NL2030160B1

NL2030160B1 - Coupling controller for steerable instrument

Info

Publication number: NL2030160B1
Application number: NL2030160A
Authority: NL
Inventors: Hendrik Louis Thissen Mattheus
Original assignee: Fortimedix Assets Ii B V
Priority date: 2021-12-16
Filing date: 2021-12-16
Publication date: 2023-06-28

Abstract

A coupling controller that can be coupled to a steerable instrument (1), and has an opening (1309) to allow the proximal end ofa steerable instrument (1) to be inserted into the coupling controller, a controller coupling unit (1405(j)) to be coupled to a steering wire coupling unit (1101(j)) of a steering wire (16(j), and a controller alignment unit (1403, 1439, 1443). The steerable instrument has a steerable instrument alignment unit (1117, 1118, 1120). The controller alignment unit (1403, 1439, 1443) and the steerable instrument alignment unit (1117, 1118, 1120) are designed such that the controller alignment unit (1403, 1439, 1443) and the steerable instrument alignment unit (1117, 1118, 1120) are mutually longitudinally and tangentially aligned by a first mechanical action caused by inserting the proximal end ofthe steerable instrument (1) into the coupling controller (1301) until a coupling depth, and, then, each steering wire coupling unit (1101 (j)) is at least tangentially aligned with one ofthe at least one controller coupling units (1405(j)).

Description

Coupling controller for steerable instrument

Field of the invention

[0001] The present invention relates to a steerable instrument for invasive and non-invasive type of applications, such as in surgery. Such instruments can be used in, for instance, the field of gastroscopy, colonoscopy, endoscopy, laparoscopy, and other medical applications. However, the steerable instrument according to the invention can also be used in non-medical applications.

Examples of the latter include inspection and/or repair of mechanical and/or electronic hardware at locations that are difficult to reach.

Background art

[0002] Transformation of surgical interventions that require large incisions for exposing a target area into minimal invasive surgical interventions, i.e. requiring only natural orifices or small incisions for establishing access to the target area, is a well-known and ongoing process. In performing minimal invasive surgical interventions, an operator such as a physician, requires an access device that is arranged for introducing and guiding invasive instruments into the human or animal body via an access port of that body. In order to reduce scar tissue formation and pain to a human or animal patient, the access port is preferably provided by a single small incision in the skin and underlying tissue. In that respect the possibility to use a natural orifice of the body would even be better. The access device preferably enables the operator to control one or more degrees of freedom that the invasive instruments offer. In this way, the operator can perform required actions at the target area in the human or animal body in an ergonomic and accurate manner.

[0003] Steerable surgical invasive instruments in the field of gastroscopy, colonoscopy, endoscopy, laparoscopy, etc. are well-known in the art. The invasive instruments can comprise a steerable tube shaped device that enhances its navigation and steering capabilities. Such a steerable tube shaped device may comprise a proximal end part, a distal end part including at least one deflectable zone, and a rigid or flexible intermediate part or shaft, wherein the steerable tube shaped device, at its proximal end, further comprises a steering arrangement that is adapted to deflect the distal deflectable zone relative to a central axis of the tube shaped device. The steering arrangement may be implemented by one or more proximal deflectable zones each one connected to one distal deflectable zone by means of steering cables or steering wires. Alternatively, the steering arrangement may be implemented by a robotic device which is connected to such steering cables or steering wires.

[0004] Most of the known instruments are complex to manufacture resulting in expensive instruments. Often, the distal end of the instruments comprise a flexible zone that is composed of separate links with hinging pins, coils or flexible plastic extrusions. Steering cables should be guided through holes through these links and/or through guiding eyes or hooks.

[0005] In many prior art devices, the steering arrangement comprises conventional steering cables with, for instance, sub 1 mm diameters as control members, wherein the steering cables are arranged between related deflectable zones at the distal end part and the steering arrangements at the proximal end part of the tube shaped device. Alternatively, control members may be implemented by one or more sets of longitudinal elements that are, e.g., formed by laser cutting in tube elements. Further details regarding the design and fabrication of the abovementioned steerable tube and the steering arrangement thereof have been described for example in WO 2009/112060 A1, WO 2009/127236 A1, WO 2017/213491 A1, and WO 2018/067004.

[0006] In medical applications where longer instruments are necessary, such as in colonoscopy where 1.5 meter long instruments (or longer) may be applied, requirements as to steerability, flexibility, stiffness and accuracy increase seriously.

[0007] In medical applications, contamination of an instrument after it has been used to perform a surgical procedure on a patient can be a problem resulting in undesired post-operative complications. The contamination may be due to blood, other body fluids, tissue, etc. As a consequence of the contamination, the instrument may contain germs, viruses or other biological or chemical substances that could threat the health of the next patient on which the instrument is used.

[0008] One way of avoiding this contamination requires performing a thorough cleaning and sterilization of the instrument before each use. In many cases, the cleaning process is not capable of removing all contamination, and/or is very expensive. Therefore, a risk of adverse effects on a patient that is treated with such an instrument still exists. In order to prevent the risk of contamination, there is a preference for using disposable instruments that are used a single time and are thrown away after treating one patient.

[0009] Most steerable instruments that are used in robotic applications have in common that between the instrument and the robot an appropriate interface is required to translate the output of the robot actuators to the correct input for the steerable instrument. This interface can be a mechanical or electromechanical box that translates for example robot actuator motor rotation to the correct longitudinal displacement of the instrument's steering wires. These interface boxes can be quit complex and expensive to manufacture. In most cases, this box is permanently attached to the instrument by the manufacturer. The instrument with the box can be connected to the robot on site by the end user by means of an easy to operate “click on” coupling.

[0010] In practice, the instrument with such an attached box is often a single use or a limited use product. Huge disadvantage of this method is that usually not only the instrument but also the attached interface box is thrown away after a single use or a limited number of uses. Commercially and environmentally, this is not an optimal solution. Furthermore, because of the usually relatively large dimensions of the interface box, the packaging of such an instrument becomes quite bulky, contains a large volume of materials and occupies a significant amount of space during transport and storage.

[0011] A better solution is to couple an instrument directly onto a robot, without making use of the interface box or have the interface box permanently attached to the robot. In that case, the interface box is not needed anymore or it is attached to the robot and can be re-used. The single use instrument is then significantly less complex and cheaper. Also the packaging materials and packaging volume can be reduced significantly.

[0012] WO2020/218921A2 discloses a coupling interface device that can be used between a robot device and a steerable instrument having steering wires made by laser cutting from a tube. The steering wires have a curved cross section when viewed in a plane perpendicular to the longitudinal axis of the instrument because they are cut from a tube. This prior art document shows an interface device with arms that can be easily coupled and uncoupled from such steering wires.

Summary of the invention

[0013] The object of the present invention is to provide further refinements of coupling interface devices of which a basic operation principle is shown in WO2020/218921A2.

[0014] To that end, independent aspects of the invention are defined in independent claims whereas dependent claims relate to advantageous embodiments.

[0015] In one embodiment the invention relates to a coupling controller configured to be coupled to a steerable instrument, the steerable instrument having an elongate tube like shape extending in a longitudinal direction and with a distal end and a proximal end and comprising: at least one deflectable zone located at the distal end, at least one steering wire arranged between the proximal end and the distal end and configured to be movable in the longitudinal direction such as to transfer a longitudinal movement of the at least one steering wire into a deflection of the at least one deflectable zone, the at least one steering wire having a strip like shape, at least one steering wire coupling unit, one for each steering wire, and configured to be coupled to a controller coupling unit of the coupling controller, and a steerable instrument alignment unit, the coupling controller comprising: an opening configured to allow the proximal end of the steerable instrument to be inserted into the coupling controller, at least one controller coupling unit, each one configured to be coupled to one of the at least one steering wire coupling units, and a controller alignment unit, the controller alignment unit and the steerable instrument alignment unit being configured such that the controller alignment unit and the steerable instrument alignment unit are mutually longitudinally and tangentially aligned by a first mechanical action caused by inserting the proximal end of the steerable instrument into the coupling controller until a coupling depth, and, then, each steering wire coupling unit is at least tangentially aligned with one of the at least one controller coupling units.

[0016] In a further embodiment the invention relates to a steerable instrument configured to be coupled to a coupling controller, the steerable instrument having an elongate tube like shape extending in a longitudinal direction and with a distal end and a proximal end and comprising: at least one deflectable zone located at the distal end,

at least one steering wire arranged between the proximal end and the distal end and configured to be movable in the longitudinal direction such as to transfer a longitudinal movement of the at least one steering wire into a deflection of the at least one deflectable zone, the at least one steering wire having a strip like shape, at least one steering wire coupling unit, one for each steering wire, and configured to be coupled to a controller coupling unit of the coupling controller, a steerable instrument alignment unit configured to cooperate with a controller alignment unit of the coupling controller such that when the proximal end of the steerable instrument is inserted into the coupling controller until a coupling depth each steering wire coupling unit is at least tangentially aligned with a controller coupling unit.

[0017] Such a steerable instrument can be inserted into the coupling controller after which coupling will be automatically established by inserting the steerable instrument further into the coupling controller.

[0018] In this application, the terms “proximal” and “distal” are defined with respect to an operator, e.g. a robot or physician that operates the instrument or endoscope. For example, a proximal end part is to be construed as a part that is located near the robot or physician and a distal end part as a part located at a distance from the robot or physician, i.e., in the area of operation.

[0019] In many embodiments, the invention comprises an instrument having the same and improved performance as prior solutions, but which is built with significantly less separate parts and significantly less assembly effort. All the necessary elements to construct a steerable instrument, may be integrally manufactured, in a largely pre-assembled state, from a number of tubes. The only remaining assembly steps consist of sliding the tubes into each other and attach the tubing to each other in the required places. The preassembled parts can be made in a tube wall by material deposition processes like 3D printing or plating techniques. Preferably the preassembled parts can be made by material removal processes from a solid wall metal or plastic tube (stainless steel, cobalt chromium alloys, super-elastic alloys like nitinol, etc). The material removal processes that can be used are for example conventional chipping processes, water jet cutting, etching and preferably laser cutting processes.

