynchronized micro state to the synchronized micro state, and continue to apply additional micromovements to the handle portion 35, which will result in corresponding micromovements at the surgical instrument. Advantageously, this will allow the surgeon to readjust the master console 20 for comfort while the slave console 50 remains in the desired position.

The surgeon may selectively select any combination of synchronized and unsynchronized macro-states and micro-states of the surgical robotic system 10. In accordance with yet another aspect of the present invention, actuation of the clutch 11 may transition the surgical robotic system 10 between an unsynchronized macro state and a synchronized macro state, and an unsynchronized micro state and a synchronized micro state; while actuation of the clutch 11' merely transitions the surgical robotic system 10 between the unsynchronized micro-state and the synchronized micro-state. Alternatively, actuation of the clutch 11 may transition the surgical robotic system 10 between the unsynchronized macro state and the synchronized macro state and between the unsynchronized micro state and the synchronized micro state; while actuation of the clutch 11' merely transitions the surgical robotic system 10 between the unsynchronized macro state and the synchronized macro state.

According to another aspect of the present invention, described herein is a remotely actuated surgical robotic system having a hybrid telemanipulator constructed in accordance with the principles of the present invention that may be used in minimally invasive surgical routines or other applications.

Referring to fig. 31A and 31B, an exemplary remotely actuated surgical robotic system 100 with a hybrid telemanipulator is depicted. The surgical robotic system 100 is illustratively secured atop a movable cart 101, to which the hybrid telemanipulator may also be mounted 101 for mobility in the operating room and ease of transport. The surgical robotic system 100 includes a master area 400 and a remote slave area 500 proximate to the sterile area, the master area 400 being locatable by a surgeon to operate the system 100, and the remote slave area 500 being locatable by a patient to undergo a surgical procedure. As shown in fig. 31B, the operating surgeon preferably sits with ready access to the master region 400, while another surgeon or assistant may be located in a nearby slave region 500 positioned above the patient. In the embodiment of fig. 31A and 31B, the master region 400 is positioned laterally adjacent to the slave region 500. Further, the camera system 102 may be used with the surgical robotic system 100, e.g., an endoscope manipulated by an assistant located at the slave region 500 may be manipulated and/or held in place, as shown in fig. 31B. The camera system 102 may also include a display 103 for displaying the surgical site captured by the camera 102 to the surgeon in real-time. The display 103 may be mounted to the main area 400, or anywhere near the main area 400 that is easily viewed by the surgeon during the surgical routine.

Referring again to fig. 31A, the system 100 includes two hybrid remote manipulators 104 and 105, including a left hybrid remote manipulator 104 manipulated by the left hand of the surgeon and a right hybrid remote manipulator 105 manipulated by the right hand of the surgeon. Hybrid telemanipulators 104 and 105 may be operated simultaneously and independently of each other, for example, by the left and right hands of a surgeon. Preferably, the remotely actuated telesurgical robotic system 100 is optimized for a surgical routine.

Each hybrid telemanipulator provides input to a master-slave configuration in which a slave unit comprised of a plurality of rigid slave links and slave joints is kinematically driven by a master unit comprised of a plurality of rigid master links and master joints. For example, the left hybrid remote manipulator 104 comprises a master unit 401 and a corresponding slave unit 501, and the right hybrid remote manipulator 105 comprises a master unit 402 and a corresponding slave unit 502. Master units 401 and 402 are disposed within master region 400 of system 100, while slave units 501 and 502 are within slave region 500 of system 100. Preferably, slave units 501 and 502 mimic the movement of corresponding portions of master units 401 and 402, respectively, without the need for offsetting the remote center of motion during operation of the device, as described in further detail below.

Still referring to fig. 31A, teleoperated surgical instrument 106 (e.g., a translating instrument interface) having end effector 107 is coupled to a distal end of slave unit 501 and a handle is coupled to a distal end of master unit 401 such that movement applied to the handle induces corresponding micro-movement of end effector 107 via a processor-driven control system. For example, the control system may receive signals indicative of movements imparted at the handle through one or more sensors coupled to the handle and perform coordinate transformations needed to activate one or more actuators operably coupled to the end effector 107 to replicate the corresponding movements of the end effector. The slave instruments 106 of the translating instrument interface may be removably attached to and operated by the slave unit 501 such that translational degrees of freedom (e.g., left/right, up/down, inward/outward) are actuated through direct mechanical coupling, while articulation degrees of freedom (e.g., pitch and yaw), actuation degrees of freedom (e.g., open/close), and rotation degrees of freedom (e.g., pronation and supination) are replicated electromechanically via sensors, actuators, and control systems, as will be described in further detail below.

Referring now to fig. 32A and 32B, the mechanisms of an exemplary remotely actuated surgical robotic system 100 with hybrid telemanipulator are shown with the outer cover depicted in fig. 31 omitted for clarity. In fig. 32A and 32B, the mechanical drive train 300 is arranged to directly couple the slave unit 501 with the master unit 401 such that translational macro-movements applied to the plurality of master joints of the master unit 401 are replicated by corresponding respective ones of the plurality of slave joints of the slave unit 501. Likewise, mechanical drive train 300 also directly couples slave unit 502 with master unit 402 such that translational macro-movements applied to the plurality of master joints of master unit 402 are replicated by corresponding respective ones of the plurality of slave joints of slave unit 502. Drive train 300 illustratively includes one or more cables 301 routed from master unit 401 to slave unit 501 via one or more pulleys, and one or more cables 303 routed from master unit 402 to slave unit 502 via one or more pulleys for controlling one of the four degrees of freedom of slave units 501 and 502. The mechanical constraint 200 of the main unit 401 constrains the movement of the main unit 401 by removing the degrees of freedom of motion, thereby limiting the movement to three translational degrees of freedom, e.g., left/right, up/down, inward/outward.

For example, the one or more cables 301 may form one or more closed loops starting at pulley P1 coupled to the master unit 401 and extending through pulleys P2, P3, P4, P5, P6, the tensioning system 302, pulley P7, and wrap around pulley P8 coupled to the slave unit 501 and extending back through pulley P7, the tensioning system 302, pulleys P6, P5, P4, P3, P2, and terminating at pulley P1. Thus, clockwise or counterclockwise rotation of pulley P1 causes a cable of the one or more cables 301 to rotate pulley P8, thereby actuating slave unit 501 in one of four degrees of freedom. However, the mechanical constraint 200 of the master unit 401 constrains the movement of the master unit 401 by removing one degree of freedom of motion, thereby limiting the movement of the slave unit 501 to three translational degrees of freedom, e.g., left/right, up/down, inward/outward. Each of the pulleys P1, P2, P3, P4, P5, P6, P7, and P8 may include a number of individual pulleys corresponding to the number of degrees of freedom of movement of the master unit 401 that can actuate the slave unit 501. Similarly, one or more cables 301 may contain a number of closed cable loops corresponding to the number of degrees of freedom of movement of the master unit 401 actuatable slave unit 501.

