WO2026015700A1 - Surgical robotic system for controlling laparoscopic and endoluminal instruments - Google Patents

Abstract

A combined endoluminal robotic (ELR) and laparoscopic surgical robotic system includes a control tower and a surgeon console operatively connected to the control tower. The surgeon console includes a display screen for visualizing surgical sites, a user interface device for receiving input commands, and a processor configured to process the input commands into movement commands. The system also includes a first laparoscopic robotic arm having a laparoscopic surgical instrument and a laparoscopic arm controller and an endoluminal robotic (ELR) arm including a flexible, steerable ELR surgical instrument and an ELR arm controller. The system also includes a communication network and a processor running software configured to: receive user inputs from the surgeon console; process the user inputs to generate movement commands; transmit the movement commands to the laparoscopic arm controller and the ELR arm controller; provide switching control between the laparoscopic robotic arm and the ELR arm; and provide coordinated control of the laparoscopic and ELR surgical instruments during surgical procedures.

Description

SURGICAL ROBOTIC SYSTEM FOR CONTROLLING LAPAROSCOPIC AND ENDOLUMINAL INSTRUMENTS

CROSS REFERENCE TO RELATED APPLICATIONS

[0001] This application claims the benefit of and priority to U.S. Provisional Application No. 63/669,722, filed July 11, 2024; U.S. Provisional Application No. 63/669,882, filed July 11, 2024; and U.S. Provisional Application No. 63/673,314, filed July 19, 2024. The entire disclosures of the foregoing applications are incorporated by reference herein.

BACKGROUND

[0002] Surgical robotic systems are currently being used in a variety of surgical procedures, including laparoscopic and endoluminal minimally invasive procedures. Laparoscopic surgical robotic systems include a surgeon console for controlling a surgical robotic arm and a surgical instrument having an end effector (e.g., forceps or grasping instrument coupled to and actuated by the robotic arm). In operation, the robotic arm is moved to a position over a patient and then guides the surgical instrument into a small incision via a surgical port to position the end effector at a work site within the patient’s body. The robotic arm and the instrument are actuated using motors, which may be controlled using various parameters. Such instruments generally have rigid shafts with optionally articulating end effectors. As a result of mechanical constraints, positioning the instruments within the patient may be accomplished by moving one or more links of the arm.

[0003] Endoluminal robotic (ELR) surgical systems insert instruments through a natural orifice of a patient. Instruments used with ELR systems are flexible and may include catheters or singlechannel or multi-channel robotic endoscopic instruments. However, due to different types of instruments using different types of mechanical movement (e.g., articulating an end effector vs. advancing a sheathed instrument), laparoscopic multiport systems and ELR systems use different types of input controls and interfaces. Thus, there is a need for a surgical robotic system that uses endoluminal robotic instruments with laparoscopic single or multi-port surgical robotic arms.

SUMMARY

[0004] The present disclosure provides different methods for combined use of a multi-port minimally invasive surgical robotic platform and an endoluminal robotics (ELR) platform that are part of the same system. A surgeon console may be used to control each of the different robotic platforms. [0005] According to one embodiment of the present disclosure, a combined endoluminal robotic (ELR) and laparoscopic surgical robotic system is disclosed. The system includes a control tower and a surgeon console operatively connected to the control tower. The surgeon console includes a display screen for visualizing surgical sites, a user interface device for receiving input commands, and a processor configured to process the input commands into movement commands. The system also includes a first laparoscopic robotic arm having a laparoscopic surgical instrument and a laparoscopic arm controller configured to control movement of the laparoscopic robotic arm and the laparoscopic surgical instrument. The system further includes an endoluminal robotic (ELR) arm including a flexible, steerable ELR surgical instrument and an ELR arm controller configured to control movement of the ELR robotic arm and the ELR surgical instrument. The system also includes a communication network operatively connecting and enabling data transmission between the control tower, the surgeon console, the laparoscopic robotic arm, and the ELR arm. The system additionally includes a processor running software configured to: receive user inputs from the surgeon console; process the user inputs to generate movement commands; transmit the movement commands to the laparoscopic arm controller and the ELR arm controller; provide switching control between the laparoscopic robotic arm and the ELR arm; and provide coordinated control of the laparoscopic and ELR surgical instruments during surgical procedures.

[0006] Implementations of the above embodiment may include one or more of the following features. According to one aspect of the above embodiment, the user interface device may include at least one of a foot pedal, a handle controller, or a touch screen. The user interface device may be remappable between controlling the laparoscopic surgical instrument and controlling the ELR surgical instrument. The system may also include a phase detection system configured to identify phases of a surgical procedure based on received surgical data and automatically switch between controlling the ELR and laparoscopic surgical instruments based on the identified surgical phase. The ELR surgical instrument may include a multi-channel flexible shaft, at least one end effector disposed at a distal end of the flexible shaft, a videoscope including a camera for capturing images of the surgical site and configured to generate endoluminal video feed, and at least one light for illuminating the surgical site. The system may further include a second laparoscopic robotic arm having a laparoscopic camera configured to generate a laparoscopic video feed. The processor may be further configured to display the endoluminal and laparoscopic video feeds simultaneously in an overlay, side-by-side, or picture-in-picture format on the display screen. The processor may be further configured to implement an image processing algorithm to maintain brightness and focal points during switching between the endoluminal video feed and the laparoscopic video feed. The processor may be also configured to switch between displaying the endoluminal video feed and the laparoscopic video feed on the display screen.

BRIEF DESCRIPTION OF THE DRAWINGS

[0007] Various embodiments of the present disclosure are described herein with reference to the drawings wherein:

[0008] FIG. 1 is a perspective view of a surgical robotic system including a control tower, a console, and one or more surgical robotic arms each disposed on a movable cart according to an embodiment of the present disclosure;

[0009] FIG. 2 is a perspective view of a surgical robotic arm of the surgical robotic system of FIG.

1 according to an embodiment of the present disclosure;

[0010] FIG. 3 is a perspective view of a movable cart having a setup arm with the surgical robotic arm of the surgical robotic system of FIG. 1 according to an embodiment of the present disclosure; [0011] FIG. 4 is a schematic diagram of a computer architecture of the surgical robotic system of FIG. 1 according to an embodiment of the present disclosure;

[0012] FIG. 5 is a plan schematic view of movable carts of FIG. 1 positioned about a surgical table according to an aspect of the present disclosure;

[0013] FIG. 6 is a schematic diagram of a system for determining phases of a surgical procedure according to an embodiment of the present disclosure;

[0014] FIG. 7 is a perspective view of the surgical robotic system with an ELR arm including an ELR instrument according to an embodiment of the present disclosure;

[0015] FIG. 8 is a side view of an IDU of an ELR instrument according to an embodiment of the present disclosure;

[0016] FIG. 9 is a perspective view of a distal end portion of ELR instrument according to an embodiment of the present disclosure;

[0017] FIG. 10 shows a perspective view of the laparoscopic and ELR instruments in operation instrument according to an embodiment of the present disclosure;

[0018] FIGS. HA and 11B show representative rendered views of the laparoscopic and ELR instruments in operation instrument according to an embodiment of the present disclosure; [0019] FIGS. 12A and 12B show views from a videoscope of the ELR instrument with and without overlays representing laparoscopic instrument and camera according to an embodiment of the present disclosure;

[0020] FIG. 13 shows view from the laparoscopic camera with and without overlays representing the ELR instrument according to an embodiment of the present disclosure;

[0021] FIG. 14 shows representative rendered views of the laparoscopic and ELR instruments in operation according to an embodiment of the present disclosure;

[0022] FIG. 15 shows a view from the laparoscopic camera with overlays representing the directions with respect to both laparoscopic and endoscopic views according to an embodiment of the present disclosure; and

[0023] FIG. 16 shows view from the endoscopic camera with overlays representing the directions with respect to both laparoscopic and endoscopic views according to an embodiment of the present disclosure.