[0020] Therefore, those embodiments of this invention enable a significant reduction of manufacturing costs of such instruments and therefor the costs of an intervention in which these instruments are used. It even becomes commercially viable to use these instruments only once, and then throw them away. This increases the safety of an intervention because one can now use new instruments instead of pre-used and re-sterilized instruments that are known to have a 10% risk of post procedural complication due to contaminating or infecting the patient with not properly cleaned or re-sterilized pre-used instruments.

[0021] Another advantage of such an instrument is that by using this integrated way of producing parts in a pre-assembled state they always fit to each other and that minimal play between the parts can be achieved. This is especially true when a laser cutting process is used. The minimal achievable play between two integrally manufactured parts is as low as the width of the used laser beam, which can be as small as 0.01mm. Typically a play of 0.01 to 0.05mm can be obtained easily.

The integral fabrication of parts according to the invention therefor is so accurate with respect to fitting of parts and the play between them, that an improved accuracy and repeatability of the instrument's functional performance is ensured.

Brief description of the drawings

[0022] Further features and advantages of the invention will become apparent from the description of the invention by way of non-limiting and non-exclusive embodiments. These embodiments are not to be construed as limiting the scope of protection. The person skilled in the art will realize that other alternatives and equivalent embodiments of the invention can be conceived and reduced to practice without departing from the scope of the present invention. Embodiments of the invention will be described with reference to the figures of the accompanying drawings, in which like or same reference symbols denote like, same or corresponding parts, and in which:

[0023] Figure 1 shows a schematic cross sectional view of a distal section of a prior art invasive instrument assembly.

[0024] Figure 2 shows a schematic overview of distal portions of three prior art cylindrical elements from which the distal portion of Figure 1 may be manufactured.

[0025] Figure 3a shows a distal portion of a prior art intermediate cylindrical element of the instrument of Figures 1 and 2.

[0026] Figure 3b shows a distal portion of an alternative example of a prior art intermediate cylindrical element of such an instrument.

[0027] Figure 4 shows a distal portion of an example of a prior art intermediate cylindrical element and an inner cylindrical element inserted in the intermediate cylindrical element.

[0028] Figure 5 shows an outside view of a distal section of a prior art steerable invasive instrument assembly having two steerable bendable distal end portions and two proximal flexible control portions.

[0029] Figure 6 shows an enlarged view of the distal tip of the instrument shown in Figure 5.

[0030] Figure 7A shows a cross section view through the invasive instrument shown in Figure 5.

[0031] Figure 7B shows a distal end of an inner tube and intermediate tube of an alternative embodiment of a double bendable instrument in 3D view.

[0032] Figures 8 and 9 show examples of how the invasive instrument of Figures 5 and 7 can bend.

[0033] Figures 10A and 10B show examples of how different sets of steering wires of a double bendable instrument can be arranged at the proximal end of the steerable instrument.

[0034] Figures 11A-11C show schematic views of a coupling arrangement that can coupled to and decoupled from a steerable instrument having strip like steering wires.

[0035] Figures 12A, 12B, 12C show a proximal end of embodiments of a steerable instrument which can be coupled to a coupling device according to the invention.

[0036] Figure 13 shows the outside of an example of a coupling device according to the invention.

[0037] Figure 14 shows an example of a coupling device according to the invention.

[0038] Figures 15 to 18H show further details of the example coupling device shown in figure 14.

[0039] Figure 19 shows a cross section of the example coupling device according to the invention, as taken through the lines XIX-XIX shown in figure 14.

[0040] Figure 20 shows some components of a robot device.

Description of embodiments

[0041] For the purpose of the present document, the terms cylindrical element and tube may be used interchangeably, i.e., like the term tube a cylindrical element also refers to a physical entity.

The invention will be explained with reference to steering wires which are cut from such cylindrical elements and are operative as push and/or pull steering wires to transfer longitudinal movement of the steering wires at the proximal end of the instrument to the distal end to thereby control bending of one or more flexible distal end portions. They have a strip like shape and, because they are cut from a tube, have a curved rectangular, cross section seen in the tangential direction of the steerable instrument.

[0042] Figures 1, 2, 3a, and 3b show distal portions of instruments known from WO2009/1 12060.

They are explained in detail because the present invention can be applied in this type of instruments.

[0043] Figure 1 shows a longitudinal cross-section of a distal section of a prior art steerable instrument comprising three co-axially arranged cylindrical elements, i.e. inner cylindrical element 2, intermediate cylindrical element 3 and outer cylindrical element 4. Suitable materials to be used for making the cylindrical elements 2, 3, and 4 include stainless steel, cobalt-chromium, shape memory alloy such as Nitinol®, plastic, polymer, composites or other materials that can be shaped by material removal processes like laser cutting or EDM. Alternatively, the cylindrical elements can be made by a 3D printing process or other known material deposition processes.

[0044] The inner cylindrical element 2 comprises a first rigid end part 5, which is located at a distal end part 13 of the instrument, a first flexible part 8, and an intermediate rigid part 7 located at an intermediate part 12 of the instrument.

[0045] The outer cylindrical element 4 also comprises a first rigid end part 17, a first flexible part 18, and an intermediate rigid part 19. The lengths of the parts 5, 6, and 7, respectively, of the cylindrical element 2 and the parts 17, 18, and 19, respectively, of the cylindrical element 4 are, preferably, substantially the same so that when the inner cylindrical element 2 is inserted into the outer cylindrical element 4, these different respective parts are longitudinally aligned with each other.

[0046] The intermediate cylindrical element 3 also has a rigid end part 10 which in the assembled condition is located between the corresponding rigid parts 5 and 17 of the two other cylindrical elements 2, 4. An intermediate part 14 of the intermediate cylindrical element 3 comprises one or more separate steering wires 16 which can have different forms and shapes as will be explained below. They are made from the cylindrical element 3 themselves and have the form of a longitudinal strip. In figure 2, three such steering wires 16 are shown. After assembly of the three cylindrical elements 2, 3 and 4 whereby the element 2 is inserted in the element 3 and the two combined elements 2, 3 are inserted into the element 4 (any other order is possible), at least the first rigid end part 5 of the inner cylindrical element 2, the first rigid end part 10 of the intermediate cylindrical element 3 and the first rigid end part 17 of the outer cylindrical element 4 at the distal end of the instrument are attached to each other, e.g., by means of glue or one or more (laser) welding spots.

[0047] In the embodiment shown in figure 2 the intermediate part 14 of intermediate cylindrical element 3 comprises a number of steering wires 16 with a uniform cross-section so that the intermediate part 14 has the general shape and form as shown in the unrolled condition of the intermediate cylindrical element 3 in figure 3a. From figure 2 it also becomes clear that the intermediate part 14 is formed by a number of over the circumference of the intermediate cylindrical part 3, possibly equally, spaced parallel steering wires 16. Advantageously, the number of steering wires 16 is at least three, so that the instrument becomes fully controllable in any direction, but any higher number is possible as well. The number of steering wires 16 may, e.g., be four or eight.

[0048] It is observed that the steering wires 16 do not need to have a uniform cross section along their entire length. They may have a varying width along their length, possibly such that at one or more locations adjacent steering wires 16 are only separated by a small slot resulting from the laser cutting in the cylindrical element 3. These wider portions of the steering wires, then, operate as spacers to prevent adjacent steering wires 16 from buckling in a tangential direction in a pushed state. Spacers may, alternatively, be implemented in other ways.

[0049] An embodiment with spacers is shown in figure 3b which shows distal portions of two adjacent steering wires 16 in an unrolled condition. In the embodiment shown in figure 3b each steering wire 16 comprises portions 64 and 62, co-existing with the first flexible part 6, 18 and the intermediate rigid part 7, 19, respectively. In the portion 62 coinciding with the intermediate rigid portion, each pair of adjacent steering wires 16 is almost touching each other in the tangential direction so that in fact only a narrow slot is present there between just sufficient to allow independent movement of each steering wire. The slot results from the manufacturing process and its width is, e.g., caused by the diameter of a laser beam cutting the slot.

[0050] In portion 61 each steering wire 16 consists of a relatively small and flexible part 64 as seen in circumferential direction, so that there is a substantial gap between each pair of adjacent flexible parts, and flexible part 64 is provided with a number of spacers 66, extending in the tangential direction and almost bridging completely the gap to the adjacent flexible part 64. Because of these spacers 66 the tendency of the steering wires 16 in the flexible portions of the instrument to shift in tangential direction is suppressed and tangential direction control is improved. The exact shape of these spacers 66 is not very critical, provided they do not compromise flexibility of flexible part 64.

One or more spacers 66 are attached to flexible part 64 and form an integral part with the flexible part 64 and may result from a suitable laser cutting process too. They extend to an adjacent flexible part 64 of an adjacent steering wire 16.

[0051] In the embodiment shown in figure 3b the spacers 66 are extending towards one tangential direction as seen from the flexible part 64 to which they are attached. It is however also possible to have these spacers 66 extending to both circumferential directions starting from one flexible part 64. By using this it is either possible to have alternating types of flexible parts 64 as seen along the tangential direction, wherein a first type is provided at both sides with spacers 66 extending until the next flexible part, and a second intermediate set of flexible parts 64, without spacers 66.

Otherwise it is possible to have flexible parts with cams at both sides, where as seen along the longitudinal direction of the instrument the cams originating from one flexible part are alternating with spacers originating from the adjacent flexible parts. It is obvious that numerous alternatives are available.

