Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
  • A61B34/70—Manipulators specially adapted for use in surgery
  • A61B34/74—Manipulators with manual electric input means
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
  • A61B34/30—Surgical robots
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
  • A61B34/30—Surgical robots
  • A61B34/37—Leader-follower robots
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
  • A61B34/70—Manipulators specially adapted for use in surgery
  • A61B34/76—Manipulators having means for providing feel, e.g. force or tactile feedback
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
  • A61B90/50—Supports for surgical instruments, e.g. articulated arms
• • B—PERFORMING OPERATIONS; TRANSPORTING
  • B25—HAND TOOLS; PORTABLE POWER-DRIVEN TOOLS; MANIPULATORS
  • B25J—MANIPULATORS; CHAMBERS PROVIDED WITH MANIPULATION DEVICES
  • B25J13/00—Controls for manipulators
  • B25J13/02—Hand grip control means
  • B25J13/025—Hand grip control means comprising haptic means
• • B—PERFORMING OPERATIONS; TRANSPORTING
  • B25—HAND TOOLS; PORTABLE POWER-DRIVEN TOOLS; MANIPULATORS
  • B25J—MANIPULATORS; CHAMBERS PROVIDED WITH MANIPULATION DEVICES
  • B25J18/00—Arms
  • B25J18/06—Arms flexible
• • B—PERFORMING OPERATIONS; TRANSPORTING
  • B25—HAND TOOLS; PORTABLE POWER-DRIVEN TOOLS; MANIPULATORS
  • B25J—MANIPULATORS; CHAMBERS PROVIDED WITH MANIPULATION DEVICES
  • B25J3/00—Manipulators of leader-follower type, i.e. both controlling unit and controlled unit perform corresponding spatial movements
  • B25J3/04—Manipulators of leader-follower type, i.e. both controlling unit and controlled unit perform corresponding spatial movements involving servo mechanisms
• • B—PERFORMING OPERATIONS; TRANSPORTING
  • B25—HAND TOOLS; PORTABLE POWER-DRIVEN TOOLS; MANIPULATORS
  • B25J—MANIPULATORS; CHAMBERS PROVIDED WITH MANIPULATION DEVICES
  • B25J9/00—Program-controlled manipulators
  • B25J9/16—Program controls
  • B25J9/1679—Program controls characterised by the tasks executed
  • B25J9/1689—Teleoperation
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods
  • A61B2017/00017—Electrical control of surgical instruments
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods
  • A61B2017/00367—Details of actuation of instruments, e.g. relations between pushing buttons, or the like, and activation of the tool, working tip, or the like
  • A61B2017/00398—Details of actuation of instruments, e.g. relations between pushing buttons, or the like, and activation of the tool, working tip, or the like using powered actuators, e.g. stepper motors, solenoids
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods
  • A61B2017/0046—Surgical instruments, devices or methods with a releasable handle; with handle and operating part separable
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
  • A61B34/20—Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
  • A61B2034/2046—Tracking techniques
  • A61B2034/2061—Tracking techniques using shape-sensors, e.g. fiber shape sensors with Bragg gratings
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
  • A61B34/30—Surgical robots
  • A61B2034/305—Details of wrist mechanisms at distal ends of robotic arms
  • A61B2034/306—Wrists with multiple vertebrae
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
  • A61B34/70—Manipulators specially adapted for use in surgery
  • A61B34/74—Manipulators with manual electric input means
  • A61B2034/742—Joysticks
• • G—PHYSICS
  • G05—CONTROLLING; REGULATING
  • G05B—CONTROL OR REGULATING SYSTEMS IN GENERAL; FUNCTIONAL ELEMENTS OF SUCH SYSTEMS; MONITORING OR TESTING ARRANGEMENTS FOR SUCH SYSTEMS OR ELEMENTS
  • G05B2219/00—Program-control systems
  • G05B2219/30—Nc systems
  • G05B2219/45—Nc applications
  • G05B2219/45119—Telesurgery with local assistent, voice communication

Definitions

• the present invention relates to surgical systems used in performing surgery, and methods for using such systems, and particularly to controlling the bending and rotating of portions of articulated mechanical arms using multiple operating modes and input devices.
• Instruments for such surgery typically have a surgical end effector located at the distal end of an articulated surgical arm (preferably with minimum diameter) that is inserted through a small opening (e.g., body wall incision, natural orifice) to reach a surgical site.
• surgical instruments can be passed through a cannula and an endoscope can be used to provide images of the surgical site.
• Surgical instruments have been developed that utilize an end effector (e.g., a surgical tool such as for tissue fusing or cutting, or a measurement tool) for convenience, accuracy, and wellbeing of the subject.
• an end effector e.g., a surgical tool such as for tissue fusing or cutting, or a measurement tool
• articulated surgical arms have one or more bending portions which are controlled remotely using various input devices (e.g., hand and foot controls) to ultimately control the location of the end effector and change its orientation with reference to the surgical arm’s longitudinal axis.
• the surgical arm is capable of retroflected bending relative to the surgical arm longitudinal axis.
• the method comprises: (a) commencing operation of the surgical system in a retroflexing mode wherein, with respect to flexing and rotation of the arm joints: (i) the first user-input device is active to direct flexion and rotation of only a given one of the arm joints, and (ii) the second user-input device is disabled; (b) while in the retroflexing mode, retroflecting a distal portion of the articulated mechanical arm by flexion and rotation of the given one of the arm joints, responsive to electronic control-output from the first user-input device so as to bring the end effector to a retroflex operating position; (c) transitioning the surgical system from the retroflexing mode to a surgical-operation mode to enable the second user-input device with respect to flexing and rotating at least one of the arm joints of the arm other than the given one of the arm joints; and (d) while in the surgical-operation mode, effect flexing and rotating of at least two of the arm joints in accordance with respective degrees of freedom of each arm joint, responsive to electronic control-out
• the surgical system can additionally comprise control circuitry effective, while the surgical system is in the retroflexing mode, to restrict the actuation of arm joints other than the single arm joint.
• the transitioning can include calibrating the input device with respect to at least one of a position and an orientation of the end effector or of a distal portion of the arm.
• the first input device is configured for controlling actuation of the single arm joint and/or is not configured for controlling actuation of arm joints other than the single arm joint.
• the transitioning to the surgical-operation mode can be in response to and/or contingent upon detecting that the arm is in a retroflex position.
• a surgical system comprises: (a) an articulated mechanical arm comprising a plurality of arm joints, and a surgical end effector at a distal end of the arm; and (b) first and second user-input devices for controlling the arm, wherein the surgical system is configured to operate, asynchronously, in (i) a retroflex mode in which a distal portion of the articulated mechanical arm is operative to be retroflected, responsive to electronic control-output from the first user-input device, so as to bring the end effector to a retroflex operating position , and in (ii) a surgical-operation mode in which at least two of the arm joints are operative to be flexed and rotated, responsive to electronic control-output from the second user-input device, so as to thereby move the surgical end-effector to perform one or more surgical actions, such that: (A) while in the retroflexing mode, with respect to flexing and rotation of the arm joints, the first user-input device is active to direct flexion and rotation of only
• the surgical system can additionally comprise control circuitry effective, while the surgical system is in the retroflexing mode, to restrict the actuation of arm joints other than the single arm joint.
