WO2023201116A1

WO2023201116A1 - Robotic endoscope devices, systems, and methods

Info

Publication number: WO2023201116A1
Application number: PCT/US2023/018857
Authority: WO
Inventors: Travis Sessions; Dustin Edward GORRINGE; Brian Curtis; Jeffrey PENMAN
Original assignee: Triton Endoscopy Technologies, Llc
Priority date: 2022-04-15
Filing date: 2023-04-17
Publication date: 2023-10-19

Abstract

A system can include a base with a first platform and a second platform that is movable relative to the first platform. The system can further include a first endoscope that includes a first insertion shaft that has a portion of a working channel, a first cartridge attached to the first insertion shaft that has a further portion of the working channel. The first cartridge can selectively couple with the first platform and selectively decouple from the first platform. The system can include a second endoscope that includes a second insertion shaft sized to fit within the working channel of the first endoscope, a second cartridge attached to the second insertion shaft and able to selectively couple with and decouple from the second platform. Movement of the second platform toward the first platform advances the second insertion shaft of the second endoscope through the working channel of the first endoscope.

Description

ROBOTIC ENDOSCOPE DEVICES, SYSTEMS, AND METHODS

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims priority to U.S. Provisional Patent Application No. 63/363,050, filed April 15, 2022, titled ROBOTIC ENDOSCOPE, the entire contents of which are hereby incorporated by reference herein.

TECHNICAL FIELD

Embodiments of the present disclosure generally relate to robotic endoscope devices, systems, and methods.

BACKGROUND

Endoscopes are medical devices that generally include an elongated shaft that is inserted into the body for a variety of purposes. In many instances, the elongated shaft includes an imaging system, such as a camera, CCD, or other suitable image capturing device, and can further include a lighting system, such as one or more optical fibers that transport light from a proximal end of the device and/or tip-mounted LEDs, which can illuminate a region observed by the imaging system. Endoscopes permit visualization inside the body, such as within a body cavity or organ. They may be inserted through a natural opening, such as the mouth during a bronchoscopy, or the rectum for a sigmoidoscopy, or through a surgical opening, such as in any of a variety of percutaneous procedures (e.g., percutaneous nephrolithotomy or percutaneous endoscopic gastrostomy). A medical procedure using any type of endoscope is called an endoscopy.

Duodenoscopes are specialized endoscopes that are often used for endoscopic retrograde cholangiopancreatography (ERCP). They are typically side-viewing (rather than forward-viewing) endoscopes that have the advantage of looking at the major duodenal papilla en-face. Typical duodenoscopes include a lever that is used to manipulate an elevator located at the tip of the endoscope. By maneuvering the elevator, the operator can raise and lower accessories passed through a working channel into the field of view. Duodenoscopes can facilitate access to the bile duct and pancreatic duct. Accessories, such as cholangioscopes, can be passed through the working channel of the duodenoscope into the biliary duct or pancreatic duct for real-time visualization and sampling of, e.g., the mucosa. Other or further procedures with the cholangioscopes are also possible. Embodiments described herein can ameliorate, rectify, resolve, overcome, or otherwise address one or more drawbacks of known endoscopy systems and/or procedures, including, for example, certain systems that utilize duodenoscopes and/or cholangioscopes and/or certain ERCP procedures in which such duodenoscopes and/or cholangioscopes are used. The subject matter of the present disclosure is not limited to embodiments that solve any disadvantages or that operate only in environments such as those described above. Rather, this background illustrates example technology areas where some embodiments described in the present disclosure may be practiced. For example, the present disclosure can generally apply to a variety of endoscopic systems and procedures in which an endoscope or other device is advanced through the working channel of another endoscope.

BRIEF DESCRIPTION OF THE DRAWINGS

Example embodiments will be described and explained with additional specificity and detail through the accompanying drawings in which:

Figure 1 depicts an illustrative embodiment of a system that includes a duodenoscope and a catheter that is passed through a working channel of the duodenoscope, and further depicts steps of various methods of using the system, with an early stage of some methods depicted in the rectangular box, and alternative or sequential methods depicted in circular insets;

Figure 2A is a perspective view of an illustrative embodiment of a duodenoscope that is compatible with the system depicted in Figure 1;

Figure 2B is a schematic cross-sectional view of the duodenoscope of Figure 2A;

Figure 3 is a perspective view of an illustrative example of a distal tip of an illustrative embodiment of a cholangioscope that is usable in a robotic system;

Figure 4 depicts an illustrative embodiment of a distal tip of another embodiment of a duodenoscope that is usable in a robotic system;

Figure 5 A is a side elevation view of an illustrative embodiment of a robotic system that includes another embodiment of a duodenoscope;

Figure 5B is a perspective view of an upper portion of the robotic system of Figure 5 A;

Figure 5C is a cross-sectional view of a portion of the robotic system of Figure 5A;

Figure 5D depicts another view of the portion of the robotic system shown in Figure 5C;

Figure 5E is a top view of the robotic system of FIG. 5 A; Figure 6A is a side elevation view of another illustrative embodiment of a robotic system that includes another embodiment of a duodenoscope;

Figure 6B is a perspective view of an upper portion of the robotic system of Figure 6A;

Figure 6C is a perspective view of another region of the robotic system of Figure 6A;

Figure 6D is a view of a further region of the robotic system of Figure 6A;

Figure 7A is a perspective view of an embodiment of a cartridge associated with a duodenoscope that is compatible with, e.g., embodiments of the robotic system depicted in Figures 5A-5E and/or the robotic system depicted in Figures 6A-6D, wherein a portion of a housing of the cartridge is omitted from view to permit visualization of internal componentry;

Figure 7B is a perspective view of an embodiment of a cartridge associated with a cholangioscope that is compatible with, e.g., embodiments of the robotic system depicted in Figures 5A-5E and/or the robotic system depicted in Figures 6A-6D, wherein a portion of a housing the cartridge is omitted from view to permit visualization of internal componentry, the cartridge being shown attached in fixed relation to a movable platform;

Figure 7C is a perspective view of the platform of Figure 7B;

Figure 8A is a perspective view of an embodiment of a controller for operating, e.g., embodiments of the system depicted in Figures 5A-5E and/or embodiments of the system depicted in Figures 6A-6D;

Figure 8B is another perspective view of the controller of Figure 8 A;

Figure 9A is a front view of another embodiment of a controller for operating, e.g., embodiments of the system depicted in Figures 5A-5E and/or embodiments of the system depicted in Figures 6A-6D;

Figure 9B is a top view of the controller of Figure 9A;

Figure 10A is a front perspective view of another embodiment of a controller for operating, e.g., embodiments of the system depicted in Figures 5 A-5E and/or embodiments of the system depicted in Figures 6A-6D;

Figure 1 OB is a rear perspective view of the controller of Figure 10A;

Figure 11 A is a front perspective view of another embodiment of a controller for operating, e.g., embodiments of the system depicted in Figures 5 A-5E and/or embodiments of the system depicted in Figures 6A-6D;

Figure 1 IB is a rear perspective view of the controller of Figure 11 A; Figure 12 is a schematic depiction of a computing system that is compatible with, e.g., embodiments of the robotic system depicted in Figures 5A-5E and/or embodiments of the robotic system depicted in Figures 6A-6D;

Figure 13 is a front perspective view of a portion of another embodiment of a robotic system that includes another embodiment of a duodenoscope;

Figure 14 is a rear perspective view of the robotic system of Figure 13;

Figure 15 depicts an illustrative procedural or surgical suite within which the system of Figure 13 is present and operationally coupled with further components;

Figure 16 depicts another view of the system of Figure 13;

Figure 17 depicts another embodiment of a robotic system that includes pinch valves;

Figure 18A is a perspective view of another embodiment of a controller for operating, e.g., embodiments of one or more of the systems of the present disclosure;

Figure 18B is another perspective view of the controller of Figure 18 A; and

Figure 19 is a perspective view of another embodiment of a controller for operating, e.g., any of the embodiments of oner or more of the systems of the present disclosure.

DETAILED DESCRIPTION

Certain embodiments described in the present disclosure relate to, among other things, the use of robotic systems to perform procedures using endoscopes. For example, robotic systems may be utilized in conjunction with the use of duodenoscopes and cholangioscopes in performing ERCP procedures. While the use of duodenoscopes and cholangioscopes may be used as examples in the present disclosure, it will be appreciated that the principles are readily applicable to any other suitable endoscope arrangement. For example, the present disclosure is applicable to any suitable endoscope that includes a working channel through which another elongated instrument may be advanced, such as an additional endoscope and/or a separate catheter. The primary endoscope may include steering capabilities, such that a distal end thereof may be bent or otherwise reconfigured to a desired orientation. In further instances, the catheter or secondary endoscope that is inserted through the working channel of the primary endoscope may include steering capabilities and/or a working channel of its own. The working channels of the primary and secondary endoscopes and/or the channel through any other suitable catheter or elongated instrument may also or alternatively be referred to herein as lumens. Further, the shafts of the endoscopes and/or catheters may also or alternatively be referred to herein as tubes.

Figure 1 depicts an illustrative embodiment of a duodenoscope 110 and an embodiment of a catheter 120 that has been advanced through the duodenoscope 110 in the course of a typical procedure. In some procedures, a patient P may lie flat on a surgical table with their head tilted to the side. The duodenoscope 110 may be fed through the mouth, throat, and into the stomach. The duodenoscope 110 may be forced past the pyloric sphincter and into the duodenum. The duodenoscope 110 may be fed through the duodenum until arriving at the major duodenal papilla. The duodenoscope 110 may then be held in place and a catheter 120 or other device may be passed through a working channel 111 of the duodenoscope 110. In some embodiments, a cauterizer or other device may be used to open the major duodenal papilla such that a cholangioscope may travel down the duodenoscope and exit the duodenoscope, traverse the wall of the duodenum, and access the gallbladder, pancreas, or other such portions of the body.

Such procedures are often performed by medical professionals who have years of training with specific devices. Furthermore, a significant portion of such procedures may be performed by “feel.” For example, as a medical professional may advance the duodenoscope 110 into the patient P, the medical professional may rely on tactile feedback to determine positioning of a distal end of the duodenoscope 110 and/or whether an obstruction has been reached or bypassed. This can result in injury or discomfort to the patient, such as when the duodenoscope 110 is forced past the pyloric sphincter.

Figures 2A and 2B illustrate another embodiment of a duodenoscope 200, which can resemble known duodenoscopes and may include standard features thereof. The duodenoscope 200 includes a control handle 210 that can be manipulated during advancement of the insertion tube of the duodenoscope 200 through the gastrointestinal tract of the patient P. In particular, as shown in Figure 2B, the control handle 210 can include a pair of actuators 214, 216 that can control deflection of a distal end 212 of the duodenoscope 200 along two orthogonal planes. That is, the actuators 214, 216 may be manipulated to achieve four-way steering of the distal end 212. The actuator 214 can control right/left movement of the distal end 212, while the actuator 216 can independently control up/down movement of the distal end 212. For example, the actuator 214 can be coupled with two control or tensioning wires (not shown) that extend through the shaft of the duodenoscope 200 and can be alternatingly tensioned or slackened to effect movement of the distal end 212 along a first plane. Similarly, the actuator 216 can be coupled with two further control or tensioning wires (not shown) that extend through the shaft of the duodenoscope 200 and can be altematingly tensioned or slackened to effect movement of the distal end 212 along a second plane that is orthogonal to the first plane.

The duodenoscope 200 may include an instrument channel 220 (which may also be referred to as a working channel), which may be in fluid communication at a proximal end thereof with a biopsy port 225. The biopsy port 226 may be toward a distal end of the control handle 210. In some embodiments, the duodenoscope 200 includes an elevator wire channel 230 with an elevator wire channel port 235 at a proximal end of the control handle 210.

The elevator recess 238 may be located at the distal end 212 of the duodenoscope 200. An elevator (such as the elevator 430 depicted in Figure 4) may be positioned within the elevator recess 238. The duodenoscope 200 can include an elevator control lever 218, which may permit activation of the elevator, causing the elevator to move within the elevator recess 238 to push or redirect components, tools, or other features out of the elevator recess and within the field of view of the duodenoscope 200. The elevator control lever 218 may control movement of the elevator in any suitable manner known in the art. For example, the control lever 218 can be coupled with a wire or other actuation mechanism that extends through the elongated shaft of the duodenoscope 200 to selectively raise and lower the elevator as the lever 218 is rotated back and forth.

Experienced practitioners may have comfort, familiarity, and/or muscle memory associated with holding and/or moving the control handle 210 for longitudinal advancement and/or rotation of the shaft into and/or within the patient P. Experienced practitioners may also or alternatively have comfort, familiarity, and/or muscle memory associated with manipulating the actuators 214, 216 to achieve a desired curvature and/or other configuration of the distal end 212 of the shaft. They may also or alternatively have comfort, familiarity, and/or muscle memory associated with manipulating the elevator control lever 218 to actuate or retract the elevator. Such comfort, familiarity, and/or muscle memory may also or alternatively exist with respect to other features of the control handle 210, such as valves (e.g., for suction, air, water), buttons (e.g., for lighting, image capture, and/or video capture), locks (e.g., for fixing angulation of the actuators 214, 216), etc. As further discussed below, e.g., with respect to Figures 18 A, 18B, and 19, some embodiments of controllers for robotic endoscopes may be well-suited for use by practitioners who have such comfort, familiarity, and/or muscle memory. The duodenoscope 200 may also include suction, irrigation, illumination, and other tools for performing an endoscopy procedure. The elevator recess 238 may be positioned at the distal end 212, but along the longitudinal side of the duodenoscope 200, rather than on a distal -facing tip of the duodenoscope 200. With the elevator recess 238 on the longitudinal side of the shaft, the elevator permits the tools to be advanced laterally outside of the duodenoscope 200 to conduct procedures at a side of the shaft.

The instrument channel 220 or working channel may provide access for tools or other components down or through a length of the duodenoscope 200. For example, a cauterizer may be passed down the instrument channel 220 and advanced out of the distal end 212 to provide access to the gallbladder, pancreas, or other such portions of the body. The cauterizer may then be withdrawn through the instrument channel 220 and a cholangioscope may then be passed distally through the instrument channel 220 to proceed out of the elevator recess 238 and ultimately into the gallbladder, pancreas, or other such region of the body during an ERCP procedure. Any other suitable instruments for providing access to the gallbladder, pancreas, or other region (e.g., instruments other than a cauterizer) are contemplated.

Cholangioscopes are also known in the art and generally include an elongated shaft that is sized to pass through the working channel of a duodenoscope. Cholangioscopes can include handles that are holdable and manipulable by a practitioner. In some embodiments, a handle can include control elements similar to those described above with respect to the duodenoscope 200. For example, embodiments of a cholangioscope can include actuators similar to the actuators 214, 216 described above that can each be coupled with a pair of control or tensioning wires, respectively. Each pair of wires may extend through a shaft of the cholangioscope to the distal end thereof. The wires can be tensioned and slackened via the actuators to bend the distal end of the cholangioscope in two orthogonal planes in manners such as previously described with respect to the duodenoscope shaft (e.g., up/down and left/right). Cholangioscopes may further include buttons for lighting and/or video capture, valves, etc.

Figure 3 illustrates an example tip 300 that may be incorporated into a cholangioscope 301 of either a manual variety or robotic variety (including robotic cholangioscopes described below). Stated otherwise, in some instances, a robotic cholangioscope may include a distal tip that can resemble distal tips that are used in conventional hand-mani pulable cholangioscopes. The tip 300 may include one or more openings or channels to facilitate the use of various tools or features in conjunction with the cholangioscope 301. While the proximal end of the cholangioscope 301 is not depicted in the images, in certain manually operable embodiments, the proximal end can include a handle with control elements similar to those described above with respect to the duodenoscope 200. For example, the cholangioscope can include actuators similar to the actuators 214, 216 described above that can each be coupled with a pair of control or tensioning wires, respectively. Each pair of wires may extend through a shaft of the cholangioscope 301 to the distal end thereof. The wires can be tensioned and slackened via the actuators to bend the distal end of the cholangioscope 301 in two orthogonal planes in manners such as previously described (e.g., up/down and left/right). Robotic versions of cholangioscopes that may include embodiments of the tip 300 are discussed further below.

The tip 300 may include a distal opening 311 of a working channel 310. The working channel 310 may permit the passage of a tool to pass along the length of the cholangioscope to be deployed through the tip 300. For example, one or more of the following may be used through the working channel 310: a stone retrieving tool, a forceps tool, a balloon tool, a stent tool, a cauterizing tool, a stitching tool, a radiation tool, an imaging tool, a medication delivering tool, etc. In broad terms, the working channel 310 of the cholangioscope 301 may provide for positioning of a device within a tube (e.g., the cholangioscope 301 or other cholangioscopes described herein) that is itself positioned within a tube (e.g., the duodenoscope 200 or other duodenoscopes described herein).

In some embodiments, the tip 300 includes a cauterizing feature 320 that may provide for performance of a number of procedures via the cholangioscope. Additionally or alternatively, another frequent or commonly used tool or feature may be disposed at or on the tip 300.

The tip 300 may include a first and/or second port 330, 340 for irrigation and/or insufflation (e.g., the use of water and/or air). The ports 330, 340 may provide the same or similar functionality as those ports/features as occur in other cholangioscopes. Additionally or alternatively, suction may be selectively applied via the working channel 310.

The tip 300 may include one or more light features 350, such as the light features 350a, 350b. For example, a light pipe may extend the length of the cholangioscope and have an output light feature to provide illumination at the tip 300 of the cholangioscope. For example, the light may provide illumination during a procedure and/or for the guidance of the cholangioscope. Any suitable number and variety of electrical or other communication leads, lumens, optical fibers, tensioning wires, or other elements can extend from an associated component at the tip 300, through the elongated shaft, and to a proximally located handle, as is customary in the art for manually operable cholangioscopes. In robotic embodiments, however, the handle may be substantially different from manually operable cholangioscopes. For example, the handle may be mountable (e.g., selectively attachable) to a robotic base, such as a cart, as further discussed below.

Figure 4 illustrates an example tip 400 that may be incorporated into a duodenoscope 410 of either a manual variety or robotic variety (including robotic duodenoscopes described below). Stated otherwise, in some instances, a robotic duodenoscope may include a distal tip that can resemble distal tips that are used in conventional hand-manipulable duodenoscopes. The tip 400 may include one or more openings or channels to facilitate the use of various tools or features in conjunction with the duodenoscope 410. While the proximal end of the duodenoscope 410 is not depicted in the images, in certain manually operable embodiments, the proximal end can include a handle with control elements similar to those described above with respect to the duodenoscope 200. For example, the duodenoscope 410 can include the actuators 214, 216 described above that can each be coupled with a pair of control or tensioning wires, respectively. Each pair of wires may extend through a shaft of the duodenoscope 410 to the distal end thereof. The wires can be tensioned and slackened via the actuators 214, 216 to bend the distal end of the duodenoscope 410 in two orthogonal planes in manners such as previously described (e.g., up/down and left/right). Robotic versions of duodenoscopes that may include embodiments of the tip 400 are discussed further below.

The tip 400 may include an elevator recess 420 through which various tools or features may be advanced. The elevator recess 420 may be at the end of a working channel of the duodenoscope 410. An elevator 430 at the tip 400 may be activated to elevate and push tools upward and out from the elevator recess 420. For example, one or more of a cholangioscope, a forceps tool, a balloon tool, a stent tool, a cauterizing tool, a stitching tool, a radiation tool, an imaging tool, a medication delivering tool, etc. may be deployed (e.g., individually) via the working channel and exit the duodenoscope 410 via the elevator recess 420.

The tip 400 may include a locking tool 440 proximate the elevator 430. For example, a guide wire over which tools or devices may be guided may be used in certain procedures. The guide wire can be advanced through the duodenoscope 410 and positioned at a desired location during the procedure, and the locking tool 440 may be invoked to lock the guide wire in place. For example, the locking tool 440 may include a clamp or clamplike feature that is contracted to pinch the guide wire between the locking tool 440 and the elevator 430. This feature may facilitate greater control and precision by fixing the guide wire in place relative to the duodenoscope 410. In these and other embodiments, after fixing the guide wire in place, a tool or other component may be fed over the guide wire towards and through the distal end of the duodenoscope 410 for deployment.

In some embodiments, the tip 400 may include a number of tools associated therewith. For example, the tip 400 may include a tool panel 450 with a camera 452 and/or a light 454. The camera 452 may be any image capturing device and may be coupled with a data line that conveys the data captured by the camera 452 to a video processing device. The camera 452 may include a charge-coupled device (CCD) image sensor, a complementary metal-oxide-semiconductor (CMOS) image sensor, or any other type of image sensor or combinations thereof. The camera 452 may capture images at the tip 400 to facilitate guidance of the duodenoscope 410 and/or performance of a procedure proximate the tip 400. The light 454 may provide illumination at the tip 400 of the duodenoscope 410. The light 454 may project light outwards in a direction outward from the elevator recess 420. For example, rather than illuminating in the distal direction along a longitudinal axis of the duodenoscope 410, the light 454 may illuminate in a lateral direction outwards from the elevator recess 420. In some embodiments, the light 454 may be coupled to a light pipe or other light conveying channel that extends through the shaft of the duodenoscope. Additionally or alternatively, the light 454 may include a light producing or generating object positioned at the tip 400, such as a light-emitting diode (LED) or LED array.

In some embodiments, the tip 400 may include a distal end of a working channel 460 and an irrigation and/or insufflation nozzle 470. The working channel 460 may extend along the length of the duodenoscope 410, such that one or more tools or objects may be guided down the length of the duodenoscope 410 to the tip 400 through the working channel 460. Additionally or alternatively, the working channel 460 may be used to provide suction or vacuum at the tip 400. For example, the working channel 460 may be coupled to a vacuum source at a proximal end of the duodenoscope 410 to allow suction through the working channel 460.

Any suitable number and variety of electrical or other communication leads, lumens, optical fibers, tensioning wires, or other elements can extend from an associated component at the tip 400, through the elongated shaft, and to a proximally located handle, as is customary in the art for manually operable duodenoscopes. In robotic embodiments, however, the handle may be substantially different from manually operable duodenoscopes. For example, the handle may be mountable (e.g., selectively attachable) to a robotic base, such as a cart, as further discussed below.