Similarly, the one or more cables 303 may form one or more corresponding closed loops starting from pulley P9 coupled to the master unit 402 and extending through the tensioning system 304, pulleys P10, P11, P12, P13, P14, and wrapping pulley P15 coupled to the slave unit 502 and extending back through pulleys P14, P13, P12, P11, P10, tensioning system 304, and terminating at pulley P9. In this manner, clockwise or counterclockwise rotation of pulley P9 may cause a cable of the one or more cables 303 to rotate pulley P15, thereby actuating slave unit 502 in one of four degrees of freedom. The mechanical constraint 201 (see fig. 32A) of the master unit 402 also constrains the movement of the master unit 402 by removing the degrees of freedom of motion, thereby limiting the movement of the slave unit 502 to three translational degrees of freedom, e.g., left/right, up/down, inward/outward. Each of the pulleys P9, P10, P11, P12, P13, P14, and P15 may include a number of individual pulleys corresponding to the number of degrees of freedom of movement that the master unit 402 may actuate the slave unit 502. Similarly, the one or more cables 303 may contain a number of closed cable loops corresponding to the number of degrees of freedom of movement of the master unit 402 actuatable slave unit 502.

As will be understood by those of ordinary skill in the art, the number of pulleys P2-P7 used to route cable 301 between pulleys P1 and P8 and the number of pulleys P10-P14 used to route cable 303 between pulleys P9 and P15 will depend on the configuration of the right and left hybrid remote manipulators, respectively.

Referring now to fig. 33, one or more cables 301 of mechanical drive train 300 are passed through tensioning system 302 and one or more cables 303 are passed through tensioning system 304. Tensioning system 302 is designed to apply a predetermined tensioning force to cable 301, while tensioning system 304 is designed to apply a predetermined tensioning force to cable 303. For example, tensioning system 302 may include pulley P16 coupled to pulley P17 via tensioning link 305, and pulley P18 coupled to pulley P19 via tensioning link 306. The tension link 305 is adjustably and rotatably coupled to the tension link 306 about a vertical axis extending through the axle 307 such that a predetermined tension force is applied to the cable 301 through the pulleys P16, P17, P18, and P19. Additionally, the tensioning system 302 may be used to calibrate the mechanical drive train 300 to ensure that the angles of the corresponding master and slave joints are the same. The tensioning system 304 may be identical in structure to the tensioning system 302.

Also in fig. 33, pulleys P11, P12, and P13 of the mechanical drive train of the right hybrid telemanipulator are coupled to the slave link 308, the slave link 308 being rotatably coupled to the positioning system 310 via the slave link 309. Positioning system 310 may be, for example, a hydraulic device that constrains movement of slave unit 502 relative to slave unit 501 along a single plane. For example, the position of the pulley P8 may be fixed such that the position of P15 is movable along the horizontal plane (x-direction and y-direction) with respect to P8.

Referring now to fig. 34A and 34B, the components of an exemplary master unit of the system 100 are described. Since the main cells 401 are respectively identical in structure to the main cells 402, the following description of the main cells 401 also applies to the main cells 402.

The main unit 401 includes a plurality of main links, e.g., a first main link 405a, a second main link 405b, a third main link 405c, and a fourth main link (e.g., a guide main link) 404, interconnected by a plurality of main joints. A handle 403 is connected to the distal end of the main unit 401 via a guide main link 404 (e.g., a main rod), and includes a plurality of handle links interconnected by a plurality of handle joints to operate the hybrid remote manipulator. For example, a translational macro movement applied on the handle 403 causes corresponding movements of the master joints via the master links, which are transmitted to the corresponding slave joints of the slave unit 501 via the mechanical drive train 300, thereby replicating the translational macro movement at the slave unit 501. Translational movement of the handle 403 causes the guide master link 404 to transmit motion to the pulley P1 via the first, second and third master links 405a, 405b, 405c, thereby causing the slave unit 501 to mimic translational movement via the mechanical drive train 300. The first master link 405a, the second master link 405b, the third master link 405c, and the guide master link 404 are coupled to the pulley P1 via a transmission system that includes, for example, one or more toothed belts 406 routed via one or more pulleys 407. Alternatively, the transmission system coupling the pulley P1 with the plurality of master links and joints of the master unit 501 may comprise a cable and pulley system, and/or a rigid transmission chain.

In fig. 34A and 34B, the mechanical constraint 408 on the main unit 401 comprisesA yoke pivotally coupled to a sleeve that slides over the guide master link 404 and constrains movement of the distal end of the slave unit 501 to coincide with a remote center of motion that is aligned with an incision point on the patient (e.g., the point at which a trocar enters the patient's abdomen). For example, mechanical constraint 408 ensures that when the hybrid remote manipulator is actuated, the guide master link 404 of the master unit 401 is along the longitudinal axis θ₁Translate such that a corresponding slave link of the slave unit 501 (e.g., a translating instrument interface coupled to a distal end of the slave unit 501) also follows a longitudinal axis θ parallel to the guide master link 404₁Virtual axis θ of₄Translating about the remote manipulation, as depicted in fig. 35A and 35B. In addition, mechanical constraint 408 enables steering master link 404 to be oriented about second axes θ that are perpendicular to each other₂And a third axis theta₃And (4) rotating. Still referring to fig. 34A and 34B, the axis θ₃Coaxial with the axis of pulley P1. By guiding the longitudinal axis θ of the main link 404₁And a second axis theta₂The defined plane is at a single point of rest 409 from the third axis θ₃Regardless of the orientation of the master link 404. This configuration allows the corresponding slave links of the slave unit 501 to be wound around fifth virtual axes θ perpendicular to each other₅And a sixth virtual axis θ₆And (4) rotating. Corresponding longitudinal axis theta of slave link₄To the fifth virtual axis theta₅And a sixth virtual axis θ₆Always intersecting each other at a virtual stationary single point 509 (e.g., a remote center of motion) near the patient incision.

When the surgical robotic system 100 is positioned such that the remote center of motion 509 is aligned with the patient incision, the translational movement imparted to the handle 403 is replicated by the end effector disposed within the patient. This arrangement advantageously eliminates the fulcrum effect between the handle and the end effector and ensures that the instrument always passes through the remote center of motion because the end effector perfectly replicates the motion imparted to the handle 403. Although in previously known surgical robots complex control electronics were required to maintain a fixed point of movement of the surgical instrument as it passed through the patient incision, in the system of the present invention the mechanical constraints 408 provide a translational replica between the master unit 401 and the slave unit 501, which ensures that the instrument always passes through the remote centre of motion 509.

The inward/outward movement of the handle 403 of the embodiment of fig. 34A and 34B causes the first, second, third, and guide master links 405a, 405B, 405c, 404 to be along the longitudinal axis θ of the guide master link 404₁Moving inward/outward. This motion is transmitted via the plurality of master links to pulley P1, causing slave unit 501 to replicate about longitudinal axis θ via mechanical drive train 300 and the plurality of slave links, joints, and timing belts₄Inward/outward movement. Similarly, upward/downward movement of the handle 403 causes the first, second, third, and guide master links 405a, 405b, 405c, and 404 to pivot about the second axis θ₂Rotating up/down. This motion is transmitted via the plurality of master links to pulley P1, which in turn causes slave unit 501 to replicate about fifth axis θ via mechanical drive train 300 and the plurality of slave links, joints, and timing belts₅Up/down movement of the slide. Finally, the leftward/rightward movement of the handle 403 causes the first, second, third, and guide main links 405a, 405b, 405c, and 404 to rotate about the third axis θ₃Rotate left/right. This motion is transmitted via the plurality of master links to pulley P1, causing slave unit 501 to replicate about sixth axis θ via mechanical drive train 300 and the plurality of slave links, joints, and timing belts₆To the left/right.

