US20070038080A1 - Devices and methods for presenting and regulating auxiliary information on an image display of a telesurgical system to assist an operator in performing a surgical procedure - Google Patents

Devices and methods for presenting and regulating auxiliary information on an image display of a telesurgical system to assist an operator in performing a surgical procedure Download PDF

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Publication number
US20070038080A1
US20070038080A1 US11/496,958 US49695806A US2007038080A1 US 20070038080 A1 US20070038080 A1 US 20070038080A1 US 49695806 A US49695806 A US 49695806A US 2007038080 A1 US2007038080 A1 US 2007038080A1
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image
surgical
auxiliary information
ultrasound transducer
operator
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US11/496,958
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J. Salisbury
Gunter Niemeyer
Robert Younge
Gary Guthart
David Mintz
Thomas Cooper
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Intuitive Surgical Inc
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Intuitive Surgical Inc
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Priority claimed from US09/457,406 external-priority patent/US6799065B1/en
Application filed by Intuitive Surgical Inc filed Critical Intuitive Surgical Inc
Priority to US11/496,958 priority Critical patent/US20070038080A1/en
Publication of US20070038080A1 publication Critical patent/US20070038080A1/en
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    • A61B8/5215Devices using data or image processing specially adapted for diagnosis using ultrasonic, sonic or infrasonic waves involving processing of medical diagnostic data
    • A61B8/5238Devices using data or image processing specially adapted for diagnosis using ultrasonic, sonic or infrasonic waves involving processing of medical diagnostic data for combining image data of patient, e.g. merging several images from different acquisition modes into one image
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    • G16H40/60ICT specially adapted for the management or administration of healthcare resources or facilities; ICT specially adapted for the management or operation of medical equipment or devices for the operation of medical equipment or devices
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    • G16H40/67ICT specially adapted for the management or administration of healthcare resources or facilities; ICT specially adapted for the management or operation of medical equipment or devices for the operation of medical equipment or devices for remote operation
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    • A61B90/00Instruments, 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
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    • A61B90/36Image-producing devices or illumination devices not otherwise provided for
    • A61B90/361Image-producing devices, e.g. surgical cameras

Definitions

  • the present invention is generally related to improved robotic devices, systems and methods, for use in telerobotic surgery.
  • Minimally invasive medical techniques are aimed at reducing the amount of extraneous tissue which may be damaged during diagnostic or surgical procedures, thereby reducing patient recovery time, discomfort, and deleterious side effects. Many surgeries are performed each year in the United States. A significant amount of these surgeries can potentially be performed in a minimally invasive manner. However, only a relatively small percentage of surgeries currently use minimally invasive techniques due to limitations of minimally invasive surgical instruments and techniques currently used and the difficulty experienced in performing surgeries using such traditional instruments and techniques.
  • laparoscopy is minimally invasive inspection or surgery within the abdominal cavity.
  • laparoscopic surgery a patient's abdominal cavity is insufflated with gas and cannula sleeves are passed through small (approximately 1 ⁇ 2 inch) incisions in the musculature of the patient's abdomen to provide entry ports through which laparoscopic surgical instruments can be passed in a sealed fashion.
  • the laparoscopic surgical instruments generally include a laparoscope for viewing the surgical field and working tools defining end effectors.
  • Typical surgical end effectors include clamps, graspers, scissors, staplers, and needle holders, for example.
  • the working tools are similar to those used in conventional (open) surgery, except that the working end or end effector of each tool is separated from its handle by an approximately 12-inch long extension tube, for example, so as to permit the surgeon to introduce the end effector to the surgical site and to control movement of the end effector relative to the surgical site from outside a patient's body.
  • the surgeon typically passes these working tools or instruments through the cannula sleeves to the internal surgical site and manipulates the instruments or tools from outside the abdomen by sliding them in and out through the cannula sleeves, rotating them in the cannula sleeves, levering (i.e., pivoting) the instruments against the abdominal wall and actuating the end effectors on the distal ends of the instruments from outside the abdominal cavity.
  • the instruments normally pivot around centers defined by the incisions which extend through the muscles of the abdominal wall.
  • the surgeon typically monitors the procedure by means of a television monitor which displays an image of the surgical site via the laparoscopic camera.
  • the laparoscopic camera is also introduced through the abdominal wall so as to capture an image of the surgical site.
  • MIS minimally invasive surgical
  • existing MIS instruments deny the surgeon the flexibility of tool placement found in open surgery. Difficulty is experienced in approaching the surgical site with the instruments through the small incisions.
  • the length and construction of many endoscopic instruments reduces the surgeon's ability to feel forces exerted by tissues and organs on the end effector of the associated instrument.