• the surgical system can be configured such that transitioning includes calibrating the input device with respect to at least one of a position and an orientation of the end effector or of a distal portion of the arm.
• it can be that the first input device is configured for controlling actuation of the single arm joint and/or is not configured for controlling actuation of arm joints other than the single arm joint.
• the surgical system can be configured such that the transitioning to the surgical-operation mode can be in response to and/or contingent upon detecting that the arm is in a retroflex position.
• the surgical system comprises (i) a user-input device, and (ii) an articulated mechanical arm comprising a plurality of arm joints, and surgical end effector at a distal end of the arm.
• the method comprises: (a) commencing operation of the surgical system in a retroflexing mode wherein, with respect to flexing and rotation of the arm joints, the user-input device is active to direct flexion and rotation of only a given one of the arm joints; (b) while in the retroflexing mode, retroflecting a distal portion of the articulated mechanical arm by flexion and rotation of the given one of the arm joints, responsive to electronic control-output from the user-input device, so as to bring the end effector to a retroflex operating position; (c) transitioning the surgical system from the retroflex mode to the surgical-operation mode to enable the user-input device with respect to flexing and rotating at least one of the arm joints of the arm other than the given one of the arm joints; and (d) while in the surgical-operation mode, effect flexing and rotating of at least two of the arm joints in accordance with respective degrees of freedom of each arm joint, responsive to electronic control-output from the user-input device, to thereby move the surgical end-effector to perform one
• the surgical system can additionally comprise control circuitry effective, while the surgical system is in the retroflexing mode, to restrict the actuation of arm joints other than the given one of the arm joints.
• the restricting can be by disabling actuation of arm joints of the arm other the given one of the arm joints.
• the user-input device can control the actuation of the plurality of arm joints in both the retroflexing mode and the surgical-operation mode. In some embodiments, the user-input device can be precluded from generating or transmitting control outputs that would control actuation of arm joints of the arm other than the given one of the arm joints.
• the transitioning to the surgical-operation mode can be in response to and/or contingent upon detecting that the arm is in a retroflex position.
• the transitioning can includes calibrating the user-input device with respect to at least one of a position and an orientation of the end effector or of a distal portion of the arm.
• the method can additionally comprise, following the operating in the second mode, unflexing the distal end of the arm, so as to bring the arm to an unflexed position.
• a surgical system comprising: (a) a user- input device; and (b) an articulated mechanical arm comprising (i) a plurality of arm joints and (ii) a surgical end effector at a distal end of the arm, wherein the surgical system is configured to operate, asynchronously, in (A) a retroflexing mode in which a distal portion of the articulated mechanical arm is retroflected, responsive to electronic control-output from the user-input device, so as to bring the end effector to a retroflex operating position, and in (B) a surgical-operation mode in which at least two of the arm joints are flexed and rotated, responsive to electronic control-output from the user-input device, so as to thereby move the surgical end-effector to perform one or more surgical actions, such that (A) while in the retroflexing mode, with respect to flexing and rotation of the arm joints, the user-input device is active to direct flexion and rotation of only a given one of the arm joints,
• the surgical system can additionally comprise control circuitry effective, while the surgical system is in the retroflexing mode, to restrict the actuation of arm joints other than the given one of the arm joints.
• the restricting can be by disabling actuation of arm joints of the arm other the given one of the arm joints.
• the user-input device can be effective to control the actuation of the plurality of arm joints in both the retroflexing mode and the surgical- operation mode.
• the surgical system can be configured such that the user- input device can be precluded from generating or transmitting control outputs that would control actuation of arm joints of the arm other than the given one of the arm joints.
• the surgical system can be configured such that the transitioning to the surgical-operation mode can be in response to and/or contingent upon detecting that the arm is in a retroflex position.
• the surgical system can be configured such that the transitioning can includes calibrating the user-input device with respect to at least one of a position and an orientation of the end effector or of a distal portion of the arm.
• the surgical system can be additionally configured to effect unflexing the distal end of the arm, following the operating in the second mode, so as to bring the arm to an unflexed position.
• a method is disclosed, according to embodiments, of operating a surgical system comprising (i) an articulated mechanical arm comprising a surgical end effector at a distal end thereof and a plurality of arm joints and (ii) an input-device array of one or more user-input devices, wherein the arm joints are configured to flex and rotate in response to an electronic control-output from one or more user-input devices of the input-device array.
• the method additionally comprises: (c) in response to and contingent upon detecting that the arm is in a retroflex position, transitioning operation of the surgical system from the first operating mode to a second operating mode in which the system is enabled to control flexing and rotating of at least one first- mode-precluded arm joint in accordance with respective degrees of freedom of each arm joint; and (d) operating the surgical system in the second operating mode so as to perform a surgical action using the end effector.
• the system can be configured such that the transitioning can include calibrating the second input device with respect to at least one of a position and an orientation of the end effector or of a distal portion of the arm.
• a single user-input device can be effective to control the actuation of the plurality of arm joints in both the first operating mode and the second operating mode.
• the surgical system can additionally comprise a control console including a display screen, and at least one user-input device of the input-device array is disposed on or in proximity to the display screen.
• an additional user-input device for actuating linear advancement and retraction of the arm can be disposed upon, co-located with, or in proximity to, at least one user-input device of the input-device array.
• the operating in the second mode can be with the arm in the retroflex position.
• the method comprises: (a) retroflecting a distal portion of the articulated mechanical arm by flexion and rotation of a given one of arm joints, responsive to electronic control- output from the input-device array, so as to bring the end effector to a retroflex operating position without flexing or rotating any of the arm joints other than the given one of the arm joints; and (b) in response to and contingent upon detecting that the arm is in a retroflex position, effect flexing and rotating of at least two of the arm joints in accordance with respective degrees of freedom of each arm joint, responsive to electronic control-output from the input-device array, to thereby move the surgical end-effector to perform one or more surgical actions.
• the surgical system can additionally comprise control circuitry effective to restrict the actuation of arm joints other than the given one of the arm joints during the retroflexing.
• a surgical system comprises: (a) an articulated mechanical arm comprising (i) a plurality of arm joints and (ii) a surgical end effector at a distal end of the arm, and (b) an input-device array of one or more user-input devices for controlling the arm, wherein the surgical system is configured: (i) to retroflect a distal portion of the articulated mechanical arm by flexion and rotation of a given one of arm joints, responsive to electronic control-output from the input-device array, so as to bring the end effector to a retroflex operating position without flexing or rotating any of the arm joints other than the given one of the arm joints, and (ii) to effect flexing and rotating of at least two of the arm joints in accordance with respective degrees of freedom of each arm joint in response to and contingent upon detecting that the arm
• the surgical system can additionally comprise control circuitry effective to restrict the actuation of arm joints other than the given one of the arm joints during the retroflexing.