Still referring to fig. 34A and 34B, the movement imparted at the handle 403 of the main unit 401 electromechanically actuates the articulation degrees of freedom (e.g., pitch and yaw), the actuation degrees of freedom (e.g., open/close), and the rotation degrees of freedom (e.g., pronation and supination) via the sensors, motors, and control system. The main unit 401 preferably comprises one or more sensors 410 coupled to the handle 403 via a circuit board 411 for detecting movement of the handle 403. As will be appreciated, the sensor 410 may be any sensor designed to detect rotational movement, such as a magnetic-based rotation sensor that includes a magnet on one side and a sensor on the other side to measure rotation by measuring angle and position. The circuit board 411 is coupled to the control system for generating a signal indicative of the rotation measured by the sensor 410 and transmitting the signal to one or more motors coupled to the slave unit 501 that can reproduce the movement applied to the handle 403 to the end effector. For example, an electrical cable may extend from the handle 403 to a control system, e.g., a unit containing control electronics, and additional cables may extend from the control system to one or more motors coupled to the slave unit 501.

Actuation of the trigger 412 of the handle 403 generates a signal that is transmitted via the control system to the motor coupled to the slave unit 501, thereby actuating the translation transmission system coupled to the translating instrument interface of the slave unit 501, which in turn actuates the end effector of the translating instrument interface to open/close.

The handle 403 may also include a ball 413, the ball 413 being designed to be easily grasped by the surgeon and to align the surgeon's wrist with the master unit 401. The ball 413 may be about the handle axis θ₇Rotates such that rotation of the ball 413 is detected by a sensor that generates a signal and transmits the signal to a motor coupled to the slave unit 501 via a control system. The signal received at the slave unit from the control system causes rotation of the translating instrument interface coupled to the slave unit 501, thereby rotating the end effector of the translating instrument interface in a pronation and supination degree of freedom.

The handle 403 is also about the handle axis θ₈Rotatable so as to be about a handle axis theta₈Is detected by a sensor which generates a signal and transmits the signal via a control system to the motor of the slave unit 501. This signal causes actuation of a translation drive system coupled to the translating instrument interface of the slave unit 501, which in turn causes movement of the end effector of the translating instrument interface in a yaw degree of freedom. In addition, handle 403 is about handle axis θ₉Is rotatable so that handle 403 is about handle axis θ₉Is detected by a sensor that generates a signal and transmits the signal to the motor of the slave unit 501 via the control system. This signal causes actuation of a translation drive system coupled to the translation instrument interface of the slave unit 501, which causes movement of the end effector of the translation instrument interface in a pitch degree of freedom.

Referring now to fig. 34C and 34D, an alternative embodiment of the handle of the main unit 401 is described. In FIG. 34C, handle 403' is about handle axis θ₇Axis of the handle theta₈And a handle axis theta₉Is rotatable such that rotation of the handle 403' about the handle axis is detected by one or more sensors 410, the sensors 410 generating and transmitting a signal to the motor of the slave unit 501 via the control means. This signal actuates a translation drive system coupled to the translating instrument interface of the slave unit 501, causing the end effector of the translating instrument interface to move in the pronation, supination, yaw, and pitch degrees of freedom, respectively.

Similarly, handle 403 "of FIG. 34D is about handle axis θ₇Axis of the handle theta₈And a handle axis theta₉May be rotated such that rotation of the handle 403 "about the handle axis is detected by one or more sensors 410 which generate and transmit signals to one or more motors coupled to the slave unit 501 via the control means. This signal actuates a translation drive system coupled to the translating instrument interface of the slave unit 501, causing the end effector of the translating instrument interface to move in the pronation, supination, yaw, and pitch degrees of freedom, respectively.

Referring now to fig. 35A and 35B, exemplary slave units of the system 100 are described. Since the slave units 501 are identical in structure to the slave units 502, respectively, the following description of the slave unit 501 also applies to the slave unit 502.

As described above, the main unit 401 includes a plurality of main links interconnected by a plurality of main joints. Slave unit 501 includes a corresponding plurality of slave links, e.g., first slave link 505a, second slave link 505b, third slave link 505c, and fourth slave link (e.g., translating instrument interface) 503, interconnected by a plurality of slave joints such that a direct mechanical coupling is formed by the plurality of slave links and the corresponding plurality of slave joints of slave unit 501, which is the same as the kinematic model formed by the corresponding plurality of master links and the corresponding plurality of master joints of master unit 401. For example, during operation of the hybrid telemanipulator, the first slave link 505a is always parallel to the first master link 405a, the second slave link 505b is always parallel to the second master link 405b, the third slave link 505c is always parallel to the third master link 405c, and the translating instrument interface 503 is always parallel to the guide master link 404. Thus, each translational macro-movement of the plurality of master joints of the master unit 401 is imparted to a corresponding respective one of the plurality of slave joints of the slave unit 501 via the mechanical drive train 300 and the plurality of slave link copies.

In fig. 35A and 35B, the translating instrument interface 503 is coupled to the distal end 504 of the slave unit 501. The translational movement of handle 403 is transmitted to pulley P9 via mechanical drive train 300. More specifically, translational actuation of handle 403 causes pulley P9 to transmit motion to end effector 512 via first slave link 505a, second slave link 505b, third slave link 505c, and translating instrument interface 503, thereby causing a translational movement to be replicated from unit 501. The first slave link 505a, the second slave link 505b, the third slave link 505c, and the translating instrument interface 503 are coupled to pulley P9 via a transmission system that includes one or more timing belts 506 routed, for example, via one or more pulleys 507. Thus, each of the four pulleys of P9 is operably coupled to and controls movement of the first slave link 505a, the second slave link 505b, the third slave link 505c, and the translating instrument interface 503. Alternatively, the drive system coupling the pulley P9 with the plurality of slave links and joints of the slave unit 501 may comprise a cable and pulley system, and/or a rigid drive chain.

The mechanical constraints 408 of the main unit 401 ensure that the first slave link 505a, the second slave link 505b, the third slave link 505c and the translating instrument interface 503 always rotate about the virtual rest point 509 when the hybrid remote manipulator is operating. For example, end effector 512 coupled to translating instrument interface 503 of slave unit 501 always follows a longitudinal axis θ with master link 404₁Corresponding longitudinal axis theta₄Translating in the vicinity of the remote manipulation. In addition, mechanical constraint 408 allows end effector 512 to be about a fifth virtual axis θ that is perpendicular to each other₅And a sixth virtual axis θ₆And (4) rotating. A longitudinal axis θ coupled to the translating instrument interface 503 of the slave unit 501₄And a fifth virtual axis θ₅And a sixth virtual axis θ₆Always intersecting each other at a virtual stationary single point 509 near the remote manipulation.During a minimally invasive surgical routine, the virtual resting point 509 is aligned with the surgical incision point, thereby reducing trauma to the patient and improving the cosmetic outcome of the surgical procedure.