[0052] The production of such an intermediate part is most conveniently done by injection moulding or plating techniques or starting from a cylindrical tube with the desired inner and outer diameters and removing parts of the wall of the cylindrical tube required e.g. by laser or water cutting to end up with the desired shape of the intermediate cylindrical element 3. However, alternatively, any 3D printing method can be used.

[0053] The removal of material can be done by means of different techniques such as laser cutting, photochemical etching, deep pressing, conventional chipping techniques such as drilling or milling, high pressure water jet cutting systems or any suitable material removing process available.

Preferably, laser cutting is used as this allows for a very accurate and clean removal of material under reasonable economic conditions. The above mentioned processes are convenient ways as the cylindrical element 3 can be made so to say in one process, without requiring additional steps for connecting the different parts of the intermediate cylindrical element as required in the conventional instruments, where conventional steering cables must be connected in some way to the end parts.

[0054] The same type of technology can be used for producing the inner and outer cylindrical elements 2 and 4 with their respective flexible parts 8, 18. These flexible parts 6, 18 can be manufactured as hinges resulting from cutting out any desired pattern from the cylindrical elements, e.g., by using any of the methods described in European patent application 08 004 373.0 filed on 10.03.2008, page 5, lines 15-26, but any other suitable process can be used to make flexible portions.

[0055] It is observed that the instrument portions shown in figures 4-9 are known from prior art

WO2020/214027. Also in these instruments the present invention can be applied.

[0056] Figure 4 shows an exemplary embodiment of longitudinal (steering) elements 16 that have been obtained after providing longitudinal slots 70 to the wall of the intermediate cylindrical element 3. Here, steering wires 16 are, at least in part, spiralling about a longitudinal axis of the instrument such that an end portion of a respective steering element 16 at the proximal portion of the instrument is arranged at another angular orientation about the longitudinal axis than an end portion of the same steering wire 16 at the distal portion of the instrument. Were the steering wires 16 arranged in a linear orientation, than a bending of the instrument at the proximal portion in a certain plane would result in a bending of the instrument at the distal portion in the same plane but in a 180 degrees opposite direction. This spiral construction of the steering wires 16 allows for the effect that bending of the instrument at the proximal portion in a certain plane may result in a bending of the instrument at the distal portion in another plane, or in the same plane in the same direction. A preferred spiral construction may be such that the end portion of a respective steering element 16 at the proximal portion of the instrument is arranged at an angularly shifted orientation of 180 degrees about the longitudinal axis relative to the end portion of the same steering wire 16 at the distal portion of the instrument. However, e.g. any other angularly shifted orientation, e.g. 90 degrees, is within the scope of this document. The slots 70 are dimensioned such that movement of a steering wire is guided by adjacent steering wires when provided in place in a steerable instrument. However, especially at the flexible zone 13 of the instrument, the width of steering wires 16 may be less to provide the instrument with the required flexibility / bendability at this location.

[0057] Figure 5 provides a detailed perspective view of the distal portion of an embodiment of an elongated tubular body 76 of a steerable instrument which has two steerable distal bendable zones 74, 75. Figure 5 shows that the elongated tubular body 76 comprises a number of co-axially arranged layers or cylindrical elements including an outer cylindrical element 104 that ends after a first distal flexible zone 74 at the distal end portion 13. The distal end portion 13 of the outer cylindrical element 104 is fixedly attached to a cylindrical element 103 located inside of and adjacent to the outer cylindrical element 104, e.g. by means of (laser) welding at welding spots 100. However, any other suitable attachment method can be used, including any mechanical snap fit connection or gluing by a suitable glue.

[0058] Figure 6 provides a more detailed view of the distal end part 13 and shows that, in this embodiment, it includes three co-axially arranged layers or cylindrical elements, i.e., an inner cylindrical element 101, a first intermediate cylindrical element 102 and a second intermediate cylindrical element 103. The distal ends of inner cylindrical element 101, first intermediate cylindrical element 102 and second intermediate cylindrical element 103 are all three fixedly attached to one another. This may be done by means of (laser) welding at welding spots 100. However, any other suitable attachment method can be used, including any mechanical snap fit connection or gluing by a suitable glue. The points of attachment may be at the end edges of inner cylindrical element 101, first intermediate cylindrical element 102 and second intermediate cylindrical element 103, as shown in the figures. However, these points of attachment may also be located some distance away from these edges, be it, preferably, between the end edges and the locations of the flexible zone 75.

[0059] It will be clear to the skilled person that the elongated tubular body 76 as shown in figure 5 comprises four cylindrical elements in total. The elongated tubular body 76 according to the embodiment shown in figure 5 comprises two intermediate cylindrical elements 102 and 103 in which the steering members of the steering arrangement are arranged. However, extra or less cylindrical elements may be provided if desired.

[0060] An exemplary actual arrangement of the steering members is shown in figure 7A, which provides a schematic longitudinal cross-sectional view of the exemplary embodiment of the elongated tubular body 76 as shown in figure 5.

[0061] Flexible zones 74, and 75 are, in this embodiment, implemented by providing the respective cylindrical elements with slits 74a, and 75a, respectively. Such slits 74a, and 75a may be arranged in any suitable pattern such that the flexible zones 74, and 75 have a desired flexibility in the longitudinal and tangential direction in accordance with a desired design.

[0062] Figure 7A shows a longitudinal cross section of the four layers or cylindrical elements mentioned above, i.e. the inner cylindrical element 101, the first intermediate cylindrical element 102, the second intermediate cylindrical element 103, and the outer cylindrical element 104.

[0063] The inner cylindrical element 101, as seen along its length from the distal end to the proximal end of the instrument, comprises a rigid ring 111, which is arranged at the distal end part 13 of the steerable instrument 10, a first flexible portion 112, a first intermediate rigid portion 113, a second flexible portion 114, and a second intermediate rigid portion 115.

[0064] The first intermediate cylindrical element 102, as seen along its length from the distal end to the proximal end of the instrument, comprises a rigid ring 121, a first flexible portion 122, a first intermediate rigid portion 123, a second flexible portion 124, and a second intermediate rigid portion 125. The portions 122, 123, 124, and 125 together form a steering wire 16(1) that can be moved in the longitudinal direction like a wire. The longitudinal dimensions of the rigid ring 121, the first flexible portion 122, the first intermediate rigid portion 123, the second flexible portion 124, and the second intermediate rigid portion 125 of the first intermediate element 102, respectively, are aligned with, and preferably approximately equal to the longitudinal dimensions of the rigid ring 111, the first flexible portion 112, the first intermediate rigid portion 113, the second flexible portion 114, and the second intermediate rigid portion 115 of the inner cylindrical element 101, respectively, and are coinciding with these portions as well. In this description “approximately equal” means that respective same dimensions are equal within a margin of less than 10%, preferably less than 5%.

[0065] Similarly, the first intermediate cylindrical element 102 comprises one or more other steering wires 16(2).

[0066] The second intermediate cylindrical element 103, as seen along its length from the distal end to the proximal end of the instrument, comprises a first rigid ring 131, a first flexible portion 132, a second rigid ring 133, a second flexible portion 134, and a first intermediate rigid portion 135. The portions 133, 134, and 135 and 136 together form a steering wire 130(1) that can be moved in the longitudinal direction like a wire. The longitudinal dimensions of the first rigid ring 131, the first flexible portion 132 together with the second rigid ring 133 and the second flexible portion 134 and the first intermediate rigid portion 135 of the second intermediate cylinder 103, respectively, are aligned with, and preferably approximately equal to the longitudinal dimensions of the rigid ring 111, the first flexible portion 112, the first intermediate rigid portion 113, the second flexible portion 114, and the second intermediate rigid portion 115 of the first intermediate element 102, respectively, and are coinciding with these portions as well.

[0067] Similarly, the second intermediate cylindrical element 103 comprises one or more other steering wires of which one is shown with reference number 13002).

[0068] The outer cylindrical element 104, as seen along its length from the distal end to the proximal end of the instrument, comprises a first rigid ring 141, a first flexible portion 142, and a first intermediate rigid portion 143. The longitudinal dimensions of the first flexible portion 142 and the of the outer cylindrical element 104, respectively, are aligned with, and preferably approximately equal to the longitudinal dimension of the second flexible portion 134 and the first intermediate rigid portion 135 of the second intermediate element 103, respectively, and are coinciding with these portions as well. The rigid ring 141 may have approximately the same length as the rigid ring 133 and is fixedly attached thereto, e.g. by spot welding or gluing. The rigid rings 111, 121 and 131 are attached to each other, e.g., by spot welding or gluing. This may be done at the end edges thereof but also at a distance of these end edges.

[0069] The inner and outer diameters of the cylindrical elements 101, 102, 103, and 104 are chosen in such a way at a same location along the elongated tubular body 76 that the outer diameter of inner cylindrical element 101 is slightly less than the inner diameter of the first intermediate cylindrical element 102, the outer diameter of the first intermediate cylindrical element 102 is slightly less than the inner diameter of the second intermediate cylindrical element 103 and the outer diameter of the second intermediate cylindrical element 103 is slightly less than the inner diameter ofthe outer cylindrical element 104, in such a way that a sliding movement of the adjacent cylindrical elements with respect to each other is possible. The dimensioning should be such that a sliding fit is provided between adjacent elements. A clearance between adjacent elements may generally be in the order of 0.02 to 0.1 mm, but depends on the specific application and material used. The clearance may be smaller than a wall thickness of the steering wires to prevent an overlapping configuration thereof. Restricting the clearance to about 30% to 40% of the wall thickness of the steering wires is generally sufficient.

[0070] The use of the construction as described above allows the steerable instrument 10 to be used for double bending. The working principle of this construction will be explained with respect to the examples shown in figures 8 and 9.