• the surgical system can additionally comprise control circuitry effective to restrict the actuation of arm joints other than the given one of the arm joints during the retroflexing.
• the method can additionally comprise, following the performing the one or more surgical actions, unflexing the distal end of the arm, so as to bring the arm to an unflexed position.
• a method is disclosed, according to embodiments, of using a surgical system.
• the method comprises: (a) providing an articulated mechanical arm having a surgical end effector at a distal end thereof, the arm comprising a plurality of arm segments connected serially by a corresponding plurality of arm joints configured to flex and rotate in response to an electronic control-output from a user-input device, wherein the providing is such that the end effector is displaced; (b) maneuvering the end effector to a retroflex operating position while operating in a first input mode in which a displacement of an input device or of a displaceable portion thereof is translated to a speed of at least one of (i) a flexion of an arm joint and (ii) a rotation of an arm joint; (c) in response to and contingent upon detecting that the end effector is in the retroflex operating position, transitioning from operating in the first input mode to operating in a second input mode in which a displacement of an input device or of a displaceable portion thereof is translated to a corresponding displacement
• an additional user-input device can be used for actuating linear advancement and retraction of the arm.
• the retroflex operating position can be at, or in proximity to, a surgical worksite.
• the system can be configured such that a first input device is used in the first input mode, and/or that a second input device is used in the second input mode.
• the system can be configured such that an additional user- input device can be used for actuating linear advancement and retraction of the arm.
• Fig. 2A is a schematic perspective view of a surgical system comprising a mechanical surgical arm according to embodiments of the present invention.
• Fig. 2B shows a distal portion of a mechanical surgical arm according to embodiments of the present invention.
• Figs. 3-C show the distal portion of a mechanical surgical arm in a variety of flexed and retroflexed positions, according to embodiments of the present invention.
• Fig. 6 shows a flowchart of a method for operating surgical mechanical arms using two operating modes, according to embodiments of the present invention.
• Fig. 7 is a schematic illustration of a control console for a surgical system with input devices positioned in proximity thereto, according to embodiments of the present invention.
• Fig. 10 is a schematic illustration of an articulated user-input device according to embodiments of the present invention.
• Fig. 11 is a schematic view of a handle member of the user-input device of Fig. 10 according to embodiments of the present invention.
• Figs. 12A-B illustrate an exemplary graphical aid for use in aligning the respective positions of a mechanical surgical arm and an articulated user-input device, according to embodiments of the present invention.
• Fig. 13 shows a sample screen display for use in aligning the respective positions of a mechanical surgical arm and an articulated user-input device, according to embodiments of the present invention.
• Figs. 14A-E show time-consecutive images showing exemplary control of surgical mechanical arms using a plurality of different input devices, according to embodiments of the present invention.
• Fig. 15 shows a block diagram of a surgical system according to embodiments of the present invention.
• Fig. 16 shows a flowchart of a method for operating a surgical system in two different operating modes, according to embodiments of the present invention.
• FIG. 17A shows a flowchart of a method for dual control of surgical arms, according to embodiments of the present invention.
• FIGs. 17B and 17C are schematic illustrations of control consoles comprising dual control means, according to embodiments of the present invention.
• FIG. 18 is a flowchart of a method of using haptic handles to control one or more surgical arms, according to embodiments of the present invention.
• Embodiments disclosed herein relate to controlling one or more surgical mechanical arms, i.e., articulated mechanical arms, using a plurality of different operating modes and/or a plurality of different input devices.
• ‘arm’ means an articulated, mechanical arm that is part of a surgical system or electrosurgical system and used for performing or helping to perform surgical (including electrosurgical) actions inside a human subject’s body.
• Surgical actions when unspecified can include any medical or surgery-related or diagnostic action taken inside the human body, including, but not exhaustively: cutting tissue, dissecting tissue, manipulating tissue, suturing tissue, retracting tissue, fusing tissue, taking measurements, and imaging.
• a surgical arm be sized and/or shaped for insertion into a human body.
• an arm can be sized and/or shaped for insertion through a laparoscopic port and/or for performing laparoscopic surgery.
• an arm can be sized and/or shaped for insertion through a natural body orifice, e.g. vagina, anus, trachea, esophagus, ear canal.
• An arm may include an end effector, which is used herein to mean a tool or device used in connection with surgery, electrosurgery, diagnosis or imaging when deployed within a human body.
• An end effector may be supplied as part of an arm, i.e., already mounted, mechanical attached and/or integrated with the power and communications conveyances of the arm; in some embodiments an arm an end effector may be provided separately for assembly and/or integration into a working unit before or even during a surgical operation, i.e., before insertion into a subject’s body.
• terms such as ‘an arm comprising an end effector’ and ‘and arm configured for use with an end effector’, etc. should be understood as equivalent for the purposes of this disclosure and the claims appended thereto.
• An ‘input device’ or, equivalently, a ‘user-input device’, as used herein can be any device capable of receiving a user input, i.e., an input received from a user of a surgical system.
• Input devices can include, for example but not exhaustively: buttons, switches, toggles, wheels, knobs, small sticks such as thumbsticks (alternatively called nipples), and joysticks (whether articulated or not). Disclosure of specific device-type for any specific input device is not intended to exclude the substitution of other types of input devices for the specific input devices.
• Input devices can be standalone, grouped on a single control member or on a small number of control members, disposed upon another input device, or co-located, e.g., on or in proximity to a control console, display screen, etc.
• Input devices can be operated by a user employing one or more fingers, thumbs, hands or feet. Additionally or alternatively, and without limitation, input devices can be eye- or hand- motion operated, voice-operated, or controlled by facial expressions.
• Arms and input devices as well as other aspects and features of the present invention may be understood in combination with any of the teachings of co-pending US Patent Application Ser. No. 16/121,704 filed on Sep. 5, 2018 and published as US Patent Publication US20190000574A1 which is hereby incorporated by reference herein in its entirety.
• a ‘handle’, or, equivalently a ‘handle-member’ is used herein generally to describe a hand-operated user-input device or a hand-operated portion of a user-input device, and in some embodiments to describe a hand-grasped or finger-grasped user-input device or portion thereof.
• module and/or ‘electrical circuitry’ or ‘electronic circuitry’ and/or control circuitry’ and/or element and/or unit and/or controller and/or module and/or sensor and/or detector may include any combination of analog and/or digital circuitry and/or software/computer readable code module and/or firmware and/or hardware elements including but not limited to a digital computer, CPU, volatile or non-volatile memory, field programmable logic array (FPLA) elements, hard-wired logic elements, field programmable gate array (FPGA) elements, and application-specific integrated circuit (ASIC) elements.
• Any instruction set architecture may be used including but not limited to reduced instruction set computer (RISC) architecture and/or complex instruction set computer (CISC) architecture.