Embodiments of robotic systems described herein can incorporate some or all of the features described above with respect to manual duodenoscopes and/or manual cholangioscopes. Embodiments may be used in ERCP procedures. Many of the features are automated and may be controlled via one or more handheld controllers, rather than by physically manipulating a handle and controls positioned thereon. For example, embodiments include robotic elements that tension or slacken control or tensioning wires to effect movement of a distal end of a duodenoscope and/or an elevator. Further embodiments include robotic elements that can longitudinally advance the insertion tube of a duodenoscope into or within a patient and/or rotate the insertion tube within the patient. A cholangioscope can be advanced through the working channel of the duodenoscope. As previously discussed, while such embodiments are discussed in the context of duodenoscopes, cholangioscopes, and ERCP procedures, other endoscope varieties and procedures are contemplated.

Figures 5A-5E illustrate an embodiment of a robotic system 500 that includes a duodenoscope 520. The system 500 may further include a robotic base, such as a cart 510, for supporting at least portions of the system 500. In the illustrated embodiment, the system 500 further includes a cholangioscope 530, a shaft manipulator 540, a guiding arm 550, a safety pedal 580, and a stiffening arm 590.

The cart 510 may take any suitable shape or form, and may operate as a base for supporting various components of the system 500. The cart 510 may be positioned adjacent to a patient in a procedure room or surgical suite. The cart 510 may include a top end at or upon which multiple components may be situated (such as the shaft manipulator 540, the guiding arm 550, the duodenoscope 520, and/or the cholangioscope 530). The cart 510 may be positioned so that the guiding arm 550 is positioned adjacent to or with a portion thereof positioned within a mouth of the patient. The cart 510 may be adjustable in height in any suitable manner. The cart 510 may contain or include various features for interacting with other systems or devices in the procedure or surgical suite. For example, the cart 510 may include a power outlet. In some embodiments, the cart 510 may include a controller or control unit 511 that is in electrical or other suitable communication with various components of the system 500 in any suitable manner. For example, in some embodiments, the control unit 511 may be positioned within an external housing 513 of the cart 510 and may be in communication with one or more components of the system 500 via one or more electrical, optical, or other communication leads that are extend through a portion of the housing 513, or may be in wireless communication therewith. Accordingly, hereafter, it may be said that the control unit 511 provides control signals to one or more components of the system 500 (such as electromechanical elements or the like), and it should be understood that the control unit 511 is communicatively coupled with such elements in any suitable manner, such as electrical, optical, wireless, etc. The control unit 511 can include any suitable hardware (processors, controllers, etc., such as further described below) to control operation of system components that are secured to the cart 510. In the illustrated embodiment, the control unit 511 includes any suitable communication device 512 (such as an ethemet port, a wireless network chip, a near field communication (NFC) chip, a Bluetooth device, or some other related or similar device) via which control signals may be input to the control unit 511. Illustrative examples of controllers that a practitioner may use to input controls to the control unit 511 are discussed below with respect to Figures 8A-11B, 18 A, 18B, and 19. In various embodiments, the controller 511 may communicate in wired or wireless fashion with such a physical controller.

Stated otherwise, commands or instructions entered by a practitioner, physician or other operator of the robotic system, e.g., by way of a physical controller, may be communicated in wired or wireless fashion to the control unit 511, which can control operation of various components of the system 500 in response to the commands. For example, the control unit 511 can be communicatively coupled with the duodenoscope 520, the cholangioscope 530, and/or the shaft manipulator 540 to thereby control operation of these elements. For example, the practitioner may interact with a controller (such as those illustrated in Figures 8A-11B, 18A, 18B, and 19) to give commands to the control unit 511. Those commands may be interpreted or otherwise processed by the control unit 511, which may in turn deliver control signals to the various components of the system 500 in electrical or other form. Such a process will be described in greater detail with reference to Figures 8A-1 IB. The cart 510 may be used for multiple procedures. The cart 510 may be cleaned and sanitized between each procedure, such as by sterilization of the outer surfaces of the cart 510. The cart 510 may be made of a material that may be readily sanitized.

The duodenoscope 520 can include an insertion shaft 521 that may be similar or comparable in configuration, including dimension and/or size, to the insertion shafts of traditional duodenoscopes. At a proximal end, the duodenoscope 520 may include a first cartridge 560, rather than a traditional handle. The insertion shaft 521 of the duodenoscope 520 can be fixedly secured to the first cartridge 560. The duodenoscope 520 may be designed to be discarded after a single use.

The duodenoscope 520 can also or alternatively be referred to as a robotic duodenoscope, or more generally, as an endoscope or as a robotic endoscope. For example, in the illustrated embodiment, the duodenoscope 520 differs from traditional handheld duodenoscopes in that the handle thereof (e.g., the cartridge 560) does not include actuators that are manually manipulable by a user to control deflection, steering, or other directional movements of a distal end of the insertion shaft and/or does not include actuators that are manually manipulable by a user to raise or lower an elevator, capture video, apply suction or irrigation, etc. Rather, the cart 510 to which the duodenoscope 520 is attached is configured to receive such control inputs from a user, e.g., via one or more handheld or other controllers (discussed below), which are communicated to a control unit 511, and the control unit 511 then manages actuation of electromechanical elements to operate the duodenoscope 520.

The cartridge 560 of the duodenoscope 520 may also be referred to herein as a handle bundle, puck, packet, or connection element. In various embodiments, the cartridge 560 can include some, most, or all of the functionalities of a traditional duodenoscope handle. However, at least certain operations, such as deflection of the distal end of the insertion shaft 521, are achieved robotically, such as by electromechanical devices, rather than by hand-manipulable actuators. For example, electromechanical systems can be coupled to tensioning wires that extend through the insertion shaft 521 and may be activated to deflect the distal end of the insertion shaft 521, in contrast to physical manipulation of knobs coupled with such tensioning wires in traditional duodenoscopes.

In some embodiments, the cartridge 560 includes a housing 561, which may also be referred to as a shell or case, that includes components therein. In some embodiments, the housing 561 may be manipulable by a user to selectively attach the cartridge 560 to a sled, shuttle, pedestal, stage, mount, or platform 563 that is coupled to the cart 510 and/or to selectively remove the cartridge 560 from the platform 563. In some embodiments, the platform 563 and the cartridge 560, when attached together, may be movable in unison relative to the housing 513 of the cart 510, as further discussed below.

Similarly, the cholangioscope 530 can include an insertion shaft 531 that may be similar or comparable in configuration, including dimension and/or size, to the insertion shafts of traditional cholangioscopes. At a proximal end, the cholangioscope 530 may include a second cartridge 570, rather than a traditional handle. The insertion shaft 531 of the cholangioscope 530 can be fixedly secured to the second cartridge 570 and can be insertable into the duodenoscope 520. The cholangioscope 530 may be designed to be discarded after a single use.

The cholangioscope 530 can also or alternatively be referred to as a robotic cholangioscope, or more generally, as an endoscope or as a robotic endoscope. For example, in the illustrated embodiment, the cholangioscope 530 differs from traditional handheld cholangioscopes in that the handle thereof (e.g., the cartridge 570) does not include actuators that are manually manipulable by a user to control deflection, steering, or other directional movements of a distal end of the insertion shaft and/or does not include actuators that are manually manipulable by a user to capture video, apply suction or irrigation, etc. Rather, the cart 510 to which the cholangioscope 530 is attached is configured to receive such control inputs from a user, e.g., via one or more handheld or other controllers (discussed below), which are communicated to a control unit 511, and the control unit 511 then manages actuation of electromechanical elements to operate the cholangioscope 530.

The cartridge 570 of the cholangioscope 530 may also be referred to herein as a handle bundle, puck, packet, or connection element. In various embodiments, the cartridge 570 can include some, most, or all of the functionalities of a traditional duodenoscope handle. However, at least certain operations, such as deflection of the distal end of the insertion shaft 531, are achieved robotically, such as by electromechanical devices, rather than by hand-manipulable actuators. For example, electromechanical systems can be coupled to tensioning wires that extend through the insertion shaft 531 and may be activated to deflect the distal end of the insertion shaft 531, in contrast to physical manipulation of knobs coupled with such tensioning wires in traditional duodenoscopes.

In some embodiments, the cartridge 570 includes a housing 571, which may also be referred to as a shell or case, that includes components therein. In some embodiments, the housing 571 may be manipulable by a user to selectively attach the cartridge 570 to a stage, mount, or platform 573 that is coupled to the cart 510 and/or to selectively remove the cartridge 570 from the platform 573. In some embodiments, the platform 573 and the cartridge 570, when attached together, may be movable in unison relative to the housing 513 of the cart 510.

With reference to Figures 5A, 5B, and 5E, the platforms 563, 573 are movable bases to which the cartridges 560, 570, respectively, can be selectively coupled in a temporary yet secure attachment or decoupled and removed. Such selective coupling and decoupling is discussed further below with respect to Figures 7A-7C. In the illustrated embodiment, the platforms 563, 573 are substantially the same size, as are the cartridges 560, 570, but this may differ in other embodiments. In the illustrated embodiment, each of the platforms 563, 573 is selectively linearly translatable relative to the other. In other embodiments, only the platform 573 may be translatable relative to the platform 563. In the illustrated embodiment, the platform 573 may be advanced distally toward the platform 563 or retracted proximally away from the platform 563. Similarly, in the illustrated embodiment, the platform 573 may be advanced distally away from the platform 563 or retracted proximally toward the platform 563.

Each of the platforms 563, 573 can be coupled with the cart 510 via any suitable electromechanical system that may be controlled by the control unit 511. For example, in the illustrated embodiment, the cart 510 includes a parallel pair of rails 592a, 592b each having a longitudinal axis that runs parallel to a longitudinal axis of the system 500. In the illustrated embodiment, the rails 592a, 592b are threaded rods. The longitudinal axis of the system 500 runs through the center of the duodenoscope 520 and the cholangioscope 530, when each of these is coupled to the platforms 563, 573, respectively. Each of the platforms 563, 573 includes at least one coupler (see the coupler 793a in Figure 7C) that movably couples the platform 563, 573 to the first threaded rail 592a and at least one additional coupler (see the coupler 793b in Figure 7C) that movably couples the platform 563, 573 to the second threaded rail 592b. Stated otherwise, the platform 563 can include at least a pair of couplers that couple the platform 563 to the pair of threaded rails 592a, 592b, respectively, and the platform 573 can include at least a pair of couplers that couple the platform 573 to the pair of threaded rails 592a, 592b, respectively. The couplers can include any suitable electromechanical system or element, such as, e.g., a motor (servomotor, stepper motor, etc.) that rotates a threaded nut that is positioned on one of the respective rails 592a, 592b and is in threaded engagement therewith, as further discussed below with respect to Figure 7C. For example, each of the nuts can include internal threading that is complementary to and mates with the external threading of a respective one of the rails 592a, 592b.

Accordingly, when the cartridges 560, 570 of the duodenoscope 520 and the cholangioscope 530, respectively, are engaged to the platforms 563, 573, respectively, the platforms 563, 573 can be actively controlled by the control unit 511 to advance or retract along the rails 592a, 592b, and the duodenoscope 520 and the cholangioscope 530 can thereby likewise be actively controlled by the control unit 511 to advance or retract relative to the rails 592a, 592b. It may also be said that the duodenoscope 520 and the cholangioscope 530 are passively advanced and retracted, in that the controls and electromechanical or other systems that are used for such advancement and retraction are integral to the robotic cart 510. That is, all control and effectuation of movement is orchestrated by the controls and componentry of the cart 510, while the disposable (in some embodiments) duodenoscope 520 and cholangioscope 530 are merely advanced and retracted by virtue of being selectively securely connected to the platforms 563, 573.

In other embodiments, more or fewer rails 592a, 592b may be used. For example, in some embodiments, only a single rail 592a is used, and one or more longitudinally extending tracks may run parallel to the single rail 592a. The tracks may provide stability to the platforms 563, 573 and may provide a low-friction interface along which the platforms 563, 573 can slide. Each of the platforms may include at least one coupler (e.g., such as the coupler 793 shown in Figure 7C) that movably couples the platform 563, 573 to the single rail 592a, which can be controlled by the control unit 511 to advance or retract said platform 563, 573.

In various embodiments, the shaft manipulator 540 can include one or more components for interfacing with the duodenoscope 520 to longitudinally advance and/or rotate the duodenoscope 520. The shaft manipulator 540 is described in greater detail below with reference to Figures 5C and 5D.

The guiding arm 550 may be configured to provide a rigid support to the flexible tube of the duodenoscope 520 when the duodenoscope 520 is being inserted into the patient (e.g., inserted into the mouth and through the throat of the patient). In some embodiments, the guiding arm 550 may be selectively openable to permit the insertion shaft 521 of the duodenoscope 520 to be inserted laterally into the guiding arm 550, rather than being threaded through the guiding arm 550 (e.g., in a proximal -to-distal direction). For example, in the illustrated embodiment, the guiding arm 550 includes a pair of hinges 551, 552 at a lateral side thereof that permit the guiding arm 550 to be selectively opened and closed along a side edge thereof. In some embodiments, a closure may be positioned opposite the hinged portion to permit selective closing of the guiding arm 550.

After the guiding arm 550 is opened, the duodenoscope 520 may be placed within a lumen of the guiding arm 550 and the guiding arm 550 can then be closed around the duodenoscope 520. The guiding arm 550 may be sized such that the duodenoscope 520 may be positioned within the guiding arm 550 while still being able to progress through the guiding arm 550. For example, the lumen of the guiding arm 550 may be sufficiently large to permit the insertion shaft 521 of the duodenoscope 520 to pass therethrough with little or minimal resistance while being sufficiently small to inhibit substantial lateral movements of the enclosed portion of the insertion shaft 521 that would otherwise bend or buckle, such as due to longitudinally compressive forces that might arise during an insertion event. In some embodiments, an internal portion of the guiding arm 550 may include rollers, bearings, or other similar devices to facilitate the duodenoscope 520 progressing through the guiding arm 550, such as by reducing friction and/or to reducing or preventing contact between a portion of the guiding arm 550 during an insertion event. For example, the use of the guiding arm 550 may permit the duodenoscope 520 to be fed into the patient by applying a distally directed force at the shaft manipulator 540. Resistive forces encountered by, e.g., a distal portion of the insertion shaft 521 at or within the patient may be directed proximally, such that compressive forces might arise within the insertion shaft 521 that would tend to make the insertion shaft 521 laterally bend or buckle. Such lateral movement of the enclosed portion of the shaft 521 that would result from bending or buckling can be counteracted by the guiding arm 550. Further, the guiding arm 550 can inhibit bending or buckling along additional lengths of the insertion shaft 521 that are positioned external to the guiding arm 550, e.g., along lengths that proximally and distally neighbor the guiding arm 550, due to the support of a significant length of the insertion shaft 521 provided by the guiding arm 550.

The first cartridge 560 of the duodenoscope 520 can include one or more pulleys, reels, spools, bobbins, or other mechanical components around which the tensioning wires can be wound or unwound (see Figure 7A) to respectively tighten or loosen the wires. That is, the pulleys may be controlled by the control unit 511 to selectively tighten or slacken the wires to achieve a desired deflection of a distal end of the insertion shaft 521. Stated another way, the first cartridge 560 may act as the interface between a control system and the insertion shaft 521 of the duodenoscope 520, the control system including the control unit 511 and a controller (e.g., any of the controllers depicted in Figures 8A-11B, 18A, 18B, and 19) manipulable by a user, as discussed further below. In some embodiments, the first cartridge 560 may be snapped or otherwise selectively secured into place on the cart 510 (e.g., in an engaged position, such as in a fixed relationship to the movable platform 563) in preparation of performing a procedure, and may be removed and discarded as a disposable component after a single procedure (e.g., a single use item). As discussed further below, the pulleys, spools, bobbins, or other internal components within the disposable cartridge 560 may be passive elements that are couplable, when the first cartridge 560 is selectively secured to the platform 563, to electromechanical devices (e.g., motors, such as servomotors, stepper motors, or the like) that are permanently secured to the platform 563. The electromechanical devices can be controlled (e.g., wired or wirelessly) by the control unit 511. This may reduce the cost of the disposable cartridge 560 and make the disposable duodenoscope 520 relatively economical.

In other embodiments, electromechanical devices may be positioned within or otherwise attached directly to the cartridge 560 itself, and may merely be controlled by the control unit 511 via any suitable form of communication (electrical, optical, wireless, etc.), such as via an electrical connection that may be established between electrodes positioned on the platform 563 and corresponding electrodes on the cartridge 560. This, however, may be relatively less economical, in some circumstances.

In some embodiments, the first cartridge 560 is fixedly secured to the insertion shaft 521 of the duodenoscope 520, such that the first cartridge 560 and the insertion shaft 521 are integrated as a unitary element, which can be disposable or single-use, in certain instances. In other embodiments, the first cartridge 560 may be provided separately from the insertion shaft 521, and the insertion shaft 521 may be selectively secured to the first cartridge 560. In certain of such instances, the first cartridge 560 may be reusable while the insertion shaft 521 may be disposable.

In the illustrated embodiment, the first cartridge 560 and the insertion shaft 521 of the duodenoscope 520 are permanently coupled together. In certain embodiments, the duodenoscope 520 is a single-use device that is selectively couplable with and decouplable from the cart 510, and specifically, couplable with and decouplable from the first platform 563, which is itself movable relative to the cart 510.

The first cartridge 560 can interface with the cart 510 and/or one or more other systems, such as a water source, a vacuum source, an air source, a light source, a video processing unit, etc., as described further below. Embodiments of the first cartridge 560 are described in greater detail with reference to Figure 7A. The second cartridge 570 of the cholangioscope 530 can include one or more spools, bobbins, or other features around which the tensioning wires can be wound or unwound (see Figure 7B) to respectively tighten or loosen the wires. That is, the spools may be controlled by the control unit 511 to selectively tighten or slacken the wires to achieve a desired deflection of a distal end of the insertion shaft 531. Stated another way, the second cartridge 570 may act as the interface between a control system and the insertion shaft 531 of the cholangioscope 530, the control system including the control unit 511 and a controller manipulable by a user, as discussed further below. In some embodiments, the second cartridge 570 may be snapped into place on the cart 510 in preparation of performing a procedure, and may be removed and discarded as a disposable component after a single procedure (e.g., a single use item). As discussed further below, the spools, bobbins, or other internal components within the disposable cartridge 570 may be passive elements that are couplable, when the second cartridge 570 is selectively secured to the platform 573, to servomotors or other devices (electromechanical or otherwise) that are permanently secured to the platform 573. The servomotors or other devices can be controlled (e.g., wired or wirelessly) by the control unit 511. This may reduce the cost of the disposable cartridge 570 and make the disposable cholangioscope 530 relatively economical.

In other embodiments, electromechanical devices, such as servo motors or the like, may be positioned within or otherwise attached directly to the cartridge 570 itself, and may be controlled by the control unit 511 in manners such as described with respect to the cartridge 560, such as via an electrical connection that may be established between electrodes positioned on the platform 573 and corresponding electrodes on the cartridge 570. This, however, may be relatively less economical, in some circumstances.

In some embodiments, the second cartridge 570 is fixedly secured to the insertion shaft 531 of the cholangioscope 530, such that the second cartridge 570 and the insertion shaft 531 are integrated as a unitary element, which can be disposable or single-use, in certain instances. In other embodiments, the second cartridge 570 may be provided separately from the insertion shaft 531, and the insertion shaft 531 may be selectively secured to the second cartridge 570. In certain of such instances, the second cartridge 570 may be reusable while the insertion shaft 531 may be disposable.

The second cartridge 570 can interface with the cart 510 and/or one or more other systems, such as a water source, a vacuum source, an air source, a light source, a video processing unit, etc., as described further below. Embodiments of the second cartridge 570are described in greater detail with reference to Figure 7B.

The safety pedal 580 may include a foot pedal that disables the control system in a default state and enables the control system when in an engaged state. In some embodiments, the safety pedal 580 is physically connected to the cart 510, such as by being fixedly secured to the cart 510 or movably connected thereto, e.g., via a cable. In other embodiments, the safety pedal 580 is configured to communicate wirelessly with the control unit 511 and/or may be unattached to the cart 510 and fully movable relative thereto. In some embodiments, the safety pedal 580 must be depressed to enable the control system. For example, a physician or other operator may step on the foot pedal 580 and while depressing the foot pedal 580 may interact with the controls of the robotic device to perform an ERCP procedure. As another example, the physician may press on and release the safety pedal 580, or toggle the safety pedal 580, to enable the control system and may then proceed to perform the procedure, and may not need to continuously engage the safety pedal 580 throughout the course of an ERCP procedure. Stated otherwise, the safety pedal 580 may comprise a two-state switch that may be selectively activated or deactivated and need not be held or depressed continuously to transfer from one state to another. While illustrated as a foot pedal 580, it will be appreciated the foot pedal 580 may be implemented as a safety button, lever, or other feature that the operator may actuate, whether with a foot, hand, finger, or in some other manner.

The stiffening arm 590 may also or alternatively be referred to herein as a stiffener, stiffening member, support element, or the like. The stiffening arm 590 can provide a rigid or reinforced passageway between the first cartridge 560 and the second cartridge 570 during an insertion event, and in particular, during insertion of the insertion shaft 531 into and/or through a working channel that extends through the duodenoscope 520 (see, e.g., the working channel 751 in Figure 7A). Stated another way, the stiffening arm 590 can inhibit lateral bending or kinking of the cholangioscope 530 as the second cartridge 570 is advanced distally and longitudinally, or in a direction along or parallel to a longitudinal axis of the cholangioscope 530, toward the first cartridge 560. For example, because the insertion tube 531 can be laterally flexible, the stiffening arm 590 can include a relatively rigid outer structure that laterally reinforces the insertion tube 531.

The stiffening arm 590 may be sized such that the cholangioscope 530 may be positioned at an interior thereof while still being able to advance distally therethrough. For example, a lumen of the stiffening arm 590 may be sufficiently large to permit the insertion shaft 531 of the cholangioscope 530 to pass therethrough with little or minimal resistance while being sufficiently small to inhibit substantial lateral movements of the enclosed portion of the insertion shaft 53 that would otherwise bend or buckle, such as due to longitudinally compressive forces that might arise during an insertion event. In some embodiments, an internal portion of the stiffening arm 590 may include rollers, bearings, or other similar devices to facilitate the cholangioscope 530 progressing through the guiding arm 590, such as by reducing friction and/or to reducing or preventing contact between a portion of the stiffening arm 590 during an insertion event. In other embodiments, no such rollers or the like are present.