  • coordination of the movement of the end effector of the instrument as viewed in the image on the television monitor with actual end effector movement is particularly difficult, since the movement as perceived in the image normally does not correspond intuitively With the actual end effector movement. Accordingly, lack of intuitive response to surgical instrument movement input is often experienced. Such a lack of intuitiveness, dexterity and sensitivity of endoscopic tools has been found to be an impediment to the expansion of the use of minimally invasive surgery.
  • Telesurgery is a general term for surgical systems where the surgeon uses some form of remote control, e.g., a servomechanism, or the like, to manipulate surgical instrument movements, rather than directly holding and moving the tools by hand.
  • the surgeon is typically provided with an image of the surgical site on a visual display at a location remote from the patient.
  • the surgeon can typically perform the surgical procedure at the location remote from the patient whilst viewing the end effector movement during the surgical procedure on the visual display. While viewing typically a three-dimensional image of the surgical site on the visual display, the surgeon performs the surgical procedures on the patient by manipulating master control devices at the remote location, which master control devices control motion of the remotely controlled instruments.
  • such a telesurgery system can be provided with at least two master control devices (one for each of the surgeon's hands), which are normally operatively associated with two robotic arms on each of which a surgical instrument is mounted. Operative communication between master control devices and associated robotic arm and instrument assemblies is typically achieved through a control system.
  • the control system typically includes at least one processor which relays input commands from the master control devices to the associated robotic arm and instrument assemblies and from the arm and instrument assemblies to the associated master control devices in the case of, e.g., force feedback, or the like.
  • One object of the present invention is to provide improved telesurgery systems, devices and methods for use in surgery.
  • Another object of the invention is to provide a telesurgical system and method whereby auxiliary information related to a surgical procedure to be performed by the telesurgical system can be selectively displayed on a viewer of the system, together with an image of the surgical site captured by an image capture device, such as an endoscope, of the system, so as to enable an operator of the system selectively to reference such auxiliary information on the viewer during the performance of the surgical procedure.
  • an image capture device such as an endoscope
  • a method of performing a surgical procedure on a patient typically comprises positioning a surgical work station of a robotically controlled surgical system and a patient on which a surgical procedure is to be performed in close proximity relative to each other, directing a field of view of an image capture device of the surgical work station at a surgical site on the patient, at which site the surgical procedure is to be performed, and introducing at least one robotically controlled surgical instrument on the surgical work station to the surgical site so that an end effector of the surgical instrument is within the field of view of the image capture device.
  • the method typically further comprises displaying an image of the surgical site and the end effector on a display area of an image display at an operator control station of the surgical system.
  • the image display is typically operatively connected to the image capture device so as to display, on the display area, the image of the surgical site and the end effector captured by the image capture device.
  • the method can further include permitting an operator of the surgical system to manipulate a master control at the operator control station whilst viewing the image of the surgical site on the image display, the master control being operatively associated with the surgical instrument thereby to cause the end effector to move in response to manipulation of the master control so as to perform at least part of the surgical procedure on the patient at the surgical site.
  • the method yet further typically comprises operatively linking the image display to a source of selectively accessible auxiliary information related to the surgical procedure to be performed, enabling the operator selectively to access the source of auxiliary information from the operator control station so as to forward the auxiliary information to the image display, causing the auxiliary information to be displayed across the display area of the image display in response to the operator selectively accessing the source of auxiliary information at the operator control station and enabling the operator selectively to move the auxiliary information when displayed on the image display relative to the image of the surgical site displayed on the image display.
  • the master control is typically operatively linked with the source of auxiliary information, enabling the operator selectively to access the source of auxiliary information then including permitting the operator selectively to disassociate the master control from the surgical instrument and to use the master control to access the source of auxiliary information so as to enable the auxiliary information to be displayed on the display area of the image display.
  • a method of performing a surgical procedure on a patient comprising manipulating a master control whilst viewing a real time image of a surgical site on an image display, moving an end effector in response to manipulation of the master control so as to perform at least part of a surgical procedure at the surgical site and selectively accessing a source of auxiliary information by means of the master control.
  • the method typically further comprises displaying the auxiliary information on the image display.