[0071] For the sake of convenience, as shown in figures 7A, 8 and 9, the different portions of the cylindrical elements 101, 102, 103, and 104 have been grouped into zones 151 - 155 that are defined as follows. Zone 151 comprises the rigid rings 111, 121, and 131. Zone 152 comprises the portions 112, 122, and 132. Zone 153 comprises the rigid rings 133 and 141 and the portions 113 and 123. Zone 154 comprises the portions 114, 124, 134 and 142. Zone 155 comprises the portions 115, 125, 135 and 143.

[0072] By pushing / pulling steering wires 130(1), 130{2) in the longitudinal direction of the instrument, one side of the attached rigid rings 133/141 can be moved either in the proximal or distal direction of the instrument, whereas at the opposing tangential side of the instrument these attached rigid rings 133/141 can be moved in the opposite direction, resulting in a deflection of the instrument of deflectable zone 154, as shown in figure 8.

[0073] When three or more steering wires per set 1300) (i = 1,2 , 3, ...1), preferably equally tangentially spaced, are applied deflectable zone 154 can be deflected in any desired direction.

[0074] By pushing / pulling steering wires 16(1), 16(2) in the longitudinal direction of the instrument, one side of the attached rigid rings 121/131 can be moved either in the proximal or distal direction of the instrument, whereas at the opposing tangential side of the instrument these attached rigid rings 121/131 can be moved in the opposite direction, resulting in a deflection of the instrument of deflectable zone 154, as shown in figure 8.

[0075] When three or more steering wires per set 16() (j = 1, 2 , 3, ...J), preferably equally tangentially spaced, are applied deflectable zone 152 can be deflected in any desired direction.

[0076] Due to the fact that zones 152 and 154 are deflectable independently with respect to each other, it is possible to give the distal end part 13 of the steerable instrument a position and longitudinal axis direction that are independent from each other. In particular the distal end part 13 can assume an advantageous S-like shape. The skilled person will appreciate that the capability to independently deflect zones 152 and 154 with respect to each other, significantly enhances the manoeuvrability of the distal end part 13 and therefore of the steerable instrument as a whole.

[0077] Obviously, it is possible to vary the lengths of the flexible portions shown in figures 7A to 9 as to accommodate specific requirements with regard to bending radii and total lengths of the distal end part 13 and the proximal end part 11 of the steerable instrument.

[0078] In the shown embodiment, the steering wires comprise one or more sets of steering wires that form integral parts of the one or more intermediate cylindrical elements 102, 103. Preferably, the steering wires comprise remaining parts of the wall of an intermediate cylindrical element 102, 103 after the wall of the intermediate cylindrical element 102, 103 has been provided with longitudinal slits that define the remaining steering wires.

[0079] Whereas in figures 7A, 8, 9 an embodiment is shown in which steering wires 16(1), 16(2) for deflecting the most distal steerable zone 75 are made in another tube than steering wires 130(1), 130(2) for deflecting steerable zone 74, all such steering wires can be made in one single tube as shown in figure 7B. Figure 7B shows four steering wires 16(1) — 16(4) of a total of eight steering wires all made in tube 102. Figure 7B shows how rigid rings 111 and 121 are attached to another at one or more attachment points 170, e.g. by (laser) welding or gluing, etc. It also shows that steering wires 16(1) and 16(3) are attached to rigid ring 121 (the same is true for steering wires 16(5) and 16(7) but they are not visible in figure 7B). The distal ends of steering wires 16(2), 16(4) (as well as 16(8) and 16(8)) are attached to intermediate rigid portion 113 at attachment points 172, e.g. by (laser) welding or gluing, etc.

[0080] By pulling/pushing steering wires 16(1), 16(3), 16(5), 16(7) one can deflect flexible portion 112 and by pulling/pushing steering wires 16(2), 16(4), 16(8), 16(8) one can deflect flexible portion 114, as one will understand based on the above explanations.

[0081] Figures 10A and 10B, respectively, show embodiments of arrangements of steering wires at the proximal end of the instrument for controlling deflection of double bendable instruments in accordance with figure 7B and 7A, respectively.

[0082] Figure 10A shows an embodiment in which all steering wires 16(1) - 16(8) are made from single tube 102. It also shows that all of these steering wires 16(1) — 16(8) are provided with an opening 1101(1) — 1101(8) which are used for coupling the steering wires 16(1) — 16(8) to a coupling controller 1301, as will be explained in detail hereinafter.

[0083] Inthe embodiment shown in figure 10B, steering wires 16{1) - 16(4) are made in tube 102 whereas steering wires 130(1) — 130(4) are made in tube 103. As shown, the proximal ends of steering wires 16(1) — 16(4) may be attached to plates 1001{1) — 1001(4) which are made from tube 103 and located in a space between two of the adjacent steering wires 130(1) — 130(4). Openings 1101(1) — 1101(4) are then made in these plates 1001{1) — 1001(4). Steering wires 130(1) — 130(4)

are provided with respective openings 1150(1) — 1150(4) which are designed for the same purpose as openings 1101(1) — 1101(4), i.e. coupling to a coupling controller.

[0084] Figures 11A-11C show a prior art arrangement for controlling longitudinal movement of steering wires 16(j) at the proximal end of the instrument, as is explained in WO2020218921A2.

[0085] The instrument 1 comprises an outer tube 1103 covering the steering wires 16(j). The outer tube 1103 comprises a plurality of openings 1105((j), i.e., one per steering wire 16(j). The steering wires 16(j) of instrument 1 also comprise a plurality of openings 1101(j) overlapping with respective openings 1105(j) of outer tube 1103.

[0086] The openings 1105) of outer tube 1103 and the openings 1101(j) of the steering wires 16(j) may result from laser cutting in respective cylindrical tubes inserted into one another. As an alternative to laser cutting other techniques may be used, e.g., cutting by means of water jets. Also, other methods such as 3D laser printing may be used. These openings 1101(j) and 1105()) extend through the whole thickness of the material.

[0087] Figure 11B shows an example of the instrument 1 and a steering device 1107 wherein the steering device 1107 and the instrument 1 are detached. In the shown example, the steering device 1107 comprises a steering unit 1109 and a supporting unit 1111 wherein the steering unit 1109 is rotationally mounted on the supporting unit 1111. The steering unit 1109 comprises a plurality of arm-shaped elements 1113(j) fixedly connected to the steering unit 1109 and extending outwardly from the steering unit for connecting each one of the plurality of longitudinal elements 16{j) to one of the plurality of arm-shaped elements 1113{j of the steering unit 1109.

[0088] Figure 11C shows the instrument 1 and the steering device 1107 of Figure 11B connected together by inserting one end part of a plurality of end parts 1115(j) of arm-shaped element 1113(j) into an opening 1101) of one steering wire 16(j} such that, by steering the steering unit 1109 around the supporting unit 1111, the arm-shaped elements 1113(j) may pull or push the steering wires 16(j) in the longitudinal direction of the instrument for controlling deflection of one or more deflectable zones 13, 152, 154 of the distal end of the instrument 1.

[0089] Figure 12A shows a proximal end of an instrument 1 which can be used in the present invention. The outer tube 1103 covering the tube with steering wires 16(j) is shown to have a slit 1117. Slit 1117 is, in the shown example, extending in the longitudinal direction of the instrument 1.

At its proximal end, it may have an opening with a slanted edge 1120 widening towards the proximal end of the instrument 1. At its distal end, it may have a slit shaped end portion 1118 extending in the tangential direction of instrument 1. Thus, slit 1117 is shaped to easily receive a pin 1439 of a coupling controller 1301 (cf. figures 17A and 17B) by means of the opening with the slanted edge 1120. Moreover, pin 1439 is then able to slide longitudinally in slit 1117 towards and move into slit shaped end portion to lock pin 1439 in a fixed longitudinal and tangential position relative to instrument 1.

[0090] Figure 12A also shows a proximal end of an actuation cable 1119 located inside instrument 1 and extending from the proximal end to the distal end. Such an actuation cable 1119 is known to persons skilled in the art and needs no explanation here. The actuation cable 1119 is arranged for actuating an end effector at the distal end of instrument 1. The actuation cable 1119 has a cylinder attached to the end with a circular slot 1151 in which a coupling plate 1431 of a robot coupling controller can engage, as will be explained in detail hereinafter. By using a circular slot 1151, the instrument can be rotated in the coupling controller and coupling and activation is possible in each rotational position. Instead of actuation cable 1119, instrument 1 can accommodate other cable like instruments, like an electrical cable for providing electrical current to an end effector or other instrument arranged at its distal end.

[0091] Figure 12B shows a proximal end of instrument 1 in which eight steering wires 16(1) — 16(8) (only three are visible) are made in one tube 102, cf. figure 10A. Outer tube 103 comprises slit 1117 with slit shaped end portion 1118.

[0092] Figure 12C shows a proximal end of instrument 1 like the one shown in figure 12A but in which outer tube 103 extends such that it also accommodates the proximally located cylinder of actuation cable 1118. Tube 103 is shown to have an opening 1158 uncovering an opening 1160 in a proximal tube portion 1154, e.g., made of tube 102. This proximal tube portion 1154 is attached to a proximal tube portion 1156, e.g., made of tube 101 inside tube 102. Proximal tube portion 1156 is attached to the proximally located cylinder of actuation cable 1119. Proximal tube portion 1154, proximal tube portion 1156, and proximally located cylinder of actuation cable 1119 are arranged such that they can move together in the longitudinal direction of instrument 1 relative to steering wires 16(1), 16(2), .... Such independent longitudinal movement can be controlled by the robot coupling controller once it is connected to opening 1160 via opening 1158.

[0093] Figure 13 shows a schematic view of a coupling controller 1301. Coupling controller 1301 is configured to couple instrument 1 (shown in 180 degrees rotated view relative to figures 1-12) to a robot device configured to operate instrument 1 either entirely automatically as controlled by a suitable computer program or semi-automatically with some human control being involved in operating the robot device.