For example, the stiffening arm 590 may permit the cholangioscope 530 to be fed into the duodenoscope 520 by advancing the platform 573, to which the second cartridge 570 is secured, distally relative to the first cartridge 560. Resistive forces encountered by the insertion shaft 531 at or within the working channel of the duodenoscope 520 may be directed proximally, such that compressive forces might arise that would tend to make the insertion shaft 531 laterally bend or buckle. Such lateral movement of the enclosed portion of the insertion shaft 531 that would result from bending or buckling can be counteracted by the stiffening arm 590.

In some embodiments, the stiffening arm 590 may be adjustable in length such that as a distance between the second cartridge 570 and the first cartridge 560 changes, the stiffening arm 590 likewise changes to maintain a rigid pathway between the first and second cartridges 560, 570. For example, in some embodiments, a distal end of the stiffening arm 590 can be secured to a proximal end of the first cartridge 560 in such manner that a lumen of the stiffening arm 590 aligns with the working channel through the first cartridge 560 and the insertion shaft 521 of the duodenoscope 520, and a proximal end of the stiffening arm 590 can be secured to a distal end of the second cartridge 570 in such manner that the stiffening arm 590 is substantially rectilinear and the insertion shaft 531 of the cholangioscope 530 extends through a lumen defined by the stiffening arm 590. As the second cartridge 570 advances distally toward the first cartridge 560, a length of the stiffening arm 590 can be reduced concurrently with and in an amount equal to a distance moved by the second cartridge 570. In some embodiments as the length of the stiffening arm 590 is reduced, the stiffening arm 590 maintains its rectilinear form. For example, in some embodiments, the stiffening arm 590 may be configured to telescopically collapse as the second cartridge 570 is advanced distally. In like manner, the stiffening arm 590 may be telescopically expanded, e.g., by a user, during initial securement of the stiffening arm 590 to the first and/or second cartridges 560, 570. In the illustrated embodiment, the stiffening arm 590 includes three nested telescopic segments 591a, 591b, 591c (see Figure 5E), listed in order of decreasing inner and outer diameters. Any suitable material is contemplated for the stiffening arm 590, and the stiffening arm 590 may be more resistant to lateral deflection than is the insertion shaft 531 of the cholangioscope 530.

Any suitable temporary yet secure connection interfaces 593a, 593b (see Figures 5B and 5E) between either end or both ends of the stiffening arm 590 and one or both of the first and second cartridges 560, 570 are contemplated. For example, in some embodiments, a press-fit or a snap-fit arrangement is used to connect one or both ends of the stiffening arm 590 to one or both of the first and second cartridges 560, 570.

In certain illustrative methods or procedures (e.g., in operation), a user or practitioner (e.g., a surgeon) may prepare for a procedure by obtaining the duodenoscope 520. The first cartridge 560 may be selectively secured to the platform 563 (e.g., via a snapped or other suitable mechanical arrangement, as further discussed below). For example, the cart 510 may include snap-in tabs or other features that snap into place in the first cartridge 560 when it is pressed into place. The first cartridge 560 may likewise snap out of engagement from the platform 563 when the procedure is complete, such as be exertion of sufficient force to overcome the snapped engagement or, in other embodiments, such as by engagement of a release button that deflects clip arms so as to permit removal of the first cartridge 560 from the platform 563. The robotic system may then pretension one or more of the guiding wires, elevator wires, or other such features of the first cartridge 560, as discussed below with respect to Figure 7A. The practitioner may then manually insert a distal end of the duodenoscope into the patient in manners such as may be performed traditionally for ERCP procedures. Alternatively, the physician may open the shaft manipulator 540 and the guiding arm 550 and place the duodenoscope 520 within the shaft manipulator 540 and the guiding arm 550. For example, when the clamp-like portion of the shaft manipulator 540 is open, the insertion shaft 521 can be introduced laterally into the shaft manipulator 540, and then the clamp-like shaft manipulator 540 can be closed. This is similar to introduction of the insertion shaft 521 into the guiding arm 550, which was previously discussed. The shaft manipulator 540 and the guiding arm 550 may be closed. The guiding arm 550 may be positioned close to or even partially within the mouth of the patient. The physician may step on the safety pedal 580 to engage the robotic system. The physician may then utilize the controller to provide direction to guide the duodenoscope 520 into the patient. For example, the commands from the controller may be received by the robotic system and converted to commands that are sent to the shaft manipulator 540 to progress the duodenoscope 520 in a longitudinal direction through the guiding arm 550 and into the patient. For example, the robotic system, under the direction of the physician, may guide the duodenoscope 520 down the throat of the patient, into the stomach of the patient, and past the pyloric sphincter. Once in position past the pyloric sphincter and into the duodenum, the robotic system may lock the duodenoscope 520 into place. For example, the shaft manipulator 540 may lock the duodenoscope into position by holding the motors associated with the drive rollers in place such that the duodenoscope no longer moves in the longitudinal direction.

After positioning and locking the duodenoscope 520 into place, the second cartridge 570 may be snapped into place and the stiffening arm 590 may be set to the correct length and attached to the front end of the second cartridge 570 and the back end of the first cartridge 560. In some embodiments, the cholangioscope 530 may be pre- loaded for at least a portion in the stiffening arm 590. Additionally or alternatively, the insertion shaft 531 of the cholangioscope 530 may be fed through the stiffening arm 590 prior to snapping the second cartridge 570 into place.

In some embodiments, after snapping the second cartridge 570 into place, the robotic system may pretension the tensioning wires of the cholangioscope 530. After coupling the stiffening arm 590 to both the first and the second cartridges 560, 570, the insertion shaft 531 of the cholangioscope 530 may be fed down the length of the duodenoscope 520. For example, the physician may interact with the controller and the robotic system may instruct the second cartridge 570 to actuate rotors, motors, or other components within the second cartridge 570 to feed the cholangioscope 530 down the length of the duodenoscope 520. When at a desired position for a procedure, including traversing along the elevator and out the elevator recess, the locking tool 440 may be engaged to hold the cholangioscope 530 in place. In these and other embodiments, there may be two mechanisms holding the cholangioscope 530 in place in the longitudinal direction. For example, under the control of the robotic system, the components of the second cartridge 570 may hold the cholangioscope 530 in place at the proximal end of the cholangioscope 530, and the locking tool 440 may hold the cholangioscope 530 in place towards the distal end of the cholangioscope 530. In some embodiments, one or more further accessories, tools, or the like may be utilized in conjunction with the cholangioscope 530. For example, in some embodiments, a sphincterotome may be used. In these and other embodiments, the further tool may be inserted manually through a working channel (e.g., the working channel 707 as shown in Figure 7B) accessible via the back of the second cartridge 570. The further tool may traverse the working channel of the cholangioscope 530 until a desired location for a procedure, and then may perform the procedure. Additionally or alternatively, an access port to the working channel of the cholangioscope 530 may be located on a lateral side or a top side of the second cartridge 570.

As illustrated in Figure 5B, the first cartridge 560 may include one or more fluid lines, such as hoses, coupled to and/or passing through the first cartridge 560. For example, the suction hose 562 may couple to an in-suite vacuum or suction channel and may proceed into the first cartridge and couple with the working channel of the duodenoscope 520 with a controllable valve or other feature such that as the physician interacts with the controller to indicate suction is desired, the robotic system may send a command to the first cartridge 560 to open the valve and apply suction to the working channel. As another example, an irrigation hose 564 (which may include air and/or water) may pass through the first cartridge 560 and enter the duodenoscope from within the first cartridge 560 and pass along the duodenoscope 520 to the distal end. At the proximal end, the irrigation hose 564 may include a port for coupling to a water line, air line, or any other fluid line in the surgical or procedure suite. In this manner the first cartridge 560 in combination with the duodenoscope 520, the suction hose 562, and/or the irrigation hose 564 may be used in a single procedure and then discarded. By providing a disposable component, the risk of infection between procedures may be greatly reduced.

In some embodiments, the fluid, air, and/or suction channels may be caried through to interface with the controller in a similar or comparable manner to typical duodenoscopes. For example, the air channel may extend to the controller (such as the controllers 1800, 1900 depicted in Figures 18 A, 18B and 19) and have a hole in the handle where, covering the hole may cause air to flow down the air channel of the duodenoscope 520. As another example, the handle may include an irrigation button that, when pressed, mechanically opens the water channel so water flows down a water channel of the duodenoscope 520, and a suction button may mechanically apply suction to the working channel. In these and other embodiments, the interfaces with the controller and/or the actuators (e.g., buttons) associated with air, water, and/or suction may be removable from the controller such that they can be disposed of or autoclaved or otherwise sterilized between procedures.

In a similar manner, the second cartridge 570 may include one or more fluid lines, such as hoses, coupled to and/or passing through the second cartridge 570 in a similar or comparable manner as the first cartridge 560. As used herein, the term “fluid” includes a liquid, a gas, or a combination thereof. For example, a suction hose 572 and an irrigation hose 574 may interact with and provide similar functionality to the cholangioscope 530 as the suction hose 562 and the irrigation hose 564 provide for the duodenoscope 520. Additionally, the second cartridge 570, the cholangioscope 530, and/or the suction hose 572 and irrigation hose 574 may be packaged and utilized as a single-use device that is discarded after a single procedure.

In some embodiments, the system 500 may include a torsional load sensor 522 (see Figure 5B) that is configured to determine an amount of torsional load that arises within the insertion shaft 521 when a user manually introduces and/or advances the insertion shaft 521 into and/or through the patient during cannulation. That is, in some instances, a user may desire to first attach the cartridge 560 to the platform 563 before manually cannulating the patient with the insertion shaft 521. The user may find it more familiar to cannulate the patient by manually manipulating the insertion shaft 521, rather than by robotically advancing and/or rotating the insertion shaft 521 via the robotic console or cart 510 — for example, via the shaft manipulator 540. The user may, however, prefer that the cartridge 560 be secured to the cart 510 in advance of the cannulation. For example, this may ensure that the cartridge 560 is out of the way and/or does not risk being damaged itself or imparting damage to anything else, such as by swinging around, during the cannulation.

In certain of such instances, the user may rotate the insertion shaft 521 during cannulation. With the proximal end of the insertion shaft 521 rotationally fixed in place at or by the cartridge 560 (as further discussed elsewhere herein), this rotation of the insertion shaft 521 can cause torsional forces to arise within the insertion shaft 521. In some embodiments, the torsional load sensor 522 senses an amount of this torsional load, and in further embodiments, may deliver this sensed data to the control unit 511. The control unit 511 may control componentry of the cartridge (such as a worm drive or other mechanical system, as discussed below) to rotate the insertion shaft 521 to reduce or eliminate the torsional load. After the manual cannulation is complete and the distal end of the duodenoscope 520 is in place within the patient as desired, the practitioner may clamp down the shaft manipulator 540 to immobilize the duodenoscope 520 thereat. To the extent there is any slack in the insertion shaft 521 between the shaft manipulator 540 and the cartridge 560, the user may deliver control signals, by manipulating a controller, to the control unit 511, which may then effect movement of the platform 563 proximally to retract the proximal end of the shaft 521 and straighten the insertion shaft 521 to a substantially rectilinear form. Having a substantially rectilinear form may facilitate subsequent insertion of tools and or a further endoscope (e.g., cholangioscope) through the working channel of the duodenoscope 520.

Further aspects of rotational coupling between embodiments of the cartridge 560 and the insertion shaft 521 are discussed below. In the foregoing example, the cartridge 560 is capable of actively rotating the insertion shaft 521. In other embodiments, the insertion shaft 521 is coupled with the cartridge 560 so as to freely and passively rotate relative thereto. Certain of such embodiments may not include torsion sensors or the ability of the cartridge 560 to actively rotate the insertion shaft 521 in response to readings therefrom.

Stated otherwise, in various embodiments, the sensor 522 may include a load sensor, a strain gauge, a force sensor, or some other sensor to measure a torque applied to the duodenoscope 520. Using the sensor 522 may facilitate the use of the robotic system while permitting a clinician to take similar actions used in canulation (e.g., duodenoscope insertion) as used with a more typical duodenoscope. For example, with a typical duodenoscopy, a clinician might rotate the handle or shaft of a duodenoscope during insertion to use the tip geometry and steerability of the shaft to guide the tip around and through anatomy. With the duodenoscope 520 interfacing with the shaft manipulator 540, such rotation of the duodenoscope 520 would not allow for this rotation. Using the sensor 522, the sensor 522 may sense when the clinician is applying torque to the duodenoscope 520. The sensor 522 may signal the robotic system to rotate the shaft of the duodenoscope 520 in the direction and magnitude of the torsional input of the clinician, which may be automatic in some instances. For example, the shaft manipulator 540 may cause the duodenoscope 520 to automatically rotate the proximal end of the insertion shaft 521 in a corresponding direction and magnitude as a distal end of the insertion shaft 521 as said distal end is being manually manipulated by the practitioner. In certain of these and other embodiments, the practitioner would have the option to canulate with or without manually rotating the duodenoscope 520, and/or would have the option to canulate with or without the first cartridge 560 attached to the cart 510. As illustrated in Figures 5C and 5D, the shaft manipulator 540 may include a rotation block 541 that resides in a channel 514 of the cart 510. The shaft manipulator 540 may include an upper portion 542a and a lower portion 542b, with the duodenoscope 520 traversing an opening between the upper and lower portions 542a, 542b. The upper and lower portions 542a, 542b can be selectively opened and closed in clamp-like fashion. When opened, the insertion shaft 521 may be introduced into the rotation block 541 in a lateral direction, or stated otherwise, in a direction substantially perpendicular to a longitudinal axis of the insertion shaft 521. Within the opening, two rollers 546a and 546b may interface with the duodenoscope 520. The rollers 546a 546b may be driven rollers, such as being driven by the motors 544a and 544b respectively. The entire rotation block 541 may interface with one or more rollers 547a and 547b, which may be driven rollers by electromechanical elements of any suitable variety (e.g., motors, such as those illustrated with respect to other electromechanical elements). In these and other embodiments each of the motors for driving the rollers may be under control of the robotic system.

The upper portion 542a may be rotated at a hinge 548 to be opened to facilitate placement of the duodenoscope within the opening between the upper portion 542a and the lower portion 542b.

In operation, when it is desired to feed the duodenoscope 520 in the longitudinal direction (e.g., when the physician interacts with the controller to feed the duodenoscope 520 down the throat and into the stomach of the patient), the robotic system may issue a command to the motors 544a and/or 544b to drive the rollers 546a and/or 546b to feed the duodenoscope 520 in the longitudinal direction. In some embodiments, there may be a small amount of compression of the duodenoscope 520 by the rollers 546a and/or 546b to prevent movement of the duodenoscope 520 without rotation of the rollers 546a and/or 546b. In some embodiments, only one of the rollers 546a and 546b are driven and the other may be a passive roller.

In some embodiments, the rollers 546a and/or 546b may be removable and disposable and/or cleanable via an autoclave, sterilization, or other process such that the components of the system 500 that interface with the disposable components or with the components that contact the patient may be sterilized in a more thorough manner and/or be disposable.

In operation, when it is desired to rotate the duodenoscope 520 (e.g., when the physician interacts with the controller to rotate the duodenoscope), the robotic system may issue a command to the motors associated with the rollers to drive one or more of the rollers 547a, 547b. By rotating the rollers 547a, 547b, the entire shaft manipulator 540 may be rotated. Because the duodenoscope 520 is held in place by the rollers 546a, 546b, the duodenoscope 520 may rotate based on rotation of the shaft manipulator 540, moving as a single body in rotational motion with the shaft manipulator 540. As illustrated in Figure 5D, additional rollers 547c and/or 547d may be disposed proximate the rotation block 541 to facilitate rotation thereof. One or more of the rollers 547a-d may be located within the lower portion 542b. In some embodiments, the rotation of the insertion shaft 521 of the duodenoscope 520 may be extended using another feature or component beyond that provided by the rollers 547a/547b.

As illustrated in Figure 5E, the cart 510 may include one or more rails 592a/592b along which the first and/or second cartridges 560/570 may travel. For example, when working to insert the duodenoscope 520 into the patient, if there is retraction of the insertion shaft 521 that occurs, the first cartridge 560 may follow the action of the insertion shaft 521 by moving along the rails 592a/592b. Additionally or alternatively, one or more of the components within the first cartridge 560 may cause a rotation of the insertion shaft 521 to follow the rotation at the shaft manipulator 540. For example, in some embodiments in which the cartridge 560 is configured to actively rotate the proximal end of the insertion shaft 521, the control unit 511 can simultaneously cause the cartridge 560 to rotate the proximal end of the insertion shaft 521 and the shaft manipulator 540 to rotate the portion of the insertion shaft 521 that is clamped therein to rotate the insertion shaft 521 at an identical angular rate.

In some embodiments, an outer sheath of the insertion shaft 521 of the duodenoscope 520 may begin at the outer housing of the first cartridge 560. In these and other embodiments, any excess length in the insertion shaft 521 may be located between the first cartridge 560 and the shaft manipulator 540. For example, the excess length may form a working loop or other span in the region between the first cartridge 560 and the shaft manipulator 540. In some embodiments, much or all of the slack or excess length of the insertion sheath 521 may be taken up by moving the first cartridge 560 rearwardly, or in a proximal direction, along the rails 592a/592b until the duodenoscope 520 is generally straight in length running parallel with the rails 592a/592b. As the duodenoscope 520 is then fed distally into the mouth and down the throat of the patient, the robotic system may automatically cause the first cartridge 560 to move distally along the rails 592a/592b and follow the rate of insertion of the insertion shaft into the patient, and thereby maintain the proximal portion of the insertion shaft 521 in a substantially rectilinear state. In some embodiments, a motor or other device may provide the motive force for the first cartridge 560. Such a motor may cause a rotation of the rails 592a/592b, which may be threaded, causing the first cartridge 560 to travel along the rails 592a/592b at a controlled rate. Additionally or alternatively, the motor may be disposed within the first cartridge 560 and may cause rotation of a threaded member that interfaces with the rails 592a/592b to cause the first cartridge 560 to travel along the rails 592a/592b. The latter arrangement may be preferable when more than one platform is coupled to the rails 592a, 592b, as maintaining the externally threaded rails stationary while actuating motors uniquely associated with the platforms may permit the platforms to move along the rails independently of each other, in some instances.

Figures 6A-6D illustrate another example system 600 for utilizing a robotic system in conjunction with a duodenoscope 620. The system 600 may include many components similar or comparable to the system 500. For example, the system 600 may include a cart 610, a duodenoscope 620 that includes a first cartridge 660 and an insertion shaft 621, a cholangioscope 630 that includes a second cartridge 670 and an insertion shaft 621, a guiding arm 650, a suction hose 662, an irrigation hose 664, a suction hose 672, an irrigation hose 674, and/or a stiffening arm 690 that may be comparable or similar to like- named and/or like-numbered features of the system 500.

In various embodiments, the shaft manipulator 640 can vary in form and/or function from the shaft manipulator 540. For example, in the system 600, the shaft manipulator 640 may advance or retract the insertion shaft 621 of the duodenoscope 620 in a longitudinal direction (e.g., via the use of drive roller), but may not participate in rotation of the insertion shaft 621. Rather, in some embodiments, the first cartridge 660 can effect rotation of the insertion shaft 621 on its own. In further embodiments, the shaft manipulator 640 can be configured to release or otherwise disengage from the insertion shaft 621 to facilitate rotation thereof by the first cartridge 660. For example, the controller 511 can cause the shaft manipulator 640 to disengage from the insertion shaft 621 for an amount of time sufficient for the first cartridge 660 to rotate the insertion shaft 621, and may reengage the insertion shaft 621 after such rotation is complete.

As illustrated in Figure 6C and 6D, the shaft manipulator 640 may include an upper portion 642a and a lower portion 642b. The upper portion 642a may rotate away from the lower portion 642b at a hinge 648 to allow placement of the duodenoscope 620 within an opening between the upper portion 642a and the lower portion 642b. Thus, like the shaft manipulator 540, the shaft manipulator 640 may be clamp like, side-opening, and/or side- loading. The shaft manipulator 640 may include rollers 646a/646b that may operate in a similar or comparable manner to the rollers 546a/546b. For example, the rollers 646a/646b may or may not be associated with a motor (such as the motor 644 associated with the roller 646b).

In operation, the physician may snap the first cartridge 660 into place and may open the shaft manipulator 640 by rotating the upper portion 642a about the hinge 648. The duodenoscope 620 may be placed in the opening and the shaft manipulator 640 closed. When the physician interacts with the controller to advance or feed the duodenoscope 620 in the longitudinal direction, the robotic system may send a command to the motor 644 to rotate the roller 646b, feeding the duodenoscope 620 into the patient. When the physician interacts with the controller to cause rotation of the duodenoscope 620, the duodenoscope may be caused to rotate by the first cartridge 660, e.g., while the shaft manipulator 640 is disengaged from the insertion shaft 621.

In some embodiments, the cart 510 and/or the cart 610 may include a video monitor, a keyboard, or other computer-interfacing devices. For example, the cart 510 and/or the cart 610 may include a display via which the physician or operator is able to visualize the procedure in real time. For example, an imaging device on the duodenoscope 520 and/or the cholangioscope 530 may be communicatively coupled to the display. An example of such an embodiment is illustrated in Figures 13, 14, 16, and 17.

In some embodiments, the robotic system may be mounted on or be part of the cart 510 and/or the cart 610. In some embodiments, the robotic system may be part of the surgical/procedure suite. An example of such a suite is illustrated in Figure 15. In some embodiments, the robotic system may be movable but disposed on a separate cart. In some embodiments, the controller via which the physician interacts with the robotic system may be mounted to the cart 510 and/or the cart 610 (or mounted to the robotic system if separate from the cart 510 and/or the cart 610).