  • FIG. 1 shows a three-dimensional view of an operator control station, or surgeon's console, and a surgical work station, or cart, of a telesurgical system in accordance with the invention, the cart carrying three robotically controlled arms, the movement of the arms being remotely controllable from the control station;
  • FIG. 2 shows, at an enlarged scale, a side view of a robotic arm and surgical instrument assembly of the surgical station shown in FIG. 1 ;
  • FIG. 3 shows, at an enlarged scale, a three-dimensional view of a typical surgical instrument of the system shown in FIG. 1 ;
  • FIG. 4 shows a schematic kinematic diagram corresponding to the side view of the robotic arm shown in FIG. 2 , and indicates the arm having been displaced from one position into another position;
  • FIG. 5 shows, at an enlarged scale, a wrist member and an end effector of the surgical instrument shown in FIG. 3 , the wrist member and the end effector being movably mounted on a working end of a shaft of the surgical instrument;
  • FIG. 6 shows a three-dimensional view of one of the master control devices of the control station shown in FIG. 1 , the master control device including a hand-held part, or wrist gimbal, and an articulated arm portion on which the hand-held part is mounted;
  • FIG. 7 shows a schematic three-dimensional drawing indicating the positions of the end effectors relative to a viewing end of an endoscope on the surgical station and the corresponding positions of the master control devices relative to the eyes of an operator, typically a surgeon, at the control station;
  • FIG. 8 shows a schematic three-dimensional drawing indicating the position and orientation of an end effector relative to a camera Cartesian coordinate reference system at a viewing end of the endoscope
  • FIG. 9 shows a schematic three-dimensional drawing indicating the position and orientation of a pincher formation of one of the master control devices relative to an eye Cartesian coordinate reference system at a viewer of the control station;
  • FIG. 10 shows a block diagram indicating control steps of a control system of the surgical system, the control system being arranged to effect control between master control device input and corresponding surgical instrument movement output;
  • FIG. 11 shows a flow diagram indicating control steps of a method, in accordance with the invention, whereby an operator of the telesurgical system can selectively access one or more sources of auxiliary information related to a surgical procedure to be performed by the telesurgical system, so as to display the information from the selected source or sources on an image display of the telesurgical system together with an image of the surgical site captured by an image capturing device, such as an endoscope, of the system;
  • an image capturing device such as an endoscope
  • FIG. 12 shows a schematic view of an image of a surgical site displayed on the image display of the telesurgical system and further shows an image corresponding to auxiliary information from a selected source of auxiliary information displayed in a window overlaid on the image of the surgical site;
  • FIGS. 13A and B show schematic views illustrating the adjustment in position and orientation of an image corresponding to auxiliary information from a selected source of auxiliary information, relative to an image of the surgical site from an image capturing device;
  • FIG. 14 shows a schematic diagram of an image displayed at a viewer of the system shown in FIG. 1 , and further shows a probe gathering auxiliary information relating to a surgical procedure;
  • FIG. 15 shows a schematic side view of an image capturing device for capturing an image along a shaft of a surgical instrument of the system shown in FIG. 1 , in accordance with the invention
  • FIGS. 16A and 16B show schematic drawings indicating a rotational movement of a displayed image and a line or bar displayed in the image to indicate orientational position of a scene in the displayed image relative to a world reference frame
  • FIGS. 17A and 17B show schematic drawings indicating a rotational movement of a displayed image and opposed markers or indicators displayed in the image to indicate orientational position of a scene in the displayed image relative to a world reference frame.
  • a minimally invasive telesurgical system, or robotically controlled surgical system in accordance with the invention is generally indicated by reference numeral 10 .
  • the system 10 includes a control station, or surgeon's console, generally indicated by reference numeral 12 .
  • the station 12 includes an image display or viewer 14 where an image of a surgical site is displayed in use.
  • a support 16 is provided on which an operator, typically a surgeon, can rest his or her forearms while gripping two master control devices, one of which is shown in FIG. 6 of the drawings, one in each hand.
  • the master controls are positioned in a space 18 inwardly beyond the support 16 .
  • the surgeon typically sits in a chair in front of the control station 12 , positions his or her eyes in front of the viewer 14 and grips the master controls one in each hand while resting his or her forearms on the support 16 .
  • the system 10 further includes a surgical work station, or cart, generally indicated by reference numeral 20 .
  • the cart 20 is positioned in close proximity to a patient requiring surgery and is then normally caused to remain stationary until a surgical procedure to be performed by means of the system 10 has been completed.
  • the cart 20 typically has wheels or castors to render it mobile.
  • the station 12 is typically positioned remote from the cart 20 and can be separated from the cart 20 by a great distance, even miles away, but will typically be used within an operating room with the cart 20 .
  • the cart 20 typically carries at least three robotic arm assemblies.
  • One of the robotic arm assemblies, indicated by reference numeral 22 is arranged to hold an image capture device 24 , e.g., an endoscope, or the like.
  • Each of the other two arm assemblies 26 , 26 respectively, is arranged to hold a robotically controlled surgical instrument 28 .