DETAILED DESCRIPTION

[0024] Embodiments of the presently disclosed surgical robotic system are described in detail with reference to the drawings, in which like reference numerals designate identical or corresponding elements in each of the several views.

[0025] As will be described in detail below, the present disclosure is directed to a surgical robotic system that combines use of a multi-port minimally invasive surgical robotic platform and an endoluminal robotics (ELR) platform in the same system. The system includes a surgeon console, a control tower, and one or more movable carts having a laparoscopic robotic arm having a laparoscopic surgical instrument and an endoluminal robotic (ELR) arm including a flexible, steerable ELR surgical instrument. The surgeon console receives user input through one or more interface devices. The input is processed by the control tower as movement commands for moving the robotic arms and an instrument and/or camera coupled thereto. Thus, the surgeon console enables teleoperation of the robotic arms and attached instruments/camera. The robotic arms each include a controller, which is configured to process the movement commands and to move the robotic arms in response to the movement commands.

[0026] With reference to FIG. 1, a surgical robotic system 10 includes a control tower 20, which is connected to all of the components of the surgical robotic system 10 including a surgeon console 30 and one or more movable carts 60. Each of the movable carts 60 includes a robotic arm 40 having a surgical instrument 50 coupled thereto (e.g., a laparoscopic robotic arms having a laparoscopic instrument or an ELR robotic arm having an ELR instrument). The robotic arms 40 also couple to the movable carts 60. The robotic system 10 may include any number of movable carts 60 and/or robotic arms 40.

[0027] The surgical instrument 50 is configured for use during minimally invasive surgical procedures. In embodiments, the surgical instrument 50 may be configured for open surgical procedures. In further embodiments, the surgical instrument 50 may be an electrosurgical forceps configured to seal tissue by compressing tissue between jaw members and applying electrosurgical current thereto. In yet further embodiments, the surgical instrument 50 may be a surgical stapler including a pair of jaws configured to grasp and clamp tissue while deploying a plurality of tissue fasteners, e g., staples, and cutting stapled tissue. In yet further embodiments, the surgical instrument 50 may be a surgical clip applier including a pair of jaws configured to apply a surgical clip onto tissue. However, it will be understood that various types of surgical instruments for use during minimally invasive surgical procedures are contemplated and within the scope of this disclosure.

[0028] One of the robotic arms 40 may include a laparoscopic camera 51 configured to capture video of the surgical site. The camera 51 may be a stereoscopic endoscope configured to capture two side-by-side (i.e., left and right) images of the surgical site to produce a video stream of the surgical scene. The camera 51 is coupled to a video processing device 56, which may be disposed within the control tower 20. The video processing device 56 may be any computing device as described below configured to receive the video feed from the camera 51 and output the processed video stream.

[0029] The surgeon console 30 includes a first display 32, which displays a video feed of the surgical site provided by camera 51 disposed on the robotic arm 40, and a second display 34, which displays a user interface for controlling the surgical robotic system 10. The first display 32 and second display 34 may be touchscreens allowing for displaying various graphical user inputs.

[0030] The surgeon console 30 also includes a plurality of user interface devices, such as foot pedals 36 and a pair of handle controllers 38a and 38b which are used by a user to remotely control robotic arms 40. The surgeon console further includes an armrest 33 used to support clinician’s arms while operating the handle controllers 38a and 38b. [0031] The control tower 20 includes a display 23, which may be a touchscreen that may display the graphical user interfaces (GUIs). The control tower 20 also acts as an interface between the surgeon console 30 and one or more robotic arms 40. In particular, the control tower 20 is configured to control the robotic arms 40, such as to move the robotic arms 40 and the corresponding surgical instrument 50, based on a set of programmable instructions and/or input commands from the surgeon console 30, in such a way that robotic arms 40 and the surgical instrument 50 execute a desired movement sequence in response to input from the foot pedals 36 and the handle controllers 38a and 38b. The foot pedals 36 may be used to enable and lock the handle controllers 38a and 38b, repositioning camera movement and electrosurgical activation/deactivation. In particular, the foot pedals 36 may be used to perform a clutching action on the handle controllers 38a and 38b. Clutching is initiated by pressing one of the foot pedals 36, which disconnects (i.e., prevents movement inputs) the handle controllers 38a and/or 38b from the robotic arm 40 and corresponding instrument 50 or camera 51 attached thereto. This allows the user to reposition the handle controllers 38a and 38b without moving the robotic arm(s) 40 and the instrument 50 and/or camera 51. This is useful when reaching control boundaries of the surgical space.

[0032] Each of the control tower 20, the surgeon console 30, and the robotic arm 40 includes a respective computer 21, 31, 41. The computers 21, 31, 41 are interconnected to each other using any suitable communication network based on wired or wireless communication protocols. The term “network,” whether plural or singular, as used herein, denotes a data network, including, but not limited to, the Internet, Intranet, a wide area network, or a local area network, and without limitation as to the full scope of the definition of communication networks as encompassed by the present disclosure. Suitable protocols include, but are not limited to, transmission control protocol/internet protocol (TCP/IP), datagram protocol/internet protocol (UDP/IP), and/or datagram congestion control protocol (DCCP). Wireless communication may be achieved via one or more wireless configurations, e.g., radio frequency, optical, Wi-Fi, Bluetooth (an open wireless protocol for exchanging data over short distances, using short length radio waves, from fixed and mobile devices, creating personal area networks (PANs), ZigBee® (a specification for a suite of high level communication protocols using small, low-power digital radios based on the IEEE 122.15.4-1203 standard for wireless personal area networks (WPANs)). [0033] The computers 21, 31, 41 may include any suitable processor (not shown) operably connected to a memory (not shown), which may include one or more of volatile, non-volatile, magnetic, optical, or electrical media, such as read-only memory (ROM), random access memory (RAM), electrically erasable programmable ROM (EEPROM), non-volatile RAM (NVRAM), or flash memory. The processor may be any suitable processor (e.g., control circuit) adapted to perform the operations, calculations, and/or set of instructions described in the present disclosure including, but not limited to, a hardware processor, a field programmable gate array (FPGA), a digital signal processor (DSP), a central processing unit (CPU), a microprocessor, and combinations thereof. Those skilled in the art will appreciate that the processor may be substituted by using any logic processor (e.g., control circuit) adapted to execute algorithms, calculations, and/or set of instructions described herein.