Figures 7A-7B illustrate examples of cartridges associated with the example systems of Figures 5A-5E and/or 6A-6D. Figure 7A illustrates an example first cartridge 700a that may be similar or comparable to the first cartridges 560 and/or 660 associated with the duodenoscopes 520, 620. Figure 7B illustrates an example second cartridge 700b that may be similar or comparable to the second cartridges 570 and/or 670 associated with the cholangioscopes 530, 630. Figure 7C illustrates an example of a platform 763 to which the cartridges may be selectively attached in fixed relation and from which the cartridges may be selectively detached. In particular, the illustrated platform 763 may be particularly suited for selective connection to the cartridge 700b depicted in Figure 7B, which may be suitable for use with a robotic cholangioscope.

The first cartridge 700a may include a suction line 710a, a suction port 712 to the working channel, water/air lines 715, one or more pulleys 720a-d, a rotation assembly 730a, an elevator actuator 740, and a back access port 750a. The first cartridge 700a may further be coupled with a first endoscope shaft 721, such as a duodenoscope shaft. The first cartridge 700a can include a proximal portion of a working channel 705 that can extend through the first endoscope shaft 721.

The suction line 710a may enter the first cartridge 700a and connect with the working channel 705 via the suction port 712. The suction port 712 may have an electronically controllable valve such that when the physician invokes suction through the insertion shaft 721 by interacting with the controller, the robotic system sends a message to the electronic valve to open, thereby introducing suction into the working channel 705.

The water/air lines 715 may traverse an outer covering or housing of the first cartridge 700a and enter the insertion shaft 721 near the rotation assembly 730a.

The pulleys 720a-720d may work in cooperation to effectuate movement of the distal end of the insertion shaft 721. The pulleys 720a-720d may each be coupled with an electromechanical element, such as motor (as discussed further below with respect to Figure 7C) that can rotate the respective pulley with which it is coupled. Tensioning or tension wires 723a-723d can be wound around and coupled with the respective pulleys 720a-720d at their proximal ends, and can extend through the insertion shaft 721 to a distal end thereof. The tensioning wires can be tightened or slackened, or stated otherwise, a level of tension within each of the tensioning wires can be adjusted, to effectuate steering movement at the distal end of the insertion shaft 721. The electromechanical elements (e.g., motors) that are associated with the platform to which the first cartridge 700a is attached (as discussed further below with respect to Figure 7C), rotate to wind or unwind their respective tensioning wire(s) 720a-720d. In certain embodiments, the electromechanical elements can be controlled to wind or unwind the tension wires 723a- 723d in any suitable combination and/or among to achieve a desired bend at the distal end, or at some other region, of the insertion shaft 721, depending on how and where the distal ends of the tension wires 723a-723 are attached to the insertion shaft 721.

In some embodiments, each of the electromechanical elements that are coupled to the pulleys 720a-720d may include a corresponding force sensor to monitor tension on the tensioning wire (e.g., how hard a motor must rotate to coil the tensioning wire further or to release the tensioning wire). In some embodiments, threshold amounts of force may be placed as stop gaps or safety measures such that if the operator of the robotic system attempted to push the duodenum beyond the safety measures, the robotic system would cease issuing commands beyond the threshold amount of force. Additionally or alternatively, the robotic device may send feedback to the physician or operator that the threshold had been exceeded. Such feedback may include haptic feedback (e.g., vibration in the controller), visual feedback (e.g., a warning or alert on the display), or any other feedback.

In some embodiments, force sensors (or other sensors) may be disposed in various locations throughout the system. For example, a force sensor may be disposed on the tip of the duodenoscope to monitor the force with which the duodenoscope is being fed into the patient. As another example, a force sensor may be disposed in the rollers in the shaft manipulator to monitor how hard the rollers are pressing against the duodenoscope.

In some embodiments, when a cartridge 700a is first snapped into place or otherwise coupled to a platform of the robotic base, the robotic system may automatically pre-tension the tension wires 723a-723d via rotation of the pulleys 720a-720d. For example, servo motors may rotate the pulleys 720a-720d to create an initial amount of tension in each tensioning wire. By doing so, any slack or play may be removed such that the insertion shaft 721 may be immediately responsive to commands from the robotic system. Additionally, by using four independent tensioning lines, the tensioning lines of opposite or opposing sides for opposite directions of motion along two orthogonal planes may be simultaneously tensioned against each other. In other embodiments, more or fewer tensioning lines may be used. In still other or further embodiments, a pair of tensioning lines may be coupled to a single pulley, which in turn may be coupled to a single electromechanical element, to effect deflection of the insertion shaft 721 along a single plane.

In addition or alternatively to the use of the pulleys 720a-720d, other wire tensioning approaches may be utilized. For example, idler pulleys may be used to tension the tensioning wires, spring loaded lubricious slides may be utilized, or other approaches to tensioning the wires may be utilized. Still other arrangements are also contemplated.

The rotation assembly 730a may include a set of gears, motors, and/or other components to cause rotation of the insertion shaft 721 relative to the cartridge 700a. For example, the rotation assembly 730a may comprise a worm drive, which can include a worm screw 734a and a worm wheel 732a. The worm screw 734a may be coupled to an electromechanical element (e.g., a motor) associated with the platform, as discussed with respect to Figure 7C, which can be controlled by the control unit 511. As the worm screw 734a is rotated, the worm wheel 734a undergoes a corresponding rotation, likewise causing rotation of the insertion shaft 721. In some embodiments, the rotation assembly 730a may be configured to follow the rotation of the insertion shaft 721 caused by the shaft manipulator 540. For example, the robotic device may monitor the degree of rotation introduced by the shaft manipulator 540 and may apply a corresponding amount of rotation using the rotation assembly 730a. In these and other embodiments, by causing a corresponding amount of rotation, tension, binding, kinking, or other problems may be avoided in the span of the insertion shaft 721 between the first cartridge 700a and the shaft manipulator.

In some embodiments, the first cartridge 700a may provide all of the rotational force for the insertion shaft 721. For example, the rotation imparted to the insertion shaft 721 by the rotation assembly 730a may provide all of the rotational force of the insertion shaft 721, such as when working with the shaft manipulator 640. In these and other embodiments, the rollers of the shaft manipulator 640 may be caused to turn slightly when performing rotation to reduce friction between the rollers and the insertion shaft 721. For example, the robotic device may cause the drive rollers to engage and rotate slightly when the rotation assembly 730a is rotating the insertion shaft 721. The rotation may be to feed inwards, outwards, alternating between inwards and outwards, or any other movement to reduce friction while generally maintaining the insertion shaft 721 at roughly the same longitudinal position.

As with other components of the cartridge 700a previously discussed, the elevator actuator 740 may be coupled with an electromechanical element (e.g., a motor) that is associated with the platform to which the cartridge is selectively attached, and the electromechanical element can be controllable by the control unit 511. The actuator 740 can be mechanically coupled to an elevator wire 725 that extends through the insertion shaft 721 to an elevator (such as the elevator 430 depicted in Figure 4). The actuator 740 can be actuated to advance or retract the elevator wire 725, which can raise or lower the elevator. The electromechanical element to which the elevator actuator 740 is connected, by virtue of the connection between the cartridge 700a and the platform, may be under the control of the control unit 511, which may receive instructions from a handheld or other controller (such as those discussed below). For example, a user may actuate an elevator actuator on, e.g., a handheld controller, which communicates this command to the control unit 511, which in turn operates the motor associated with the elevator actuator 740 to extend or retract the elevator wire to correspondingly raise or lower the elevator as commanded by the user.

The back access port 750a may include an opening or selectively openable port to the working channel 705 of the insertion shaft 721. In the illustrated embodiment, the back access port 750a is shown coupled to a cholangioscope support element of stiffening arm (such as the telescoping stiffening arm previously discussed), and so is shown covered. Any suitable opening and/or connection interface is contemplated or the back access port 750. The back access port 750a may provide access via which one or more tools may be fed down the insertion shaft 721, and may resemble working channel access ports found in standard duodenoscopes. Additionally or alternatively, the back access port 750a may include a specific feature for interlocking with a stiffening arm (such as the stiffening arms 590 or 690), as depicted in Figure 7A.

In some embodiments, the working channel 705 may include a y-port or other feature such that the working channel may be accessed from above or from another lateral direction, such as through a top or side wall of the first cartridge 700a. An example of such an arrangement is depicted in Figures 16 and 17. For example, the y-port may permit the physician to access the working channel of the duodenoscope from a position in addition to the back of the first cartridge 700a. In some embodiments, the access port may be on the top of the first cartridge 700a. In such a circumstance, the cholangioscope and/or the second cartridge 700b may be positioned vertical to the first cartridge 700a rather than horizontal to the first cartridge 700a. In certain of these and/or other embodiments, the access port may be rotatable such that it may rotate from the vertical orientation to a side orientation, such that a physician may access the working channel from the side of the first cartridge 700a, and the cholangioscope may be fed into the working channel and/or otherwise used in the vertical orientation.

Figure 7B illustrates the second cartridge 700b that may be similar or comparable to the second cartridges 570 and/or 670 associated with the cholangioscopes 530, 630. The second cartridge 700b may be similar or comparable to the first cartridge 700a, although shaped and sized to provide the interface via which the robotic system interacts with cholangioscope-control componentry rather than duodenoscope-control componentry. For example, the second cartridge 700b may include a suction channel 710b, an air/water channel 715b, one or more pulleys 721a-d, a rotation assembly 730b (with a worm wheel 732b and a worm screw 734b), and a back access port 750b that may be comparable in function to the suction channel 710a, the air/water channel 715a, the pulleys 720a-d, the rotation assembly 730a (with the worm wheel 732a and the worm screw 734b), and the back access port 750a of Figure 7A, respectively.

In some embodiments, the pulleys 721a-d may be of a smaller scale and/or lighter tensions due to the smaller size of the cholangioscope as compared to the pulleys 720a-d. Additionally or alternatively, the rotating assembly 730b may provide a lower torque than the rotating assembly 730a when rotating the cholangioscope.

In some embodiments, the back access port 750b may provide access to a working channel 707 of the cholangioscope, via which various other tools or components may be deployed to the location at the end of the cholangioscope. In some embodiments, these tools may be deployed manually by the physician. Additionally or alternatively, a robotic arm or other robotic feeding device may be used to feed the further tool along the cholangioscope.

Figure 7C depicts an embodiment of a movable platform 763 such as the movable platforms previously discussed. The platform 763 can be configured to translate along rails 792a, 792b, such as like-named and like-numbered rails previously described. In the illustrated embodiment, the rails 792a, 792b have external threading. The rails may be stationary or secured in fixed relation to a robotic base, such as embodiments of the carts previously described.

The platform 763 can include a pair of couplers 793a, 793b that connect the platform 763 to the rails 792a, 792b. Each of the couplers 793a, 793b can include any suitable electromechanical element that can receive control signals from, e.g., a control unit (e.g., the control unit 511), and can rotate an internally threaded element 795a, 795b (e.g., a nut) in response. Coordinated rotation of the nuts 795a, 795b in a first angular direction can achieve translation of the platform 763 in a first longitudinal direction. Coordinated rotation of the nuts 795a, 795b in a second angular direction opposite the first angular direction can achieve translation of the platform 763 in a second longitudinal direction opposite the first longitudinal direction.

The platform 763 can further include a coupling interface 770, which may also be referred to as a mechanical coupling interface. In the illustrated embodiment, the coupling interface 770 includes a plurality of hooks, catches, or clips 771a-d. As shown in Figure 7B, in order to securely attach a cartridge 770b to the platform 763, the coupling interface 770 can interact or cooperate with a coupling interface 790 (e.g., mechanical coupling interface) of the cartridge 770b. In the illustrated embodiment, the coupling interface 790 includes a plurality of openings 791a-d that are configured to permit passage of the clips 771a-d therethrough when in a deflected state, and once the clips 771a-d have fully passed therethrough, the clips 771a-d return to an undeflected state to securely maintain the cartridge 770b in fixed relation to the platform 763. The clips 771a-d can be disengaged in any suitable manner when the cartridge 770b is to be removed from the platform 763. The cartridge 770b thus may be selectively coupled to and decoupled from the platform 763 via interaction of the coupling interfaces 770, 790. Any suitable arrangement and/or variety of coupling interfaces 770, 790 is contemplated.

As previously discussed, the platform 763 can include a plurality of electromechanical elements 781a-d that can couple with the pulleys 721a-d, respectively, of the cartridge 700b to effect movement of the pulleys 721a-d when the cartridge 700b is attached to the platform 763. In the illustrated embodiment, the electromechanical elements 781a-d are electrical motors. Each electromechanical element 781a-d includes a coupling element 782a-d for mechanically coupling with mechanical components (e.g., pulleys) that control tensioning of the tensioning wires. In the illustrated embodiment, the coupling elements 782a-d include hex sockets. The pulleys 721a-d (Figure 7B) can include downwardly projecting hex extensions that are complementary to and fit within the hex sockets to couple with the elements 781a-d. Any suitable connection interface is contemplated. Accordingly, when the cartridge 700b is coupled to the platform 763, the electromechanical elements 781a-d can control movement of the pulleys 721a-d in manners such as previously discussed. Like arrangements are contemplated with respect to the cartridge 700a and components thereof.

As shown in Figure 7C, the platform 763 can include a further motor 78 le with a coupling element 782e. These can connect to rotation assembly 730b of the cartridge 700b (see Figure 7B) in a manner such as described with respect to the motors 781a-d.

For platforms couplable to the cartridge 700a of Figure 7A, yet an additional motor and coupling element may be present for coupling with the elevator actuator 740.

Figures 8A-11B illustrate various examples of controllers for operating the example systems of Figures 5A-5E and/or 6A-6D, in accordance with one or more embodiments of the present disclosure. For each of the controllers, both a front and a back view is provided so the various buttons are viewable. For each of the controllers, the controllers may be wired or wirelessly in communication with the robotic system such that the actions taken by the physician or other operator using the controller(s) translates to a corresponding action by the duodenoscope system (such as the system 500 and/or 600). The robotic system may obtain the inputs from the physician via the controller and may convert that interaction into commands to various components of the systems 500 and/or 600 to accomplish the desired function. For example, if a user invokes an irrigation feature of the controller, the robotic system may receive that input and may open a valve or divider to permit fluid such as water to flow through the fluid channel and to an exit port at the end of the duodenoscope/cholangioscope.

As illustrated in Figures 8A-8B, some embodiments utilize a controller 800 with a form factor similar to what physicians currently use when performing a duodenoscope or a cholangioscope procedure. By maintaining a similar form factor, the muscle memory and training which physicians have undergone may be harnessed to improve physician adoption, performance, and/or outcomes of procedures based on the consistent form factor.

The controller 800 may include a first dial 810 and a second dial 812. With the first dial 810, the physician may be able to control translation of the tip of the endoscope left and right, and with the second dial 812 the physician may be able to control movement of the tip up and down. Using the first dial 810 and the second dial 812, the physician may have complete flexibility in moving the tip of the endoscope.

When either the first dial 810 or the second dial 812 are turned, the robotic system may correlate the rotation to a corresponding amount of tension to be increased or decreased in an associated cartridge, resulting in the movement of the tip of the endoscope.

In some embodiments, the controller 800 may include a lock button to lock the position of one or both of the first dial 810 and/or the second dial 812. In these and other embodiments, because the motors are under control of the robotic system, the tension may continuously remain on the lines at the same level as long as the dials 810/812 are not being rotated. Stated another way, the robotic system may operate to keep the position of the endoscope locked unless the dials 810/812 are actively being rotated. In these and other embodiments, each direction of movement may be independently lockable. For example, the physician may lock left/right movement, while still adjusting the tip in the up/down direction.

In some embodiments, there may be a threshold amount of movement that the tip is able to undergo, after which whether due to space constraints or mechanical constraints, the system may be unable to or it may be undesirable to have the tip of the endoscope move any further. When the threshold is reached or attempted to be passed, the robotic system may provide feedback to the physician. For example, the robotic system may provide haptic feedback (e.g., vibrations) in the controller. As another example, the robotic system may cause an alert to be displayed to the physician that further movement in one given direction is prevented.

The controller 800 may include an elevator switch 820. The elevator switch 820 may be used to raise the elevator at the distal end of the duodenoscope. For example, by interacting with the elevator switch 820, the robotic system may issue a command that the elevator wire is to be shortened/lengthened an amount corresponding to how far the physician has moved the elevator switch 820.

The controller 800 may include a four-directional rocker switch 830. The rocker switch 830 may control rotation with a first set of tabs 832 and may control travel in the longitudinal direction with a second set of tabs 834. For example, with reference to the system 500, when the physician toggles the first tab 832 of the rocker switch 830, the motors associated with the rollers 547 may be activated by the robotic system, resulting in the shaft manipulator 540 rotating in a same direction and in a corresponding amount to the length of time the first tab 832 of the rocker switch 830 is invoked. As another example, with reference to the system 500, when the physician toggles the second tab 834 of the rocker switch 830, the motors 544a/b associated with the rollers 546a/546b may be invoked, resulting in feeding or retracting the duodenoscope in the longitudinal direction. When retracting the duodenoscope, the first cartridge 560 may automatically be retracted along the rails 592a/592b in a corresponding amount by the robotic device.

In some embodiments, the use of robotic control to feed the duodenoscope into the patient may provide greater safety to patients. For example, force feedback sensors on the motors providing the force to feed the duodenoscope and/or force sensors on the tip may provide feedback regarding a threshold beyond which the motors may be prevented from going. For example, the physician may continue to press the button to feed the duodenoscope into the patient, but if the amount of force has exceeded a threshold amount of force, the motor may cease feeding the duodenoscope into the patient. Additionally or alternatively, the physician may be provided with feedback that the amount of force has been exceeded. For example, when forcing the duodenoscope through the pyloric sphincter, if not aligned properly the duodenoscope may be pressing against a side wall of the stomach instead of the pyloric sphincter. Rather than continuing to increase force and potentially cause injury, the motor may stop increasing the force when the threshold is reached and may provide feedback to the physician, such as haptic feedback or a warning or indication on the display. The controller 800 may include a media button 840. The media button 840 may be configured to activate a camera or other image capturing device at the tip of the endoscope. Such image capture may be still images, video, dye- or contrast agent-enhanced images or videos, or other types of media.

The controller 800 may include a select rocker switch 850. The select rocker switch 850 may permit the physician to designate whether the interactions with the controller 800 are directed to the duodenoscope or the cholangioscope. By including such a switch, the same controller 800 may be used for controlling both the duodenoscope and the cholangioscope.

The controller 800 may include an irrigation button 860 and a suction button 870. The irrigation button 860 may provide for the dispensing of water at the tip of the endoscope and/or the dispensing of air at the tip of the endoscope. In some embodiments, the endoscope and/or the robotic system may be configured to continuously provide one of water or air at the end of the endoscope and the activation of the irrigation button 860 may cause the endoscope and/or the robotic system to switch and provide the other of the water or the air. The suction button 870 may cause the working channel of the endoscope to have suction therein. For example, rather than covering the working channel with their finger to have suction in the working channel of the endoscope, the physician may press the suction button 870 to cause a valve or other feature to open such that suction is applied to the working channel.

In addition to the illustrated buttons, other buttons may be included on any of the controllers. For example, one or more customizable buttons may be included to perform specific functions. Such functions may include video capture, lighting control (e.g., increase or decrease brightness, UV or IR light, among other light features), or any other such functions.

Figures 9A and 9B illustrated another example of a controller 900. The controller 900 may be similar or comparable to the controller 800 but with a form factor similar to a video game controller. The controller 900 may include a first half 901 for controlling the duodenoscope and a second half 902 for controlling the cholangioscope.

The first half 901 may include a direction pad 910 to replace the functionality of the first and second dials 810 and 812. For example, movement of the direction pad 910 may result in a corresponding movement of the tip of the duodenoscope as directed by the robotic device. The first half 901 may also include an elevator switch 920, a rocker switch 930 with first tabs 932 and second tabs 934, a media capture button 940, an irrigation button 960, and a suction button 962, each of which may perform a similar or comparable function to the similarly named component of Figures 8A-8B.

The second half 902 may include a direction pad 911 to replace the functionality of the first and second dials 810 and 812. For example, movement of the direction pad 911 may result in a corresponding movement of the tip of the duodenoscope as directed by the robotic device. The second half 902 may also include a rocker switch 931 with first tabs 933 and second tabs 935, a media capture button 941, an irrigation button 961, and a suction button 963, each of which may perform a similar or comparable function to the similarly named component of Figures 8A-8B.

Figures 10A and 10B illustrated another example of a controller 1000. The controller 1000 may be similar or comparable to the controller 900 but with the two halves in two distinct components that may be held in each hand. The controller 1000 may include a first handle 1001 for controlling the duodenoscope and a second handle 1002 for controlling the cholangioscope.

The first handle 1001 may include a direction pad 1010, an elevator switch 1020, a rocker switch 1030 with first tabs 1032 and second tabs 1034, a media capture button 1040, an irrigation button 1060, and a suction button 1062, each of which may perform a similar or comparable function to the similarly named component of Figures 9A-9B.

The second handle 1002 may include a direction pad 1011, a rocker switch 1031 with first tabs 1033 and second tabs 1035, a media capture button 1041, an irrigation button 1061, and a suction button 1063, each of which may perform a similar or comparable function to the similarly named component of Figures 9A-9B.

Figures 11A and 11B illustrated another example of a controller 1100. The controller 1100 may be similar or comparable to the controller 1000 but with motion sensing rather than the rocker switches 1030 and 1031. For example, the first handle may include the motion button 1130 that, when depressed, causes the robotic system to monitor the motion of the handle 1101 via accelerometers, gyroscopes, or other motion sensors to detect rotation or longitudinal movement of the handle 1101. The robotic system may translate the detected motions into corresponding activations of motors and/or rollers to cause the corresponding rotation and/or feeding or extraction of the duodenoscope.

The first handle 1101 may include a direction pad 1110, an elevator switch 1120, the motion button 1130, a media capture button 1140, an irrigation button 1160, and a suction button 1162, each of which may perform a similar or comparable function to the similarly named component of Figures 9A-9B. The second handle 1102 may include a direction pad 1111, a motion button 1131 (that may be similar or comparable to the motion button 1130), a media capture button 1141, an irrigation button 1161, and a suction button 1163, each of which may perform a similar or comparable function to the similarly named component of Figures 9A-9B.