Movement of handle 403 in the inward/outward direction causes end effector 512 coupled to slave unit 501 to replicate about longitudinal axis θ via mechanical drive train 300 and a drive train coupling pulley P9 with a plurality of slave links and joints of slave unit 501₄Inward/outward movement. The upward/downward movement of handle 403 causes end effector 512 coupled to slave unit 501 to replicate about longitudinal axis θ via mechanical drive train 300 and a drive train coupling pulley P9 with the plurality of slave links and joints of slave unit 501₅Up/down movement of the slide. Left/right movement of handle 403 replicates end effector 512 coupled to slave unit 501 about longitudinal axis θ via mechanical drive train 300 and a drive train coupling pulley P9 with a plurality of slave links and joints of slave unit 501₆To the left/right.

Further, the movements imparted at the handle 403 of the main unit 401 electromechanically actuate, via sensors, motors, and control systems, the articulation degrees of freedom (e.g., pitch and yaw), actuation degrees of freedom (e.g., open/close), and rotation degrees of freedom (e.g., pronation and supination) of the end effector of the translating instrument interface 503. The translating instrument interface 503 may be constructed as described in U.S. patent publication No.2018/0353252 to chapsto, assigned to the assignee of the present application, the entire contents of which are incorporated herein by reference. For example, translating instrument interface 503 includes a slave hub 510 and a surgical instrument 511. A slave hub 510 may be secured to the distal end 504 of the slave unit 501. The surgical instrument 511 includes an end effector 512 disposed at a distal end of a shaft of the surgical instrument 511, and may be removably coupled to the slave hub 510. A sterile interface may be positioned between the slave hub 510 and the surgical instrument 511. In addition, translating instrument interface 503 includes a translation transmission system that extends from one or more motors positioned within hub 510 to components of end effector 512. For example, the end effector 512 includes a plurality of end effector links interconnected by a plurality of end effector joints coupled to a translation drive system of the translation instrument interface 503 such that actuation of the translation drive system by one or more motors moves the end effector 512 via the plurality of end effector links and joints.

Further details regarding the components and operation of the slave hub 510 are described with reference to fig. 36A and 36B. The slave hub 510, which is secured to the translation instrument interface 503 of the slave unit 501, includes one or more motors, such as a first motor 601a, a second motor 601b, a third motor 601c, and a fourth motor 601d, which are operably coupled (e.g., via wires) with the control system via the circuit board 602. The motors 601a-601d receive signals indicative of the measured movement and trigger actuation of the handle 403 as measured by one or more sensors 410 coupled to the handle 403. These signals are processed by the control system, which in turn provides signals to the motor that actuates the translation instrument interface 503 to replicate the micro-movements corresponding to those inputs at the handle 403. First motor 601a, second motor 601b, and third motor 601c are directly coupled to a translation drive train 603 of translating instrument interface 503 for actuating end effector 512 in open/close, pitch, and yaw degrees of freedom. The translation drive system 603 includes a plurality of drive elements, such as cables and/or lead screws, such that each of the plurality of drive elements is coupled at one end to the first motor 601a, the second motor 601b, and the third motor 601c, and at an opposite end to the first end effector link, the second end effector link, and the third end effector link to move the end effector in open/close, pitch, and yaw degrees of freedom. The translation drive system 603 may include multiple lead screws and/or a closed cable loop. Fourth motor 601d actuates rotation of slave device 503 via pronation and supination timing belt 513. One of ordinary skill in the art will appreciate that the slave hub 510 may include any combination of motors 601a-601d, for example, only one or more motors for actuating the end effector 512 in the open/close degrees of freedom and a motor for rotating the end effector 512 in the pronation and supination degrees of freedom when a non-articulated instrument is used.

Circuit board 602 may also include one or more sensors designed to detect undesired movement of translation instrument interface 503 and in electrical communication with first motor 601a, second motor 601b, third motor 601c, and fourth motor 601d to resist such undesired movement.

According to one aspect of the invention, the control system may identify the kinematics of the end effector 512 of the translating instrument interface 503 by reading an identifier element 516 (e.g., an RFID token integrated with the instrument) as shown in FIG. 36C, where the RFID token contains information about the kinematic configuration of the instrument. In particular, based on information read from identifier element 516, the control system may configure the operation of one or more motors interfacing with translating instrument interface 503 to operate differently (e.g., simultaneously clockwise rotation, or one clockwise rotation and another counterclockwise rotation) to cause actuation of the end effector element. For example, in fig. 36D, a forceps-type end effector with parallel-serial instrument kinematics is depicted. For this configuration, the first motor 601a may be operably coupled to a first link, e.g., a first blade, of the end effector 512 'via a transmission element 514a of the translation transmission system such that the first motor 601a moves the first link of the end effector 512' outward/inward. The second motor 601b may be operably coupled to a second link, e.g., a second blade, of the end effector 512 'via a transmission element 514b of the translation transmission system such that the second motor 601b moves the second link of the end effector 512' outward/inward. Thus, the control system may instruct first motor 601a to move the first link of end effector 512 ' outward via transmission element 514a while instructing second motor 601b to move the second link of end effector 512 ' outward via transmission element 514b based on actuation of trigger 412 of handle 403, thereby causing end effector 512 ' to open. Conversely, the control system may instruct first motor 601a to move the first link of end effector 512 ' inward via transmission element 514a while instructing second motor 601b to move the second link of end effector 512 ' inward via transmission element 514b based on actuation of trigger 412 of handle 403, thereby causing end effector 512 ' to close. Thus, the first motor 601a and the second motor 601b may move the end effector 512' with an opening/closing degree of freedom.

The control system may be based on handle 403 about handle axis θ₉Instructs the first motor 601a to move the first link of the end effector 512 ' outward via the transmission element 514a, and simultaneously instructs the second motor 601b to move the second link of the end effector 512 ' inward via the transmission element 514b, thereby tilting the end effector 512 ' upward. Instead, the control system may be based on the handle 403 being about the handle axis θ₉Instructs the first motor 601a to move the first link of the end effector 512 ' inwardly via the transmission element 514a, while instructing the second motor 601b to move the second link of the end effector 512 ' outwardly via the transmission element 514b, thereby pitching the end effector 512 ' downwardly. Thus, first motor 601a and second motor 601b can move end effector 512' in a pitch degree of freedom.

The third motor 601c may be operably coupled to the third link of the end effector 512' via a transmission element 514c of the translational transmission system such that the third motor 601c is based on the handle 403 about the handle axis θ₈Causes the end effector 512' to move in a yaw degree of freedom. Fourth motor 601d may be operably coupled to first motor 601a, second motor 601b, third motor 601c, and surgical instrument 511 via a rotatable pronation and supination timing belt 513 such that fourth motor 601d rotates first motor 601a, second motor 601b, third motor 601c, and surgical instrument 511 (and thus end effector 512') in a pronation degree of freedom based on rotation of ball 413 of handle 403.