[0094] Figure 13 shows an example in which the coupling controller 1301 has a housing 1305 with a release button 1307, an opening 1309 and some indication lights 1303. As will become apparent from the specification to follow, instrument 1 can be inserted to a certain depth into opening 1309 until it is locked. The locked status can be released by pushing the release button 1307 that is mechanically or electromechanically coupled to a release mechanism inside the coupling controller.

Indication lights 1303 are configured to indicate a certain status of the coupling controller 1301, e.g., being connected to instrument 1 yes/no, operating instrument 1 yes/no, etc.

[0095] Figure 14 shows coupling controller 1301 having its housing 1305 removed. Coupling controller 1301 comprises a frame 1401 accommodating controller elements and supporting those controller elements.

[0096] Frame 1401 may have some openings 1402 allowing a technician to enter the inside of the frame 1401, e.g., for maintenance purposes. Frame 1401, in this example, is shown to support four steering wire control units 1404(j) (j equals the number of steering wires in instrument 1) (cf. figure 15), and one actuation cable control unit 1406 (cf. also figure 15). It is to be noted that there may be less or more than four steering wire control units 1404(j).

[0097] Each steering wire control unit 1404(j) comprises a shaft 1411(j) supported by frame 1401 at its distal end. Frame 1401 also supports a hollow shaft 1403 having opening 1309 for accommodating instrument 1. Hollow shaft 1403 may be arranged such that its central axis coincides with a central axis of instrument 1, once inserted, and a central axis of coupling controller 1301.

[0098] Each steering wire control unit 1404(j) comprises a controller coupling unit 1405() and a steering wire actuator 1407(j), as schematically visible via openings 1402 in figure 14. Each steering wire actuator 1407{j} has a steering wire actuator housing 1409(j) supported by frame 1401.

Steering wire actuator 1407(j) might be an electric motor, or a pneumatic or hydraulic actuator, possibly an electric linear actuator that may be integrated into a head of a robot-arm or coupled to an electronic steering input such as an electronic joystick.

[0099] Figure 15 shows further details of the four steering wire control units 1404(j) and the actuation cable control unit 1406 which are visible once the frame 1401 is removed. Figure 16 shows an enlarged view of portions one such steering wire control unit 1404(j) and actuation cable control unit 1406.

[00100] Each controller coupling unit 1405()) has a release shaft 1416), a slider 1415() and a bearing 1417(j) in which release shaft 1416(j) can rotate. Release shaft 1416(j) has a first opening 1418) and a second opening 1414(j) approximately 180 degrees tangentially rotated relative to first opening 1418(j). Shaft 1411(j) has a through hole 1408(j) perpendicular to its longitudinal direction (cf. figures 18C and 18D), which through hole 1408() is longitudinally and tangentially aligned with first opening 1418(j) and second opening 1414(j) in release shaft 1411(j). In the aligned state, slider 1415(j) extends through first and second openings 1418(j), 1414(j) and through hole 1408(j) (cf. figures 18C and 18D).

[00101] Hollow shaft 1403 is provided with pin 1439 in opening 1309 extending towards its central axis. A disk 1419 is attached to hollow shaft 1403. Disk 1419 has an outer edge provided with j openings 1423(j). Each opening 1423(j)) accommodates a pin 1421(j) attached to release shaft 1416(j). Each pin 1421(j) can rotate inside opening 1423(j). Disk 1419 and hollow shaft 1403 are arranged such that they can rotate together about a central hollow controller shaft 1425. Central hollow controller shaft 1425 is provided with j openings 1427(j) which, in the shown example, are implemented as slits extending in the longitudinal direction. Central hollow controller shaft 1425 is arranged and configured to receive instrument 1. As will be explained hereinafter, in operation, each opening 1427(j) in central hollow controller shaft 1425 will be longitudinally and tangentially aligned with both one opening 1105() in outer tube 1103 of instrument 1 and one opening 1101(j) in steering wire 16(j) (cf. figure 124A).

[00102] Longitudinally shifted in the proximal direction of the coupling controller 1301 there is an actuation cable controller 1413. Its central axis coincides with the central axis of central hollow controller shaft 1425. Actuation cable controller 1413 has a housing 1410 and an opening 1412 about its central axis for receiving and accommodating the proximal end of actuation cable 1119.

[00103] An actuation cable release shaft 1429 is provided in parallel to both actuation cable controller 1413 and central hollow controller shaft 1425. Actuation cable release shaft 1429 has a proximal end adjacent to actuation cable controller 1413 and a distal end adjacent to central hollow controller shaft 1425. Moreover, a pin 1433 is attached off-axis to its distal end such that pin 1433 can be rotated about a central axis of actuation cable release shaft 1429 in order to rotate actuation cable release shaft 1429 about its own central axis. Pin 1433 is accommodated in a slit 1435 (cf. figures 17A, 17B, 18E and 18F).

[00104] An actuation cable coupling plate 1431 extends from actuation cable controller 1413 and is operable by actuation cable release shat 1429 for coupling/uncoupling to actuation cable 1119 as will be explained in detail with reference to figure 18E and 18F.

[00105] Figures 17A and 17B show a front view of disk 1419 when looking into the proximal direction in a state where no instrument is coupled.

[00106] Figure 17A shows disk 1419 in a state in which slider tips 1437(j) (cf. figure 18C) of sliders 1415(j) extend through opening 1427(j) in central hollow controller shaft 1425 into its hollow inside.

In that state each slider tip 1437(j) can extend into one opening 1101(j) of one steering wire 16(j) of instrument 1 when instrument 1 is coupled to coupling controller 1301.

[00107] Figure 17B shows disk 1419 in a tangentially rotated state relative to the state of figure 17A, in which slider tips 1437(j) of sliders 1415(j) are radially moved away from the central axis of central hollow controller shaft 1425 and do not extend into the inside of central hollow controller shaft 1425 anymore. In that state, instrument 1 can be freely inserted into or removed from coupling controller 1301 via opening 1309 and is still in the uncoupled state.

[00108] Figures 18A and 18B show how the coupling mechanism works. However, first some more details of the sliders 1415(j) are explained with reference to figures 18C and 18D. These latter figures show, as an example, schematic cross sections in the distal direction of slider 14151), release shaft 1416(1), shaft 1411(1), central hollow controller shaft 1425, outer tube 1103 and steering wire 16(1) when the steering wire 16(1) is inserted into coupling controller 1301.

[00109] Figure 18C shows the coupled state and figure 18D shows the uncoupled state. Ie, in figure 18C, slider 1415(1) extends through first and second openings 1418(1) and 1414(1) in release shaft 1416(1), through hole 1408(1) in shaft 1411(1), through opening 1427(1) in central hollow controller shaft 1425, and through opening 1105(1) in outer tube 1103 such that its slider tip 1437(1) extends into opening 1101(1) of steering wire 16(1). In this coupled state, any longitudinal movement of slider 1415(1) causes a same longitudinal movement of steering wire 16(1). In the state of figure 18C, slider tip 1437(1) is pressed inside opening 1101(1) of steering wire 16(1), e.g. by means of a spring 1420(1) (cf. figure 19).

[00110] Slider 1415(1) can be moved to the uncoupled state shown in figure 18D by rotating release shaft 1416(1) in a rotation direction A such that an edge of first opening 1418(1) pushes against an extension of slider 1415(1) causing slider 1415(1) to move in a radial direction B away from through hole 1408(1) and lifting slider tip 1437(1) out of opening 1101(1) of steering wire 16(1) and opening 1427(1) in outer tube 1103. This is also shown in a 3D view in figures 18A and 18C. Then, instrument can be removed freely from coupling controller 1301.

[00111] Figure 19 shows a cross section through the example coupling controller 1301 along lines

XIX-XIX in figure 14. Figure 19 show springs 1420(j), one for each slider 1415(j). Each spring 1420(j)

is configured to press its associated slider 1415(j) inside central hollow controller shaft 1425 in rest.

Reference number 1422(j) refers to bolts configured to keep springs 1420) in a predetermined place. Each slider 1415(j) can move in the radial direction of the coupling controller 1301 against the spring force exerted by its associated slider spring 1420(j).

[00112] Instead of springs 1420(j)) any force generating component like an electromagnetic component may be used to generate a radial counter electromagnetic force on slider 1415(j) backwards into opening 1101(j) when slider 1415{j is lifted radially away from opening 1101(j).

[00113] Figures 17A, 17B, 18A and 18B show how rotation of release shaft 1416() can be accomplished causing slider 1415(j) to move in a radial direction.

[00114] Figures 17A, 18A and 18C correspond to the same state, ie, the state in which sliders 1415(j) are in the coupled state, i.e., having their slider tip 1437(j) inside central hollow controller shaft 1425. Moreover, in this state, an internal portion 1431b of coupling plate 1431 located inside actuation cable controller 1413 is in its coupled state, i.e. is in a position shifted to its centre axis to allow engaging circular slot 1151 of actuation cable 1119. Also visible in figure 17A is a pin 1443 located inside central hollow controller shaft 1425, having, preferably, the same size as pin 1439.

These figures 17A, 18A and 18C also show the state at rest, i.e, the state in which no instrument 1 is coupled to the coupling controller.

[00115] Figures 17B, 18B and 18D also correspond to the same state, i.e., the state in which sliders 1415() are in the uncoupled state, i.e., having their slider tip 1437(j) outside central hollow controller shaft 1425. Moreover, then internal portion 1431b of coupling plate 1431 is moved away from the centre axis of actuation cable controller 1413 such that it can no longer engage circular slot 1151 of actuation cable 1119.