[0034] With reference to FIG. 2, each of the robotic arms 40 may include a plurality of links 42a, 42b, 42c, which are interconnected at joints 44a, 44b, 44c, respectively. Other configurations of links and joints may be utilized as known by those skilled in the art. The joint 44a is configured to secure the robotic arm 40 to the movable cart 60 and defines a first longitudinal axis. With reference to FIG. 3, the movable cart 60 includes a lift 67 and a setup arm 61, which provides a base for mounting of the robotic arm 40. The lift 67 allows for vertical movement of the setup arm 61. The movable cart 60 also includes a display 69 for displaying information pertaining to the robotic arm 40. In embodiments, the robotic arm 40 may include any type and/or number of joints.

[0035] The setup arm 61 includes a first link 62a, a second link 62b, and a third link 62c, which provide for lateral maneuverability of the robotic arm 40. The links 62a, 62b, 62c are interconnected at joints 63a and 63b, each of which may include a motor (not shown) for rotating the links 62b and 62b relative to each other and the link 62c. In particular, the links 62a, 62b, 62c are movable in their corresponding lateral planes that are parallel to each other, thereby allowing for extension of the robotic arm 40 relative to the patient (e.g., surgical table). In embodiments, the robotic arm 40 may be coupled to the surgical table (not shown). The setup arm 61 includes controls 65 for adjusting movement of the links 62a, 62b, 62c as well as the lift 67. In embodiments, the setup arm 61 may include any type and/or number of joints.

[0036] The third link 62c may include a rotatable base 64 having two degrees of freedom. In particular, the rotatable base 64 includes a first motor 64a and a second motor 64b. The first motor 64a is rotatable about a first stationary arm axis which is perpendicular to a plane defined by the third link 62c and the second motor 64b is rotatable about a second stationary arm axis which is transverse to the first stationary arm axis. The first and second motors 64a and 64b allow for full three-dimensional orientation of the robotic arm 40.

[0037] The motor 48b of the joint 44b is coupled to the joint 44c via the belt 45a, and the joint 44c is in turn coupled to the joint 46b via the belt 45b. Joint 44c may include a transfer case coupling the belts 45a and 45b, such that the motor 48b is configured to rotate each of the links 42b, 42c and a holder 46 relative to each other. More specifically, links 42b, 42c, and the holder 46 are passively coupled to the motor 48b which enforces rotation about a pivot point “P” which lies at an intersection of the first axis defined by the link 42a and the second axis defined by the holder 46. In other words, the pivot point “P” is a remote center of motion (RCM) for the robotic arm 40. Thus, the motor 48b controls the angle 0 between the first and second axes allowing for orientation of the surgical instrument 50. Due to the interlinking of the links 42a, 42b, 42c, and the holder 46 via the belts 45a and 45b, the angles between the links 42a, 42b, 42c, and the holder 46 are also adjusted in order to achieve the desired angle 0. In embodiments, some or all of the joints 44a, 44b, 44c may include a motor to obviate the need for mechanical linkages.

[0038] The joints 44a and 44b include a motor 48a and 48b configured to drive the joints 44a, 44b, 44c relative to each other through a series of belts 45a and 45b or other mechanical linkages such as a drive rod, a cable, or a lever and the like. In particular, the motor 48a is configured to rotate the robotic arm 40 about a longitudinal axis defined by the link 42a.

[0039] With reference to FIG. 2, the holder 46 defines a second longitudinal axis and configured to receive an instrument drive unit (IDU) 52 (FIG. 1). The IDU 52 is configured to couple to an actuation mechanism of the surgical instrument 50 and the camera 51 and is configured to move (e g., rotate) and actuate the instrument 50 and/or the camera 51. IDU 52 transfers actuation forces from its motors to the surgical instrument 50 to actuate components of an end effector 49 of the surgical instrument 50. The holder 46 includes a sliding mechanism 46a, which is configured to move the IDU 52 along the second longitudinal axis defined by the holder 46. The holder 46 also includes a joint 46b, which rotates the holder 46 relative to the link 42c. During endoscopic procedures, the instrument 50 may be inserted through an endoscopic access port 55 (FIG. 3) held by the holder 46. The holder 46 also includes a port latch 46c for securing the access port 55 to the holder 46 (FIG. 2). [0040] The TDU 52 is attached to the holder 46, followed by a sterile interface module (STM) 43 being attached to a distal portion of the IDU 52. The SIM 43 is configured to secure a sterile drape (not shown) to the IDU 52. The instrument 50 is then attached to the SIM 43. The instrument 50 is then inserted through the access port 55 by moving the IDU 52 along the holder 46. The SIM 43 includes a plurality of drive shafts configured to transmit rotation of individual motors of the IDU 52 to the instrument 50 thereby actuating the instrument 50. In addition, the SIM 43 provides a sterile barrier between the instrument 50 and the other components of robotic arm 40, including the IDU 52.

[0041] The robotic arm 40 also includes a plurality of manual override buttons 53 (FIG. 1) disposed on the IDU 52 and the setup arm 61, which may be used in a manual mode. The user may press one or more of the buttons 53 to move the component associated with the one or more buttons 53.

[0042] With reference to FIG. 4, each of the computers 21, 31, 41 of the surgical robotic system 10 may include a plurality of controllers, which may be embodied in hardware and/or software. The computer 21 of the control tower 20 includes a controller 21a and safety observer 21b. The controller 21a receives data from the computer 31 of the surgeon console 30 about the current position and/or orientation of the handle controllers 38a and 38b and the state of the foot pedals 36 and other buttons. The controller 21a processes these input positions to determine desired drive commands for each joint of the robotic arm 40 and/or the IDU 52 and communicates these to the computer 41 of the robotic arm 40. The controller 21a also receives the actual joint angles measured by encoders of the motors 48a and 48b and uses this information to determine force feedback commands that are transmitted back to the computer 31 of the surgeon console 30 to provide haptic feedback through the handle controllers 38a and 38b. The safety observer 21b performs validity checks on the data going into and out of the controller 21a and notifies a system fault handler if errors in the data transmission are detected to place the computer 21 and/or the surgical robotic system 10 into a safe state.