• any computation or analysis procedure may be performed using any combination of analog and/or digital circuitry and/or software/computer readable code module and/or firmware and/or hardware elements including but not limited to a digital computer, CPU, volatile or non-volatile memory, field programmable logic array (FPLA) elements, hard-wired logic elements, field programmable gate array (FPGA) elements, and application-specific integrated circuit (ASIC) elements.
• Any instruction set architecture may be used including but not limited to reduced instruction set computer (RISC) architecture and/or complex instruction set computer (CISC) architecture.
• Fig. 1 shows a schematic illustration of a surgical system 100 according to embodiments.
• the system 100 of Fig. 1 includes two surgical mechanical arms 102.
• a single surgical arm is provided.
• more than two (e.g., 3 or 4) surgical arms are provided.
• Surgical mechanical arms 102 are preferably sized and/or shaped for insertion into a human body or patient 106.
• Each of the surgical mechanical arms 102 is actuated by a respective motor unit 108.
• the surgical arms 102 and/or motor units 108 are supported in this simplified illustrative example by attachment to a patient support 116, e.g., a bed, but may also be supported by a patient side cart or any other suitable equipment.
• Power to the arms 102 and the motor units 108 can supplied by an electrosurgical generator 112 in embodiments in which the surgical system is used in electrosurgery.
• an electrosurgical generator supplies high-frequency (e.g. radio frequency) alternating polarity, electric current.
• An electrosurgical generator 112 can be configured to supply different frequencies and/or power levels, for example, suitable for cutting and/or coagulating and/or sealing and/or desiccating and/or fulgurating tissue.
• Power is supplied to the motor units 108 via one or more cables 114 which are configured to transfer radio frequency electrosurgical power.
• Control console 118 includes a plurality of user interfaces including one or more of: input devices, e.g., input device arms 120 where the control console is configured to generate control signals based upon movement of the input device arms 120; display screen 128 configured to receive user input and/or display, for example, system-status information or imaging of a surgical zone, for example, to display images collected by a camera inserted into patient 106 using one of surgical arms 102 or display arm position and orientation; and one or more additional user interfaces 130 (e.g. button, switch, etc.).
• input devices e.g., input device arms 120 where the control console is configured to generate control signals based upon movement of the input device arms 120
• display screen 128 configured to receive user input and/or display, for example, system-status information or imaging of a surgical zone, for example, to display images collected by a camera inserted into patient 106 using one of surgical arms 102 or display arm position and orientation
• additional user interfaces 130 e.g. button, switch, etc.
• Control console 118 includes a processor (not shown) configured to receive signals from a user input/s and to send control signals to motor units 108 and/or electrosurgical generator 112.
• Foot pedal 126 and/or electrosurgical generator 112 include/s a processor (not shown) configured to receive control signals (e.g. generated by a user pressing on a portion/s of the foot pedal 126) to vary electrical power supplied to motor units 108 based on the control signals.
• Foot pedal control signals do not necessarily pass through a control unit processor.
• Input arms 120 are one form of input device, and are shown here for illustrative purposes. In other embodiments, other types or forms of input devices can be used.
• an arm unit 104 includes a proximal end which is shaped for acceptance by the motor unit 108, and a distal end where an end effector 174 such as the illustrated multi -jaw grasper (shown only as a non-limiting illustrative example) is attached to the arm 102.
• an end effector 174 such as the illustrated multi -jaw grasper (shown only as a non-limiting illustrative example) is attached to the arm 102.
• an ‘operating mode’ or its equivalent ‘mode’ (which can be used in conjunction with various non-limiting descriptive words, e.g., ‘retroflexing mode’, ‘surgical-operating mode,’ etc.) means an operating regime imposed on the use of a surgical system or an arm, either by hardware, firmware or software design or by control circuitry of the surgical system or in other ways.
• the word ‘operating’ in ‘operating mode’ means ‘working’ or ‘functioning/al’ and describes the operating of, e.g., an arm, and does not mean the performance of surgery, i.e., an ‘operating mode’ may happen to include the performance of surgery but not necessarily.
• Operation of the surgical system can be differentiated between different modes, in various ways, as further described hereinbelow.
• the differentiation can be on the basis of (and not exhaustively): having a different input device (or multiple input devices) dedicated to each mode; having various restrictions or limitations on specific arm movements and/or on specific arm joints and segments; having different translation schemes for displacement of input devices or control elements of input devices to arm movements, e.g., displacement-to-speed vs.
• Some differentiations between modes can be implemented in more than one way.
• the differentiation between modes involves restricting or limiting certain arm movements (e.g., flexing and rotating of certain joints) or permitting only certain arm movements
• the differentiation can be implemented by using different input devices for each mode, or by using one input device in both modes but enforcing, on the one input device, a software or hardware restriction that can be user-switchable or system-enforced.
• a software-implemented or hardware-implemented solution may actively permit the actuation of a single given arm joint, or may actively prevent or preclude the actuation of any arm joint (of the same arm) that is not the single arm joint.
• a transition may include ending restrictions or limitations imposed during first-mode operation, such as limiting joint flexion and rotation to a given single arm joint of any particular arm, e.g. the elbow joint.
• a transition can include enabling the actuation of arm joints that were disabled (or not specifically enabled) in the first-mode operation, i.e., in addition to the single given joint that was enabled in the first mode.
• Enablement can include enablement of joints to move unrestrictedly in accordance with respective degrees of freedom of each joint. For example, if a given arm joint is only configured for rotation and not flexion, the enablement will enable it only for rotation.
• a transition may include restoring restrictions or limitations removed during a transition to second-mode operation, such as limiting joint flexion and rotation to a given single arm joint of any particular arm, e.g. the elbow joint. Additionally or alternatively, a transition can include disabling the actuation of arm joints that were enabled for the second-mode operation. Additionally or alternatively, a transition can change back a processing of control-outputs from user-input devices from a displacement-to- displacement translation to a displacement-to-velocity translation.
• transitioning from a first operating mode to a second operating mode can include an alignment calibration.
• an alignment calibration which is discussed in further detail with respect to Figs. 12A-12B, the orientation of the surgical arm, including the ‘internal’ orientation of arm elements (e.g., arm joints and/or arm segments) with respect to each other is modified so as to match a ‘shape’ or ‘curve’ which describes the corresponding orientation of the input arm which will take over actuation control of the surgical arm in the transition to the second operating mode.
• Translation of user inputs to arm movements can be accomplished in various ways.
• the displacement (or the force of displacement) of an input device or of a control element of an input device can be translated to a velocity (e.g., velocity, speed, angular velocity) of arm movement.
• a velocity e.g., velocity, speed, angular velocity
• the surgical system can be desirable, in a second mode, and especially in embodiments in which the input device employed in the second mode is avatar-like and translates input arm displacements to surgical arm displacements, for the surgical system to receive and process inputs which directly address the displacement of arm segments.