Referring now to fig. 36E, an end effector with serial-to-serial instrument kinematics is depicted. For example, first motor 601a may be operably coupled to a first link of end effector 512 "via transmission element 515a of the translational transmission system such that actuation of first motor 601a based on trigger 412 of handle 403 moves end effector 512" in an open/close degree of freedom. The second motor 601b may be operably coupled to a second link of the end effector 512 ″ via a transmission element 515b of the translational transmission system such that the second motor 601b is based on the handle 403 about the handle axis θ₉Causes the end effector 512 "to have a pitch degree of freedomAnd (4) moving. The third motor 601c may be operably coupled to a third link of the end effector 512 ″ via a transmission element 515c of the translational transmission system such that the third motor 601c is based on the handle 403 about the handle axis θ₈Causes the end effector 512 "to move in a yaw degree of freedom. Fourth motor 601d may be operably coupled to first motor 601a, second motor 601b, third motor 601c, and surgical instrument 511 via a rotatable pronation and supination timing belt 513 such that fourth motor 601d rotates first motor 601a, second motor 601b, third motor 601c, surgical instrument 511 (and thus end effector 512 ") in a pronation degree of freedom based on rotation of ball 413 of handle 403.

According to one aspect of the present invention, the control system may read information stored on an identifier element 516 (e.g., an RFID token) integrated with the instrument to identify the kinematic/kinematic properties (kinematics) of the end effector 512 translating the instrument interface 503, as outlined in method step 700 listed in fig. 37. At step 701, a user selects a surgical instrument having an end effector for use with a hybrid telemanipulator. For example, a surgical instrument may have an end effector with parallel-serial instrument kinematics as shown in fig. 36D or serial-serial instrument kinematics as shown in fig. 36E. The surgical instrument may then be coupled to the slave unit of the hybrid telemanipulator. At step 702, the control system detects information for the kinematic configuration of the selected end effector. For example, the control system may read an RFID token integrated with the surgical instrument 511 that contains information about the kinematic configuration of the selected end effector, e.g., whether the selected end effector has parallel-serial instrument kinematics or serial-serial instrument kinematics. The RFID token may be, for example, an inductively read microchip containing identification information that may be scanned by a reader disposed on the slave hub and operatively coupled to the control system. Alternatively, the functionality of the identifier element 516 may be provided by, for example, an optical label (such as a bar code, QR code, Datamatrix, Aztec code, or Sema code) provided on the surgical instrument 511 read from the hub. If the surgical instrument is not already coupled to the slave unit of the hybrid telemanipulator, then after step 702, the surgical instrument may be coupled to the slave unit of the hybrid telemanipulator.

At step 703, the control system identifies kinematics of the selected end effector based on the information detected at step 702 to determine which type of end effector is coupled to the slave unit of the hybrid telemanipulator. At step 704, the control system adjusts its parameters based on the identity of the selected end effector so that the hybrid remote manipulator can be actuated appropriately. For example, if the end effector has parallel-serial instrument kinematics, the control system will include parameters that instruct the first and second motors 601a, 601b to simultaneously actuate the first and second end effector links to move the end effector in the open/close and pitch degrees of freedom, as described above. If the end effector has serial-to-serial instrument kinematics, the control system will include parameters that instruct the first motor 601a to actuate the end effector in the open/close degree of freedom and that instruct the second motor 601b to actuate the end effector in the pitch degree of freedom, as described above.

Referring to fig. 38, an alternative exemplary embodiment of a remotely actuated surgical robotic system is depicted in which all degrees of freedom are electromechanically controlled. Although all seven degrees of freedom (e.g., inward/outward, upward/downward, leftward/rightward, yaw, pitch, open/close, and pronation/supination) are electromechanically controlled via the sensor system, motors, and control system, the system 800 maintains mechanical constraining elements as described above on the master unit, creating a single virtual stationary point, e.g., a remote center of motion, at the slave unit. Thus, system 800 does not require coordinate transformations and complex control systems to align slave unit 1001 with the incision. The mechanical constraints and corresponding remote center of motion ensure that the design is simpler and safer than using a universal robotic arm.

Referring now to fig. 39, the main unit 901 is similar in construction to the main unit 401 of fig. 34A and 34B, except that instead of a plurality of cables and pulleys coupled to the mechanical drive train of pulley P1, the main unit 901 includes one or more sensors, such as sensor 902a, sensor 902B, sensor 902c, and sensor 902d, operatively coupled to each of the four pulleys of pulley P1. The sensors 902a-902d measure rotational movement by measuring the angle and position of the pulley P1 in response to movement of a handle 903 applied to the main unit 901 via a plurality of main links, joints, and cables. Each of the four sensors measures the movement of the joint of the main unit 901 via each of the four pulleys of the pulley P1, thereby measuring the movement of the main unit 901 in four degrees of freedom of motion. However, the mechanical constraint constrains the movement of the master unit 901 by removing one degree of freedom of motion, thereby causing the slave unit 1001 to move in three degrees of freedom of motion (e.g., inward/outward, upward/downward, and leftward/rightward).

The handle 903 is constructed similarly to the handle 403 of fig. 34A and 34B. For example, the handle 903 includes one or more sensors 410 and a circuit board 411 such that micro-movements applied at the handle 903 may be transmitted to the end effector of the slave unit 1001 via the one or more sensors 410 and one or more motors coupled to the end effector of the slave unit 1001 to move the end effector in open/close, pitch, yaw, and pronation and supination degrees of freedom.

With respect to the transmission of macro movement, sensors 902a, 902b, 902c and 902d generate signals indicative of the rotation of the pulley P1 measured by the respective sensors and transmit the signals via the control system to one or more motors coupled to the slave unit 1001, thereby replicating the translational macro movement applied at the handle 903 coupled to the master unit 901. For example, a cable may extend from the master unit 901 to a control system, e.g., a unit containing control electronics, and additional cables may extend from the control system to one or more motors coupled to the slave unit 1001.

With respect to fig. 40A and 40B, the slave unit 1001 is similar in configuration to the slave unit 501 of fig. 35A and 35B. For example, the slave unit 1001 includes first, second, third, and fourth motors 601a, 601b, 601c, 601d operably coupled to the end effectors of the slave unit 1001 such that micro-movements imparted at the handle 903 may be transmitted to the end effectors of the slave unit 1001 via the one or more sensors 410 and the first, second, third, and fourth motors 601a, 601b, 601c, 601d to move the end effectors in the open/close, pitch, yaw, and supination degrees of freedom. Slave unit 1001 differs from slave unit 501 in that, instead of multiple cables and pulleys of the mechanical drive train being coupled to pulley P8, slave unit 1001 includes one or more motors, e.g., first motor 1002a, second motor 1002b, third motor 1002c, and fourth motor 1002d, operatively coupled to each of the four pulleys of pulley P8. One or more motors are coupled to the circuit board to receive signals indicative of the rotation of the pulley P1 as measured by the sensors 902a, 902b, 902c and 902d in response to movement applied to the handle 903 of the master unit 901, thereby actuating the pulley P8 via a plurality of slave links, joints, timing belts and/or cable and pulley systems to replicate translational macro movement applied to the handle 903 coupled to the master unit 901 at the slave unit 1001. For example, a first motor 1002a can be operatively coupled to and control movement of the first slave link 505a, a second motor 1002b can be operatively coupled to and control movement of the second slave link 505b, a third motor 1002c can be operatively coupled to and control movement of the third slave link 505c, and a fourth motor 1002d can be operatively coupled to and control movement of the translating instrument interface 503 via a pulley P8 and a plurality of slave joints, timing belts, and/or cable and pulley systems.