[0043] The computer 41 includes a plurality of controllers, namely, a main cart controller 41a, a setup arm controller 41b, a robotic arm controller 41c, and an instrument drive unit (IDU) controller 4 Id. The main cart controller 41a receives and processes joint commands from the controller 21a of the computer 21 and communicates them to the setup arm controller 41b, the robotic arm controller 41c, and the IDU controller 4 Id. The main cart controller 41a also manages instrument exchanges and the overall state of the movable cart 60, the robotic arm 40, and the IDU 52. The main cart controller 41a also communicates actual joint angles back to the controller 21a. [0044] Each of joints 63 a and 63b and the rotatable base 64 of the setup arm 61 are passive joints (i.e., no motors are present therein) allowing for manual adjustment thereof by a user. The joints 63a and 63b and the rotatable base 64 include brakes that are disengaged by the user to configure the setup arm 61. The setup arm controller 41b monitors slippage of each of joints 63a and 63b and the rotatable base 64 of the setup arm 61, when brakes are engaged or can be freely moved by the operator when brakes are disengaged, but do not impact controls of other joints. The robotic arm controller 41c controls each joint 44a and 44b of the robotic arm 40 and calculates desired motor torques required for gravity compensation, friction compensation, and closed loop position control of the robotic arm 40. The robotic arm controller 41c calculates a movement command based on the calculated torque. The calculated motor commands are then communicated to one or more of the motors 48a and 48b in the robotic arm 40. The actual joint positions are then transmitted by the motors 48a and 48b back to the robotic arm controller 41c.

[0045] The IDU controller 41d receives desired joint angles for the surgical instrument 50, such as wrist and jaw angles, and computes desired currents for the motors in the IDU 52. The IDU controller 41 d calculates actual angles based on the motor positions and transmits the actual angles back to the main cart controller 41a.

[0046] The robotic arm 40 is controlled in response to a pose of the handle controller controlling the robotic arm 40, e.g., the handle controller 38a, which is transformed into a desired pose of the robotic arm 40 through a hand eye transform function executed by the controller 21a. The hand eye function, as well as other functions described herein, is/are embodied in software executable by the controller 21a or any other suitable controller described herein. The pose of one of the handle controllers 38a may be embodied as a coordinate position and roll-pitch-yaw (RPY) orientation relative to a coordinate reference frame, which is fixed to the surgeon console 30. The desired pose of the instrument 50 is relative to a fixed frame on the robotic arm 40. The pose of the handle controller 38a is then scaled by a scaling function executed by the controller 21a. In embodiments, the coordinate position may be scaled down and the orientation may be scaled up by the scaling function. In addition, the controller 21a may also execute a clutching function, which disengages the handle controller 38a from the robotic arm 40. In particular, the controller 21a stops transmitting movement commands from the handle controller 38a to the robotic arm 40 if certain movement limits or other thresholds are exceeded and in essence acts like a virtual clutch mechanism, e.g., limits mechanical input from effecting mechanical output.

[0047] The desired pose of the robotic arm 40 is based on the pose of the handle controller 38a and is then passed by an inverse kinematics function executed by the controller 21a. The inverse kinematics function calculates angles for the joints 44a, 44b, 44c of the robotic arm 40 that achieve the scaled and adjusted pose input by the handle controller 38a. The desired angles are then passed to the robotic arm controller 41c, which includes a joint axis controller having a proportional- derivative (PD) controller, the friction estimator module, the gravity compensator module, and a two-sided saturation block, which is configured to limit the commanded torque of the motors of the joints 44a, 44b, 44c. In aspects, handle controller 38a may be substituted for and/or employed in conjunction with handle controller 38b. While reference is made above to handle controller 38a, handle controller 38b may also be used in a similar manner.

[0048] With reference to FIG. 5, the surgical robotic system 10 is set up around a surgical table 90. The system 10 includes movable carts 60a-d, which may be numbered “1” through “4.” During setup, each of the carts 60a-d are positioned around the surgical table 90. The robotic arm 60a is an ELR arm 40a and includes an ELR instrument 50a, which may be inserted through any natural orifice of a patient and as shown in FIG. 5, is inserted through the mouth. FIGS. 7-9 below shows the ELR arm 40a and the ELR instrument 50a in more detail.

[0049] Position and orientation of the carts 60a-d depends on a plurality of factors, such as placement of a plurality of access ports 55b-d, which in turn, depends on the surgery being performed. Once the port placements are determined, the access ports 55b-d are inserted into the patient, and carts 60b-d are positioned to insert instruments 50 and the camera 51 into corresponding ports 55b-d. The robotic arm 60a is positioned in proximity of the natural orifice through which the ELR instrument 50a is going to be inserted.

[0050] During use, each of the robotic arms 40b-d is attached to one of the access ports 55b-d that is inserted into the patient by attaching the latch 46c (FIG. 2) to the access port 55 (FIG. 3). The IDU 52 is attached to the holder 46, followed by the SIM 43 being attached to a distal portion of the IDU 52. Thereafter, the instrument 50 is attached to the SIM 43. The instrument 50 is then inserted through the access port 55 by moving the IDU 52 along the holder 46.

[0051] With reference to FIG. 6, the surgical robotic system 10 may include an AI/ML processing system 310 that processes the surgical data using one or more ML models to identify one or more features, such as surgical phase, instrument, anatomical structure, etc., in the surgical data. The ML processing system 310 includes a ML training system 325, which may be a separate device (e.g., server) that stores its output as one or more trained ML models 330. The ML models 330 are accessible by a ML execution system 340. The ML execution system 340 may be separate from the ML training system 325, namely, devices that “train” the models are separate from devices that “infer,” i.e., perform real-time processing of surgical data using the trained ML models 330.

[0052] System 10 includes a data reception system 305 that collects surgical data, including the video data and surgical instrumentation data. The data reception system 305 can include one or more devices (e.g., one or more user devices and/or servers) located within and/or associated with a surgical operating room and/or control center. The data reception system 305 can receive surgical data in real-time, i.e., as the surgical procedure is being performed.

[0053] The ML processing system 310, in some examples, may further include a data generator 315 to generate simulated surgical data, such as a set of virtual or masked images, or record the video data from the image processing device 56, to train the ML models 330 as well as other sources of data, e.g., user input, arm movement, etc. Data generator 315 can access (read/write) a data store 320 to record data, including multiple images and/or multiple videos.

[0054] The ML processing system 310 also includes a phase detector 350 that uses the ML models to identify a phase within the surgical procedure. Phase detector 350 uses a particular procedural tracking data structure 355 from a list of procedural tracking data structures. Phase detector 350 selects the procedural tracking data structure 355 based on the type of surgical procedure that is being performed. In one or more examples, the type of surgical procedure is predetermined or input by user. The procedural tracking data structure 355 identifies a set of potential phases that may correspond to a part of the specific type of surgical procedure.