• the flexing and rotating of arm joints are then indirectly addressed by the surgical system by controlling the arm joints to flex and rotate to the extent necessary for achieving the required arm segment displacement and reorientation.
• an avatar-like input arm can be manipulated by a user into a shape or configuration that anticipates or drives the intended shape of the surgical arm post-manipulation.
• Bendable portion 2179 comprises shoulder joint 2101 and elbow joint 2103, which are labeled variously as 2101a, 2101bc, 2103a, 2103b and 2103c so as to indicate to which one or more of the scenarios (A, B or C) the instance of the joint is relevant.
• joint 2103a is the elbow joint position in scenario A.
• scenario A involves the bending of only elbow joint 2103a (shoulder joint 2101a remains unactuated and unbent), and specifically one can see that the bending of only elbow joint 2101a does not cause a collision between end effector 174 and the obstacle 2177.
• Scenario B in which only the shoulder joint 2101b is bent, there is a collision between end effector 174 with the obstacle 2177.
• Fig. 3A illustrates examples of elbow joint 2103 flexion from an unflexed orientation to various post-flexion orientations ranging from less than 90° to more than 180° relative to proximal arm base segment 2181.
• the flexion range of movement for an elbow joint is >90°
• an end-effector 174 is capable of being positioned at >90°, >120°, >140°, >160°, > 180°, >190°, >200° or about 210° ⁇ 10° relative to the base 2181 of the arm 102. In some embodiments, an end-effector 174 is able to be parallel to the base 2181 of the arm 102 or alternatively reach the base 2181 of the arm 102 when fully flexed.
• the Elbow Rotation joint range of motion shall be at least 200°, at least 250°, at least 300°, at least 310°, at least 320°, at least 330°, at least 350° or about 360°.
• Fig. 3C shows an arm 102 with flexion of elbow joint 2103 of more than 180° rotated from the unflexed orientation indicated in Fig. 3B, so as to bring the arm 102 to a retroflex configuration or, equivalently, retroflex position, and so as to deliver end effector 174 to a retroflex operation position.
• the retroflexion of a surgical arm can be done automatically, i.e., by arranging the arm to respond to a single or limited number of electronic control-outputs by flexing and/or rotating a single arm joint until a pre programmed retroflex position of the arm and/or of an end effector at the distal end of the arm is achieved.
• Fig. 4 shows, in front perspective, an arm 102 with elbow joint 2103 flexed similarly to elbow joint 2103a in scenario A of Fig. 3B, and subsequently rotated - i.e., elbow joint 2103 in Fig. 4 is both flexed and rotated.
• the rotation of any arm joint can be independent of the flexion of the same arm joint.
• the flexion and rotation can be simultaneous, and in other embodiments, a restriction of non-simultaneity can be enforced, for example by hardware design or by a software component of control circuitry governing the actuation of the joint.
• Fig. 5 shows, in front perspective, an arm 102 with elbow joint 2103 flexed and rotated similar to that of Fig. 4, and with shoulder joint 2101 flexed so as to form, together with elbow joint 2101, a complex “S” shape.
• the shoulder joint 2101 is preferably actuated to flex and rotate only after the flexing of the elbow joint 2103 has ‘cleared’ the obstacle
• FIG. 6 a flowchart of a general method is shown for controlling surgical mechanical arms using different operating modes, according to some embodiments.
• a process for example as described herein may be implemented for various types of operations such as gynecologic, laparoscopic, otorhinolaryngology (ear, nose and throat) surgeries, carried out, at least in part, using one or more surgical mechanical arms inserted into the body of a patient.
• operations such as gynecologic, laparoscopic, otorhinolaryngology (ear, nose and throat) surgeries, carried out, at least in part, using one or more surgical mechanical arms inserted into the body of a patient.
• different operating modes can be characterized by different types of feedback to the user, for example, feedback sensed by a user controlling the surgical arms via one or more input devices.
• selecting and/or switching between operating modes is controlled by a user, e.g. a surgeon.
• selection of operating modes can be carried out via a user interface of the system, for example via a touch screen and/or via buttons or other input devices disposed on or in proximity to another input device, or a control console or display screen.
• selecting operating modes can be automatic, for example, carried out by suitable control circuitry, such as by a system controller or processor.
• selecting and/or switching an operating mode is triggered by and contingent upon: one or more of, and not exhaustively: identifying the current ‘anatomical’ position of the surgical arm or of the end effector of the arm, for example, by using electromechanical instruments such as encoders or other sensors (NOT SHOWN) associated with the actuators and/or motors (e.g. of 104 or 108) of the arms, or by accessing and analyzing images of arm 102 obtained by a camera - through image processing or visually, upon identifying a current position of the input device, upon performing a certain articulation of the surgical arms, upon receiving an indication of one or more position sensors of the surgical arms, upon a timed indication, for example by setting a time point by which an operating mode is changed.
• electromechanical instruments such as encoders or other sensors (NOT SHOWN) associated with the actuators and/or motors (e.g. of 104 or 108) of the arms, or by accessing and analyzing images of arm 102 obtained by a camera - through image processing or
• the flowchart in Fig. 6 describes a method of operating surgical mechanical arms using two operating modes, according to some embodiments.
• the method includes:
• Step SOI inserting and navigating surgical arm(s) to a predetermined location in a first operating mode.
• the surgical arms are introduced into the body and navigated to a selected anatomical location and/or to a selected arm position.
• the surgical arms may be introduced to the body via a natural body orifice (e.g., the vagina, anus, trachea, esophagus, ear canal) and/or via an incision.
• arm articulation is limited.
• one or more arm joints can be restricted or precluded from articulating (flexing and rotating).
• the arm comprises 3 joints: a shoulder joint, an elbow joint and a wrist joint that rotates but doesn’t flex, and one or two of the joints are prevented from articulating.
• only movement of the elbow joint is allowed, e.g. flexion, extension and/or rotation of the elbow joint, while the shoulder and wrist joint are restricted from moving.
• the arm as a whole is allowed to move linearly (including only linearly), such as to be advanced or retracted in a one dimensional movement.
• restriction of arm movement is achieved mechanically, for example by one or more locks (e.g. solenoid locks) affecting actuation of the arm joints. Additionally or alternatively, restriction of arm movement can be achieved by suitable circuitry, for example, by implementing software control functions that limit the extent of movement and/or the type of movement.
• limiting an extent of arm movement and/or restricting certain types of movement is performed in accordance with a current arm position, as indicated, for example, by one or more position sensors of the arm. In some embodiments, limiting an extent of arm movement and/or restricting certain types of movement is performed in accordance with a current anatomical location of the arms, for example as visualized by optical means (e.g. a camera introduced into the body, optionally along with the surgical arms).
• optical means e.g. a camera introduced into the body, optionally along with the surgical arms.
• Step S02 articulate surgical arm(s) to a base position in the first operating mode
• the surgical arm(s) is(are) articulated to a base position.
• the base position comprises a retroflected position of the arms, for example, when the arms are flexed by at least 120 degrees, at least 150 degrees, at least 180 degrees or intermediate, larger or smaller angles.