While the present disclosure has utilized a duodenoscope and a cholangioscope as example devices, it will be appreciated that the concepts of the present disclosure are equally applicable to other endoscopes. For example, bronchoscopes, gastroscopes, cholodoscopes, or other endoscopes are contemplated. The size of the cartridge, the tensions on the guiding wires, the force for feeding the endoscopes, etc. may be varied based on the application. For example, the physician may snap a cartridge into place, may position the endoscope proximate an orifice of a human (such as the mouth, nose, or anus). Using robotic control, a force may be applied a threshold distance away from the orifice to still drive the flexible endoscope into the human. For example, the rollers of the shaft manipulator may feed the endoscope shaft into the mouth of the patient while applying force to the flexible endoscope some distance away from the mouth. Such distance may include six inches, eight inches, twelve inches, eighteen inches, twenty-four inches, between three inches and twenty-four inches, between six inches and fifteen inches, or any other such distance.

Figure 12 illustrates an example computing system according to at least one embodiment described in the present disclosure. The computing system may be distributed throughout the system in any suitable manner and need not be localized in a single physical locus, although, in some embodiments, at least a portion of the computing system resides on or within a cart, such as previously described. The computing system may correspond with the control units described elsewhere herein, and may be referred to as a control unit 1200. The control unit 1200 may include a processor 1210, a memory 1220, a data storage 1230, and/or a communication unit 1240, which all may be communicatively coupled.

Generally, the processor 1210 may include any suitable special-purpose or general- purpose computer, computing entity, or processing device including various computer hardware or software modules and may be configured to execute instructions stored on any applicable computer-readable storage media. For example, the processor 1210 may include a microprocessor, a microcontroller, a digital signal processor (DSP), an application-specific integrated circuit (ASIC), a Field-Programmable Gate Array (FPGA), or any other digital or analog circuitry configured to interpret and/or to execute program instructions and/or to process data. Although illustrated as a single processor in Figure 12, it is understood that the processor 1210 may include any number of processors distributed across any number of network or physical locations that are configured to perform individually or collectively any number of operations described in the present disclosure. In some embodiments, the processor 1210 may interpret and/or execute program instructions and/or process data stored in the memory 1220, the data storage 1230, or the memory 1220 and the data storage 1230. In some embodiments, the processor 1210 may fetch program instructions from the data storage 1230 and load the program instructions into the memory 1220.

The memory 1220 and the data storage 1230 may include computer-readable storage media or one or more computer-readable storage mediums for carrying or having computer-executable instructions or data structures stored thereon. Such computer- readable storage media may be any available media that may be accessed by a general - purpose or special-purpose computer, such as the processor 1210. In some embodiments, the control unit 1200 may or may not include either of the memory 1220 and the data storage 1230.

By way of example, and not limitation, such computer-readable storage media may include non-transitory computer-readable storage media including Random Access Memory (RAM), Read-Only Memory (ROM), Electrically Erasable Programmable Read- Only Memory (EEPROM), Compact Disc Read-Only Memory (CD-ROM) or other optical disk storage, magnetic disk storage or other magnetic storage devices, flash memory devices (e.g., solid state memory devices), or any other storage medium which may be used to carry or store desired program code in the form of computer-executable instructions or data structures and which may be accessed by a general-purpose or specialpurpose computer. Combinations of the above may also be included within the scope of computer-readable storage media. Computer-executable instructions may include, for example, instructions and data configured to cause the processor 1210 to perform a certain operation or group of operations.

The communication unit 1240 may include any component, device, system, or combination thereof that is configured to transmit or receive information over a network. In some embodiments, the communication unit 1240 may communicate with other devices at other locations, the same location, or even other components within the same system. For example, the communication unit 1240 may include a modem, a network card (wireless or wired), an optical communication device, an infrared communication device, a wireless communication device (such as an antenna), and/or chipset (such as a Bluetooth device, an 802.6 device (e.g., Metropolitan Area Network (MAN)), a Wi-Fi device, a WiMAX device, cellular communication facilities, or others), and/or the like. The communication unit 1240 may permit data to be exchanged with a network and/or any other devices or systems described in the present disclosure. For example, the communication unit 1240 may allow the control unit 1200 to communicate with other systems, such as computing devices and/or other networks.

One skilled in the art, after reviewing this disclosure, may recognize that modifications, additions, or omissions may be made to the control unit 1200 without departing from the scope of the present disclosure. For example, the control unit 1200 may include more or fewer components than those explicitly illustrated and described.

Figure 13 illustrates another example system 1300 for utilizing a robotic system in conjunction with a duodenoscope, in accordance with one or more embodiments of the present disclosure. The system 1300 may be comparable or similar to the system 500 and/or the system 600.

As illustrated in Figure 13, the system 1300 may include a cart 1310, a display device 1320, a first button 1332, and a second switch 1334. The system 1300 may also include a controller 1340 and a hutch 1342. The cart 1310 may be similar or comparable to the cart 510 and/or 610 disclosed herein.

The display device 1320 may include a screen for displaying images, video, and/or data. For example, the display device 1320 may display video and/or image associated with a tip of a duodenoscope (such as real time video of the procedure), video and/or an image associated with a tip of a cholangioscope, data associated with a patient receiving treatment, data associated with a current procedure, data regarding the duodenoscope, data regarding the cholangioscope, and/or any other images or data. In some embodiments, the display device 1320 may be associated with or include video processing hardware for generating and/or producing the images, video, and/or data. In some embodiments, the display device may be a touchscreen such that a user or clinician can provide commands and/or interactions to the system 1300 via the display device 1320.

The first button 1332 may include an interface via which the user or clinician may operate the duodenoscope and/or the cholangioscope. For example, the first button 1332 may be used to extend or retract the duodenoscope and/or the cholangioscope. Additionally or alternatively, the first button 1332 may be used to rotate the duodenoscope and/or the cholangioscope. In some embodiments, the first button 1332 may be implemented as a four-directional switch with two opposing sides of the switch used for extending or retracting the duodenoscope and/or the cholangioscope and the two other opposing sides of the switch for rotating the duodenoscope and/or the cholangioscope in opposite directions.

The second switch 1334 may include an interface via which the user or clinician may control aspects of the cart 1310 to alternate between different endoscopes. For example, toggling the second switch 1334 may determine whether the first button 1332 controls the duodenoscope or the cholangioscope. As another example, toggling the second switch 1334 may determine whether the display device 1320 displays real-time video of the duodenoscope or the cholangioscope.

While two buttons are illustrated, it will be appreciated that any other number of buttons or controls may be included on the cart 1310. For example a full suite of buttons may be included to include all or some of the controls of the controllers illustrated in Figures 8A-1 IB.

In some embodiments, the cart 1310 may include a hutch 1342 for holding a controller 1340. The controller 1340 may take any form, such as the controllers illustrated in Figures 8A-11B and/or 18A-19. In these and other embodiments, the hutch 1342 may be shaped and adapted to hold the controller 1340 or otherwise allow the controller 1340 to rest in or be supported by the hutch 1342. In some embodiments, the hutch 1342 may include charging electrodes, a wireless charging interface, or other charging feature (not illustrated) to interface with the controller 1340 such that if implemented as a wireless controller, the controller 1340 may include batteries that are charged when the controller 1340 is sitting in the hutch 1342.

Figure 14 illustrates another view of the example system 1300 of Figure 13, in accordance with one or more embodiments of the present disclosure. As illustrated in Figure 14, the system 1300 may include a first suite interface 1360 and a second suite interface 1370. While two such interfaces are illustrated, it will be appreciated that any number of such interfaces are contemplated. The first suite interface 1360 and the second suite interface 1370 are configured to permit the cart 1310 to interface with a procedural or surgical suite.

The first suite interface 1360 may include a first port 1362 on the cart 1310 and a first physical connector 1364 that plugs into the procedural or surgical suite. For example, a cable may plug into the cart 1310 or be permanently attached to the cart 1310 and extend along a length to the first physical connector 1364. In some embodiments, the first physical connecter 1364 may plug into a light port and may provide an endpoint of a light tube associated with the cart 1310, such as a fiber optic tube. The light tube of the cart 1310 may proceed along the length of either or both of the cholangioscope and/or the duodenoscope to provide light at the tip(s) thereof.

The second suite interface 1370 may include a second port 1372 on the cart 1310 and a second physical connector 1374 that plugs into the procedural or surgical suite. For example, a cable may plug into the cart 1310 or be permanently attached to the cart 1310 and extend along a length to the second physical connector 1374. In some embodiments, the second physical connecter 1374 may plug into a video port and may provide data or images received from a tip of the cholangioscope and/or the duodenoscope. The images and/or video data from the tip of the cholangioscope and/or the duodenoscope may be processed by the procedural/surgical suite and display such images and/or video to a clinician.

While two interfaces are illustrated, it will be appreciated that other interfaces are contemplated, such as an interface with a water source, an air source, a vacuum source, a second video processing unit, among others.

Figure 15 illustrates an example procedural/surgical suite 1500 using the example system 1300 of Figure 13, in accordance with one or more embodiments of the present disclosure.

The procedural/surgical suite 1500 may include a tower 1510 with various bays, each of which may provide one or more functional aspects of the procedural/surgical suite 1500. For example, the tower 1510 may include a first bay 1511 that may include a light producing device with a fiber optic output. The first physical connector 1364 may interface with the first bay 1511 to provide light to the duodenoscope and/or the cholangioscope. As another example, the tower 1510 may include a second bay 1513 with a video processing unit with a video port, dedicated graphics processing hardware (e.g., one or more video cards), one or more display outputs, etc. The second physical connector 1374 may interface with the video port to provide data from the duodenoscope and/or the cholangioscope. In some embodiments, the second bay 1513 may be coupled with one or more displays within the procedural/surgical suite 1500, such as a first display 1520 and a second display 1521.

In some embodiments, the first display 1520 may display an image or video associated with the duodenoscope while the second display 1521 may display an image or video associated with the cholangioscope. In some embodiments, the procedural/surgical suite 1500 may include multiple video processing units to produce independent displays on the first display 1520 and the second display 1521. In some embodiments, the procedural/surgical suite 1500 may include a single video processing unit and the first display 1520 and the second display 1521 may include duplicate displays of the same image or video. In some embodiments, the procedural/surgical suite 1500 may include a single video processing unit and the first display 1520 may display the video or image processed by the video processing unit of the procedural/surgical suite 1500 and the second display 1521 may display an independent display based on a video processing unit of the system 1300. For example, in older or smaller surgical or procedural suites with only one video processing unit, a clinician may still enjoy the benefit of having multiple displays, such as simultaneously displaying video from the tip of the cholangioscope and the tip of the duodenoscope in real time by having the video processing unit of the tower 1510 process one display and a second, distinct video processing unit of the cart 1310 process the other display.

By providing interfaces as described herein, the system 1300 may interface with existing technologies, such as existing towers 1510 and/or bays in towers. Some examples of such towers and/or bays can include those produced by OLYMPUS® (such as the EVIS EXERA®), PENTAX®, KARL STORZ®, FUJI®, or STRYKER®, among others.

Figure 16 illustrates an additional view of the example system 1300 of Figure 13, in accordance with one or more embodiments of the present disclosure. As illustrated in Figure 16, the system 1300 may include a cartridge 1380 that may be similar or comparable to the cartridge 560/660, 570/670, 700a, and/or 700b.

As illustrated in Figure 16, the cartridge 1380 may include one or more fluid ports, such as a first fluid port 1382 and a second fluid port 1384. The fluid ports may provide an interface via which the cartridge 1380 may interface air, water, vacuum, and/or other fluid sources, such as those in a surgical or procedure suite. In some embodiments, the first and/or second fluid ports 1382/1384 may include barbed features or other components for coupling tubing to the first and/or second fluid ports 1382/1384. For example, first flexible and disposable tubing may interface with a water source in a surgical or procedural suite on one end and the first fluid port 1382 at the second end, and second flexible and disposable tubing may interface with a vacuum source in the surgical or procedural suite on one end and the second fluid port 1384 at the other end. By doing so, the tubing may be disposable and discarded after a procedure.

As illustrated in Figure 16, the cartridge 1380 may include a first access port 1386 that may follow a longitudinal line through the cartridge 1380 through which linear access may be granted to the endoscope of the cartridge 1380. For example, if the cartridge 1380 is associated with a duodenoscope, the first access port 1386 may be a port via which a cholangioscope interfaces with and enters the duodenoscope. As another example, the first access port 1386 may permit tools or other devices to access a working channel of the endoscope in a linear direction.

In some embodiments, the cartridge 1380 may include a second access port 1388. The second access port 1388 may permit access to the endoscope of the cartridge 1380 from an off-angle position. For example, the second access port 1388 may permit access to a working channel off-axis from the longitudinal direction of the endoscope, such as at an angle of thirty degrees, forty -five degrees, fifty-five degrees, or any other angle relative to the longitudinal direction.

In the illustrated embodiment, a sphincterotome 1600 is depicted accessing the working channel of the duodenoscope from the upper or second access port 1388.

Figure 17 illustrates an additional example system 1700 for utilizing a robotic system in conjunction with a duodenoscope with pinch valves 1710 and/or 1720. The system 1700 may be comparable or similar to the system 500, 600, and/or 1300.

As illustrated in Figure 17, a first pinch valve 1710 may be associated with the water line associated with the system 1700. For example, a water line may be made of flexible and compressible tubing that may be fed into the first pinch valve 1710 before operation, and the first pinch valve 1710 may be started to pinch off the water line. When the first pinch valve 1710 is closed off, no water is fed down the line of the system 1700 and deployed at the end of the corresponding endoscope. As another example, an air line may be made of flexible and compressible tubing that may be fed into the second pinch valve 1720 before operation, and the second pinch valve 1720 may be started to pinch off the air line. When the second pinch valve 1720 is closed off, no air is fed down the line of the system 1700 and deployed at the end of the corresponding endoscope.

In some embodiments, the first pinch valve 1710 and/or the second pinch valve 1720 may be part of the robotic system in that electronic signals may be used to control the first and/or second pinch valves 1710, 1720. Using the electronically controllable pinch valves may permit control of the respective air and/or water lines, for example, from a wireless controller.

In some embodiments, the first pinch valve 1710 and/or the second pinch valve 1720 may be disposed within a cavity or region within which the cartridges are located. By using pinch valves, the tubing may be integrally coupled with the cartridge and still be disposable without contaminating components of the system. For example, the pinch valves may only contact the external portions of the tubing and thus the pinch valves and the cart may avoid contact with bodily fluids or other potential contaminants traveling within the tubing which might otherwise contact valves or other portions of the system.

Figures 18A-18B illustrate an additional example controller 1800 for operating any of the example systems of the present disclosure. As previously discussed, experienced practitioners may have comfort, familiarity, and/or muscle memory associated with holding and/or moving the control handle of a duodenoscope for longitudinal advancement and/or rotation of the insertion shaft into and/or within the patient P. Experienced practitioners may also or alternatively have comfort, familiarity, and/or muscle memory associated with manipulating the actuators of such a device to achieve a desired curvature and/or other configuration of the distal end of the shaft. They may also or alternatively have comfort, familiarity, and/or muscle memory associated with manipulating the elevator control lever of a standard duodenoscope to actuate or retract the elevator. Such comfort, familiarity, and/or muscle memory may also or alternatively exist with respect to other features of the control handle of a duodenoscope, such as valves (e.g., for suction, air, water), buttons (e.g., for lighting, image capture, and/or video capture), locks (e.g., for fixing angulation of the actuators), etc.

In the illustrated embodiment, the controller 1800 may have a same form factor as a traditional or mechanical handle for a duodenoscope, such as one or more duodenoscopes available from OLYMPUS. By providing a controller with a same form factor, a clinician or physician may take advantage of their former training and/or muscle memory used in previously performing procedures while still enjoying the benefits of the robotic controlled system described in the present disclosure. While using the same form factor, it will be appreciated that certain interfaces may utilize electronic controls, such as for a vacuum port which would use a mechanical interface on a traditional handle for a duodenoscope.

In other embodiments, the controller 1800 may have the same form factor or otherwise closely match or approximate the configuration of a traditional handle or one or more other varieties of endoscopes. For example, in some embodiments, the controller 1800 may have the same configuration as a traditional cholangioscope. In certain of such embodiments, an elevator control lever 1820 may be omitted.

Figure 19 illustrates a further example controller 1900 for operating any of the example systems of the present disclosure. The controller 1900 may be similar or comparable to the controller 1800 of Figures 18A and 18B. As illustrated in Figure 19, the controller 1900 may include a switch 1924, which may be operable to toggle between multiple devices to be controlled by the controller 1900. For example, the switch 1924 may operate in a similar or comparable manner to the switch 1334 of the present disclosure.

In some embodiments, the switch 1924 may change whether the controller 1900 is controlling an associated duodenoscope or an associated cholangioscope. That is, when the switch 1924 is in a first state, the controller 1900 is in a first operational mode in which the various actuators (rotational knobs, buttons, etc.) of the controller 1900 are used to control the duodenoscope but not the cholangioscope. When the switch 1924 is in a second state, the controller 1900 is in a second operational mode in which the very same actuators (rotational knobs, buttons, telephone conference.) of the controller 1900 are used to instead control the cholangioscope but not the duodenoscope.

In some embodiments, the controller 1900 includes an elevator lever 1920 that is configured to control movement of an elevator of a duodenoscope, as previously discussed. The robotic system in which the controller 1900 is used can include both a duodenoscope and a cholangioscope, but the cholangioscope may not have an elevator. In some embodiments, the elevation lever 1920 may be operational to control movement of the elevator of the duodenoscope regardless of the actuation state of the switch 1924. For example, when the switch 1924 is in a first state in which the control actuators of the controller 1900 are used to control the duodenoscope, the elevator lever 1920 can be operational to control the elevator of the duodenoscope. Similarly, when the switch 1924 is in a second state in which the control actuators of the controller 1900 are used to control the cholangioscope, the elevator lever 1920 may nevertheless remain operational to continue controlling the elevator of the duodenoscope.

Additionally or alternatively, the switch 1924 may cause a display or other component in the surgical or procedural suite to change automatically when actuated. For example, when a clinician presses the switch 1924 to switch from the duodenoscope to the cholangioscope, a display may also change the display from presenting video of the duodenoscope to video of the cholangioscope, and vice versa.

EXAMPLES

The present section recites 156 illustrative examples of devices, systems, and methods pertaining to robotic endoscopes that correspond with and/or may provide further detail with respect to various embodiments of the foregoing written description and/or the illustrative drawings. Embodiments capable of derivation from the various Examples that follow are also expressly incorporated into the present written description. These additional embodiments are determined by replacing the dependency of a given dependent Example with the phrase "any one of Example [x] through the preceding Example," where the bracketed term "[x]" is replaced with the number of the most recently recited independent Example. For example, for the first Example set that begins with independent Example 1, Example 3 can depend from either of Examples 1 or 2, with these separate dependencies yielding two distinct embodiments; Example 4 can depend from any one of Examples 1, 2, or 3, with these separate dependencies yielding three distinct embodiments; Example 5 can depend from any one of Examples 1, 2, 3, or 4, with these separate Examples yielding four distinct embodiments; and so on. As a further illustration, for the Example set that begins with independent Example 84, Example 86 can depend from either of Examples 84 or 85, with these separate dependencies yielding two distinct embodiments; Example 87 can depend from any one of Examples 84, 85, or 86, with these separate dependencies yielding three distinct embodiments; Example 88 can depend from any one of Examples 84, 85, 86, or 87, with these separate Examples yielding four distinct embodiments; and so on. Further embodiments are contemplated by recasting Examples 2 through 82 as being dependent upon independent Example 83, rather than upon Example 1; recasting Examples 2 through 82 as being dependent upon independent Example 108, rather than upon Example 1; and recasting Examples 2 through 82 as being dependent upon independent Example 129, rather than upon Example 1, with each such embodiment being expressly incorporated into the present written description.

Example 1. A system comprising: a base comprising: a first platform; and a second platform that is movable relative to the base; a first endoscope that comprises: a first insertion shaft that comprises a portion of a working channel; and a first cartridge attached to the first insertion shaft that comprises a further portion of the working channel such that a lumen defined by the working channel extends through both the first cartridge and the first insertion shaft, the first cartridge being configured to selectively couple with the first platform so as to be fixed relative thereto and configured to selectively decouple from the first platform; and a second endoscope that comprises: a second insertion shaft sized to fit within the working channel of the first endoscope; a second cartridge attached to the second insertion shaft and being configured to selectively couple with the second platform so as to be fixed relative thereto and configured to selectively decouple from the second platform, wherein when the first cartridge is coupled with the first platform and the second cartridge is coupled with the second platform, movement of the second platform toward the first platform advances the second insertion shaft of the second endoscope through the working channel of the first endoscope.

Example 2. The system of Example 1, further comprising a control unit.

Example s. The system of Example 2, wherein the control unit is communicatively coupled to the second platform to control movement of the second insertion shaft when the second cartridge is coupled to the second platform.

Example 4. The system of Example 3 wherein the second platform comprises an electromechanical element, and wherein the control unit is communicatively coupled to the electromechanical element so as to cause the electromechanical element to advance the second platform toward the first platform or retract the second platform away from the first platform, thereby longitudinally advancing or retracting the second insertion shaft, respectively, when the second cartridge is coupled to the second platform.

Example 5. The system of Example 2, wherein the second endoscope comprises a plurality of tensioning wires that extend through the second insertion shaft from a distal end of the second insertion shaft and into the second cartridge, and wherein the control unit is configured to selectively tension or slacken each of the plurality of tensioning wires to steer the distal end of the second insertion shaft when the second cartridge is coupled to the second platform.

Example 6. The system of Example 5, wherein the second platform comprises one or more electromechanical elements, and wherein the control unit is communicatively coupled to the one or more electromechanical elements to selectively tension or slacken the plurality of tensioning wires when the second cartridge is coupled to the second platform.

Example 7. The system of Example 2, wherein the control unit is configured to control rotation of the second insertion shaft about a longitudinal axis thereof when the second cartridge is coupled to the second platform. Example 8. The system of Example 7, wherein the second platform comprises an electromechanical element, and wherein the control unit is communicatively coupled to the electromechanical element so as to cause the electromechanical element to rotate the second insertion shaft about a longitudinal axis thereof when the second cartridge is coupled to the second platform.