[0055] In some examples, the procedural tracking data structure 355 may be a graph that includes a set of nodes and a set of edges, with each node corresponding to a potential phase. The edges may provide directional connections between nodes that indicate (via the direction) an expected order during which the phases will be encountered throughout an iteration of the surgical procedure. The procedural tracking data structure 355 may include one or more branching nodes that feed to multiple next nodes and/or may include one or more points of divergence and/or convergence between the nodes. In some instances, a phase indicates a procedural action (e.g., surgical action) that is being performed or has been performed and/or indicates a combination of actions that have been performed. In some instances, a phase relates to a biological state of a patient undergoing a surgical procedure. For example, the biological state may indicate a complication (e.g., blood clots, clogged arteries/veins, etc.), pre-condition (e.g., lesions, polyps, etc.). In some examples, the ML models 330 are trained to detect an “abnormal condition,” such as hemorrhaging, arrhythmias, blood vessel abnormality, etc.

[0056] The phase detector 350 outputs the phase prediction associated with a portion of the video data that is analyzed by the ML processing system 310. The phase prediction is associated with the portion of the video data by identifying a start time and an end time of the portion of the video that is analyzed by the ML execution system 340. The phase prediction that is output may include an identity of a surgical phase as detected by the phase detector 350 based on the output of the ML execution system 340. Further, the phase prediction, in one or more examples, may include identities of the structures (e.g., instrument, anatomy, etc.) that are identified by the ML execution system 340 in the portion of the video that is analyzed. The phase prediction may also include a confidence score of the prediction. Other examples may include various other types of information in the phase prediction that is output. The predicted phase may be used by the controller 21a to determine when to enable interfaces for controlling combined laparoscopic and ELR instruments as described below with respect to FIGS. 7-9.

[0057] With reference to FIG. 7, robotic system 10 includes the surgeon console 30 and other robotic arms 40b-d described above. The ELR arm 40a is coupled to a movable cart 60 via the setup arm 61. The ELR arm 40a may be substantially similar to the robotic arm 40. The ELR arm 40a includes an ELR IDU 152 configured to drive the ELR instrument 50a, which may be any flexible endoscopic instrument as shown in FIG. 8.

[0058] The ELR instrument 50a is a flexible, steerable instrument such as a catheter or an endoscope. The ELR instrument 50a may be a single-channel having one end effector or a multichannel with multiple end effectors. FIG. 9 shows a distal end portion 159 of the elongated shaft 156, which is a multi-channel shaft. The ELR instrument 50a may include a plurality of end effectors 160 and a videoscope 162, which may include a camera for capturing images of the surgical site and one or more lights for illuminating the same.

[0059] The ELR instrument 50a includes an instrument housing 154 and a flexible elongated shaft 156 extending therefrom. A sterile interface module (SIM) 158 may be disposed between the instrument housing 154 and the shaft 156 The SIM 158 may include mechanical couplers for transferring motor output from the ELR IDU 152 to the shaft 156. In addition, the SIM 158 may be used to secure a sterile drape to the ELR arm 40a. The instrument housing 154 may be integrally connected to the shaft 156 and disposed after use. Alternatively, the instrument housing 154 may be re-usable while the shaft 156 is disconnected and is disposed after use.

[0060] The ELR instrument 50a may be driven longitudinally, e.g., inserted into or extended from the body lumen, by moving the holder 46 along the sliding mechanism 46a (FIGS. 2 and 8). The ELR instrument 50a may also be bent in any suitable direction as shown in FIG. 8. This may be accomplished by a plurality of cables (not shown) inside the ELR instrument 50a.

[0061] The surgeon console 30 may be used to control all of the robotic arms 40a-d. In particular, the handle controllers 38a and 38b, the foot pedals 36, and touch screen of the second display 34 may be remapped to control a steerable flexible manipulator of the ELR instrument 50a. In particular, the surgeon console 30 is configured to use the same interface (i.e., handle controllers 38a and 38b, foot pedals 36, etc.) that may be switched between different operating modes of the system 10. The system 10 may be operated in a multi-port configuration, where each robotic arm 40 inserts the instrument 50 or the camera 51 through a corresponding access port 55. In a single port mode, the system 10 may use a multi-channel instrument that is inserted through the access port 55. Endoluminal modes include single channel and multi-channel modes during which the system 10 operates the corresponding ELR instrument 50a.

[0062] In embodiments, instead of having one surgeon using one console 30 to swap between different instrument types, the system 10 could have two separate surgeon consoles connected to a single tower with two separate surgeons operating them at the same time. Alternatively, the second surgeon console (e.g., driven by second surgeon from different department) may be connected through a hospital network or any telesurgery communication network.

[0063] Interface options for controlling the ELR instrument 50a include velocity command or position (e.g., backward or forward) command, or combinations thereof, such as where a position command is used until reaching a set position and then switching to velocity command. The position and velocity commands may be mapped to buttons or other inputs (e.g., capacitive pads) on the handle controllers 38a and 38b, the foot pedals 36, as well as buttons on the second display 34 and/or the instrument housing 154. In additional embodiments, the surgeon console 30 may include a gaze tracking device 37 (FIG. 7) or alternatively, a head set with gaze tracking may be used to a certain pattern in eye blink for, for example, an emergency stop, or it can detect a certain gaze pattern for motion command. Head tracking or eye tracking may be used to generate a motion command for the instruments 50 or 50a to move in the direction. To register the input command, the user may hold the gaze or head position as an input to enable this mode. The phase detector 350 may also be used to automatically change the insertion command method based on current phase of the procedure.

[0064] In another exemplary embodiment, the existing bedside interfaces of the controls 65 of the setup arm 61 may be remapped to drive the ELR instrument 50a. In particular, a button that is normally used to adjust the positioning of the robotic arm 40 may be remapped to articulate a steerable catheter.

[0065] With reference to FIG. 8, the system 10 may also include custom-designed inputs 150 for ELR instrument 50a. The inputs 150 may include a combination of joysticks, buttons, knobs, track balls, wheels, touch screens, voice commands or other non-touch inputs, and other inputs for a user to convey intended motion to the ELR instrument 50a. The inputs 150 can be connected directly to the arm cart 60a, the control tower 20, or any other suitable location on the system 10. [0066] The inputs 150 may be disposed on the instrument housing 154. Buttons, touchscreens, etc., may be placed on the housing 154 and can transmit user input data into a motor command to navigate the instrument 50a. The input data could be routed directly into the motors of the ELR IDU 152 for localized command processing or it could be route into a central processing unit (e.g., computer 21 of the control tower 20, the computer 41 of the robotic arm 40, etc ). The inputs 150 may include steering inputs, e.g., directional arrows, as well as non-steering functions, such as return-to-neutral or center.

[0067] In one embodiment, the inputs 150 may be disposed on the SIM 158, rather than the instrument housing. This design choice may offer more flexibility on input interface cost as the sterile adapter is expected to be used during more life cycles than the instrument. To minimize cost, the buttons of the inputs 150 may be membrane or capacitive switches that are built into a disposable barrier. Placing the inputs 150 close to the ELR instrument 50a provides a convenient location for a user to interact with the ELR instrument 50a directly such as steering the instrument and passing tools through the working channel. In one embodiments, the console 30 may have the capability to lock out one or more of the other controllers, e.g., inputs 150, and act as the master controller of the system 10, for example, because the console 30 has gaze tracking device 37 and provides for additional safety constraints. Thus, in embodiments if two controllers are being used simultaneously, the user can enable or disable from the console 30.