• the base position is one in which the arms are positioned to allow a user to perform surgical acts from a selected orientation (e.g. corresponding to an abdominal orientation) which the user may be more comfortable or familiar with.
• control of surgical arm movement in the first operating mode comprises robotic control.
• manipulation of an input device by a user in the first operating mode involves only limited types of user movement, for example, limited movement of an input device along a defined axis and/or pressing of buttons.
• moving the input device along a first defined axis actuates rotation of selected arm joint, e.g. elbow; moving the input device along a second defined axis actuates flexion of a selected arm joint, e.g. elbow; pushing one or more buttons actuates linear advancement or retraction of the surgical arm.
• manipulation of an input device by a user in the first operating mode is translated to the speed of movement of the surgical arm. For example, when the user moves an input device relative to the rest position of the input device, the extent to which the input device was moved relative to its rest position sets the relative speed of movement of the surgical arm.
• surgical arm movement is not as restricted as in the first operating mode.
• all arm joints shoulder, elbow, wrist
• the extent and/or speed of arm movement during the second operating mode is limited based on safety considerations, for example, not to damage surrounding tissue, not to perform a movement at a speed that is too high and may risk damage.
• control of the surgical arms at the second operating mode involves tele-operated control.
• displacement of an input device by the user is mimicked by a respective displacement of the surgical arm.
• the speed of displacement of an input device by the user is reflected in the respective speed of surgical arm movement.
• the arms are retracted outwardly from the patient body.
• retraction is performed in the first operating mode.
• the arms are straightened.
• a control console 118 can comprise a display screen 407, with input devices 405 positioned in proximity thereto - on opposite sides of screen 407 in the non-limiting example of Fig. 7.
• one or more of the surgical arm joints are restricted from movement, and only flexion and/or rotation of the elbow joint are enabled.
• linear movement of the surgical arm (as a single body) is also enabled, for example to advance or retract the arm.
• movement of the nipple 409 actuates flexion and/or rotation of the elbow joint.
• linear movement of the arm 102 is actuated by separate actuators, for example using another pair of input devices such as input devices 406, 408 which are implemented as push buttons disposed, in the illustrated example of Fig.
• buttons 406, 408 can be provided independently, or on (or in closer proximity to) the display screen 407.
• button 406 advances the surgical arm distally (e.g. in an abdominal direction) and button 408 retracts the surgical arm proximally.
• input devices 406, 408 may be used while in a first mode in which flexing and rotating arm joints that are not the elbow joint is precluded, as the linear motion does not require any flexing or rotating.
• other input devices such as avatar-input arms 411 provided for use in the second mode without any first-mode restrictions, are locked at a rest position, for example by solenoid locks.
• the rest position of the input arms 411 is selected as the retroflected position of the surgical arm 102, so that once the surgical arms 102 have been retroflected (e.g. using the thubmsticks), a user may pick up the avatar input arms 411 and continue the procedure directly.
• operation of the thumbsticks is disabled.
• the surgical arms 102 during insertion of the surgical arms 102 into the body of a patient 106, the surgical arms are straight, i.e., unflexed. In some cases insertion is via a cannula.
• the avatar input arms are at a rest position, which can be a locked position and which can be a retroflexed position.
• the surgeon may release the thumbsticks 405 and moves her hands to the avatar input arms 411.
• control over the surgical arms 102 can be automatically transferred or transitioned from the first user-input device 405 to the second 411, and the surgeon may continue the procedure using the avatar input arms 411.
• thumbstick 501 comprises a nipple 509, extending for example from a proximal end of the gripping handle 503.
• nipple 509 is shaped and/or sized for a user’s thumb.
• nipple 509 comprises a rounded profile.
• a proximal surface of the nipple 509 is formed with circumferential protrusions 511. The circumferential protrusions may assist in maintaining the thumb placed on the nipple 509, potentially preventing or reducing sliding of the thumb away from the nipple 509.
• the nipple 509 moves in a spring-like manner.
• the nipple 509 springs back to its central position.
• Fig. 9 is a schematic diagram illustrating an example of control of the thumb- operated input 501, according to some embodiments.
• moving (‘displacing’) the nipple 509 with respect to first axis actuates a first type of surgical arm movement, for example a flexion; and displacing the nipple 509 with respect to a second axis actuates a second type of surgical arm movement, for example rotation.
• the thumbsticks 501 are used during the first operation mode, when at least some of the joints are restricted, for example, the shoulder and wrist joints 2101, 2105.
• displacing the nipple 509 along the Y-axis generates flexion of an elbow joint 2103 of the surgical arm 102; and displacing the nipple 509 along the axis generates rotation of the elbow joint.
• actuation of simultaneous bending and rotation can be achieved by pushing the nipple relative to both axes, for example, diagonally relative to the center.
• FIGs. 10 and 11 side and front view images are shown of an exemplary avatar-like input arm 701 comprising multiple joints for actuating respective movement of surgical arm joints: as illustrated the joints include a shoulder joint 703, an elbow joint 705 and a wrist rotation knob 707 for controlling a wrist joint 2105 of a surgical arm 102.
• the joints include a shoulder joint 703, an elbow joint 705 and a wrist rotation knob 707 for controlling a wrist joint 2105 of a surgical arm 102.
• a set of two avatar input arms are provided, for controlling left and right arms respectively.
• a first avatar input arm 701 can control a first motor unit 108 associated with a first surgical arm 102 (e.g. a “right” arm) and a second avatar input arm 701 can control a second motor unit 108 associated with a second surgical arm 102 (e.g. a “left” arm).
• any or all of input arms 120, 411 and 701 can be the same.
• a first mode and a second mode both use the same input device, an avatar-like input arm.
• an avatar-like or joystick-like input device be wholly or almost wholly or mostly comprised of a hand-operated and/or hand-graspable handle member.
• a handle member can incorporate multiple operating functions in its design by including, and not exhaustively, buttons, switches, toggles, wheels, knobs, and/or small sticks such as thumbsticks so as to ‘combine’ multiple input devices and their respective functions into what appears visually to be a single input device.
• the repeated presentation herein of the input device 701 and handle member 702 of Fig. 10 is for convenience and easier comprehension, and should not be understood as a limitation of input device and handle member design.
• each line of the slot represents a different type of articulation, for example, the horizontal line 803 represents rotation of the joint; the vertical 805 line represents flexion of the joint.
• a user manipulates the input device according to the joint position indicated at the cross by the two colored dots 807. As the position of the input device (in response to manipulation by the user) becomes closer to that of the surgical mechanical arm, the colored dots move closer to the center of the cross (see FIG. 12B).
• the dots change color, for example, from red to green as indicated in Figs. 12A-B.
• control apparatus of Figs. 12A and 12B can be used in an alignment calibration as part of a transitioning from a first mode using a first input device to a second mode using the avatar-like input arm.
• the first input device can be used to adjust the position of the surgical arm so as to align with a fixed position of the input arm.