  • the endoscope 24 has an object viewing end 24 . 1 at a remote end of an elongate shaft thereof. It will be appreciated that the endoscope 24 has an elongate shaft to permit its viewing end 24 . 1 to be inserted through an entry port in a patient's body so as to access an internal surgical site.
  • the endoscope 24 is operatively connected to the viewer 14 to display an image captured at its viewing end 24 .
  • Each robotic arm assembly 26 , 26 is normally operatively connected to one of the master controls.
  • the instruments 28 on the robotic arm assemblies 26 , 26 have end effectors which are mounted on wrist members which are pivotally mounted on distal ends of elongate shafts of the instruments 28 .
  • the instruments 28 have elongate shafts to permit the end effectors to be inserted through entry ports in a patient's body so as to access the internal surgical site. Movement of the end effectors relative to the ends of the shafts of the instruments 28 is also controlled by the master controls.
  • the cart 20 carrying the robotic arms 22 , 26 , 26 is wheeled to the patient and is normally maintained in a stationary position relative to, and in close proximity to, the patient, during the surgical procedure.
  • FIG. 2 of the drawings one of the robotic arm assemblies 26 is shown in greater detail, and on an enlarged scale.
  • Each assembly 26 typically has a surgical instrument, schematically and generally indicated by reference numeral 28 , releasably mounted thereon.
  • FIG. 3 indicates the general appearance of a typical surgical instrument 28 in greater detail.
  • the surgical instrument 28 includes an elongate shaft 28 . 1 .
  • the wrist-like mechanism generally indicated by reference numeral 32 , is located at a working end of the shaft 28 . 1 .
  • a housing 34 arranged releasably to couple the instrument 28 to the robotic arm 26 , is located at an opposed end of the shaft 28 . 1 .
  • the shaft 28 . 1 extends along an axis indicated at 28 . 2 .
  • the instrument 28 is typically releasably mounted on a carriage 36 , which can be driven to translate along a linear guide formation 38 of the arm 26 in the direction of arrows P.
  • the robotic arm 26 includes a cradle, generally indicated at 40 , an upper arm portion 42 , a forearm portion 44 and the guide formation 38 .
  • the cradle 40 is pivotally mounted on a plate 46 in a gimbaled fashion to permit rocking movement of the cradle 40 about a pivot axis 48 .
  • the upper arm portion 42 includes link members 42 . 1 , 42 . 2 and the forearm portion 44 includes link members 44 . 1 , 44 . 2 .
  • the link members 42 . 1 , 42 . 2 are pivotally mounted on the cradle 40 and are pivotally connected to the link members 44 . 1 , 44 . 2 .
  • the pivotal connections between the link members 42 . 1 , 42 . 2 , 44 . 1 , 44 . 2 , the cradle 40 , and the guide formation 38 are arranged to constrain the robotic arm 26 to move in a specific manner.
  • the movement of the robotic arm 26 is illustrated schematically in FIG. 4 .
  • the solid lines schematically indicate one position of the robotic arm 26 and the dashed lines indicate another possible position into which the arm 26 can be displaced from the position indicated in solid lines.
  • the pivot center 50 normally remains in the same position relative to the stationary cart 20 on which the arm 26 is mounted.
  • the pivot center 50 is positioned at a port of entry into a patient's body when an internal surgical procedure is to be performed.
  • the shaft 28 . 1 extends through such a port of entry, the wrist-like mechanism 32 then being positioned inside the patient's body.
  • the general position of the mechanism 32 relative to the surgical site in a patient's body can be changed by movement of the arm 26 . Since the pivot center 50 is coincident with the port of entry, such movement of the arm does not excessively effect the surrounding tissue at the port of entry.
  • the robotic arm 26 provides three degrees of freedom of movement to the surgical instrument 28 when mounted thereon. These degrees of freedom of movement are firstly the gimbaled motion indicated by arrows A, pivoting or pitching movement as indicated by arrows B and the linear displacement in the direction of arrows P. Movement of the arm 26 as indicated by arrows A, B and P is controlled by appropriately positioned actuators, e.g., electrical motors, or the like, which respond to inputs from an associated master control to drive the arm 26 to a required position as dictated by movement of the master control.
  • actuators e.g., electrical motors, or the like
  • sensors e.g., potentiometers, encoders, or the like
  • sensors are provided on the arm 26 to enable a control system of the minimally invasive telesurgical system 10 to determine joint positions, as described in greater detail herein below.
  • sensors are referred to in this specification, the term is to be interpreted widely to include any appropriate sensors, such as, for example, positional sensors, velocity sensors, or the like. It will be appreciated that by causing the robotic arm 26 selectively to displace from one position to another, the general position of the wrist-like mechanism 32 relative to the surgical site can be varied during the performance of a surgical procedure.