[0068] The above-described user interface inputs may also be used to switch control between laparoscopic robotic arms/instruments and the ELR robotic arms/instruments. The switching may be done using surgeon console buttons, pedals, touchscreen of the second display 34, etc. In embodiments where two surgeon consoles 30 are connected to the system 10, the consoles 30 may indicate which instruments are being currently driven. Switching may also be done based on bedside assist using an interface on one of the robot systems at the patient side, e.g., on the robotic arms 40a-d, at the ELR instrument 50a. In further embodiments, switching may be based on the current phase of the procedure. The phase-based change may be done automatically or may suggested. For the single console approach, different settings for motion scaling may be available to the user for the each of the laparoscopic robotic arms/instruments and the ELR robotic arms/instruments.

[0069] Bedside assist access may be further expanded to support both the ELR and laparoscopic robotic arms 40a-d. Bedside user interfaces are designed to allow for interaction with both laparoscopic and ELR instruments 50a-d. The user interface of the control tower 20 allows for selection and management of each of the robotic arms 40a-d and their respective instruments 50a- d. In addition, the system 10 features sterility reminders for each instrument type as some procedures might have different sterility handling with the different instrument sets entering different body systems.

[0070] The system 10 could use the surgeon console 30 to display endoluminal sensing data and video from the videoscope 162 and video from the laparoscopic camera 51. Alternatively, a headset with a display capability can be used. Switching between laparoscopic robotic arms/instruments and the ELR robotic arms/instruments also causes the display screen 32 to update as well. Display of endoluminal instruments is likely different than typical rigid robotic instruments. For example, if the user is controlling the laparoscopic instruments, the surgeon console 30 displays the video feed from the camera 51. If the user changes control to the ELR arm 40a and the ELR instrument 50a then the surgeon console 30 automatically switches to the ELR display. The switching implements image processing software that limits ergonomic issues (e.g., maintains consistent brightness, focal point, etc ). In embodiments, the user can manually switch which displays to show on the monitor using any input on the surgeon console 30. Alternatively, the non-dominant display could be shown on the surgeon console’s second display 30.

[0071] Each of the robotic arms 40a-d may include lights to indicate which robotic arm(s) is currently active. In embodiments, where two consoles 30 are connected to the system 10, each of the surgeon consoles 30 may include lights on the console to indicate which console is driving which specific robotic arm. For example, first (e.g., red) color lights on the first console would match the color lights on the first robot and second (e.g., green) color lights on the second console would match the color lights on the second robot.

[0072] A GUI may be shown on the displays 32 and 34 of the surgeon console 30 to indicate which instruments are actively being controlled and which instruments are on hold or in reserve. Additionally, when two surgeon consoles are used, their respective displays may show the surgeon’s name or console identifier overlaid with the instrument on the GUI. Labeling of the instruments with the name of the surgeon or the console designator (e.g., console 1 or console 2) may also be done on the video feed provided by the camera 51 and/or the videoscope 162 to clearly indicate which instruments are being used.

[0073] The system 10 also provides for coordination between the ELR and laparoscopic robotic arms 40a-d. The system 10 provides hand-eye coordination which can relate motions in different references frames, depending on which imaging device (e.g., the camera 51 or the videoscope 162) is in use and which robotic arms 40a-d are being controlled. The control device motions result in instruments moving on screen in the expected direction, e.g., up input results in up motion in the video feed). Multi-channel ELR instrument 50a is controlled in the same manner as laparoscopic instruments 50. Combined devices (i.e., laparoscopic and ELR instruments) may be operated in the same coordinate frame. If the instruments are not in the same coordinate frame, they may still be operated. The system 10 is also configured switch hand-eye coordination to be from the perspective of the camera 51 or from the videoscope 162 view and the instruments 50 and 50a can be driven by either perspective view. When video is not available with the ELR instrument 50a, a virtualized tip view (i.e., 3D model) may be used for navigation. The 3D model may be constructed from one or more imaging modalities. The system 10 can also change perspectives automatically when the inputs are changed to control a different instrument. Alternatively, the perspectives can be selected through an interface. The system can preview to show a user what a motion of the instrument 50 and 50a will look like upon changing perspective. [0074] The display screens 32 and 34 may be used to view both video feeds at the same time, as overlays, side-by-side, picture in picture, or individually (one feed per each screen). The screens 32 and 34 may also show highlights or other graphical features to indicate which viewpoint is being currently shown.

[0075] The motion of the robotic arms 40a-d may also be coordinated. The user can drive each of the laparoscopic and ELR arms at the same time. This coordination may be used in the following exemplary procedures. Endoluminal end effectors 160 may be used to perform small, programmed motions and gestures to assist visualization and/or localization as viewed from endoscope. For example, if the ELR instrument tip moves with a specific signature (such as twitching) then the camera 51 can visualize it externally.

[0076] FIG. 10 shows an exemplary operation of the system 10 with two laparoscopic instruments

50 inserted to the surgical site and the camera 51, each of which is attached and controlled by their respective robotic arm 40b-d. The laparoscopic instruments 50 and camera 51 are positioned outside an organ or a lumen with the ELR instrument 50a inserted into the organ and the lumen, thus, each of the camera 51 and the videoscope 162 provide different views, one from the outside and the other from the inside of the organ. Due to the organ wall separating the ELR instrument 50a and instruments 50, the end effectors 160 and the end effectors 49 of the instruments 50 are not viewable simultaneously on a single video feed, requiring switching between the camera 51 and the videoscope 162. Accordingly, the system 10 is configured to render 3D models for the instruments and other devices that are not viewable directly by the camera 51 and/or the videoscope 162. The rendered 3D models are then displayed on the video feed from the camera

51 and/or the videoscope 162 to allow for simultaneous viewing of all instruments and devices being used by the system 10. FIGS. 11A and 11B shows a schematic view of the system 10 switching between overlays. In a first outside observer view 200 of FIG. 11A, the end effectors 160, the videoscope 162, and the ELR instrument 50a are rendered as overlays 160’, 162’, and 50a’, respectively. In a second outside observer view 202 of FIG. 1 IB, the instruments 50 and the camera 51 are rendered as overlays 50’ and 51’, respectively.

[0077] FIGS. 12A and 12B show views 204 and 206 from the videoscope 162 with and without overlays of the overlays 50’ and 51’, respectively. Similarly, FIG. 13 shows a view 208 from the laparoscopic camera 51 with the overlays of the overlays 160’, 162’, and 50a’. The overlays may be based on a 3D model of each of the instruments being used or reconstructed from the video feed imaging the instruments and cameras. The location for placing the overlays on the displayed video feed may be determined based on kinematics of the robotic arms 40a-d and/or other location tracking of the objects being rendered, such as electromagnetic, Fiber Bragg, optical, etc. tracking systems. The location of the instruments may be then mapped to the video feed from the camera 51 and/or the videoscope 162 depending on the selected video feed being used. In addition, the video feed of the other camera that is not being currently displayed may also be used in mapping and rending of the overlays. The transparency of the overlays may be controlled by the user or automatically, e.g., based on the phase, overlap with critical structures, etc. Transparency may be controlled using a slider or any other suitable GUI or physical inputs.