• FIG. 13 is an example of a screen displayed to the user during alignment, according to some embodiments.
• a first input device (such as corresponding with the right avatar arm) is shown to be properly aligned with the first surgical arm, as indicated for example by the checkmarks 809 at the position of both the elbow and shoulder joints, and/or by the locked lock 811.
• a second input device (such as corresponding with the left arm) is shown at a position in which it is not yet aligned with the surgical arm.
• the joint position is represented by the two cross shaped diagrams, for example as described hereinabove, and the lock is unlocked.
• Figs. 14A-E show a set of images showing exemplary control of surgical mechanical arms using a plurality of different input devices, according to some embodiments. Two arms are shown in the non-limiting example of Figs. 14A-E, and in other examples there can be a single arm or more than 2 arms.
• Fig. 14A shows control of two surgical mechanical arms 901 during introducing of the arms into a model 903 simulating access to the body via the vagina, according to some embodiments.
• control of the surgical arms 901 during advancing of the arms into the body is via thumb-operated input, including a set of thumbsticks 905 for example as described hereinabove.
• Fig. 14B shows manipulation of the surgical arms, via the thumbsticks 905, into a retroflected position.
• the arms are flexed (e.g. by 120, 150, 180, 210 degrees or intermediate, larger or smaller angles) to obtain the retroflected position.
• FIG. 14C shows the surgical arms in a retroflex position. Following retroflection, a user may, in some examples, switch the input device used, for example by releasing the thumbsticks and picks up avatar input arms. At this point, alignment of the avatar input arms with current a position of the surgical arms can be performed, for example as described in Figs. 12A-B and 13.
• Figs. 14D and 14E show maneuvering of the surgical arms using a set of avatar input arms 907, according to some embodiments. It can be seen that the respective positions of the surgical arms correspond to the positions of the input arms.
• FIG. 15 The block diagram of Fig. 15 shows articulated arm 102, input-device array 1500, and detector 1520.
• input-device array 1500 as illustrated in Fig. 15 shows two user input devices 1510A (e.g. thumbstick 501), 1510B (e.g. joystick 701)
• the joystick 701 can be both the first user-input device 1510A and the second user-input device 1510B; in other words, the first user-input device 1510A and the second user-input device 1510B can be the same single user-input device.
• the term “user-input device ” relates to a device for converting input received by a user into electronic output and/or signals. Examples of user-input devices include but are not limited to joysticks, touch screens, thumbsticks, mouse, keyboards, gesture detection devices (e.g. including a camera [not shown]). Unless specified otherwise, the term “array” relates to one or more of an item.
• articulated arm 102 has one or more objects 1530 mounted at a distal end thereof.
• the object(s) 1530 can be provided with the arm 102 or can be added or exchanged separately.
• Examples of such objects 1530 include but are not limited to end effectors, e.g., surgical end effectors.
• surgical tools can include, and not exhaustively: an endoscope for diagnostic/surgical feedback, surgical end effector tools such as a needle driver (e.g., large needle driver, curved needle driver), mono and bipolar instruments (e.g., monopolar scissors, bipolar forceps), clip appliers (e.g., large and medium clip appliers), vessel sealers, graspers or dissectors (e.g., Maryland dissectors, Tenacululm forceps, micro forceps, long tip forceps, grasping retractors, Fundus graspers, Crocodile graspers, Cadiere forceps, ), scissors (e.g., Potts Scissors, curved scissors), hooks (e.g., cautery hook)., and spatulas (e.g., cautery spatula).
• a needle driver e.g., large needle driver, curved needle driver
• mono and bipolar instruments e.g., monopolar scissors, bipolar forceps
• clip appliers e.g.
• arm 102 and/or object(s) 1530 operate responsive to electronic control output of one or more of the control device(s).
• control output and ‘control signal’ are used synonymously.
• the control output may be sent to arm 102 and/or to a controller thereof via wired and/or wireless communication.
• detector 1520 detects whether or not a portion (e.g. distal portion) of arm 102 is retroflexed and/or in a retroflex position.
• detector 1520 may acquire an image of arm 102 and detector 1520 the camera and image-processing circuitry.
• encoders not shown
• other electromechanical sensors e.g.
• step S101 may provide the one or more of the following features, singly or in combination:
• configuration of the arm is controlled by output of a user input device (e.g. a thumbstick device 501) such that a magnitude (i.e. magnitude of the displacement from a base position and/or initial and/or starting and/or center position) as opposed to a speed of the displacement) of a displacement of an user input device or of a displaceable portion (e.g. located on tiltable nipple 409 or 509) thereof is translated to a speed of a flexion and/or of a rotation of an arm joint such as elbow 2103;
• a user input device e.g. a thumbstick device 501
• a magnitude i.e. magnitude of the displacement from a base position and/or initial and/or starting and/or center position
• a displaceable portion e.g. located on tiltable nipple 409 or 509
• step S121 may provide the one or more of the following features, singly or in combination:
• a configuration of the arm 102 is controlled by output of user-input device 1510B such that a magnitude of a displacement of the given input device or of a displaceable portion thereof is translated to a corresponding displacement of at least one portion of the arm and/or of at least one arm segment of the arm - for example, in Fig. 10 a displacement of shoulder element 703 of joystick 701 may be translated into a corresponding displacement of shoulder joint 2101 of arm 102 and/or for example, in Fig.
• a first input device 1510A e.g. thumbstick
• a second input device 1510B e.g. joystick
• the input-device array 1500 controls actuation of the plurality of arm joints (e.g. elbow 2103 and shoulder 2101) while the surgical system is in the second operating mode.
• the array of input devices includes first 1510A (e.g. thumbstick 501) and second 1510B (e.g. joystick 701) input devices; (ii) the first input device is configured for controlling actuation of the single arm joint (e.g. elbow 2103) and is not configured for controlling actuation of arm joints (e.g. shoulder 2101, etc) other than the single arm joint (e.g. elbow 2103); (iii) the second input device controls actuation of the plurality of arm joints (e.g.
• the control circuity is effective, while the surgical system is in the first operating mode, to achieve the restricting by permitting control of the arm 102 by the first input device 1510A while disabling control of the arm by the second input device 1510B.
• the transition from the first operating mode to second operating mode may ‘handoff control from the first 1510A to the second 1510B user input devices.
• a first embodiments relates to a method of operating a surgical system comprising (i) an input-device array of one or more user-input devices and (ii) an articulated mechanical arm comprising a surgical end effector at a distal end thereof and a plurality of arm joints configured to flex and rotate in response to an electronic control-output from said user- input device, the method comprising: (a) commencing operation of the surgical system in a first operating mode S101 defined with respect to a given single one (e.g. elbow 2103) of the arm joints, wherein the first mode precludes actuation of any arm joint (e.g. including shoulder 2101) of the arm that is not the given single arm joint, and permits controlling the actuation of the single arm (e.g.