  • the wrist-like mechanism 32 includes a wrist member 52 .
  • One end portion of the wrist member 52 is pivotally mounted in a clevis, generally indicated at 54 , on the end 28 . 3 of the shaft 28 . 1 by means of a pivotal connection 56 .
  • the wrist member 52 can pivot in the direction of arrows D about the pivotal connection 56 .
  • An end effector, generally indicated by reference numeral 60 is pivotally mounted on an opposed end of the wrist member 52 .
  • the end effector 60 is in the form of, e.g., a clip applier for anchoring clips during a surgical procedure, or the like. Accordingly, the end effector 60 has two parts 60 . 1 , 60 . 2 together defining a jaw-like arrangement.
  • the end effector 60 can be in the form of any desired surgical tool, e.g., having two members, or fingers, which pivot relative to each other, such as, for example, scissors, pliers for use as needle drivers, or the like. Instead, it can include a single working member, e.g., a scalpel, cautery electrode, or the like.
  • a tool other than a clip applier is required during the surgical procedure, the tool 28 is simply removed from its associated arm 26 and replaced with an instrument bearing the required end effector, e.g., a scissors, or pliers, or the like.
  • the end effector 60 is pivotally mounted in a clevis, generally indicated by reference numeral 62 , on an opposed end of the wrist member 52 , by means of a pivotal connection 64 .
  • a pivotal connection 64 It will be appreciated that free ends 60 . 3 , 60 . 4 of the parts 60 . 1 , 60 . 2 are angularly displaceable about the pivotal connection 64 toward and away from each other as indicated by arrows E. F.
  • the members 60 . 1 , 60 . 2 can be displaced angularly about the pivotal connection 64 to change the orientation of the end effector 60 as a whole, relative to the wrist member 52 .
  • the end effector 60 is angularly displaceable about the pivotal connection 64 independently of the other, so that the end effector 60 , as a whole, is angularly displaceable about the pivotal connection 64 as indicated in dashed lines in FIG. 5 .
  • the shaft 28 . 1 is rotatably mounted on the housing 34 for rotation as indicated by the arrows G.
  • the end effector 60 has three degrees of freedom of movement relative to the arm 26 , namely, rotation about the axis 28 . 2 as indicated by arrows G, angular displacement as a whole about the pivot 64 and angular displacement about the pivot 56 as indicated by arrows D.
  • a hand held part, or wrist gimbal, of the master control 70 is generally indicated by reference numeral 80 .
  • Part 80 has an articulated arm portion including a plurality of members or links 82 connected together by pivotal connections or joints 84 .
  • the surgeon grips the part 80 by positioning his or her thumb and index finger over a pincher formation 86 .
  • the pincher formation 86 is squeezed between the thumb and index finger, the fingers or end effector elements 60 . 1 , 60 . 2 of the end effector 60 close.
  • the thumb and index finger are moved apart, the fingers 60 . 1 , 60 . 2 of the end effector 60 move apart in sympathy with the moving apart of the pincher formation 86 .
  • the joints 84 of the part 80 are operatively connected to actuators, e.g., electric motors, or the like, to provide for, e.g., force feedback, gravity compensation, and/or the like.
  • actuators e.g., electric motors, or the like
  • sensors e.g., encoders, or potentiometers, or the like, are positioned on each joint 84 of the part 80 , so as to enable joint positions of the part 80 to be determined by a control system of the surgical system 10 .
  • the part 80 is typically mounted on an articulated arm 90 .
  • the articulated arm 90 includes a plurality of links 92 connected together at pivotal connections or joints 94 .
  • the articulated arm 90 has appropriately positioned actuators, e.g., electric motors, or the like, to provide for, e.g., force feedback, gravity compensation, and/or the like.
  • appropriately positioned sensors e.g., encoders, or potentiometers, or the like, are positioned on the joints 94 so as to enable joint positions of the articulated arm 90 to be determined by the control system as described in greater detail herein below.
  • the surgeon simply moves the pincher formation 86 to cause the end effector 60 to move to where he wants the end effector 60 to be with reference to the image viewed at the viewer 14 .
  • the end effector position and/or orientation can be arranged to follow that of the pincher formation 86 .
  • the actuators and sensors associated with the robotic arms 26 , 26 and the surgical instruments 28 , 28 mounted thereon, and the actuators and sensors associated with the master control devices 70 , 70 are operatively linked in the control system.
  • the control system typically includes at least one processor, typically a plurality of processors, for effecting control between master control device input and responsive robotic arm and surgical instrument output and for effecting control between robotic arm and surgical instrument input and responsive master control output in the case of, e.g., force feedback, or the like.