Example 9. The system of Example 2, wherein the first platform is movable relative to the base, and wherein the control unit is communicatively coupled to the first platform to control movement of the first insertion shaft when the first cartridge is coupled to the first platform.

Example 10. The system of Example 9 wherein the first platform comprises an electromechanical element, and wherein the control unit is communicatively coupled to the electromechanical element so as to cause the electromechanical element to advance the first platform toward a distal end of the cart or retract the first platform toward a proximal end of the cart, thereby longitudinally advancing or retracting the first insertion shaft, respectively, when the first cartridge is coupled to the first platform.

Example 11. The system of Example 2, wherein the first endoscope comprises a plurality of tensioning wires that extend through the first insertion shaft from a distal end of the first insertion shaft and into the first cartridge, and wherein the control unit is configured to selectively tension or slacken each of the plurality of tensioning wires to steer the distal end of the first insertion shaft when the first cartridge is coupled to the first platform.

Example 12. The system of Example 11, wherein the first platform comprises one or more electromechanical elements, and wherein the control unit is communicatively coupled to the one or more electromechanical elements to selectively tension or slacken the plurality of tensioning wires when the first cartridge is coupled to the first platform.

Example 13. The system of Example 2, wherein the control unit is configured to control rotation of the first insertion shaft about a longitudinal axis thereof when the first cartridge is coupled to the first platform.

Example 14. The system of Example 13, wherein the first platform comprises an electromechanical element, and wherein the control unit is communicatively coupled to the electromechanical element so as to cause the electromechanical element to rotate the first insertion shaft about a longitudinal axis thereof when the first cartridge is coupled to the first platform. Example 15. The system of Example 2, wherein the first endoscope further comprises an elevator, and wherein the control unit is communicatively coupled to the first platform to control movement of the elevator when the first cartridge is coupled to the first platform.

Example 16. The system of Example 15, wherein the first platform comprises an electromechanical element, and wherein the control unit is communicatively coupled to the electromechanical element so as to cause the electromechanical element to raise or lower the elevator when the first cartridge is coupled to the first platform.

Example 17. The system of Example 2, further comprising a shaft manipulator positioned distal to the first platform, the shaft manipulator being configured to move the first insertion shaft when engaged therewith.

Example 18. The system of Example 17, wherein the shaft manipulator is configured to rotate the first insertion shaft of the first endoscope about a longitudinal axis of the first insertion shaft.

Example 19. The system of Example 18, wherein the shaft manipulator comprises a rotation block configured to engage the first insertion shaft, wherein the rotation block is configured to be rotated relative to the cart while engaging the first insertion shaft to effect rotation of the first insertion shaft.

Example 20. The system of Example 19, wherein the shaft manipulator comprises one or more electromechanical elements coupled to the rotation block, and wherein the control unit is communicatively coupled to the one or more electromechanical elements to control rotation of the rotation block when the rotation block engages the first insertion shaft to thereby control rotation of the first insertion shaft.

Example 21. The system of Example 20, wherein the control unit is communicatively coupled to the first platform to control rotation of the first insertion shaft at the first cartridge when the first cartridge is attached to the first platform.

Example 22. The system of Example 21, wherein the control unit is configured to simultaneously control a rate of rotation of the first insertion shaft at the first cartridge and a rate of rotation of the first insertion shaft at the rotation block to be the same.

Example 23. The system of Example 21, wherein the first platform comprises an electromechanical element, and wherein the control unit is communicatively coupled to the electromechanical element so as to cause the electromechanical element to rotate the first insertion shaft when the first cartridge is coupled to the first platform. Example 24. The system of Example 20, wherein the first cartridge is coupled with the first insertion shaft such that the first insertion shaft passively rotates at the first cartridge as the shaft manipulator rotates the first insertion shaft.

Example 25. The system of Example 17, wherein the shaft manipulator is configured to longitudinally advance or retract the first insertion shaft when engaged therewith.

Example 26. The system of Example 25, wherein the shaft manipulator comprises one or more electromechanical elements that are communicatively coupled to the control unit, and wherein the control unit is configured to control actuation of the one or more electromechanical elements to thereby control longitudinal advancement or retraction of the first insertion shaft when the shaft manipulator is engaged therewith.

Example 27. The system of Example 25, wherein the first platform is movable relative to the base, and wherein the control unit is configured to advance or retract the first platform at a rate that matches a rate of advancement or retraction of the first insertion shaft via the shaft manipulator.

Example 28. The system of Example 2 further comprising a controller that is communicatively couplable or communicatively coupled with the control unit to permit a user to provide control instructions to the control unit.

Example 29. The system of Example 28, wherein the controller is permanently attached to the base.

Example 30. The system of Example 29, further comprising a handholdable controller that is separate from and movable relative to the base.

Example 31. The system of Example 28, wherein the controller comprises a first set of actuators that are configured to control the first endoscope and a second set of actuators separate from the first set of actuators that are configured to control the second endoscope.

Example 32. The system of Example 31, wherein a single handholdable housing comprises both the first and second sets of actuators.

Example 33. The system of Example 31, wherein a first handholdable housing comprises the first set of actuators and a second handholdable housing comprises the second set of actuators.

Example 34. The system of Example 28, wherein the controller comprises a set of actuators and a switch, wherein: when the switch is in a first state, the set of actuators controls functions of the first endoscope; and when the switch is in a second state, the set of actuators controls functions of the second endoscope.

Example 35. The system of Example 34, wherein a single handholdable housing comprises the set of actuators and the switch.

Example 36. The system of Example 34, wherein the first endoscope comprises an elevator, and wherein the controller comprises a dedicated actuator configured to control movement of the elevator.

Example 37. The system of Example 28, wherein the controller comprises: a handle; a first rotatable knob positioned at a proximal end of the handle; and a second rotatable knob positioned such that the first and second rotatable knobs share a common axis of rotation.

Example 38. The system of Example 37, wherein the handle is holdable by a first hand of a practitioner, and wherein each of the first and second rotatable knobs is actuatable by a second hand of the practitioner while the practitioner holds the handle with the first hand.

Example 39. The system of Example 37, wherein: the controller further comprises a switch; when the switch is in a first state, actuation of the first rotatable knob or second rotatable knob is configured to cause the control unit to effect movement of a distal end of the first endoscope; and when the switch is in a second state, actuation of the first rotatable knob or second rotatable knob is configured to cause the control unit to effect movement of a distal end of the second endoscope.

Example 40. The system of Example 39, wherein rotation of the first rotatable knob effects movement of the distal end of either the first or second endoscope in a first plane and rotation of the second rotatable knob effects movement the distal end of either the first or second endoscope in a second plane that is orthogonal to the first plane.

Example 41. The system of Example 39, wherein the first endoscope comprises a duodenoscope and the second endoscope comprises a cholangioscope.

Example 42. The system of Example 1, wherein the first endoscope comprises a duodenoscope and the second endoscope comprises a cholangioscope. Example 43. The system of Example 1, wherein the second endoscope comprises a plurality of tensioning wires that extend through the second insertion shaft from a distal end of the second insertion shaft and into the second cartridge, and wherein the second platform is configured to selectively tension or slacken each of the plurality of tensioning wires to steer the distal end of the second insertion shaft when the second cartridge is coupled to the second platform.

Example 44. The system of Example 43, wherein: the second platform comprises one or more electromechanical elements; the second cartridge comprises one or more pulleys coupled to one or more of the plurality of tensioning wires; and the one or more pulleys are coupled to the one or more electromechanical elements when the second cartridge is coupled to the second platform such that the one or more electromechanical elements are movable to selectively tension or slacken said one or more of the plurality of tensioning wires to deflect the distal end of the second insertion shaft.

Example 45. The system of Example 1, wherein the second cartridge is configured to rotate the second insertion shaft about a longitudinal axis thereof when the second cartridge is coupled to the second platform.

Example 46. The system of Example 45, wherein the second platform comprises an electromechanical element and the second cartridge comprises a mechanical system that couples with the electromechanical element when the second cartridge is coupled to the second platform such that the electromechanical element is movable to rotate the second insertion shaft about the longitudinal axis thereof.

Example 47. The system of Example 1, wherein the first platform is movable relative to the base.

Example 48. The system of Example 1, wherein the first endoscope comprises a plurality of tensioning wires that extend through the first insertion shaft from a distal end of the first insertion shaft and into the first cartridge, and wherein the first platform is configured to selectively tension or slacken each of the plurality of tensioning wires to steer the distal end of the first insertion shaft when the first cartridge is coupled to the first platform.

Example 49. The system of Example 48, wherein: the first platform comprises one or more electromechanical elements; the first cartridge comprises one or more pulleys coupled to one or more of the plurality of tensioning wires; and the one or more pulleys are coupled to the one or more electromechanical elements when the first cartridge is coupled to the first platform such that the one or more electromechanical elements are movable to selectively tension or slacken said one or more of the plurality of tensioning wires to deflect the distal end of the first insertion shaft.

Example 50. The system of Example 1, wherein the first cartridge is configured to rotate the first insertion shaft about a longitudinal axis thereof when the first cartridge is coupled to the first platform.

Example 51. The system of Example 50, wherein the first platform comprises an electromechanical element and the first cartridge comprises a mechanical system that couples with the electromechanical element when the first cartridge is coupled to the first platform such that the electromechanical element is movable to rotate the first insertion shaft about the longitudinal axis thereof.

Example 52. The system of Example 1, wherein the first endoscope further comprises an elevator.

Example 53. The system of Example 52, wherein the first platform comprises an electromechanical element and the first cartridge comprises a mechanical system that couples with the electromechanical element when the first cartridge is coupled to the first platform such that the electromechanical element is movable to raise or lower the elevator.

Example 54. The system of Example 1, further comprising a shaft manipulator positioned distal to the first platform, the shaft manipulator being configured to move the first insertion shaft when engaged therewith.

Example 55. The system of Example 54, wherein the shaft manipulator is configured to permit the first insertion shaft to be introduced laterally into the shaft manipulator in a direction substantially orthogonal to a longitudinal axis of the first insertion shaft.

Example 56. The system of Example 55, wherein the shaft manipulator comprises a clamp that is openable to permit introduction of the first insertion shaft into the clamp and is closeable thereafter to permit the shaft manipulator to engage the first insertion shaft.

Example 57. The system of Example 54, wherein the first platform is movable relative to the cart, and wherein the first platform is configured to translate proximally after the first insertion shaft has been engaged by the shaft manipulator and after the first cartridge has been attached to the first platform by an amount sufficient to place a portion of the first insertion shaft that extends between the first cartridge and the shaft manipulator in a substantially rectilinear state.

Example 58. The system of Example 54, wherein the shaft manipulator is configured to rotate the first insertion shaft of the first endoscope about a longitudinal axis of the first insertion shaft.

Example 59. The system of Example 58, wherein the shaft manipulator comprises a rotation block that is configured to receive therein the first insertion shaft, and wherein the rotation block is configured to rotate relative to the cart to effect rotation of the first insertion shaft.

Example 60. The system of Example 58, wherein the first cartridge, when coupled with the first platform, is configured to actively rotate the first insertion shaft about the longitudinal axis of the first insertion shaft in unison with rotation of the first insertion shaft provided by the shaft manipulator.

Example 61. The system of Example 58, wherein the first cartridge, when coupled with the first platform, is configured to passively permit the first insertion shaft to rotate about the longitudinal axis of the first insertion shaft as the shaft manipulator rotates the first insertion shaft.

Example 62. The system of Example 58, wherein the rotation block is configured to selectively couple with the cart so as to be rotated thereby and is configured to be selectively decoupled from the cart to facilitate cleaning or replacement of portions of the rotation block that contact the first insertion shaft during manipulation thereof.

Example 63. The system of Example 54, wherein the shaft manipulator is configured to longitudinally advance or retract the first insertion shaft.

Example 64. The system of Example 63, wherein shaft manipulator and the first platform are configured to engage separate portions of the insertion shaft and to longitudinally advance or retract the separate portions of the insertion shaft at a uniform speed.

Example 65. The system of Example 1, wherein the base comprises a moveable cart.

Example 66. The system of Example 65, wherein a height of the cart is adjustable.

Example 67. The system of Example 1, further comprising a stiffening arm configured to be positioned around a portion of the second insertion shaft and extend between the first and second cartridges when the first and second cartridges are coupled with the first and second platforms, respectively.

Example 68. The system of Example 67, wherein the stiffening arm is couplable with at least one of the first and second cartridges.

Example 69. The system of Example 68, wherein at least a portion of the stiffening arm is configured to move in unison with whichever of the first and/or second cartridges to which it is coupled.

Example 70. The system of Example 68, wherein an end of the stiffening arm is couplable with the first cartridge and is configured to move in unison therewith.

Example 71. The system of Example 68, wherein an end of the stiffening arm is couplable with the second cartridge and is configured to move in unison therewith.

Example 72. The system of Example 67, wherein the stiffening arm is expandable and collapsible in a telescoping fashion.

Example 73. The system of Example 1, wherein the second endoscope comprise a working channel that extends through the second cartridge and the second insertion shaft.

Example 74. The system of Example 1, wherein: the first platform of the base comprises a plurality of motors; the first cartridge of the first endoscope comprises a plurality of pulleys that are configured to couple with the plurality of motors when the first cartridge is attached to the first platform; the first endoscope further comprises a plurality of tensioning wires each coupled with a respective one of the plurality of pulleys, each tensioning wire extending through the first insertion shaft to a distal end of the first insertion shaft; and the plurality of motors are configured to deflect the distal end of the first insertion shaft by rotating one or more of the pulleys when the first cartridge is attached to the first platform.

Example 75. The system of Example 74, wherein: the second platform of the base comprises a plurality of motors; the second cartridge of the second endoscope comprises a plurality of pulleys that are configured to couple with the plurality of motors of the second platform when the second cartridge is attached to the second platform; the second endoscope further comprises a plurality of tensioning wires each coupled with a respective one of the plurality of pulleys of the second cartridge, each tensioning wire extending through the second insertion shaft to a distal end of the second insertion shaft; and wherein the plurality of motors of the second platform are configured to deflect the distal end of the second insertion shaft by rotating one or more of the pulleys of the second cartridge when the second cartridge is attached to the second platform.

Example 76. The system of Example 74, wherein the plurality of pulleys are configured to passively rotate in response to active rotation by the plurality of motors.

Example 77. The system of Example 1, wherein the cart further comprises a rail along which each of the first and second platforms is configured to translate.

Example 78. The system of Example 77, wherein the rail comprises an external thread.

Example 79. The system of Example 78, wherein each of the first and second platforms comprises an electromechanical device configured to rotate an internally threaded element that is coupled to the external thread of the rail to achieve translation of the respective first or second platform.

Example 80. The system of Example 1, wherein the working channel includes a first branch and a second branch that separate from one another at a position within the first cartridge.

Example 81. The system of Example 80, wherein the first branch of the working channel extends through a proximal face of the first cartridge.

Example 82. The system of Example 80, wherein the second branch of the working channel extends through a top face of the first cartridge.

Example 83. A system comprising: a base comprising a platform that is movable relative to the base; a first endoscope that comprises: a first insertion shaft that comprises a portion of a working channel; and a first cartridge attached to the first insertion shaft that comprises a further portion of the working channel such that a lumen defined by the working channel extends through both the first cartridge and the first insertion shaft, the first cartridge being configured to selectively couple with the base and configured to selectively decouple from the base; and a second endoscope that comprises: a second insertion shaft sized to fit within the working channel of the first endoscope; a second cartridge attached to the second insertion shaft and being configured to selectively couple with the platform so as to be fixed relative thereto and configured to selectively decouple from the platform, wherein when the first cartridge is coupled with the base and the second cartridge is coupled with the platform, longitudinal movement of the platform advances the second insertion shaft of the second endoscope through the working channel of the first endoscope.

Example 84. A robotic console comprising: a first platform comprising: a first set of electromechanical devices comprising first coupling elements; and a first coupling interface configured to couple in fixed relation with a first cartridge of a first endoscope such that the first coupling elements mechanically couple with first mechanical components of the first cartridge; and a second platform comprising: a second set of electromechanical devices comprising second coupling elements; and a second coupling interface configured to couple in fixed relation with a second cartridge of a second endoscope such that the second coupling elements mechanically couple with second mechanical components of the second cartridge, wherein the second platform is translatable relative to the first platform.

Example 85. The robotic console of Example 84, wherein the second platform is constrained to translate along a straight line relative to the first platform.

Example 86. The robotic console of Example 84, further comprising a linear rail, wherein the second platform is coupled to the linear rail so as to translate along the rail toward or away from the first platform.

Example 87. The robotic console of Example 84, wherein the first platform is translatable relative to the second platform.

Example 88. The robotic console of Example 84, wherein the first platform is constrained to translate along a straight line relative to the second platform.

Example 89. The robotic console of Example 84, further comprising a linear rail, wherein the first platform is coupled to the linear rail so as to translate along the rail toward or away from the second platform. Example 90. The robotic console of Example 84, further comprising a linear rail, wherein each of the first platform and the second platform are coupled to the linear rail so as to translate along the rail.

Example 91. The robotic console of Example 84, wherein the first endoscope comprises a first insertion shaft having first tensioning wires therein and further comprises a first cartridge that is attached to the first insertion shaft and that has first mechanical components attached to the first tensioning wires, and wherein the second endoscope comprises a second insertion shaft having second tensioning wires therein and further comprises a second cartridge that is attached to the second insertion shaft and that has second mechanical components attached to the second tensioning wires.

Example 92. The robotic console of Example 84, further comprising a control unit communicatively coupled with the first and second sets of electromechanical devices.

Example 93. The robotic console of Example 92, wherein the first endoscope comprises a first insertion shaft having first tensioning wires therein and further comprises a first cartridge that is attached to the first insertion shaft and that has first mechanical components attached to the first tensioning wires, and wherein the second endoscope comprises a second insertion shaft having second tensioning wires therein and further comprises a second cartridge that is attached to the second insertion shaft and that has second mechanical components attached to the second tensioning wires.

Example 94. The robotic console of Example 93, wherein the control unit is configured to control deflection of the first insertion shaft of the first endoscope by controlling the first set of electromechanical devices when the first endoscope is coupled with the first platform.

Example 95. The robotic console of Example 94, wherein the control unit is configured to control deflection of the second insertion shaft of the second endoscope by controlling the second set of electromechanical devices when the second endoscope is coupled with the second platform.

Example 96. A system comprising: the robotic console of any of Examples 84 through 95; and either the first endoscope or the second endoscope.

Example 97. A system comprising: the robotic console of any of Examples 84 through 95; the first endoscope; and the second endoscope. Example 98. An endoscope comprising: an insertion shaft; and a cartridge coupled to the insertion shaft.

Example 99. An endoscope comprising: an insertion shaft comprising a distal end; a plurality of tensioning wires that extend through the insertion shaft and are coupled to the distal end of the insertion shaft; and a cartridge coupled to the insertion shaft, the cartridge comprising: a plurality of pulleys, wherein each pulley is coupled with one or more of the tensioning wires.

Example 100. The endoscope of Example 99, further comprising: an elevator at a distal end of the insertion shaft; a further tensioning wire coupled with the elevator, the further tensioning wire extending longitudinally through the insertion shaft; and a further pulley coupled with the further tensioning wire, wherein rotation of the further pulley raises or lowers the elevator.

Example 101. The endoscope of Example 99, wherein the insertion shaft is configured to rotate relative to the cartridge.

Example 102. The endoscope of Example 101, further comprising a torsion sensor coupled to the insertion shaft.

Example 103. The endoscope of Example 101, further comprising a worm drive coupled to the insertion shaft.

Example 104. The endoscope of Example 101, further comprising a beveled gear coupled to the insertion shaft.

Example 105. A method comprising: receiving a first cartridge of a first endoscope into coupled arrangement with a robotic console, the first endoscope comprising a first insertion shaft and a working channel that extends through both of the first cartridge and the first insertion shaft; receiving a second cartridge of a second endoscope into coupled arrangement with the robotic console, the second endoscope comprising a second insertion shaft; introducing the second insertion shaft of the second cartridge into the working channel of the first endoscope; and advancing, via the robotic console, the second endoscope toward the first endoscope to advance the second insertion shaft through the working channel. Example 106. The method of Example 105, wherein said advancing comprises advancing a distal end of the second insertion shaft past a distal end of the first insertion shaft.

Example 107. The method of Example 106, further comprising, after the distal end of the second insertion shaft has been advanced past the distal end of the first insertion shaft, steering the distal end of the second insertion shaft via the robotic console.

Example 108. A system comprising: a platform comprising an electromechanical element; an endoscope that comprises: an insertion shaft; and a cartridge comprising a mechanical system coupled to the insertion shaft so as to rotate the insertion shaft about a longitudinal axis thereof, the cartridge being configured to selectively couple with the base so as to couple the mechanical system with the electromechanical element and configured to selectively decouple from the base; a load sensor; and a control unit communicatively coupled to each of the load sensor and the electromechanical element, the control unit comprising a processor and memory having instructions stored thereon that, when executed by the processor, cause the processor to perform operations when the cartridge is coupled with the platform comprising: sensing via the load sensor an amount of torsional load in the insertion shaft; and responsive to said sensing, actuating the electromechanical element to rotating the insertion shaft about the longitudinal axis thereof to reduce or eliminate the amount of torsional load in the insertion shaft.

Example 109. The system of Example 108, wherein the torsional load arises from manual rotation of the insertion shaft by a user while the cartridge is coupled with the platform.

Example 110. A method comprising: receiving a cartridge of an endoscope into coupled arrangement with a robotic console, the endoscope comprising an insertion shaft rotatably coupled to the cartridge; subsequently sensing, via a sensor in communication with the robotic console, an amount of torsion in the insertion shaft; and responsive to said sensing, rotating, via the robotic console, the insertion shaft about a longitudinal axis of the insertion shaft to reduce or eliminate the amount of torsion in the insertion shaft.

Example 111. The method of Example 110, wherein the sensor is physically attached to the robotic console.

Example 112. The method of Example 110, wherein the sensor is physically attached to the cartridge.

Example 113. The method of Example 110, wherein at least a portion of the sensor is positioned within the cartridge.