Since the mechanical constraints of main unit 901 limit the movement of main unit 901 to three degrees of freedom of movement, e.g., inward/outward, upward/downward, and leftward/rightward, the movement of first, second, third, and translational instrument interfaces 505a, 505b, 505c, and 503 of slave unit 1001 caused by first, second, third, and fourth motors 1002a, 1002b, 1002c, and 1002d, respectively, is constrained to three degrees of freedom of movement, e.g., inward/outward, upward/downward, and leftward/rightward, about virtual stationary point 1005 (e.g., a remote center of motion).

The slave unit 1001 may include a temporary incision indicator 1004 pointing to a virtual resting point 1005, e.g. a remote center of motion, created by mechanical constraints at the master unit 1001, such that the virtual resting point 1005 may be made to coincide with a surgical incision point, thereby reducing trauma to the patient and improving the cosmetic outcome of the surgical procedure. The temporary incision indicator 1004 is removably coupled to the joints of the slave unit 1001 such that the temporary incision indicator 1004 points to the virtual resting point 1005 and may be removed prior to operation of the surgical robotic system 800.

Referring now to fig. 40C and 40D, an alternative exemplary embodiment of a cut-out indicator is provided for use with the system shown and described in fig. 1-30 herein. As with the incision indicator 1004, the incision indicator 1004' may be removably coupled to a joint of the slave unit 1001 (e.g., the distal end of the link 63 described above) such that the temporary incision indicator 1004 points to a virtual center of motion, e.g., a virtual rest point 1005, to identify a remote center of motion of the surgical instrument. For example, the cut-out point 1004' may be removably coupled to the slave console using structures including, but not limited to, magnets, friction, velcro surfaces, mating geometries, hooks, and the like. The cut-out indicator 1004' may be made of ferritic stainless steel and illustratively includes a magnetic head 1006 at a proximal end of the cut-out indicator for magnetically coupling with a corresponding surface at the slave console (e.g., a receptacle at a joint of the slave unit 1001).

As shown in fig. 40C, the magnetic head 1006 may have a convex spherical surface with its center aligned with the distal tip of the notch indicator 1004'. Thus, the receptacle at the joint of the slave unit 1001 may have a corresponding concave spherical surface for engagement with the convex spherical surface of the incision indicator 1004'. Those of ordinary skill in the art will appreciate that the head 1006 of the incision indicator 1004' may have a concave spherical surface and the receptacle at the joint of the slave unit 1001 may have a convex spherical surface. The cut-out point 1004' may function with or without a sterile drape mounted on the slave unit 1001. Fig. 40E shows the incision indicator 1004 'inserted into the trocar 1007 such that the distal tip of the incision indicator 1004' is aligned with the body wall of the patient (e.g., the virtual resting point 1005 about which the instrument will rotate). After the surgical instrument is inserted, the incision indicator 1004' may be removed from the receptacle at the joint of the slave unit 1001 prior to operation of the surgical robotic system.

According to one aspect of the invention, the incision indicator 1004 'may be removably coupled to the joints of the slave unit 1001, for example at the links 63, and the clinician may move the joints of the slave unit 1001, and thus, the adjacent plurality of slave links and slave joints, until the distal tip of the incision indicator 1004' is aligned with and directed to a desired location on the patient's body, for example, an incision site on the patient's body. Once the joints of the slave unit 1001 and the incision indicator 1004' are pointing to the desired position, the clinician may set the desired position to a virtual resting point 1005 via the control system based on the alignment of the joints of the slave unit 1001. Thus, during operation of the surgical robotic system, all movements of the surgical instrument from the console will always rotate about virtual rest point 1005, even without mechanical constraints at the master console, as described in further detail below with reference to fig. 43. In this manner, the controller of the system ensures that the surgical instrument does not cause translational movement away from virtual rest point 1005 in order to perform a safe surgical procedure through the trocar. During surgery, the aligned links (e.g., link 63) are preferably always directed toward the surgical site (e.g., through the opening of the trocar) such that movement of the surgical instrument is limited to near the virtual resting point.

Accordingly, the controller of the system may execute instructions to set a virtual rest point 1005 based on the desired position on the linkage 63 and the patient's body being aligned at the surgical site such that movement of the surgical instrument is limited near the virtual rest point 1005 to maintain the linkage 63 (and its longitudinal axis ω) during the surgical procedure₅) Aligned with the incision site.

Referring now to fig. 41A and 41B, an alternative embodiment of a control system for a surgical robotic system is described. The control system 1100 of fig. 41A, which may be integrated with the system 100, includes a non-transitory computer-readable medium, such as the memory 1101, having stored thereon instructions that, when executed by the processor 1102 of the control system 1100, allow operation of the hybrid remote manipulator. Additionally, the control system 1100 may communicate wirelessly or using a cable with the identifier element reader 517 of the slave unit 501 such that the memory 1101 may store the identity of the kinematic configuration of the end effector read from the identifier element 516 such that when executed by the processor 1102, the instructions cause the motors for controlling the end effector in the opening/closing and pitch degrees of freedom to behave in accordance with the type of end effector selected. The control system 1100 is electrically coupled, wirelessly or using a cable, to a circuit board of the main unit 401 and thus to the one or more sensors 410 for receiving signals indicative of micro-movements applied at the handle 403. In addition, the control system 1100 is electrically coupled, wirelessly or using cables, to the circuit board of the slave unit 501, and thus to the first motor 601a, the second motor 601b, the third motor 601c, and the fourth motor 601d, for actuating micro-movements of the end effector, for example, to open/close, pitch, yaw, and pronation and supination degrees of freedom.

The control system 1110 of fig. 41B, which may be integrated with the system 800, includes a non-transitory computer-readable medium, such as the memory 1111, having stored thereon instructions that, when executed by the processor 1112 of the control system 1110, allow operation of the hybrid remote manipulator. Additionally, the control system 1110 may communicate wirelessly or using a cable with the identifier element reader 517 of the slave unit 1001, and the memory 1111 may store the identity of the kinematic configuration of the end effector read from the identifier element 516, such that when executed by the processor 1112, the instructions cause the motor to control the end effector in the opening/closing and pitch degrees of freedom to behave according to the type of end effector selected. The control system 1110 is electrically coupled, either wirelessly or using a cable, to the circuit board of the main unit 901, and thus to the one or more sensors 410 for receiving signals indicative of micro-movements applied at the handle 903, and to the sensors 902a, 902b, 902c and 902d for receiving signals indicative of macro-movements applied at the handle 903. In addition, control system 1110 is electrically coupled, either wirelessly or using cables, to the circuit board of slave unit 501, to first motor 601a, second motor 601b, third motor 601c, and fourth motor 601d for actuating micro-movements of the end effector, such as to open/close, pitch, yaw, and supination degrees of freedom, and to first motor 1002a, second motor 1002b, third motor 1002c, and fourth motor 1002d for actuating macro-movements of the end effector, such as to inward/outward, upward/downward, and leftward/rightward degrees of freedom.