  • the surgeon views the surgical site through the viewer 14 .
  • the end effector 60 carried on each arm 26 is caused to perform positional and orientational movements in response to movement and action inputs on its associated master control.
  • the master controls are indicated schematically at 70 , 70 . It will be appreciated that during a surgical procedure images of the end effectors 60 are captured by the endoscope 24 together with the surgical site and are displayed on the viewer 14 so that the surgeon sees the responsive movements and actions of the end effectors 60 as he or she controls such movements and actions by means of the master control devices 70 , 70 .
  • the control system is typically arranged automatically to cause end effector orientational and positional movement as viewed in the image at the viewer 14 to be mapped onto orientational and positional movement of the pincher formation 86 of its associated master control 70 , as will be described in greater detail herein below.
  • the operation of the control system of the surgical system or apparatus 10 will now be described. In the description which follows, the control system will be described with reference to a single master control 70 and its associated robotic arm 26 and surgical instrument 28 .
  • the master control 70 will be referred to simply as “master” and its associated robotic arm 26 and surgical instrument 28 will be referred to simply as “slave.”
  • Control between master and slave movement is achieved by comparing master position and orientation in an eye Cartesian coordinate reference system with slave position and orientation in a camera Cartesian coordinate reference system.
  • Cartesian coordinate reference system will simply be referred to as “frame” in the rest of this specification. Accordingly, when the master is stationary, the slave position and orientation in the camera frame is compared with the master position and orientation in the eye frame, and should the position and/or orientation of the slave in the camera frame not correspond with the position and/or orientation of the master in the eye frame, the slave is caused to move to a position and/or orientation in the camera frame at which its position and/or orientation in the camera frame does correspond with the position and/or orientation of the master in the eye frame.
  • the camera frame is generally indicated by reference numeral 110 and the eye frame is generally indicated by reference numeral 150 in FIG. 9 .
  • the new master position and/or orientation does not correspond with the previously corresponding slave position and/or orientation in the camera frame 110 .
  • the control system then causes the slave to move into a new position and/or orientation in the camera frame 110 at which new position and/or orientation, its position and orientation in the camera frame 110 does correspond with the new position and/or orientation of the master in the eye frame 150 .
  • control system includes at least one, and typically a plurality of processors which compute new corresponding positions and orientations of the slave in response to master movement input commands on a continual basis at a rate corresponding to the processing cycle rate of the control system.
  • a typical processing cycle rate of the control system is about 1300 Hz.
  • the control system can have any appropriate processing cycle rate depending on the processor or processors used in the control system.
  • the camera frame 110 is typically positioned such that its origin 112 is at the viewing end 24 . 1 of the endoscope 24 .
  • the z axis of the camera frame 110 extends axially along a viewing axis 114 of the endoscope 24 .
  • the viewing axis 114 is shown in coaxial alignment with a shaft axis 115 of the endoscope 24 , it is to be appreciated that the viewing axis 114 can be angled relative thereto.
  • the endoscope can be in the form of an angled scope.
  • the x and y axes are positioned in a plane perpendicular to the z axis.
  • the endoscope is typically angularly displaceable about its shaft axis.
  • the x, y and z axes are fixed relative to the viewing axis 114 of the endoscope 24 so as to displace angularly about the shaft axis in sympathy with angular displacement of the endoscope 24 about its shaft axis 115 .
  • a frame is defined on, or attached to, the end effector 60 .
  • This frame is referred to as an end effector frame or slave tip frame, in the rest of this specification, and is generally indicated by reference numeral 116 .
  • the end effector frame 116 has its origin at the pivotal connection 64 . However, depending on the type of end effector used, the origin may be offset relative to such a pivotal connection should an improved or more intuitive response between master input and slave output be achieved thereby.
  • one of the axes, e.g., the z axis, of the frame 116 is defined to extend along an axis of symmetry, or the like, of the end effector 60 .
  • the x and y axes then extend perpendicularly to the z axis.
  • the orientation of the slave is then defined by the orientation of the frame 116 having its origin at the pivotal connection 64 , relative to the camera frame 110 .
  • the position of the slave is then defined by the position of the origin 118 of the frame 116 relative to the camera frame 110 .
  • the eye frame 150 is typically chosen such that its origin corresponds with a position 152 where the surgeon's eyes are normally located when he or she is viewing the surgical site at the viewer 14 .
  • the z axis typically extends along a line of sight of the surgeon, indicated by axis 154 , when viewing the surgical site through the viewer 14 .
  • the x and y axes extend perpendicularly from the z axis at the origin 152 .