[00116] Now it will be explained how the coupling controller works. Starting for instance with the state according to figures 17A, 18A and 18C, a user inserts instrument 1 into opening 1309 of hollow shaft 1403. Pin 1439 inside opening 1309 engages the opening with slanted edge 1120 of outer tube 1103 of instrument 1 (cf. figure 12A). By pushing instrument 1 further into opening 1309, the slanted edge 1420 is forced to follow pin 1439 causing the instrument to rotate into a certain aligned position inside opening 1309. When instrument 1 is further pushed into opening 1309 pin 1439 shifts in slit 1117 and, at a certain predetermined depth, instrument 1 enters the opening in central hollow controller shaft 1425. The pin 1443 in central hollow controller shaft 1425 is circumferentially positioned such that, in rest, it's angular position differs from the angular position of pin 1439 in opening 1309 with an angle equal to the rotational angle of shaft 1403 needed to operate the sliders 1415(j) from a locked to an unlocked position. The angular position of pin 1443 in central hollow controller shaft 1425 is also such that when the instrument slit engages with this pin 1443, the rotational position of the instrument is such that the slots 1101(j) in steering wires 16(j) line up with sliders 1415(j). As soon as the slanted edge 1120 reaches pin 1443 in the central hollow controller shaft 1425, pin 1443 slides along slanted edge 1120 and forces instrument 1 to rotate and therefore also shaft 1403 rotates because shaft 1103 is rotationally locked to instrument 1 with pin 14398 located in slit 1117. Now, both pin 1439 and 1443 are in slit 1117 and are, therefore, rotationally aligned with each other.

[00117] As a consequence, disk 1419 rotates in the direction C. Because disk 1419 rotates also all pins 1421 (j) attached to respective release shafts 1416(j) in the direction C causing all release shafts 1416(j) to rotate in a direction A which is tangentially opposite to direction C.

[00118] At this point, also pin 1433 attached to actuation cable release shaft 1429 rotates in direction C causing actuation cable release shaft 1429 to rotate and move coupling plate 1431 away from the centre axis of actuation cable controller 1413 to a position in which the coupling for the actuation cable 1119 is opened. This will be explained in more detail with reference to figures 18E — 18H hereinafter.

[00119] As can best be seen in figures 18C and 18D, rotation of release shaft 1416(j) in direction A (figure 18C) causes associated slider 1415(j) to move in a radial direction B away from the central axis of central hollow control shaft 1425 (figure 18D) such that instrument 1 can be inserted further into opening 1309 until pin 1439 inside opening 1309 reaches the end of slit 1117 in outer tube 1103. This causes pin 1439 in opening 1309 to move into slit shaped end portion 1118 of slit 1117.Because disk 1419 is spring-loaded, pin 1439 and thereby disk 1419 rotate back to their rest state, i.e., in a direction opposite to direction B. In that moment, sliders 1415(j) return to the situation shown in figures 17A, 18A, 18C in which they engage a respective slot 1101(j) inside steering wire 16). Moreover, also actuation cable release shaft 1429 rotates back and the proximal end of actuation cable 1119 couples to actuation cable controller 1413 (cf. figures 18E — 18H). Stated differently, the state shown in figures 17B, 18B and 18D, respectively, returns to the one shown in figures 17A, 18A and 18C, respectively. Note that slider 1415(j) is forced to return to the state shown in figures 17A, 18A, and 18C because of spring 1420(j) (cf. figure 19).

[00120]It is noted that when instrument 1 is placed in coupling controller 1301, with all sliders 1415(j) in an open position not all openings 1101(j) in steering wires 16(j) are necessarily lined up with their corresponding slider 1415(j) because the different steering wires 16(j) may have different longitudinal positions inside instrument 1, e.g. caused by one or more bends in instrument 1. Then, not all sliders 1415(j) may fully return to their closed position, when sliders 1415(j) are released or actuated to close. The pre-load as caused by spring 1420() will then push slider 1415(j) tip onto the surface of the non-aligned steering wires 16(j) aside from opening 1101(j). The steering wire actuators 1409(j) move these sliders 1415(j) in the longitudinal direction until the slider tip 1437(j) and respective opening 1101(j) in the steering wire 16(j) line up and the slider tip 1437(j) engages in opening 1191). Then, slider 1415(j) will return to its fully closed position.

[00121] As will be explained now, inserting instrument 1 into opening 1309 will not only cause automatic alignment and coupling between all sliders 1415(j) and respective openings 1101(j) in steering wires 16(j), both longitudinally and tangentially, but may also cause automatic coupling between the proximal end of actuation cable 1119 and actuation cable controller 1413. This will be explained with reference to figures 18E — 18H.

[00122] Figures 18E — 18H show some internal components of the robot coupling controller in a different perspective than figures 15 and 16. Only one controller coupling unit 1405(1) is shown such that actuation cable controller 1413 and actuation cable release shaft 1429 are better visible.

Figures 18E and 18G relate to the coupled state and figures 18F and 18H relate to the uncoupled state.

[00123] Coupling plate 1431 comprises, in this embodiment, two portions, i.e., an external portion 1431a and an internal portion 1431b. Coupling plate 1431 is spring loaded such that, in the coupled state (figures 18E and 18G which correspond to the state of figure 17A, 18A and 18C), external portion 1431a extends from actuation cable controller 1413 and contacts a flat surface portion 1441 of actuation cable release shaft 1429. Moreover, then, internal portion 1431b is forced towards the central axis of actuation cable controller 1413 such as to engage circular slot 1151 of actuation cable 1119 (cf. figure 12A). Note that the state shown in figures 18E and 18G is also the rest-state in which no instrument 1 is coupled to the coupling controller.

[00124] Figures 18F and 18H show the uncoupled state of the actuation cable controller 1413 as caused by inserting instrument 1 into the coupling controller. l.e., as clearly visible in figures 17A and 17B, pin 1433 which is attached off-axis to actuation cable release shaft 1429 is accommodated in slit 1435 in disk 1419. Slit 1435 has a longitudinal shape directed in the radial direction of disk 1419. Therefore, when disk 1419 is rotated in direction C by inserting instrument 1 into the coupling controller, as explained above, pin 1433 is forced to rotate in the same direction C and slide inside slit 1435 towards the central axis of disk 1419. Since pin 1433 is attached off-axis to actuation cable release shaft 1429, actuation cable release shaft 1429 is forced to rotate about its own axis as indicated with an arrow D in figure 18A and 18E. Flat surface portion 1441 of actuation cable release shaft 1429 is forced to rotate about the central axis of actuation cable release shaft 1429 such that it pushes external coupling plate portion 1431a towards and internal coupling plate portion 1431b away from the central axis of actuation cable controller 1413. Instrument 1 can then be inserted in the coupling controller until a depth at which coupling plate 1431 is longitudinally aligned with circular slot 1151 of actuation cable 1119. At that moment, pin 1439 in opening 1309 of the coupling controller slides into slit shaped end portion 1118 of slit 1117 in instrument 1 and disk 1419 returns to the state shown in figures 17A, 18A, 18E, and 18G - i.e, the coupled state — in which internal coupling plate portion 1431b engages circular slot 1151. In an alternative embodiment, internal coupling plate portion 1431b is then not longitudinally aligned with circular slot 1151. If so, internal coupling plate portion 1431b is pushed against the outer surface of actuation cable 1119 and the actuation cable controller 1413 moves in the longitudinal direction until internal coupling plate portion 1431b is longitudinally aligned with circular slot 1151 and falls into that slot 1151.

[00125] In the preceding specification, an example of coupling controller 1301 is explained having one or more controller coupling units 1405(j) configured to be mechanically coupled to one or more steering wires 16(j). To that end, in the example, each steering wire 16(j) is provided with an opening 1101(j) which is configured to receive a slider 1415(j) of the controller coupling unit 1405(j). Once slider 1415(j) is inserted into opening 1101(j) steering wire actuator 1407(j) can move slider 1415(j) in the longitudinal direction of instrument 1, thus causing longitudinal movement of steering wire 16(j) and controlling deflection of a deflectable zone of instrument 1. Steering wire actuator 1407(j) is controlled by robot device 2301 shown in figure 20.

[00126] Steering wire actuator 1407(j) is controlled by a suitable robot device 2301. An example of such a robot device 2301 is schematically shown in figure 20. The example robot device 23 comprises a central processing unit, CPU, 2305 which is connected to an input unit 2303, memory 2307, an output unit 2315, and a communication module 2309. Moreover, CPU 2305 is connected to actuation cable controller 1413 and to steering wire actuators 1407(j) inside coupling controller 1301. In addition to or instead of being connected to actuation cable actuator 1413, CPU 2305 may be connected to one or other types of controllers, e.g., configured to control the operation of other types of end effectors of instrument 1 including ones that are operated by electrical current or by electrical/light signals.

[00127] Coupling controller 1301 or one or more of its components may be physically attached to or part of robot device 2301. However, coupling controller 1301 may be a separate device only connected to robot device 2301 by means of wires for transmitting data and control signals back and forth between robot device 2301 and coupling controller 1301. Such communication may, alternatively, be performed via wireless communication channels. Also all internal connections may be implemented by wired or wireless connections.

[00128]Input unit 2303 may comprise any known device to allow an operator to generate data and instructions for CPU 2305, like a keyboard, a mouse, one or more touch screens, a joystick or a dedicated device that transforms hand and finger movement into appropriate control of the steering wire actuators, etc.

[00129] Memory 2307 may comprise any suitable known memory devices to store data and computer programs to be run on CPU 2305, and may include any known type of volatile and non- volatile memory equipment, RAM and ROM types of memories, etc. The computer programs comprise instructions to be loaded by CPU 2305 such that it is configured to control actuation controller 1413 and steering wire actuators 1407(j) in accordance with the present disclosure.

Manual control via input unit 2303 may be applied as well.

[00130] Output unit 2315 may comprise any suitable output device to output data to an operator including a printer, a display, etc.

[00131] Communication module 2309 is configured to transmit signals to and receive signals from equipment outside robot device 2301. Any known and suitable transceiver equipment can be used for that purpose using any known or still to be developed (standard) communication technique including 2G, 3G, 4G, 5G, Wifi, Bluetooth, NFC, etc. Communication by means of light signals and/or acoustic signals may also be used. To that end communication module 2309 is connected to a network 2313 and an antenna 2311.