[0078] With reference to FIG. 14, representative rendered views of the laparoscopic and ELR instruments 50 and 160 are shown in operation according to an embodiment of the present disclosure. In this example, both laparoscopic instruments 50 and the ELR instrument 160 are inserted into a surgical workspace and positioned relative to a target anatomy. FIG. 14 illustrates the simultaneous presence of instruments 50 and 160 from multiple angles, depicting their distinct access paths — through ports 55 and through natural orifices, respectively. The depicted arrangement allows for coordinated manipulation and viewing from external and internal perspectives.

[0079] FIG. 15 illustrates a view from the laparoscopic camera 51 with directional overlays displayed on the first display 32 of the surgeon console 30, representing instrument motion relative to both laparoscopic and endoscopic coordinate frames. A first set of directional indicators 170 and 172, e.g., arrows, includes a rightward arrow and a leftward arrow, each indicating motion with respect to the laparoscopic view provided by the laparoscopic camera 51. A second set of directional indicators 174 and 176 includes a rightward arrow and a leftward arrow, each indicating motion with respect to the endoscopic view provided by the videoscope 162. These directional indicators 170-176 are overlaid graphically on the display 32 and enable a user to interpret instrument movement across multiple visual perspectives, facilitating accurate hand-eye coordination during instrument manipulation. In the illustrated embodiment, rightward motion relative to the laparoscopic view corresponds to leftward motion in the endoscopic view, although such directional mappings may vary depending on the specific geometric configuration of the instruments and cameras. [0080] FIG. 16 illustrates a view from the videoscope 162 with directional overlays displayed on the first display 32 of the surgeon console 30, representing instrument motion relative to both endoscopic and laparoscopic coordinate frames. The first set of directional indicators 170 and 172 and second set of directional indicators 174 and 176 may be swapped their locations on the first display 32 to provide for correspondence with the instruments being controlled.. These directional indicators 170-176 are rendered as graphical overlays on the display 32 and enable the user to interpret instrument movement from multiple perspectives, facilitating accurate control across different coordinate frames. In the illustrated embodiment, the directional meaning of each arrow is reversed between views — for example, arrow 170 indicates a rightward direction in the laparoscopic view but appears leftward when observed from the endoscopic view. This reversal highlights the mirrored spatial interpretation that arises when switching between external and internal viewpoints. The system 10 allows such directional correlations to be managed dynamically, enabling intuitive and consistent control regardless of the active camera perspective. [0081] The system 10 enables control of the laparoscopic surgical instrument 50 and the ELR surgical instrument 160, as well as the laparoscopic camera 51 and the videoscope 162, with respect to either the laparoscopic view or the endoscopic view. The movement directions indicated by the directional overlays 170, 172, 174, and 176 correspond to coordinate frames of either the laparoscopic camera 51 or the videoscope 162. In the illustrated embodiment, the right and left directions of the endoscopic view and the laparoscopic view are shown to be opposite of each other; however, such directional relationships are configurable and need not be oppositely mapped. While FIGS. 15 and 16 depict only the rightward arrows 170, 174 and leftward arrows 172, 176, the same concept applies to movement in any direction within the three-dimensional surgical workspace. For example, upward and downward movement may also be represented by graphical overlays and may likewise be mapped either consistently or in reverse between the laparoscopic and endoscopic views. The directional overlay system thereby supports full 3D spatial interpretation across multiple perspectives to enhance intuitive control.

[0082] This ability to correlate motion across different views allows the system 10 to implement consistent control strategies, even as the surgeon switches between laparoscopic and endoluminal perspectives. Whether via manual control or Al-guided coordination, the system 10 can translate control inputs between views, thereby enhancing surgical precision and minimizing operator disorientation when transitioning between cameras. [0083] The laparoscopic camera 51 and/or instruments 50 could be guided or auto adjusted to a location determined by the ELR instrument 50a. The user can selectively turn on/off the following guidance features. The ELR instrument 50a could be guided (e.g., user-controlled with guidance, or automatically) towards the laparoscopic instrument 50 and its end effector 49. If the end effector 49 is in a specific place the ELR instrument 50 is automatically controlled to follow the end effector 49. Image recognition or other tracking technology may be used to identify the end effector 49 in the video feed of the ELR instrument 50a.

[0084] The instrument 50 or 50a may be used to define a “no-go” zone into which none of the instruments may be moved. The zone may be enforced on the other instruments, i.e., the ones not being used to define the zone. In another embodiment, imaging or other data may be used to define regions to which the instruments may not be moved. The elongated shaft 156 of the ELR instrument 50a may be marked as a no-go zone to avoid damage by nearby laparoscopic instruments 50. In other embodiments, the instrument 50 or 50a may be used to define edges of anatomy intended to be removed (e.g., for planned resection initiation point or terminus).

[0085] The system 10 may also provide collision avoidance and detection between the ELR instrument 50a and laparoscopic instruments 50b-d as well as their respective robotic arms 40a-d. Collision avoidance may include external capital equipment to prevent collisions between robotic arms 40a-d and/or internal collisions based on known or expected poses of the instruments 50a-d. [0086] The combined ELR and laparoscopic system 10 offers significant advantages for various surgical procedures. For instance, in upper gastrointestinal endoluminal procedures, the ELR instrument 50a can be used to visualize the esophagus while simultaneously operating externally using laparoscopic instruments 50b-d. In rectal procedures, the light from ELR instrument 50a may be used to enhance visibility and illuminate through the rectal wall to guide laparoscopic instruments 50b-d from outside. The ELR instrument 50a may include an ultrasound probe 161 (FIG. 9), which may be robotically controlled to steer and point at a tumor site where the other instruments 50b-d are used to perform a procedure, such as a partial nephrectomy.

[0087] The system 10 may also be used in endoluminal robot-assisted anastomosis. The ELR instrument 50a can be used to hold up part of the tube being anastomosed and can be controlled through the surgeon console 30 or under full automated control. In addition, the videoscope 162 can be used to identify anastomosis portions for realignment and attachment. [0088] The system 10 may also be used in endoscopic submucosal dissection (ESD). The ELR instrument 50a may be used to confirm incisions go all the way through. When scooping out the tumor, the end effectors 160 of the ELR instrument 50a may be used to stabilize the colon from the outside, and make it much easier for the endoluminal tool. In transanal total mesorectal excision (taTME), the anastomosis from below can be confirmed from the camera coming from below by seeing the shaft of the needle through the tissue which is otherwise inserted blind. This could also be done using an automated visual confirmation. The ELR instrument 50a may also include an electrosurgical snare, which can be used to manipulate a polyp into the snare.