  • the y axis is chosen to extend generally vertically relative to the viewer 14 and the x axis is chosen to extend generally horizontally relative to the viewer 14 .
  • an appropriate point e.g., point 3 A
  • the point relative to the master at which the origin 156 of the master frame 158 is attached is chosen to enhance intuitive response between master and slave and can thus be at any appropriate location relative to the master.
  • the z axis of the master frame 158 on the master extends along an axis of symmetry of the pincher formation 86 which extends coaxially along a rotational axis H of the pincher formation 86 relative to the rest of the master 70 .
  • orientation of the master within the eye frame 150 is defined by the orientation of the master frame 158 relative to the eye frame 150 .
  • the position of the master in the eve frame 150 is defined by the position of the origin 156 at 3 A relative to the eye frame 150 .
  • a control system employed to cause the slave to track master input is generally and schematically indicated by reference numeral 200 .
  • the control method as indicated by reference numeral 200 assumes that the master and slave were at corresponding positions and the master has been moved into a new position and orientation. Accordingly, since the new position and orientation of the pincher formation 86 relative to the eye frame 150 no longer corresponds with the position and orientation of the end effector frame 116 relative to the camera frame 110 , the end effector 60 is caused to move into a corresponding new position and orientation relative to the camera frame 110 at which it does correspond with the new position and orientation of the pincher formation 86 relative to the eye frame 150 .
  • the new position and orientation of the pincher formation 86 is read in joint space as indicated by reference numeral 202 .
  • This is achieved by the processor by means of the sensors operatively associated with the joints on the master. From this joint space information, which determines the joint positions of the master, a corresponding new position and orientation of the master frame 158 relative to the eye frame 150 is determined in Cartesian space as indicated by reference numeral 204 .
  • the current position and orientation of the end effector 60 in joint space is read as indicated by reference numeral 206 . From this information the current position and orientation of the end effector frame 116 relative to the camera frame 110 in Cartesian space is computed, as indicated by reference numeral 208 .
  • the new position and orientation of the master frame 158 relative to the eye frame 150 in Cartesian space is then compared with the current position and orientation of the end effector frame 116 relative to the camera frame 110 as indicated at 210 .
  • An error between the end effector frame 116 current position and orientation relative to the camera frame 110 and the position and orientation of the end effector frame 116 relative to the camera frame 110 at which it would correspond with the new position and orientation of the master frame 158 relative to the eye frame 150 is then computed, as indicated at 212 .
  • master orientational and positional movement variation need not necessarily correspond proportionally with responsive end effector orientational and positional movement variation. Accordingly, the system is typically arranged to provide for scaling so that the translational movement of the end effector in response to translational movement input on the master is scaled e.g., at a ratio 1 to 2 , or the like.
  • end effector command signals are computed as indicated at 214 .
  • the end effector command signals are then forwarded to the slave actuators to cause them to move the end effector 60 to a new position and orientation relative to the camera frame 110 at which it corresponds with the new master position and orientation relative to the eye frame 150 , as indicated at 216 .
  • Ser. No. 09/373,678 application mentioned above.
  • auxiliary information related to a surgical procedure to be performed by the system 10 can be selectively displayed on the viewer 14 , together with an image of the surgical site captured by the endoscope 24 , so as to enable the surgeon selectively to reference such information on the viewer 14 during the performance of the surgical procedure, in accordance with the invention, will now be described.
  • auxiliary information related to the surgical procedure in the image of the surgical site displayed at the viewer 14 , the surgeon is able to reference such information without having to look at another source or display. For example, by displaying a patient's ECG signal in the image together with the image of the surgical site captured by the endoscope 24 , the surgeon need not transfer his direction of view to a location removed from the image of the surgical site. This enables the surgeon to perform the surgical procedure with greater ease and confidence and with less distraction. Furthermore, the surgeon can prepare preoperative information specific to the surgical procedure to be performed, or specific to the patient on which the surgical procedure is to be performed, so as to enable the surgeon selectively to access such specific auxiliary information in the displayed image during the performance of the actual surgical procedure.
  • auxiliary information When displaying the auxiliary information together with the image of the surgical site captured by the endoscope is referred to in this specification, such a description is to be interpreted to have a wide meaning including, for example, displaying the image in a discrete window overlaid on the image of the surgical site, displaying the auxiliary information so as to be merged with the image of the surgical site, such as merging a preoperative x-ray image with the image of the surgical site so that the surgeon can view hidden detail of the surgical site, displaying the auxiliary information selectively on the viewer instead of the image of the surgical site so that the surgeon is presented with an unobstructed view of the surgical site when performing the surgical procedure, the auxiliary information then being selectively displayable in the image at the viewer alternately with the image of the surgical site, and the like. It will be appreciated that the auxiliary information can be displayed on a separate image display or viewer where appropriate.