Coupling / decoupling

[00132] The invention enables the following procedure of coupling instrument 1 to coupling controller 1301.

[00133]Instrument 1 can first be entered into, e.g., a human or animal body, or can be handheld by an operator, in any curvature instrument 1 is designed for. Now, steering wires 16(j) are usually in an unknown position, i.e., openings 1101(j) of steering wires 18(j) are not longitudinally aligned with one another. Next step is to move all sliders 1415(j) in coupling controller 1301 to their open position

(state of figure 18D). Opening of all sliders 1415(j) is, in the shown embodiment, done by instrument 1 itself. However, this can, alternatively, be done automatically or by hand by the operator. As explained, in the embodiment, the instrument proximal end contains features (slit 1117, 1118, 1120) that activate the opening of sliders 1415(), when the instrument proximal end is entered into coupling controller 1301. As soon as the instrument proximal end is in the correct position, sliders 1415(j) are actuated or released to return to the closed position with a predetermined force (either spring loaded or electromagnetically or otherwise) (state of figure 18C). As long as opening 1101(j) in the individual steering wires 16(j) is not aligned with the tip 1437(j) of the individual slider 1415()), slider 1415(j) will not return to its fully closed position, i.e., their tip 1437(j) is pushed on the outer surface of steering wire 16(j) adjacent to opening 1101(j). Now sliders 1415(j) can be individually or simultaneously moved (back and forth) in a longitudinal direction, e.g., by steering wire actuator 1407(j), until slider tip 1437(j) automatically falls into opening 1101(j) in steering wire 16(j). As soon as an individual slider 1415() engages in steering wire opening 1101(j), the longitudinal movement of that individual slider 1415(j) is stopped. When all sliders 1415(j) are engaged with openings 1101(j), the coupling procedure is completed. For detecting when an individual slider 1415() is engaged with the steering wire one could use mechanical or electronic positioning sensors. An advantageous method when using electric motor 1407 (j) for steering, is to measure motor load or motor slip. For instance, a stepper motor with encoder may be used. As long as slider 1415()) is moved longitudinally whilst not engaged, the motor torque is at a certain level. As soon as the slider 1415()) engages with the steering wire the motor torque will increase. This increase of motor torque can be used as a coupling signal to stop longitudinal movement of that individual slider 1415(j).

[00134] Decoupling of an instrument is simple, in any position of the instrument wires, the coupling sliders 1415(j) can be opened, e.g., by manually rotating disk 1419 from the position of figure 17A to the one of figure 17B (against the spring loaded force keeping disk 1419 in the position of figure 17A), and the instrument can be pulled out of the coupling device. Instead of a manual decoupling, an electromechanical decoupling can be implemented which can be operated by release button 1307 (cf. figure 13).

Generalizations

[00135] As explained above, each steering wire 16(j) coupling unit is tangentially and longitudinally aligned with one controller coupling unit 1405(j) once instrument 1 is inserted into coupling controller 1301 to a predetermined depth coinciding with a coupling depth. To that effect, instrument 1 comprises a steerable instrument alignment unit configured to cooperate with a controller alignment unit. The steerable instrument alignment unit can be implemented in many different ways. In the explained embodiments, the steerable instrument alignment unit comprises components indicated with reference numbers 1117, 1118, and 1120. Also, the controller alignment unit can be implemented in many different ways. In the explained embodiments, the controller alignment unit comprises components indicated with reference numbers 1403, 1439 and 1443.

[00136] Inserting the instrument 1 until that coupling depth in coupling controller 1301 causes each one of the controller coupling units 1405(j) to automatically couple to an associated steering wire coupling unit. Both the tangential and longitudinal alignment functions may be implemented inside the coupling controller 1301. However, part or all of these two functionalities may be implemented in the proximal end of instrument 1.

[00137]In the provided examples, the longitudinal and tangential alignment function between instrument 1 and coupling controller 1301 is implemented by slit 1117 with tangential slit end portion 1118, and slanted edge 1120 in outer tube 1103, cooperating pin 1439 inside hollow shaft 1403 of coupling controller 1301 and pin 1443 inside central hollow controller shaft 1425. However, the implementation may be reversed, i.e, with pins on the outer surface of outer tube 1103 and slits inside opening 1309 and central hollow controller shaft 1425 of coupling controller 1301. To provide more stability, more than one such alignment construction may be implemented.

[00138] Longitudinal movement control of steering wires 16(j) is controlled by a movement of a component, like slider 1415(), of controller coupling unit 1405(j) after coupling between instrument 1 and coupling controller 1301 has been established. Movement of such a component of controller coupling unit 1405{(j) may be in a straight direction. However, other movements like curved movements, are not excluded by the invention.

[00139] Moreover, in the explained embodiment, once instrument 1 has been inserted into coupling controller 1305, proximal end of actuation cable 1119 is automatically connected to actuation cable controller 1413 inside coupling controller 1301 such that actuation cable controller 1413 can control movement of actuation cable 1119 as controlled by CPU 2305 of robot device 2301 (figure 20).

[00140]It is observed that the strip like steering wires 16(j) are presented as steering wires configured to control deflection of one or more deflectable zones in instrument 1 by longitudinally moving these steering wires 16(j). However, one or more of such steering wires 16(j) may be replaced by strip like longitudinal elements having another function, e.g., may be used as a sensing wire or as an end effector actuation wire. The sensing wire may be used to measure a physical displacement of some component inside instrument 1, for instance a displacement of wire ends.

Then, slider 1415{j) connected to such sensing wire is attached to a force sensor or displacement sensor instead of to a steering wire actuator or other steering feature. The signal generated by such a sensor can then be used by appropriate software, e.g., inside a robot (cf. figure 20) to steer the steering wires in the instrument such that this sensing wire displacement is exactly compensated by the robot to the steering wires.

[00141]Inner tube 2 of instrument 1 may be used to guide another cable from its proximal end to its distal end, e.g., a cable to transport electrical current, or optical energy, or a tube for transporting a fluid or gas. Then, coupling controller 1301 is provided with a connection unit configured to automatically connect to such other cable or tube once instrument 1 is inserted to the coupling depth inside coupling controller 1301 and, in use, provide electrical current, optical signals or fluid/gas to such cable or tube, respectively.

[00142] Sliders 1415(j) are shown to have the form of a flat plate, but they can also have a pin shape with suitable cross section (e.g., rectangular or round) or can be a finger containing multiple protrusions at the tip that can engage in multiple positions in multiple openings or recesses in a steering wire 16(j) (or sensing wire or end effector actuation wire).

[00143]First opening 1418) in release shaft 1416(j) can be shaped such that even when slider 1415) is not yet in its fully closed position, release shaft 1416(j) can be returned to its fully closed position. But, the first opening 1418(j) in release shaft 1416(j) can also be shaped such that release shaft 1416(j) cannot fully return to its closed position as long as slider 1415(j) is not in its fully closed position. This can be used as a signal to an end user that one or more of the sliders 1415{j is not engaged yet in its associated steering wire 16(j). The mechanism can be made such that when release shaft 1416(j) is moved in a longitudinal direction and slider 1415(j) engages in opening 1101) of its associated steering wire 16(j) as soon as this opening 1101(j) passes the slider tip 1437), that then release shaft 1416(j) rotates back automatically to its fully closed position (state of figure 18C). This can be used as a signal to the end user that all sliders 1415(j) are engaged with their associated steering wires 16(j) and that the instrument can be steered safely.

[00144] Furthermore, first opening 1418()) in release shaft 1416(j) can also be shaped such that it can lift and close slider 1415(j) in any longitudinal position. Also the first opening 1418(j) can be shaped such that when slider 1415(j) is lifted, shaft 1411(j) can still be used to move slider 1415(j) in a longitudinal direction. Furthermore, first opening 1418(j) can be shaped such that when slider 1415) is in a closed position and also release shaft 1416(j) is rotated in a closed position, a feature of first opening 1418(j) prevents accidental opening of slider 1415(j) by blocking radial movement of slider 1415(j).

[00145] In the drawings, a certain configuration is shown, with electric linear actuator 1407(j), a round shaft 1411(j), release shaft 1416(j) placed concentrically over shaft 1411(j) and slider 1415(j) with lifting and closing feature and first opening 1418()) in release shaft 1416(j) shaped such that it can move slider 1415(j) to an open or closed position in any longitudinal position. Of course, many other configurations can be envisioned within the scope of the invention. For example, release shaft 1416(j) could also be a rigid shaft placed aside shaft 1416(). First opening 1418(j) in release shaft 1416(j) can be substituted by a protrusion on an extra shaft placed aside shaft 1411(j). Release shaft 1416(j) could also be replaced with a lever that lifts and closes slider 1415(j). Lifting and closing of a slider 1415(j) can also be accomplished electro-magnetically. The indication of when slider 1415(j) is fully closed or not, could also be done with for example an electronic proximity sensor. Many mechanical or electro-mechanical configurations are conceivable, as long as slider 1415(j) can be closed or opened in any longitudinal position and as long as slider 1415() and opening 1101(j) individually engage automatically in the instrument wire when the steering device (hand, robot, motors) is actuated.

Material features

[00146] The material removal means for manufacturing instrument 1 can be a laser beam that melts and evaporates material or water jet cutting beam and this beam can have a width of 0.01 to 2.00 mm, more typically for this application, between 0.015 and 0.04mm.

[00147] The wall thickness of tubes inside instrument 1 depend on their application. For medical applications the wall thickness may be in a range of 0.03-2.0 mm, preferably 0.03-1.0 mm, more preferably 0.05-0.5 mm, and most preferably 0.08-0.4 mm. The diameter of tubes depend on their application. For medical applications the diameter may be in a range of 0.5-20 mm, preferably 0.5- 10 mm, more preferably 0.5-6 mm. The radial play between adjacent tubes may be in range of 0.01 —-0.3 mm.