• elbow 2103) joint to cause a flexion of and a rotation of the single arm joint (e.g. elbow 2103); (b) while the surgical system is in the first operating mode (e.g. of S101), (i) retroflexing the distal end of the arm by flexion and rotation of the single arm joint (e.g. elbow 2103), in response to control signals generated by one or more of the user-input devices (e.g. thumbstick 501), so as to bring the end effector 174 to a retroflex operating position, and (ii)monitoring a status (e.g.
• step S109 of the mechanical arm 102 to detect whether or not the arm is in a retroflex position; (c) in response to and contingent upon (in step S113) detecting that the arm 102 is in a retroflex position, transitioning operation (e.g. ‘yes branch’ from SI 13 to S121) of the surgical system from the first mode to a second mode in which the system is enabled to control flexing and rotating of at least one first-mode-precluded arm joint (e.g. elbow 2103) in accordance with respective degrees of freedom of each arm joint; and (d) operating the surgical system in the second mode (e.g. in S121) so as to perform a surgical action using the end effector.
• transitioning operation e.g. ‘yes branch’ from SI 13 to S121
• a second mode in which the system is enabled to control flexing and rotating of at least one first-mode-precluded arm joint (e.g. elbow 2103) in accordance with respective degrees of freedom of each arm joint
• operating the surgical system in the second mode e
• a method of operating a surgical system comprising (i) first 1510A (e.g. thumbstick 501) and second 1510B (e.g. joystick 701) user-input devices, and (ii) an articulated mechanical arm 102 comprising a plurality of arm joints (e.g. elbow 2103 and shoulder 2101), and a surgical end effector 174 at the distal end of the arm, the method comprising: (a) commencing operation of the surgical system in a retroflexing mode (e.g. first mode of S101) wherein, with respect to flexing and rotation of the arm joints: (i) the first 1510A (e.g.
• thumbstick 501) user-input device is active to direct flexion and rotation of only a given one of the arm joints, and (ii) the second 1510B (e.g. joystick 701) user-input device is disabled; (b) while in the retroflexing mode by flexion and rotation of the given one (e.g. elbow 2013) of the arm joints, retroflecting a distal portion of the articulated mechanical arm, responsive to electronic control-output from the first user-input device 1510A so as to bring the end effector to a retroflex operating position; (c) transitioning the surgical system from the retroflexing mode to a surgical-operation mode to enable the second user- input device 1510B with respect to flexing and rotating at least one (e.g.
• elbow 2103 of the arm joints; (b) while in the retroflexing mode, retroflecting a distal portion of the articulated mechanical arm by flexion and rotation of the given one of arm joints, responsive to electronic control-output from the input-device array, so as to bring the end effector to a retroflex operating position; (c) transitioning the surgical system from the retroflex mode to the surgical-operation mode to enable the input-device array with respect to flexing and rotating of the arm joints other than the given one of the arm joints; and (d) while in the surgical-operation mode, effect flexing and rotating of at least two (e.b. at least both elbow 2013 and shoulder 2101) of the arm joints in accordance with respective degrees of freedom of each arm joint, responsive to electronic control-output from the input-device array, to thereby move the surgical end-effector to perform one or more surgical actions.
• at least two e.b. at least both elbow 2013 and shoulder 2101
• a method of operating a surgical system comprising (i) a user-input device (e.g. joystick 701), and (ii) an articulated mechanical arm 102 comprising a plurality of arm joints, and surgical end effector at a distal end of the arm, the method comprising: (a) commencing operation of the surgical system in a retroflexing mode (e.g. S101) wherein, with respect to flexing and rotation of the arm joints, the user-input device is active to direct flexion and rotation of only a given one (e.g.
• a retroflexing mode e.g. S101
• navigating comprises retroflecting the surgical mechanical arms within the patient’s body.
• the surgical mechanical arms are controlled by thumb operated input.
• the surgical arms are controlled by avatar input arms.
• the surgical mechanical arms are controlled by haptic handles during both the first and the second modes of operation.
• a clutch-like mode is enabled, disconnecting control of the surgical arm by the one or more input device.
• a control console for control of one or more surgical mechanical arms comprising: thumb operated input for controlling the first mode of operation; hand operated input for controlling the second mode of operation; and a screen interface.
• a method for operating a patient comprising: introducing one or more surgical arms through the vagina into the abdominal cavity; bending the one or more surgical arms to a retroflected position, wherein during introducing and bending, articulation of the one or more surgical arms is limited to linear movement and to movement of a single arm joint only; and operating within the abdominal cavity using the one or more surgical arms in the retroflected position.
• the first mode is controlled by a set of thumbsticks.
• an extent of pushing of a nipple of each thumbstick relative to a central rest position of the nipple affects a speed in which an arm articulation takes place.
• the nipple springs back to its rest position when the user lifts their thumb.
• the second operation mode is controlled using a set of avatar input arms, manipulated by the user’s hands.
• some embodiments include dual-control of the surgical arms.
• a first user input in this example, thumbsticks 4005 of Fig. 17B
• retroflecting for example, bending backwards
• retroflecting is performed to reduce an area within which the surgical arm is located.
• retroflecting is performed during a surgical procedure to avoid obstacles such as certain organs or portions thereof, for example, an inner wall of the abdomen.
• retroflecting is performed to position the surgical arms at an orientation in which a laparoscopic surgeon is familiar with, for carrying out the operation.
• one or more of the surgical arm joints are restricted from movement.
• all surgical arm joints except an elbow joint are prevented from moving, and only flexion and/or rotation of the elbow joint are enabled.
• linear movement of the surgical arm (as a single body) is also enabled, for example to advance or retract the arm.
• movement of the nipple actuates flexion and/or rotation of the elbow joint.
• linear movement of the arm is actuated by separate actuators, for example using push buttons such as 4006, 4008, configured for example along a body of the thumbstick 4005.
• button 4006 advances the surgical arm distally (e.g. into the abdomen); button 4008 retracts the surgical arm proximally.
• the surgical arms are straight (optionally to provide for insertion via a cannula), while the input arms are at a rest, locked, retroflected position.
• the surgeon releases the thumbsticks and moves their hands to the input arms. Once the input arms are grasped and optionally lifted by the surgeon, control over the surgical arms is automatically gained, and the surgeon may continue the procedure using the input arms.
• lifting of the input arm by the surgeon automatically releases the solenoid locks.
• manual locks of the input arm joints are released, for example via a sensor that detects an input arm position.
• the haptic handles are programmed to operate according to various control modes.
• the control mode is selected in accordance with a current stage in the surgical operation.
• switching between different modes is performed via one or more of a screen interface, one or more buttons on the control console or handles, a foot pedal, and/or other.

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• Surgery (AREA)
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• Animal Behavior & Ethology (AREA)
• General Health & Medical Sciences (AREA)
• Biomedical Technology (AREA)
• Veterinary Medicine (AREA)
• Mechanical Engineering (AREA)
• Oral & Maxillofacial Surgery (AREA)
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• Human Computer Interaction (AREA)
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• 2020
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