Referring now to fig. 42A and 42B, an alternative application of the principles of the present invention may be applied to an alternative remote manipulator design. For example, the telemanipulator of the configuration depicted in fig. 42A as described in U.S. patent No.9,696,700 to Beira may be modified to include a handle and translating instrument interface to electromechanically control the micro-movements of the end effector, such as the open/close, pitch, yaw, and supination degrees of freedom, while the translating macro-movements of the end effector, such as the up/down, inward/outward, and left/right degrees of freedom, are mechanically controlled by a mechanical drive train. The remotely actuated surgical robotic system 1200 includes a master unit 1201 mechanically coupled directly to a slave unit 1202, a handle 1203 coupled to the master unit 1201, a translating instrument interface 1204 coupled to the slave unit 1202, and a mechanical constraint 1205. The handle 1203 is similar in construction to the handle 403 of fig. 34A and 34B, and the translation tool interface 1204 is also similar in construction to the translation instrument interface 503 of fig. 35A and 35B. For example, the handle 1203 includes one or more sensors such that micro-movements applied at the handle 1203 may be transmitted to the end effector of the translating instrument interface 1204 via the one or more sensors and one or more motors coupled to the end effector of the slave unit 1202 to move the end effector in the open/close, pitch, yaw, and supination degrees of freedom. Thus, due to the mechanical constraint 1203, the translating instrument interface 1204 will replicate the translating macro movement applied at the handle 1201 in three degrees of freedom (e.g., inward/outward, upward/downward, and leftward/rightward). Alternatively, the remotely actuated surgical robotic system 1200 may have seven degrees of freedom for electromechanical actuation.

With respect to fig. 42B, an alternative remote manipulator is depicted. For example, a telemanipulator constructed as described in U.S. patent No.2017/0245954 to Beira may be modified to include handles and a translating instrument interface to electromechanically control micro-movements of the end effector, such as open/close, pitch, yaw, and pronation/supination degrees of freedom, while mechanically controlling translational macro-movements of the end effector, such as up/down, in/out, and left/right degrees of freedom, through a mechanical drive system. The remotely actuated surgical robotic system 1210 includes a master unit 1211 mechanically coupled to a slave unit 1212, a handle 1213 coupled to the master unit 1211, a translating instrument interface 1214 coupled to the slave unit 1212, and a mechanical constraint 1215. The handle 1213 is similar in construction to the handle 403 of fig. 34A and 34B, and the translation tool interface 1214 is similar in construction to the translation instrument interface 503 of fig. 35A and 35B. For example, the handle 1213 includes one or more sensors such that micro-movements applied at the handle 1213 can be transmitted to the end effector of the translating instrument interface 1214 via the one or more sensors and one or more motors coupled to the end effector of the slave unit 1212 to move the end effector in the open/close, pitch, yaw, and supination degrees of freedom. Thus, due to the mechanical constraints 1213, the translating instrument interface 1214 will replicate the translating macro movement applied at the handle 1213 in three degrees of freedom (e.g., inward/outward, upward/downward, and leftward/rightward). Alternatively, the remotely actuated surgical robotic system 1210 may have seven electromechanically actuated degrees of freedom.

Referring now to FIG. 43, another exemplary host console constructed in accordance with the principles of the present invention is provided. The configuration of master console 20 'is similar to master console 20 of FIG. 2A, except that the master remote manipulator of master console 20' does not include mechanical constraints designed to constrain the movement of at least one master link of the plurality of master links as described above. For example, the main remote manipulator of main console 20' includes a base portion having telescoping bases 1008 and 1009 and a base cover 1010, the telescoping bases 1008 and 1009 being used to adjust the vertical height of the main remote manipulator, and the base cover 1010 being fixed atop the telescoping bases 1008 and 1009 and rotatably coupled to link 26 via joint 25.

Unlike master control station 20 of fig. 2A, the master remote manipulator of master control station 20' includes a link 1014 and a link 1016, the link 1014 being coupled to link 1012 via a joint 1013, and the link 1016 being coupled to link 1014 via a link 1015 and further coupled to a handle portion 1018 via a joint 1017. As shown in fig. 43, neither link 1014 or 1016 passes through link 1012. Conversely, once the virtual rest point (e.g., remote center of motion) is set by the control system, as described above with reference to fig. 40C-40E, the movement applied by the surgeon to the master remote manipulator will be performed by the slave links and slave joints of the slave console in a corresponding manner around the virtual rest point.

Advantageously, the master console 20 allows the surgeon to access the handle grip of the handle portion 1018 from top to bottom (rather than from bottom to top or horizontally as in other surgical robots). Furthermore, the master console 20 shares the same orientation with the surgeon's arm, such that the base of the master arm is located on the side of the surgeon's body, rather than in front of the central post area of the master console 20. Because the sterile main arm of master console 20 is positioned farther away from the ground in this configuration, the sterility of master console 20 is better maintained during use of the surgical system. In addition, this configuration reduces the depth of the surgeon's console, thereby saving valuable operating room floor space.

Further, as shown in fig. 43, the main console 20' may include a main arm breakage release button 1019 and a height adjustment button 1020. For example, actuation of the primary arm fracture release button 1019 will allow the user to readjust the plurality of primary links and primary joints until the primary telemanipulator is in the desired configuration for use by the surgeon, and actuation of the height adjustment button 1020 will allow the user to adjust the vertical height of the primary telemanipulator, e.g., up or down, via the telescoping bases 1008 and 1009.

While various illustrative embodiments of the invention have been described above, it will be apparent to those skilled in the art that various changes and modifications can be made therein without departing from the invention. It is intended by the appended claims to cover all such changes and modifications that fall within the true scope of the invention.

Claims (29)

1. A system for remote manipulation to perform a surgical procedure, the system comprising:

a patient console including a plurality of patient links coupled to a base;

a surgical instrument coupled to the patient console, a distal region of the surgical instrument configured to be inserted into a patient at a surgical site to perform a robotic surgical procedure; and

a controller configured to execute instructions to:

in a surgical mode, moving at least one of the plurality of patient links in response to movement imparted at a handle of a surgeon console operably coupled to the patient console, thereby moving the surgical instrument to perform the robotic surgical procedure; and is

Transitioning the patient console from the surgical mode to a laparoscopic mode in which the plurality of patient links are retracted from the patient while the base of the patient console remains stationary to expose the surgical site, thereby allowing a surgeon to perform a non-robotic surgical procedure at the surgical site without interference from the plurality of patient links.