[00148] Steering wires and other elements in one tube can be attached to steering wires and other elements in adjacent tubes such that they are together operable to transfer a longitudinal motion from a steering wire at the proximal end of the instrument to a bendable portion of the instrument at the distal end of the instrument such that the bendable portion bends. This is explained in detail in WO 2017/213491 (cf. e.g. figures 12, 13a and 13b in that PCT application) of the present applicant.

[00149] It will be clear to a person skilled in the art that the scope of the invention is not limited to the examples discussed in the foregoing, but that several amendments and modifications thereof are possible without deviating from the scope of the invention as defined in the attached claims.

While the invention has been illustrated and described in detail in the figures and the description, such illustration and description are to be considered illustrative or exemplary only, and not restrictive. The present invention is not limited to the disclosed embodiments but comprises any combination of the disclosed embodiments that can come to an advantage.

[00150] Variations to the disclosed embodiments can be understood and effected by a person skilled in the art in practicing the claimed invention, from a study of the figures, the description and the attached claims. In the description and claims, the word “comprising” does not exclude other elements, and the indefinite article “a” or “an” does not exclude a plurality. In fact it is to be construed as meaning “at least one”. The mere fact that certain features are recited in mutually different dependent claims does not indicate that a combination of these features cannot be used to advantage. Any reference signs in the claims should not be construed as limiting the scope of the invention. Features of the above described embodiments and aspects can be combined unless their combining results in evident technical conflicts.

Claims

Conclusions

A linkage control adapted to be coupled to a steerable instrument (1), the steerable instrument having an elongated tubular shape extending in a longitudinal direction and having a distal end and a proximal end and comprising: at least one deflectable zone (13; 74, 75) located at the distal end, at least one control wire (16()) located between the proximal end and the distal end and arranged to be movable in the longitudinal direction to transmit a longitudinal movement of the at least one control wire (16()) to a bending of the at least one deflectable zone (13; 74, 75), the at least one control wire (16(j)) being a strip-like shape, at least one pilot wire coupling unit (1101()), one for each pilot wire (166) and configured to be coupled with a steering coupling unit (1405(j)) of the coupling controller and a steerable instrument alignment unit ( 1117, 1118, 1120), the clutch controller (1301) comprising: an opening (1309) configured to allow the proximal end of the steerable instrument (1) to be inserted into the clutch controller, at least one controller clutch unit (1405( j)), each of which can be configured to interface with one of the at least one control wire coupling units (1101()) and a control alignment unit (1403, 1439, 1443), the control alignment unit (1403, 1439 , 1443) and the steerable instrument alignment unit (1117, 1118, 1120) are arranged such that the control aligner unit (1403, 1439, 1443) and the steerable instrument alignment unit (1117, 1118, 1120) are mutually longitudinal and tangential are aligned by a first mechanical action caused by inserting the proximal end of the steerable instrument (1) into the coupling control (1301) to a coupling depth and then each pilot wire coupling unit (1101()) is aligned at least tangentially with one of the at least one control interface units (1405()).

The clutch control of claim 1, wherein longitudinal alignment between each pilot wire clutch unit (1101(j)) and that one of the at least one steering clutch units (1405()) is possible using mutual longitudinal movement therebetween when the steerable instrument (1 ) until the link depth is entered into the link control (1301).

The clutch control according to claim 1 or 2, wherein the control alignment unit comprises a hollow shaft (1403) and a first pin (1439), the hollow shaft (1403) having the opening (1309) and the first pin (1439) located in the opening (1309), the hollow shaft (1403) being rotatable about a central hollow control shaft (1425) designed to receive the instrument (1) and having a second pin (1443) inside, the first pin (1439) and second pin (1443) are arranged to cooperate with the steerable instrument alignment unit (1117, 1118, 1120) so that when the proximal end of the steerable instrument (1) is in the coupling control (1301 ) is inserted, the hollow shaft (1403) is caused to rotate about the control central hollow shaft (1425) to tangentially align each pilot wire coupling unit (1101(j)) with one of the at least one control coupling units (1405( ))).

The clutch control of claim 1, wherein the steering alignment unit (1403, 1439, 1443) and the steerable instrument alignment unit (1117, 1118, 1120) are configured to cooperate such that when the proximal end of the steerable instrument ( 1) is inserted into the clutch control (1301) the at least one control clutch unit (1405(j)) is moved to a position where the at least one control clutch unit (1405(j)) allows the proximal end of the steerable instrument ( 1) up to that link depth is entered into the link control (1301).

The clutch control of claim 4, wherein the control alignment unit comprises a hollow shaft (1403) and a first pin (1439), the hollow shaft (1403) having the opening (1309) and the first pin (1439) being in located opening (1309), the hollow shaft (1403) being rotatable about a central hollow control shaft (1425) designed to receive the instrument (1) and having a second pin (1443) inside, the first pin (1439) and the second pin (1443) are arranged to cooperate with the steerable instrument alignment unit (1117, 1118, 1120) so that when the proximal end of the steerable instrument (1) is engaged in the coupling control (1301) inserted, the hollow shaft (1403) is caused to rotate about the central control hollow shaft (1425) to tangentially align each pilot wire coupling unit (1101(j)) with one of the at least one control coupling units (1405(j) ) and it is ensured that the at least one control coupling unit (1405(j)) is moved to the position where the at least one control coupling unit (1405())) allows the proximal end of the steerable instrument (1) to that coupling depth insert into the clutch control (1301).

The clutch control according to claim 3 or 5, wherein the at least one control clutch unit (1405(j)) comprises a carriage (1415(j)) slidably mounted in a radial direction relative to a central axis of the clutch control (1301) .

The clutch control of claim 6, wherein the at least one control clutch unit (1405(j)) includes a force generating component (1420(j}) configured to generate a force on the carriage (1415(j)) in the radial direction toward the center axis of the control clutch unit (1405(j)) when the carriage (14156)) is moved in the radial direction away from the center axis of the control clutch unit (1405(j)), the force generating component being a spring (1420(j)) or an electromagnetic component.

The clutch control according to claim 6 or 7, wherein the at least one control clutch unit (1405(j)) includes an unlocking shaft (1416(j)) and the hollow shaft (1403) is configured to cause the unlocking shaft ( 1416(7)) the carriage (1415(j)) in the radial direction respectively moves away from or towards the central axis of the control coupling unit (1301) by rotating the hollow shaft (1403) in respectively a first direction or a second direction, the first direction being opposite to the second direction.

The clutch control of claim 8, wherein the unlocking shaft (1416(})) is configured to be rotated by the hollow shaft (1403) so as to rotate the unlocking shaft (1416()) and cause the carriage ( 1415(j)) moves in the radial direction.

A clutch control according to any one of the preceding claims, wherein the clutch control comprises at least one pilot wire actuation (1407(j)) configured to move the at least one control clutch unit (1405())) in a longitudinal direction to move the at least one control wire (16(7)) in its longitudinal direction once the steerable instrument (1) and the clutch control (1301) are coupled.

II. Clutch control according to any one of the preceding claims, wherein the clutch control comprises a connection unit (1413) arranged to be connected to at least one of an activation cable, an electric cable, an optical cable or a pipe arranged for conveying a gas or a liquid.

The clutch controller of claim 11, wherein the connecting unit (1413) is an activation cable controller (1413) configured to be coupled to the activation cable (1119) using a second mechanical action caused by pushing to the coupling depth. insertion of the proximal end of the steerable instrument (1) into the clutch control (1301).

The clutch control of claim 12, wherein the actuation cable control (1413) comprises an engagement unit (1431) arranged to engage the actuation cable (1119) and the clutch control comprises an actuation cable release shaft (1429) configured to turning by means of said second mechanical action and operating the gripping unit (1431).

The clutch control according to claim 13, wherein the engagement unit (1431) is a clutch disc (1431) having an external clutch disc portion (14314) operable by the activation cable unlocking shaft (1429) and an internal clutch disc portion (1431b) that is made to engage the activation cable (1119).

A clutch control according to any one of the preceding claims, wherein the at least one control clutch unit (1405(j)) is configured to enable coupling with the at least one control wire (16())) and control its longitudinal movement as the steerable instrument (1), at its proximal end, is provided with at least one opening (11017); 3) in the at least one control wire (16(j)).

16. A steerable instrument adapted to be coupled to a linkage control, the steerable instrument having an elongate tubular shape extending in a longitudinal direction and having a distal end and a proximal end and comprising: at least one bendable zone (13; 74, 75) located at the distal end, at least one control wire (16()) disposed between the proximal end and the distal end and arranged to be movable in the longitudinal direction in order to achieve a longitudinal transmitting movement of the at least one control wire (16()) to a bending of the at least one deflectable zone (13; 74, 75), the at least one control wire (16(j)) having a strip-like shape, at least one pilot wire coupling unit (1101()), one for each pilot wire (16(j)) and which is configured to be coupled to a steering coupling unit (1405(1}) of the coupling controller, a steerable instrument alignment unit ( 1117, 1118, 1120) arranged to interact with a steering alignment unit (1403, 1439, 1443) of the coupling controller so that when the proximal end of the steerable instrument (1) reaches a coupling depth in the coupling controller (1301 ) is inserted, each pilot wire coupling unit (1101(j)) is at least tangentially aligned with a control coupling unit (1405())).

The steerable instrument of claim 16, wherein the alignment unit of the steerable instrument comprises a slot (1117, 1118 with a bevel (1120).

A steerable instrument according to claim 16 or 17, wherein the at least one steering wire (16()) is either part of one tube or of multiple coaxially arranged tubes.

A system comprising a clutch controller according to any one of claims 1 to 15 and an instrument according to any one of claims 16 to 18.