[0089] The videoscope 162 may be used along with the camera 51 to provide inside and outside views for combined endoscopic and laparoscopic surgery. Thus, in some procedures where laparoscopic surgeon does part of a procedure outside the target anatomy and then endoscopic surgeon works afterwards. Steps could be done at the same time instead of sequentially, thereby reducing the total procedure time by having two surgeons work in parallel.

[0090] The system 10 may be used in hiatal hernia repair where the stomach is pulled back down below the diaphragm and fixed, and then endoluminally creating the stomach-esophagus valve again. Currently the procedure involves using two different systems, with different surgeons with different training because of today’s instruments. The combined system would simplify this approach by providing a common system.

[0091] In treating pancreatic cancer, the system 10 may be used to insert the camera 51 through intestine or stomach wall, then insert one instrument 50 in bile duct, and the ELR instrument 50a may be inserted transanally to exit the colon and approach the outside of the gallbladder.

[0092] In transvaginal colectomy, the specimen may be pulled without a big incision by using access ports 55b-d to provide transabdominal access, and the ELR instrument 50a inserted transvaginally and at the same time.

[0093] Sublobar resection may also be performed, where the ELR instrument 50a is moved close to the tumor and the tracked end effector tip acts like a beacon, overlayed in the laparoscopic view provided by the camera 51.

[0094] Further aspects and embodiments of the present disclosure are set out in the below numbered clauses: [0095] It will be understood that various modifications may be made to the embodiments disclosed herein. Therefore, the above description should not be construed as limiting, but merely as exemplifications of various embodiments. Those skilled in the art will envision other modifications within the scope and spirit of the claims appended thereto.

Claims

WHAT IS CLAIMED IS:

1. A combined endoluminal robotic (ELR) and laparoscopic surgical robotic system, comprising: a display screen for visualizing a surgical site; a user interface device for receiving user inputs; a laparoscopic robotic arm including: a laparoscopic surgical instrument; and a laparoscopic arm controller configured to control movement of the laparoscopic robotic arm and the laparoscopic surgical instrument; an endoluminal robotic (ELR) arm including: a flexible, steerable ELR surgical instrument; and an ELR arm controller configured to control movement of the ELR robotic arm and the ELR surgical instrument; and a processor running software configured to: process the user inputs to generate movement commands; transmit the movement commands to the laparoscopic arm controller and the ELR arm controller; provide switching control between the laparoscopic robotic arm and the ELR arm; and provide coordinated control of the laparoscopic surgical instrument and the ELR surgical instrument during surgical procedures.

2. The system of claim 1, wherein the user interface device includes at least one of a foot pedal, a handle controller, or a touch screen.

3. The system of any one of claims 1 or 2, wherein the user interface device is remappable between controlling the laparoscopic surgical instrument and the ELR surgical instrument.

4. The system of any one of claims 1-3, further comprising a phase detection system configured to: identify a phase of a surgical procedure based on received surgical data; and automatically switch between controlling the ELR surgical instrument and the laparoscopic surgical instrument based on the identified phase.

5. The system of any one of claims 1-4, wherein the ELR surgical instrument includes: a multi-channel flexible shaft; at least one end effector disposed at a distal end of the flexible shaft; a videoscope including a camera for capturing images of the surgical site and configured to generate endoluminal video feed; and at least one light for illuminating the surgical site.

6. The system of claim 5, further comprising: a second laparoscopic robotic arm including a laparoscopic camera configured to generate a laparoscopic video feed.

7. The system of claim 6, wherein the processor is further configured to: display the endoluminal video feed and laparoscopic video feed simultaneously in an overlay, side-by-side, or picture-in-picture format on the display screen.

8. The system of claim 6, wherein the processor is further configured to: switch between displaying the endoluminal video feed and the laparoscopic video feed on the display screen.

9. The system of claim 7, wherein the processor is further configured to: perform image processing to maintain consistent brightness and focal points during switching between the endoluminal video feed and the laparoscopic video feed.

10. The system of claim 7, wherein the processor is further configured to generate directional overlays on the display screen indicating respective motion directions of the laparoscopic surgical instrument and the ELR surgical instrument relative to both laparoscopic and endoscopic coordinate frames.

11 . The system of claim 10, wherein the directional overlays comprise a first directional indicator set rendered with respect to a laparoscopic camera view, and a second directional indicator set rendered with respect to a videoscope view.

12. The system of claim 11, wherein the directional overlays indicate opposite directions for the same instrument movement when viewed from the laparoscopic camera and the videoscope, respectively.

13. The system of claim 11, wherein the processor is further configured to dynamically render or adjust the directional overlays based on which of the laparoscopic video feed or the endoluminal video feed is actively displayed.

14. A computer-implemented method performed by a combined endoluminal robotic (ELR) and laparoscopic surgical robotic system comprising a display screen, a user interface device, a laparoscopic robotic arm including a laparoscopic surgical instrument and a laparoscopic arm controller, an endoluminal robotic (ELR) arm including a flexible, steerable ELR surgical instrument and an ELR arm controller, and a processor, the method comprising: processing, by the processor, input commands received via the user interface device to generate movement commands; transmitting the movement commands to the laparoscopic arm controller and the ELR arm controller; providing switching control between the laparoscopic robotic arm and the ELR arm; providing coordinated control of the laparoscopic surgical instrument and the ELR surgical instrument during surgical procedures; and visualizing a surgical site including the laparoscopic surgical instrument and the ELR surgical instrument on the display screen.

15. The method of claim 14, wherein the user interface device comprises at least one of a foot pedal, a handle controller, or a touch screen.

16. The method of any one of claims 14 or 15, wherein the user interface device is remapped, under control of the processor, between controlling the laparoscopic surgical instrument and the ELR surgical instrument.

17. The method of any one of claims 14-16, wherein the system further comprises a phase detection system, and wherein the method further comprises: identifying, by the phase detection system, a phase of a surgical procedure based on received surgical data; and automatically switching, by the processor, between controlling the ELR surgical instrument and the laparoscopic surgical instrument based on the identified phase.

18. The method of any one of claims 14-17, wherein the ELR surgical instrument comprises a multi-channel flexible shaft, at least one end effector disposed at a distal end of the flexible shaft, a videoscope including a camera configured to generate an endoluminal video feed, and at least one light for illuminating the surgical site.

19. The method of claim 18, generating a laparoscopic video feed using a laparoscopic camera coupled to a second laparoscopic robotic arm.

20. The method of claim 19, further comprising: displaying, by the processor, the endoluminal video feed and the laparoscopic video feed simultaneously in an overlay, side-by-side, or picture-in-picture format on the display screen; switching, by the processor, between displaying the endoluminal video feed and the laparoscopic video feed on the display screen; and performing, by the processor, image processing to maintain consistent brightness and focal points during switching between the endoluminal video feed and the laparoscopic video feed.