2. The system of claim 1, wherein the controller is further configured to execute instructions to:

determining that the surgical instrument has been removed from the patient at the surgical site; and is

Transitioning the patient console from the surgical mode to the laparoscopic mode only if the surgical instrument has been removed.

3. The system of claim 2, wherein the controller determines that the surgical instrument has been removed from the patient by determining that the surgical instrument has been decoupled from the patient console.

4. The system of claim 1, wherein the controller transitions the patient console from the surgical mode to the laparoscopic mode in response to a user input received at the patient console.

5. The system of claim 1, wherein the handle is removably coupled to the surgeon console such that the handle is sterile during the surgical procedure and sterilizable when removed for additional surgical procedures.

6. The system of claim 5, further comprising a sterile drape interface having a ring defining an opening, wherein the handle, when coupled to the surgeon console, holds the ring in place such that the sterile drape of the sterile drape interface covers a portion of the surgeon console.

7. The system of claim 1, wherein the controller is configured to execute instructions to: in the surgical mode, at least one of the plurality of patient links is moved in response to movement applied at the handle of the surgeon console at a scaled degree.

8. The system of claim 7, wherein the controller is configured to execute instructions to: in the surgical mode, scaled micro-movements at the surgical instrument in micro-degrees of freedom are caused in response to corresponding movements applied at the handle of the surgeon console.

9. The system of claim 8, wherein micro-movements applied at the surgical instrument are independently scalable for each of the micro-degrees of freedom such that the scaled micro-movements at the micro-degrees of freedom are at a different scale than second scaled micro-movements at the surgical instrument at a second micro-degree of freedom.

10. The system of claim 1, wherein the surgeon console comprises a clutch configured to prevent micro-movement at the surgical instrument in response to micro-movement applied at the handle of the surgeon console when the clutch is actuated.

11. A method for remotely performing a surgical procedure, the method comprising:

coupling a surgical instrument to a patient console, the patient console including a plurality of patient links coupled to a base;

inserting a distal region of the surgical instrument into a patient at a surgical site to perform a robotic surgical procedure;

in a surgical mode, moving at least one of the plurality of patient links, thereby moving the surgical instrument to perform the robotic surgical procedure, in response to movement imparted at a handle of a surgeon console operably coupled to the patient console; and

transitioning the patient console from the surgical mode to a laparoscopic mode in which the plurality of patient links are retracted from the patient while the base of the patient console remains stationary to expose the surgical site, thereby allowing a surgeon to perform a non-robotic surgical procedure at the surgical site without interference from the plurality of patient links.

12. The method of claim 11, further comprising: determining that the surgical instrument has been removed from the patient at the surgical site, wherein transitioning the patient console from the surgical mode to the laparoscopic mode occurs only if the surgical instrument has been removed.

13. The method of claim 12, wherein determining that the surgical instrument has been removed from the patient at the surgical site comprises determining that the surgical instrument has been decoupled from the patient console.

14. The method of claim 11, further comprising receiving a user input at the patient console, wherein transitioning the patient console from the surgical mode to the laparoscopic mode is in response to the user input received at the patient console.

15. The method of claim 11, wherein the handle is removably coupled to the surgeon console, the method further comprising removing the handle for sterilization between surgeries.

16. A system for remote manipulation to perform a surgical procedure, the system comprising:

a patient console including an alignment joint and a plurality of patient links coupled to a base;

a surgical instrument coupled to the patient console, a distal region of the surgical instrument configured to be inserted into a patient at a surgical site to perform a robotic surgical procedure; and

a controller configured to execute instructions to:

setting a virtual center of motion based on the alignment of the alignment joint and the surgical site; and is

Moving at least one of the plurality of patient links in response to movement imparted at a handle of a surgeon console operably coupled to the patient console to move the surgical instrument to perform the robotic surgical procedure,

wherein movement of the surgical instrument is restricted near the virtual remote center of motion to maintain alignment of the patient joint with the surgical site during the surgical procedure.

17. The system of claim 16, further comprising a cut-out indicator configured to be removably coupled to the alignment joint to allow the alignment joint and the surgical site to be aligned.

18. The system of claim 17, wherein the cut indicator is configured to be removably coupled to the alignment joint via a magnetic attachment.

19. The system of claim 16, wherein the virtual center of motion is set based on the alignment of the alignment joint and a trocar positioned within the patient at the surgical site.

20. The system of claim 16, wherein the handle is removably coupled to the surgeon console such that the handle is sterile during the surgical procedure and sterilizable when removed for additional surgical procedures.

21. A method for remotely performing a surgical procedure, the method comprising:

aligning one of a plurality of patient joints of a patient console with a trocar insertion site, the plurality of patient joints interconnected by a plurality of patient links, the patient console operably coupled to a surgeon console and configured to move in response to movement applied at a handle of the surgeon console;

setting a virtual remote center of motion based on the alignment of the patient joint with the trocar insertion site; and

moving at least one of the plurality of patient links in response to movement applied at the handle to move a surgical instrument coupled to the patient console to perform the surgical procedure,

wherein movement of the surgical instrument is limited near the virtual remote center of motion to maintain alignment of the patient joint with the trocar insertion site during the surgical procedure.

22. The method of claim 21, further comprising coupling a cut indicator to the alignment joint, wherein aligning the one of the plurality of patient joints of the patient console with the trocar insertion site comprises aligning the cut indicator with the trocar insertion site.

23. The method of claim 22, wherein coupling the cut indicator to the alignment joint comprises coupling the cut indicator to the alignment joint via a magnetic attachment.

24. The method of claim 21, further comprising removing the handle for sterilization between surgeries.

25. A system for remote manipulation to perform a surgical procedure, the system comprising:

a patient console including a plurality of patient links coupled to a base;

a surgical instrument coupled to the patient console, a distal region of the surgical instrument configured to be inserted into a patient at a surgical site to perform a robotic surgical procedure; and

a controller configured to execute instructions to cause scaled micro-movements at the surgical instrument in micro-degrees of freedom in response to corresponding movements applied at the handle of the surgeon console in the surgical mode,

wherein the scaled micro-movement at the surgical instrument in the micro-degree of freedom is greater than the corresponding movement applied at the handle of the surgical console.

26. The system of claim 25, wherein the micro-movements applied at the surgical instrument are independently scalable for each of the micro-degrees of freedom such that the scaled micro-movements at a first micro-degree of freedom are at a different scale than second scaled micro-movements at the surgical instrument at a second micro-degree of freedom.

27. The system of claim 25, wherein the surgeon console comprises a clutch configured to prevent micro-movement at the surgical instrument in response to micro-movement applied at the handle of the surgeon console when the clutch is actuated.

28. The system of claim 27, wherein an end effector of the surgical instrument is movable to a first position via the handle, the clutch is then actuated, the handle is movable to a second position while the end effector remains stationary, and then, upon release of the clutch, the patient console resumes relative micro-movement from the handle to the end effector of the surgical instrument.

29. The system of claim 25, wherein the scaled micromotion at the surgical instrument in a roll degree of freedom of the micro degrees of freedom is at least twice as large as the corresponding movement in the roll degree of freedom applied at the handle of the surgeon console.

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