Example 114. A controller for use in a system that comprises a first robotically controlled endoscope and a second robotically controlled endoscope, the controller comprising: a plurality of actuators configured to receive input from a user to control operations of the system; and a switch configured to transition between a first state and a second state, wherein when the switch is in the first state the controller is in a first operational mode in which the plurality of actuators controls operation of the first robotically controlled endoscope but not the second robotically controlled endoscope, and wherein when the switch is in the second state the controller is in a second operational mode in which the plurality of actuators controls operation of the second robotically controlled endoscope but not the first robotically controlled endoscope.

Example 115. The controller of Example 114, wherein the first robotically controlled endoscope comprises a duodenoscope and the second robotically controlled endoscope comprises a cholangioscope.

Example 116. The controller of Example 114, wherein the controller further comprises a handholdable handle to which the plurality of actuators and the switch are coupled.

Example 117. The controller of Example 116, wherein the plurality of actuators comprises: a first rotatable knob positioned at a proximal end of the handle; and a second rotatable knob positioned such that the first and second rotatable knobs share a common axis of rotation.

Example 118. The controller of Example 114, further comprising an interface for communicating input received from the user with the system. Example 119. The controller of Example 118, wherein the interface comprises a communication cable configured to deliver control signals from the controller to a control unit of the system.

Example 120. The controller of Example 118, wherein the interface is configured to wirelessly communicate with a control unit of the system.

Example 121. The controller of Example 114, wherein the plurality of actuators are configured to steer a distal end of the first robotically controlled endoscope when the switch is in the first state and are configured to steer a distal end of the second robotically controlled endoscope when the switch is in the second state.

Example 122. The controller of Example 114, further comprising an elevator actuator separate from the plurality of actuators that is configured to raise or lower an elevator of the first robotically controlled endoscope.

Example 123. The controller of Example 122, wherein the elevator actuator is operational to raise or lower the elevator of the first robotically controlled endoscope when the switch is in each of the first and second states.

Example 124. A controller for use in a system that comprises a robotically controlled endoscope, the controller comprising: a handholdable handle; a first rotatable knob configured to generate control signals that are delivered to the system to effect movement of the robotically controlled endoscope in a first plane, the first rotatable knob being positioned at a proximal end of the handle; and a second rotatable knob configured to generate control signals that are delivered to the system to effect movement of the robotically controlled endoscope in a second plane, the second rotatable knob being positioned such that the first and second rotatable knobs share a common axis.

Example 125. The controller of Example 124, wherein the first plane is orthogonal to the second plane.

Example 126. The controller of Example 124, wherein the system further comprises an additional robotically controlled endoscope and the controller further comprises a switch configured to transition between a first state and a second state, wherein when the switch is in the first state the controller is in a first operational mode in which the first and second rotatable knobs control movement of a first of the two robotically controlled endoscopes but not a second of the two robotically controlled endoscopes, and wherein when the switch is in the second state the controller is in a second operational mode in which the first and second rotatable knobs control operation of the second of the two robotically controlled endoscopes but not the first of the two robotically controlled endoscopes.

Example 127. The controller of Example 126, further comprising an elevator actuator configured to generate control signals that are delivered to the system to effect movement of an elevator of the first of the two robotically controlled endoscopes, wherein the elevator actuator is operational to raise or lower the elevator of the first of the two robotically controlled endoscopes when the switch is in each of the first and second states.

Example 128. The controller of Example 124, further comprising an elevator actuator configured to generate control signals that are delivered to the system to effect movement of an elevator of the robotically controlled endoscope.

Example 129. A system comprising: a base comprising a longitudinally movable platform; a first endoscope comprising: a first cartridge configured to be selectively coupled to the first platform of the base; and a first insertion shaft extending from the first cartridge; and a shaft manipulator configured to couple with the first insertion shaft of the first endoscope, the shaft manipulator comprising: a first interface configured move the first endoscope in a direction aligned with a longitudinal axis of the first insertion shaft; and a second interface at which the base rotates the shaft manipulator such that, when the shaft manipulator is coupled with the first insertion shaft, both the shaft manipulator and the first insertion shaft rotate about the longitudinal axis of the first insertion shaft.

Example 130. The system of Example 129, further comprising a guiding arm coupled to the base, wherein the shaft manipulator is positioned longitudinally between the platform and the guiding arm.

Example 131. The system of Example 129, wherein the first endoscope further comprises a plurality of tensioning wires that extend from the first cartridge into the first insertion shaft, wherein the base comprises a plurality of electromechanical devices that couple with the first cartridge to alter tension levels within the plurality of tensioning wires.

Example 132. The system of Example 129, further comprising a controller configured to control operation of movement of the first platform and the shaft manipulator. Example 133. The system of Example 132, wherein the controller comprises a plurality of actuators via which input is receivable from a user.

Example 134. The system of Example 132, wherein the controller comprises a handle, a first rotatable knob positioned at a proximal end of the handle, and a second rotatable knob positioned such that the first and second rotatable knobs rotate about a common axis.

Example 135. The system of Example 132, further comprising a secondary controller disposed on the base.

Example 136. The system of Example 132, wherein the controller is wirelessly coupled to the base.

Example 137. The system of Example 129, wherein the base comprises a second platform and the system comprises a second endoscope that comprises: a second cartridge configured to be coupled to the second platform; and a second insertion shaft extending from the second cartridge and configured to be advanced through the first endoscope.

Example 138. The system of Example 137, wherein the second platform is longitudinally movable relative to the first platform such that distal longitudinal movement of the second platform advances the second insertion shaft of the second endoscope through the first endoscope when the first and second cartridges are coupled to the first and second platforms, respectively.

Example 139. The system of Example 137, further comprising a rigid body extending between the first cartridge and the second cartridge through which the second insertion shaft extends.

Example 140. The system of Example 139, wherein the rigid body is adjustable in length.

Example 141. The system of Example 140, wherein the rigid body is configured to contract in length as the second platform is advanced toward the first platform.

Example 142. The system of Example 140, wherein the rigid body is configured to expand in length as the second platform retracts from the first platform.

Example 143. The system of Example 129, wherein the first cartridge comprises a first port for conveying water through the first endoscope and a second port for conveying air through the first endoscope.

Example 144. The system of Example 143, wherein the base includes an electronically controllable pinch valve that closes off a line coupling the first port to a water source, the pinch valve controlling the conveyance of water through the first endoscope.

Example 145. The system of Example 129, wherein the first interface comprises a first roller configured to apply force to the first insertion shaft to translate the first insertion shaft longitudinally and the second interface comprises a second roller configured to apply force to the shaft manipulator to cause the shaft manipulator to rotated about the longitudinal axis of the insertion shaft.

Example 146. The system of Example 145, further comprising: a first electromechanical element configured to rotate the first roller; and a second electromechanical element configured to rotate the second roller.

Example 147. The system of Example 129, wherein the base further comprises one or more interfaces for coupling the first endoscope to one or more components of an instrument tower.

Example 148. The system of Example 147, wherein the one or more interfaces comprise a first interface for coupling to a first video processing unit associated with the tower and a second interface for coupling to an air source or water source.

Example 149. The system of Example 148, wherein the system further comprises a second endoscope configured to be deployed through the first endoscope, and wherein the one or more interfaces further comprise a third interface for coupling with a second video processing unit associated with the second endoscope.

Example 150. The system of Example 149, wherein the first video processing unit and the second video processing unit are configured to simultaneously display video associated with the first endoscope and the second endoscope, respectively.

Example 151. A method comprising: determining that a cartridge of a robotic endoscope is in an engaged position, the cartridge comprising two pulleys that are each respectively coupled with a separate one of a pair of tensioning wires that extends through an insertion shaft that is coupled to and extends from the cartridge; and automatically controlling two separate motors that are separately coupled with the two pulleys to tension the pair of tensioning wires against each other.

Example 152. The method of Example 151, further comprising controlling at least one of the motors to deflect a distal end of the insertion shaft based on control signals received from a controller being operated by a human user.

Example 153. A method comprising: positioning a flexible endoscope at an orifice of a patient; and using robotic control, feeding the first flexible endoscope into the orifice of the patient by applying force to the first flexible endoscope at least a threshold distance away from the orifice.

Example 154. The method of Example 153, wherein feeding the first flexible endoscope into the orifice of the patient includes rotating a roller associated with a shaft manipulator.

Example 155. The method of Example 154, further comprising fixing the first flexible endoscope at a depth within the patient by holding the roller stationary.

Example 156. The method of Example 155, further comprising, after fixing the first flexible endoscope at the depth, deploying a second flexible endoscope through the first flexible endoscope.

As previously discussed, many embodiments are disclosed herein in the contexts of duodenoscopes, cholangioscopes, and ERCP procedures. However, various embodiments are not necessarily limited to these contexts. For example, certain embodiments are additionally or alternatively well suited for use in other endoscopic or guided catheter contexts. By way of nonlimiting examples, certain embodiments are contemplated for use in the field of urology, and certain embodiments are suitable for use in bronchoscopy procedures. Further contexts include devices, systems, or methods in which a tube (e.g., first endoscope, catheter, or other medical instrument) is advanced into a patient and an elongated device (e.g., second tube, endoscope, catheter, accessory, or other medical instrument) is advanced into the patient through or alongside the tube. In various embodiments, the tube may be steerable and/or instrumentation at a distal end thereof may be remotely controllable. In other or further embodiments, the elongated device that is advanced through or alongside the tube may be steerable and/or instrumentation at a distal end thereof may be remotely controllable.

The present disclosure describes numerous methods. Any suitable step or sub-step of such methods may be achieved by embodiments of robotic devices and/or systems. For example, in many embodiments, method steps or sub-steps may be performed by the control unit via its communicative coupling with various system components. Likewise, any processes, subprocesses, routines, subroutines, etc. described with respect to the robotic system may more generally be described as methods, including methods that are implemented by the robotic system and/or specific components thereof. Modifications, additions, or omissions may be made to any of the drawings. For example, any of the systems or devices may include additional or fewer components. As another example, certain illustrated components may be broken down or expanded into multiple sub-components. As a further example, certain illustrated components may be combined into fewer components than those illustrated.

The foregoing disclosure is not intended to limit the present disclosure to the precise forms or particular fields of use disclosed. As such, it is contemplated that various alternate embodiments and/or modifications to the present disclosure, whether explicitly described or implied herein, are possible in light of the disclosure. Having thus described embodiments of the present disclosure, it may be recognized that changes may be made in form and detail without departing from the scope of the present disclosure. Thus, the present disclosure is limited only by the claims.

In some embodiments, the different components, modules, engines, and services described herein may be implemented as objects or processes that execute on a computing system (e.g., as separate threads). While some of the systems and processes described herein are generally described as being implemented in software (stored on and/or executed by general purpose hardware), specific hardware implementations or a combination of software and specific hardware implementations are also possible and contemplated.

Terms used in the present disclosure and especially in the appended claims (e.g., bodies of the appended claims) are generally intended as “open terms” (e.g., the term “including” should be interpreted as “including, but not limited to.”).

Additionally, if a specific number of an introduced claim recitation is intended, such an intent will be explicitly recited in the claim, and in the absence of such recitation no such intent is present. For example, as an aid to understanding, the following appended claims may contain usage of the introductory phrases “at least one” and “one or more” to introduce claim recitations. However, the use of such phrases should not be construed to imply that the introduction of a claim recitation by the indefinite articles “a” or “an” limits any particular claim containing such introduced claim recitation to embodiments containing only one such recitation, even when the same claim includes the introductory phrases “one or more” or “at least one” and indefinite articles such as “a” or “an” (e.g., “a” and/or “an” should be interpreted to mean “at least one” or “one or more”); the same holds true for the use of definite articles used to introduce claim recitations. In addition, even if a specific number of an introduced claim recitation is expressly recited, those skilled in the art will recognize that such recitation should be interpreted to mean at least the recited number (e.g., the bare recitation of “two recitations,” without other modifiers, means at least two recitations, or two or more recitations). Furthermore, in those instances where a convention analogous to “at least one of A, B, and C, etc.” or “one or more of A, B, and C, etc.” is used, in general such a construction is intended to include A alone, B alone, C alone, A and B together, A and C together, B and C together, or A, B, and C together, etc.

Further, any disjunctive word or phrase preceding two or more alternative terms, whether in the description, claims, or drawings, should be understood to contemplate the possibilities of including one of the terms, either of the terms, or both of the terms. For example, the phrase “A or B” should be understood to include the possibilities of “A” or “B” or “A and B.”

All examples and conditional language recited in the present disclosure are intended for pedagogical objects to aid the reader in understanding the present disclosure and the concepts contributed by the inventor to furthering the art, and are to be construed as being without limitation to such specifically recited examples and conditions. Although embodiments of the present disclosure have been described in detail, various changes, substitutions, and alterations could be made hereto without departing from the spirit and scope of the present disclosure.

Claims

CLAIMS What is claimed is:

1. A system comprising: a base comprising: a first platform; and a second platform that is movable relative to the base; a first endoscope that comprises: a first insertion shaft that comprises a portion of a working channel; and a first cartridge attached to the first insertion shaft that comprises a further portion of the working channel such that a lumen defined by the working channel extends through both the first cartridge and the first insertion shaft, the first cartridge being configured to selectively couple with the first platform so as to be fixed relative thereto and configured to selectively decouple from the first platform; and a second endoscope that comprises: a second insertion shaft sized to fit within the working channel of the first endoscope; and a second cartridge attached to the second insertion shaft and being configured to selectively couple with the second platform so as to be fixed relative thereto and configured to selectively decouple from the second platform, wherein when the first cartridge is coupled with the first platform and the second cartridge is coupled with the second platform, movement of the second platform toward the first platform advances the second insertion shaft of the second endoscope through the working channel of the first endoscope.

2. The system of claim 1, further comprising a control unit.

3. The system of claim 2, wherein the control unit is communicatively coupled to the second platform to control movement of the second insertion shaft when the second cartridge is coupled to the second platform.

4. The system of claim 3 wherein the second platform comprises an electromechanical element, and wherein the control unit is communicatively coupled to the electromechanical element so as to cause the electromechanical element to advance the second platform toward the first platform or retract the second platform away from the first platform, thereby longitudinally advancing or retracting the second insertion shaft, respectively, when the second cartridge is coupled to the second platform.

5. The system of claim 2, wherein the second endoscope comprises a plurality of tensioning wires that extend through the second insertion shaft from a distal end of the second insertion shaft and into the second cartridge, and wherein the control unit is configured to selectively tension or slacken each of the plurality of tensioning wires to steer the distal end of the second insertion shaft when the second cartridge is coupled to the second platform.

6. The system of claim 5, wherein the second platform comprises one or more electromechanical elements, and wherein the control unit is communicatively coupled to the one or more electromechanical elements to selectively tension or slacken the plurality of tensioning wires when the second cartridge is coupled to the second platform.

7. The system of claim 2, wherein the control unit is configured to control rotation of the second insertion shaft about a longitudinal axis thereof when the second cartridge is coupled to the second platform.

8. The system of claim 7, wherein the second platform comprises an electromechanical element, and wherein the control unit is communicatively coupled to the electromechanical element so as to cause the electromechanical element to rotate the second insertion shaft about a longitudinal axis thereof when the second cartridge is coupled to the second platform.

9. The system of claim 2, wherein the first platform is movable relative to the base, and wherein the control unit is communicatively coupled to the first platform to control movement of the first insertion shaft when the first cartridge is coupled to the first platform.

10. The system of claim 9 wherein the first platform comprises an electromechanical element, and wherein the control unit is communicatively coupled to the electromechanical element so as to cause the electromechanical element to advance the first platform toward a distal end of the base or retract the first platform toward a proximal end of the base, thereby longitudinally advancing or retracting the first insertion shaft, respectively, when the first cartridge is coupled to the first platform.

11. The system of claim 2, wherein the first endoscope comprises a plurality of tensioning wires that extend through the first insertion shaft from a distal end of the first insertion shaft and into the first cartridge, and wherein the control unit is configured to selectively tension or slacken each of the plurality of tensioning wires to steer the distal end of the first insertion shaft when the first cartridge is coupled to the first platform.

12. The system of claim 11, wherein the first platform comprises one or more electromechanical elements, and wherein the control unit is communicatively coupled to the one or more electromechanical elements to selectively tension or slacken the plurality of tensioning wires when the first cartridge is coupled to the first platform.

13. The system of claim 2, wherein the control unit is configured to control rotation of the first insertion shaft about a longitudinal axis thereof when the first cartridge is coupled to the first platform.

14. The system of claim 13, wherein the first platform comprises an electromechanical element, and wherein the control unit is communicatively coupled to the electromechanical element so as to cause the electromechanical element to rotate the first insertion shaft about a longitudinal axis thereof when the first cartridge is coupled to the first platform.

15. The system of claim 2, wherein the first endoscope further comprises an elevator, and wherein the control unit is communicatively coupled to the first platform to control movement of the elevator when the first cartridge is coupled to the first platform.

16. The system of claim 15, wherein the first platform comprises an electromechanical element, and wherein the control unit is communicatively coupled to the electromechanical element so as to cause the electromechanical element to raise or lower the elevator when the first cartridge is coupled to the first platform.

17. The system of claim 2, further comprising a shaft manipulator positioned distal to the first platform, the shaft manipulator being configured to move the first insertion shaft when engaged therewith.

18. The system of claim 17, wherein the shaft manipulator is configured to rotate the first insertion shaft of the first endoscope about a longitudinal axis of the first insertion shaft.

19. The system of claim 18, wherein the shaft manipulator comprises a rotation block configured to engage the first insertion shaft, wherein the rotation block is configured to be rotated relative to the base while engaging the first insertion shaft to effect rotation of the first insertion shaft.

20. The system of claim 19, wherein the shaft manipulator comprises one or more electromechanical elements coupled to the rotation block, and wherein the control unit is communicatively coupled to the one or more electromechanical elements to control rotation of the rotation block when the rotation block engages the first insertion shaft to thereby control rotation of the first insertion shaft.

21. The system of claim 20, wherein the control unit is communicatively coupled to the first platform to control rotation of the first insertion shaft at the first cartridge when the first cartridge is attached to the first platform.

22. The system of claim 21, wherein the control unit is configured to simultaneously control a rate of rotation of the first insertion shaft at the first cartridge and a rate of rotation of the first insertion shaft at the rotation block to be the same.

23. The system of claim 21, wherein the first platform comprises an electromechanical element, and wherein the control unit is communicatively coupled to the electromechanical element so as to cause the electromechanical element to rotate the first insertion shaft when the first cartridge is coupled to the first platform.

24. The system of claim 20, wherein the first cartridge is coupled with the first insertion shaft such that the first insertion shaft passively rotates at the first cartridge as the shaft manipulator rotates the first insertion shaft.

25. The system of claim 17, wherein the shaft manipulator is configured to longitudinally advance or retract the first insertion shaft when engaged therewith.

26. The system of claim 25, wherein the shaft manipulator comprises one or more electromechanical elements that are communicatively coupled to the control unit, and wherein the control unit is configured to control actuation of the one or more electromechanical elements to thereby control longitudinal advancement or retraction of the first insertion shaft when the shaft manipulator is engaged therewith.

27. The system of claim 25, wherein the first platform is movable relative to the base, and wherein the control unit is configured to advance or retract the first platform at a rate that matches a rate of advancement or retraction of the first insertion shaft via the shaft manipulator.

28. The system of claim 2 further comprising a controller that is communicatively couplable or communicatively coupled with the control unit to permit a user to provide control instructions to the control unit.

29. The system of claim 28, wherein the controller is permanently attached to the base.

30. The system of claim 29, further comprising a handholdable controller that is separate from and movable relative to the base.

31. The system of claim 28, wherein the controller comprises a first set of actuators that are configured to control the first endoscope and a second set of actuators separate from the first set of actuators that are configured to control the second endoscope.

32. The system of claim 31, wherein a single handholdable housing comprises both the first and second sets of actuators.

33. The system of claim 31, wherein a first handholdable housing comprises the first set of actuators and a second handholdable housing comprises the second set of actuators.

34. The system of claim 28, wherein the controller comprises a set of actuators and a switch, wherein: when the switch is in a first state, the set of actuators controls functions of the first endoscope; and when the switch is in a second state, the set of actuators controls functions of the second endoscope.

35. The system of claim 34, wherein a single handholdable housing comprises the set of actuators and the switch.

36. The system of claim 34, wherein the first endoscope comprises an elevator, and wherein the controller comprises a dedicated actuator configured to control movement of the elevator.

37. The system of claim 28, wherein the controller comprises: a handle; a first rotatable knob positioned at a proximal end of the handle; and a second rotatable knob positioned such that the first and second rotatable knobs share a common axis of rotation.

38. The system of claim 37, wherein the handle is holdable by a first hand of a practitioner, and wherein each of the first and second rotatable knobs is actuatable by a second hand of the practitioner while the practitioner holds the handle with the first hand.

39. The system of claim 37, wherein: the controller further comprises a switch; when the switch is in a first state, actuation of the first rotatable knob or second rotatable knob is configured to cause the control unit to effect movement of a distal end of the first endoscope; and when the switch is in a second state, actuation of the first rotatable knob or second rotatable knob is configured to cause the control unit to effect movement of a distal end of the second endoscope.

40. The system of claim 39, wherein rotation of the first rotatable knob effects movement of the distal end of either the first or second endoscope in a first plane and rotation of the second rotatable knob effects movement the distal end of either the first or second endoscope in a second plane that is orthogonal to the first plane.

41. The system of claim 39, wherein the first endoscope comprises a duodenoscope and the second endoscope comprises a cholangioscope.

42. The system of claim 1, wherein the first endoscope comprises a duodenoscope and the second endoscope comprises a cholangioscope.

43. The system of claim 1, wherein the second endoscope comprises a plurality of tensioning wires that extend through the second insertion shaft from a distal end of the second insertion shaft and into the second cartridge, and wherein the second platform is configured to selectively tension or slacken each of the plurality of tensioning wires to steer the distal end of the second insertion shaft when the second cartridge is coupled to the second platform.

44. The system of claim 43, wherein: the second platform comprises one or more electromechanical elements; the second cartridge comprises one or more pulleys coupled to one or more of the plurality of tensioning wires; and the one or more pulleys are coupled to the one or more electromechanical elements when the second cartridge is coupled to the second platform such that the one or more electromechanical elements are movable to selectively tension or slacken said one or more of the plurality of tensioning wires to deflect the distal end of the second insertion shaft.

45. The system of claim 1, wherein the second cartridge is configured to rotate the second insertion shaft about a longitudinal axis thereof when the second cartridge is coupled to the second platform.

46. The system of claim 45, wherein the second platform comprises an electromechanical element and the second cartridge comprises a mechanical system that couples with the electromechanical element when the second cartridge is coupled to the second platform such that the electromechanical element is movable to rotate the second insertion shaft about the longitudinal axis thereof.

47. The system of claim 1, wherein the first platform is movable relative to the base.

48. The system of claim 1, wherein the first endoscope comprises a plurality of tensioning wires that extend through the first insertion shaft from a distal end of the first insertion shaft and into the first cartridge, and wherein the first platform is configured to selectively tension or slacken each of the plurality of tensioning wires to steer the distal end of the first insertion shaft when the first cartridge is coupled to the first platform.

49. The system of claim 48, wherein: the first platform comprises one or more electromechanical elements; the first cartridge comprises one or more pulleys coupled to one or more of the plurality of tensioning wires; and the one or more pulleys are coupled to the one or more electromechanical elements when the first cartridge is coupled to the first platform such that the one or more electromechanical elements are movable to selectively tension or slacken said one or more of the plurality of tensioning wires to deflect the distal end of the first insertion shaft.

50. The system of claim 1, wherein the first cartridge is configured to rotate the first insertion shaft about a longitudinal axis thereof when the first cartridge is coupled to the first platform.

51. The system of claim 50, wherein the first platform comprises an electromechanical element and the first cartridge comprises a mechanical system that couples with the electromechanical element when the first cartridge is coupled to the first platform such that the electromechanical element is movable to rotate the first insertion shaft about the longitudinal axis thereof.

52. The system of claim 1, wherein the first endoscope further comprises an elevator.

53. The system of claim 52, wherein the first platform comprises an electromechanical element and the first cartridge comprises a mechanical system that couples with the electromechanical element when the first cartridge is coupled to the first platform such that the electromechanical element is movable to raise or lower the elevator.

54. The system of claim 1, further comprising a shaft manipulator positioned distal to the first platform, the shaft manipulator being configured to move the first insertion shaft when engaged therewith.

55. The system of claim 54, wherein the shaft manipulator is configured to permit the first insertion shaft to be introduced laterally into the shaft manipulator in a direction substantially orthogonal to a longitudinal axis of the first insertion shaft.

56. The system of claim 55, wherein the shaft manipulator comprises a clamp that is openable to permit introduction of the first insertion shaft into the clamp and is closeable thereafter to permit the shaft manipulator to engage the first insertion shaft.

57. The system of claim 54, wherein the first platform is movable relative to the base, and wherein the first platform is configured to translate proximally after the first insertion shaft has been engaged by the shaft manipulator and after the first cartridge has been attached to the first platform by an amount sufficient to place a portion of the first insertion shaft that extends between the first cartridge and the shaft manipulator in a substantially rectilinear state.

58. The system of claim 54, wherein the shaft manipulator is configured to rotate the first insertion shaft of the first endoscope about a longitudinal axis of the first insertion shaft.

59. The system of claim 58, wherein the shaft manipulator comprises a rotation block that is configured to receive therein the first insertion shaft, and wherein the rotation block is configured to rotate relative to the base to effect rotation of the first insertion shaft.

60. The system of claim 58, wherein the first cartridge, when coupled with the first platform, is configured to actively rotate the first insertion shaft about the longitudinal axis of the first insertion shaft in unison with rotation of the first insertion shaft provided by the shaft manipulator.

61. The system of claim 58, wherein the first cartridge, when coupled with the first platform, is configured to passively permit the first insertion shaft to rotate about the longitudinal axis of the first insertion shaft as the shaft manipulator rotates the first insertion shaft.

62. The system of claim 58, wherein the rotation block is configured to selectively couple with the base so as to be rotated thereby and is configured to be selectively decoupled from the base to facilitate cleaning or replacement of portions of the rotation block that contact the first insertion shaft during manipulation thereof.

63. The system of claim 54, wherein the shaft manipulator is configured to longitudinally advance or retract the first insertion shaft.

64. The system of claim 63, wherein shaft manipulator and the first platform are configured to engage separate portions of the first insertion shaft and to longitudinally advance or retract the separate portions of the first insertion shaft at a uniform speed.

65. The system of claim 1, wherein the base comprises a moveable cart.

66. The system of claim 65, wherein a height of the base is adjustable.

67. The system of claim 1, further comprising a stiffening arm configured to be positioned around a portion of the second insertion shaft and extend between the first and second cartridges when the first and second cartridges are coupled with the first and second platforms, respectively.

68. The system of claim 67, wherein the stiffening arm is couplable with at least one of the first and second cartridges.

69. The system of claim 68, wherein at least a portion of the stiffening arm is configured to move in unison with whichever of the first and/or second cartridges to which it is coupled.

70. The system of claim 68, wherein an end of the stiffening arm is couplable with the first cartridge and is configured to move in unison therewith.

71. The system of claim 68, wherein an end of the stiffening arm is couplable with the second cartridge and is configured to move in unison therewith.

72. The system of claim 67, wherein the stiffening arm is expandable and collapsible in a telescoping fashion.

73. The system of claim 1, wherein the second endoscope comprise a working channel that extends through the second cartridge and the second insertion shaft.

74. The system of claim 1, wherein: the first platform of the base comprises a plurality of motors; the first cartridge of the first endoscope comprises a plurality of pulleys that are configured to couple with the plurality of motors when the first cartridge is attached to the first platform; the first endoscope further comprises a plurality of tensioning wires each coupled with a respective one of the plurality of pulleys, each tensioning wire extending through the first insertion shaft to a distal end of the first insertion shaft; and the plurality of motors are configured to deflect the distal end of the first insertion shaft by rotating one or more of the pulleys when the first cartridge is attached to the first platform.

75. The system of claim 74, wherein: the second platform of the base comprises a plurality of motors; the second cartridge of the second endoscope comprises a plurality of pulleys that are configured to couple with the plurality of motors of the second platform when the second cartridge is attached to the second platform; the second endoscope further comprises a plurality of tensioning wires each coupled with a respective one of the plurality of pulleys of the second cartridge, each tensioning wire extending through the second insertion shaft to a distal end of the second insertion shaft; and wherein the plurality of motors of the second platform are configured to deflect the distal end of the second insertion shaft by rotating one or more of the pulleys of the second cartridge when the second cartridge is attached to the second platform.

76. The system of claim 74, wherein the plurality of pulleys are configured to passively rotate in response to active rotation by the plurality of motors.

77. The system of claim 1, wherein the base further comprises a rail along which each of the first and second platforms is configured to translate.

78. The system of claim 77, wherein the rail comprises an external thread.

79. The system of claim 78, wherein each of the first and second platforms comprises an electromechanical device configured to rotate an internally threaded element that is coupled to the external thread of the rail to achieve translation of the respective first or second platform.

80. The system of claim 1, wherein the working channel includes a first branch and a second branch that separate from one another at a position within the first cartridge.

81. The system of claim 80, wherein the first branch of the working channel extends through a proximal face of the first cartridge.

82. The system of claim 80, wherein the second branch of the working channel extends through a top face of the first cartridge.

83. A system comprising: a base comprising a platform that is movable relative to the base; a first endoscope that comprises: a first insertion shaft that comprises a portion of a working channel; and a first cartridge attached to the first insertion shaft that comprises a further portion of the working channel such that a lumen defined by the working channel extends through both the first cartridge and the first insertion shaft, the first cartridge being configured to selectively couple with the base and configured to selectively decouple from the base; and a second endoscope that comprises: a second insertion shaft sized to fit within the working channel of the first endoscope; and a second cartridge attached to the second insertion shaft and being configured to selectively couple with the platform so as to be fixed relative thereto and configured to selectively decouple from the platform, wherein when the first cartridge is coupled with the base and the second cartridge is coupled with the platform, longitudinal movement of the platform advances the second insertion shaft of the second endoscope through the working channel of the first endoscope.

84. A robotic console comprising: a first platform comprising: a first set of electromechanical devices comprising first coupling elements; and a first coupling interface configured to couple in fixed relation with a first cartridge of a first endoscope such that the first coupling elements mechanically couple with first mechanical components of the first cartridge; and a second platform comprising: a second set of electromechanical devices comprising second coupling elements; and a second coupling interface configured to couple in fixed relation with a second cartridge of a second endoscope such that the second coupling elements mechanically couple with second mechanical components of the second cartridge, wherein the second platform is translatable relative to the first platform.

85. The robotic console of claim 85, wherein the second platform is constrained to translate along a straight line relative to the first platform.

86. The robotic console of claim 85, further comprising a linear rail, wherein the second platform is coupled to the linear rail so as to translate along the rail toward or away from the first platform.

87. The robotic console of claim 85, wherein the first platform is translatable relative to the second platform.

88. The robotic console of claim 85, wherein the first platform is constrained to translate along a straight line relative to the second platform.

89. The robotic console of claim 85, further comprising a linear rail, wherein the first platform is coupled to the linear rail so as to translate along the rail toward or away from the second platform.

90. The robotic console of claim 85, further comprising a linear rail, wherein each of the first platform and the second platform are coupled to the linear rail so as to translate along the rail.

91. The robotic console of claim 85, wherein the first endoscope comprises a first insertion shaft having first tensioning wires therein and further comprises a first cartridge that is attached to the first insertion shaft and that has first mechanical components attached to the first tensioning wires, and wherein the second endoscope comprises a second insertion shaft having second tensioning wires therein and further comprises a second cartridge that is attached to the second insertion shaft and that has second mechanical components attached to the second tensioning wires.

92. The robotic console of claim 85, further comprising a control unit communicatively coupled with the first and second sets of electromechanical devices.

93. The robotic console of claim 92, wherein the first endoscope comprises a first insertion shaft having first tensioning wires therein and further comprises a first cartridge that is attached to the first insertion shaft and that has first mechanical components attached to the first tensioning wires, and wherein the second endoscope comprises a second insertion shaft having second tensioning wires therein and further comprises a second cartridge that is attached to the second insertion shaft and that has second mechanical components attached to the second tensioning wires.

94. The robotic console of claim 93, wherein the control unit is configured to control deflection of the first insertion shaft of the first endoscope by controlling the first set of electromechanical devices when the first endoscope is coupled with the first platform.

95. The robotic console of claim 94, wherein the control unit is configured to control deflection of the second insertion shaft of the second endoscope by controlling the second set of electromechanical devices when the second endoscope is coupled with the second platform.

96. A system comprising: the robotic console of any of claims 85 through 95; and either the first endoscope or the second endoscope.

97. A system comprising: the robotic console of any of claims 85 through 95; the first endoscope; and the second endoscope.

98. An endoscope comprising: an insertion shaft; and a cartridge coupled to the insertion shaft.

99. An endoscope comprising: an insertion shaft comprising a distal end; a plurality of tensioning wires that extend through the insertion shaft and are coupled to the distal end of the insertion shaft; and a cartridge coupled to the insertion shaft, the cartridge comprising: a plurality of pulleys, wherein each pulley is coupled with one or more of the tensioning wires.

100. The endoscope of claim 99, further comprising: an elevator at a distal end of the insertion shaft; an actuation wire coupled with the elevator, the actuation wire extending longitudinally through the insertion shaft; and an actuator coupled with the actuation wire, wherein actuation of the actuator raises or lowers the elevator.

101. The endoscope of claim 99, wherein the insertion shaft is configured to rotate relative to the cartridge.

102. The endoscope of claim 101, further comprising a torsion sensor coupled to the insertion shaft.

103. The endoscope of claim 101, further comprising a worm drive coupled to the insertion shaft.

104. The endoscope of claim 101, further comprising a beveled gear coupled to the insertion shaft.

105. A method comprising: receiving a first cartridge of a first endoscope into coupled arrangement with a robotic console, the first endoscope comprising a first insertion shaft and a working channel that extends through both of the first cartridge and the first insertion shaft; receiving a second cartridge of a second endoscope into coupled arrangement with the robotic console, the second endoscope comprising a second insertion shaft; introducing the second insertion shaft of the second cartridge into the working channel of the first endoscope; and advancing, via the robotic console, the second endoscope toward the first endoscope to advance the second insertion shaft through the working channel.

106. The method of claim 105, wherein said advancing comprises advancing a distal end of the second insertion shaft past a distal end of the first insertion shaft.

107. The method of claim 106, further comprising, after the distal end of the second insertion shaft has been advanced past the distal end of the first insertion shaft, steering the distal end of the second insertion shaft via the robotic console.

108. A system comprising: a platform comprising an electromechanical element; an endoscope that comprises: an insertion shaft; and a cartridge comprising a mechanical system coupled to the insertion shaft so as to rotate the insertion shaft about a longitudinal axis thereof, the cartridge being configured to selectively couple with a base so as to couple the mechanical system with the electromechanical element and configured to selectively decouple from the base; a load sensor; and a control unit communicatively coupled to each of the load sensor and the electromechanical element, the control unit comprising a processor and memory having instructions stored thereon that, when executed by the processor, cause the processor to perform operations when the cartridge is coupled with the platform comprising: sensing via the load sensor an amount of torsional load in the insertion shaft; and responsive to said sensing, actuating the electromechanical element to rotating the insertion shaft about the longitudinal axis thereof to reduce or eliminate the amount of torsional load in the insertion shaft.

109. The system of claim 108, wherein the torsional load arises from manual rotation of the insertion shaft by a user while the cartridge is coupled with the platform.

110. A method comprising: receiving a cartridge of an endoscope into coupled arrangement with a robotic console, the endoscope comprising an insertion shaft rotatably coupled to the cartridge; subsequently sensing, via a sensor in communication with the robotic console, an amount of torsion in the insertion shaft; and responsive to said sensing, rotating, via the robotic console, the insertion shaft about a longitudinal axis of the insertion shaft to reduce or eliminate the amount of torsion in the insertion shaft.

111. The method of claim 110, wherein the sensor is physically attached to the robotic console.

112. The method of claim 110, wherein the sensor is physically attached to the cartridge.

113. The method of claim 110, wherein at least a portion of the sensor is positioned within the cartridge.

114. A controller for use in a system that comprises a first robotically controlled endoscope and a second robotically controlled endoscope, the controller comprising: a plurality of actuators configured to receive input from a user to control operations of the system; and a switch configured to transition between a first state and a second state, wherein when the switch is in the first state the controller is in a first operational mode in which the plurality of actuators controls operation of the first robotically controlled endoscope but not the second robotically controlled endoscope, and wherein when the switch is in the second state the controller is in a second operational mode in which the plurality of actuators controls operation of the second robotically controlled endoscope but not the first robotically controlled endoscope.

115. The controller of claim 114, wherein the first robotically controlled endoscope comprises a duodenoscope and the second robotically controlled endoscope comprises a cholangioscope.

116. The controller of claim 114, wherein the controller further comprises a handholdable handle to which the plurality of actuators and the switch are coupled.

117. The controller of claim 116, wherein the plurality of actuators comprises: a first rotatable knob positioned at a proximal end of the handle; and a second rotatable knob positioned such that the first and second rotatable knobs share a common axis of rotation.

118. The controller of claim 114, further comprising an interface for communicating input received from the user with the system.

119. The controller of claim 118, wherein the interface comprises a communication cable configured to deliver control signals from the controller to a control unit of the system.

120. The controller of claim 118, wherein the interface is configured to wirelessly communicate with a control unit of the system.

121. The controller of claim 114, wherein the plurality of actuators are configured to steer a distal end of the first robotically controlled endoscope when the switch is in the first state and are configured to steer a distal end of the second robotically controlled endoscope when the switch is in the second state.

122. The controller of claim 114, further comprising an elevator actuator separate from the plurality of actuators that is configured to raise or lower an elevator of the first robotically controlled endoscope.

123. The controller of claim 122, wherein the elevator actuator is operational to raise or lower the elevator of the first robotically controlled endoscope when the switch is in each of the first and second states.

124. A controller for use in a system that comprises a robotically controlled endoscope, the controller comprising: a handholdable handle; a first rotatable knob configured to generate control signals that are delivered to the system to effect movement of the robotically controlled endoscope in a first plane, the first rotatable knob being positioned at a proximal end of the handle; and a second rotatable knob configured to generate control signals that are delivered to the system to effect movement of the robotically controlled endoscope in a second plane, the second rotatable knob being positioned such that the first and second rotatable knobs share a common axis.

125. The controller of claim 124, wherein the first plane is orthogonal to the second plane.

126. The controller of claim 124, wherein the system further comprises an additional robotically controlled endoscope and the controller further comprises a switch configured to transition between a first state and a second state, wherein when the switch is in the first state the controller is in a first operational mode in which the first and second rotatable knobs control movement of a first of the two robotically controlled endoscopes but not a second of the two robotically controlled endoscopes, and wherein when the switch is in the second state the controller is in a second operational mode in which the first and second rotatable knobs control operation of the second of the two robotically controlled endoscopes but not the first of the two robotically controlled endoscopes.

127. The controller of claim 126, further comprising an elevator actuator configured to generate control signals that are delivered to the system to effect movement of an elevator of the first of the two robotically controlled endoscopes, wherein the elevator actuator is operational to raise or lower the elevator of the first of the two robotically controlled endoscopes when the switch is in each of the first and second states.

128. The controller of claim 124, further comprising an elevator actuator configured to generate control signals that are delivered to the system to effect movement of an elevator of the robotically controlled endoscope.

129. A system comprising: a base comprising a longitudinally movable platform; a first endoscope comprising: a first cartridge configured to be selectively coupled to a first platform of the base; and a first insertion shaft extending from the first cartridge; and a shaft manipulator configured to couple with the first insertion shaft of the first endoscope, the shaft manipulator comprising: a first interface configured move the first endoscope in a direction aligned with a longitudinal axis of the first insertion shaft; and a second interface at which the base rotates the shaft manipulator such that, when the shaft manipulator is coupled with the first insertion shaft, both the shaft manipulator and the first insertion shaft rotate about the longitudinal axis of the first insertion shaft.

130. The system of claim 129, further comprising a guiding arm coupled to the base, wherein the shaft manipulator is positioned longitudinally between the platform and the guiding arm.

131. The system of claim 129, wherein the first endoscope further comprises a plurality of tensioning wires that extend from the first cartridge into the first insertion shaft, wherein the base comprises a plurality of electromechanical devices that couple with the first cartridge to alter tension levels within the plurality of tensioning wires.

132. The system of claim 129, further comprising a controller configured to control operation of movement of the first platform and the shaft manipulator.

133. The system of claim 132, wherein the controller comprises a plurality of actuators via which input is receivable from a user.

134. The system of claim 132, wherein the controller comprises a handle, a first rotatable knob positioned at a proximal end of the handle, and a second rotatable knob positioned such that the first and second rotatable knobs rotate about a common axis.

135. The system of claim 132, further comprising a secondary controller disposed on the base.

136. The system of claim 132, wherein the controller is wirelessly coupled to the base.

137. The system of claim 129, wherein the base comprises a second platform and the system comprises a second endoscope that comprises: a second cartridge configured to be coupled to the second platform; and a second insertion shaft extending from the second cartridge and configured to be advanced through the first endoscope.

138. The system of claim 137, wherein the second platform is longitudinally movable relative to the first platform such that distal longitudinal movement of the second platform advances the second insertion shaft of the second endoscope through the first endoscope when the first and second cartridges are coupled to the first and second platforms, respectively.

139. The system of claim 137, further comprising a rigid body extending between the first cartridge and the second cartridge through which the second insertion shaft extends.

140. The system of claim 139, wherein the rigid body is adjustable in length.

141. The system of claim 140, wherein the rigid body is configured to contract in length as the second platform is advanced toward the first platform.

142. The system of claim 140, wherein the rigid body is configured to expand in length as the second platform retracts from the first platform.

143. The system of claim 129, wherein the first cartridge comprises a first port for conveying water through the first endoscope and a second port for conveying air through the first endoscope.

144. The system of claim 143, wherein the base includes an electronically controllable pinch valve that closes off a line coupling the first port to a water source, the pinch valve controlling the conveyance of water through the first endoscope.

145. The system of claim 129, wherein the first interface comprises a first roller configured to apply force to the first insertion shaft to translate the first insertion shaft longitudinally and the second interface comprises a second roller configured to apply force to the shaft manipulator to cause the shaft manipulator to rotated about the longitudinal axis of the first insertion shaft.

146. The system of claim 145, further comprising: a first electromechanical element configured to rotate the first roller; and a second electromechanical element configured to rotate the second roller.

147. The system of claim 129, wherein the base further comprises one or more interfaces for coupling the first endoscope to one or more components of an instrument tower.

148. The system of claim 147, wherein the one or more interfaces comprise a first interface for coupling to a first video processing unit associated with the tower and a second interface for coupling to an air source or water source.

149. The system of claim 148, wherein the system further comprises a second endoscope configured to be deployed through the first endoscope, and wherein the one or more interfaces further comprise a third interface for coupling with a second video processing unit associated with the second endoscope.

150. The system of claim 149, wherein the first video processing unit and the second video processing unit are configured to simultaneously display video associated with the first endoscope and the second endoscope, respectively.

151. A method comprising: determining that a cartridge of a robotic endoscope is in an engaged position, the cartridge comprising two pulleys that are each respectively coupled with a separate one of a pair of tensioning wires that extends through an insertion shaft that is coupled to and extends from the cartridge; and automatically controlling two separate motors that are separately coupled with the two pulleys to tension the pair of tensioning wires against each other.

152. The method of claim 151, further comprising controlling at least one of the motors to deflect a distal end of the insertion shaft based on control signals received from a controller being operated by a human user.

153. A method comprising: positioning a first flexible endoscope at an orifice of a patient; and using robotic control, feeding the first flexible endoscope into the orifice of the patient by applying force to the first flexible endoscope at least a threshold distance away from the orifice.

154. The method of claim 153, wherein feeding the first flexible endoscope into the orifice of the patient includes rotating a roller associated with a shaft manipulator.

155. The method of claim 154, further comprising fixing the first flexible endoscope at a depth within the patient by holding the roller stationary.

156. The method of claim 155, further comprising, after fixing the first flexible endoscope at the depth, deploying a second flexible endoscope through the first flexible endoscope.