  • a plurality of sources of two-dimensional information is generally indicated by reference numeral 312 .
  • Another plurality of sources of two-dimensional information is generally indicated by reference numeral 314 .
  • the sources of two dimensional auxiliary information at 312 define auxiliary information to be displayed in the image at the viewer 14 and which is of a type which, when displayed in the image, is to be adjustable to vary its displayed position relative to the image of the surgical site captured by the endoscope.
  • the imaged information from 312 is typically adjustable relative to the image of the surgical site in two dimensions only. Accordingly, the position of the imaged information can be varied to change its position across the image of the surgical site.
  • the size of the window is typically also adjustable in two dimensions.
  • the types of information selectively accessible from the sources 312 include, for example, a prerecorded streaming video of the surgical procedure to be performed so that the operator can follow the procedure as depicted in the video while displayed in the image at the viewer 14 together with the image of the surgical site.
  • the types of information can further include, for example, a real time ECG signal so that the surgeon can monitor the patient's heart beat within the displayed image at the viewer 14 .
  • auxiliary information can be in the form of a previously captured and stored image from the endoscope of the surgical site, wherein the pre-captured image was taken to provide a generally panoramic view of the surgical site and the surrounding scene.
  • a pre-captured panoramic image can be obtained by the endoscope 24 .
  • the image can be captured when the viewing end of the endoscope 24 is relatively far removed from the surgical site. After the panoramic image or view is captured in this fashion, the endoscope can be moved such that its viewing end is closer to the surgical site so as to obtain a more suitable real time image for use in the performance of the actual surgical procedure.
  • images other than a panoramic image of the surgical site and surrounding scene can be provided for selective reference on the image display at the viewer 14 .
  • Such other images can include, for example, generic or patient specific anatomical images for aiding the operator, or surgeon, for example, in identifying structures so as to determine the surgical site location relative to the patient anatomy.
  • images can include, for example, images showing the location of the entry ports, or incision points, the position of the surgical instrument shafts and/or the end effectors so as to provide the operator with visible information relating to the location of surgical instruments, or parts thereof.
  • image can be computer generated where appropriate, or can be obtained from additional image capture devices, and/or the like. This can be useful to avoid collisions between the instrument shafts, for example.
  • this can provide the operator with visible information enabling him to perceive how the instruments are interacting with each other and/or the patient, in addition to the real time image of the surgical site used to perform the actual surgical procedure.
  • the auxiliary information can be displayed, where appropriate, to surround or abut a generally closer view of the surgical site captured continually, or in real time, by the endoscope and which is used by the surgeon to monitor and control the surgical procedure.
  • the surgeon, or operator can be provided with the real time image from the endoscope at a preferably generally centrally disposed location in the viewed image, while the pre-captured, or real time, auxiliary image, e.g., a more panoramic view of the surgical site and surrounding scene, is displayed along the periphery of the real time image obtained from the endoscope 24 .
  • This can serve to provide the operator with a better idea of where he or she is operating relative to the area surrounding the surgical site.
  • the auxiliary image can be displayed in a discrete window, or in a “picture in picture” arrangement, extending over the image of the real-time surgical site image.
  • the auxiliary image can be displayed alternately with the actual real-time image.
  • the surgeon can intermittently switch between the image of the real-time surgical site image and the auxiliary image by means of any appropriate switching input device or method, such as, buttons, switches, voice command, and/or the like.
  • any appropriate switching input device or method such as, buttons, switches, voice command, and/or the like.
  • the surgeon can typically vary the size of the window and place the window relative to the image of the surgical site so that the information is presented at a location which is comfortable to the surgeon and at which the window does not obstruct important detail of the surgical site image.
  • the displayed image of the surgical site is typically in the form of a “narrow” field of view image normally being live, e.g., continually updated, magnified and focused particularly on the surgical site.
  • a “narrow” field of view typically provides the operator with a large image of a relatively small area in the patient.
  • Such a “narrow” field image is typically captured in real time by means of the endoscope 24 . It has been found advantageous to provide the operator with a “wide angle” image of the surgical site and surrounding scene, to assist the operator in determining where the surgical site and surgical tools are with reference to the surrounding scene.
  • Such a “wide angle” image can be in the form of a “still” image captured by the same endoscope at a position further removed from the surgical site than at which it is normally positioned when capturing the real time image used by the operator as he or she performs the surgical procedure.
  • the “wide angle” image can be captured in real time by another image capture device, or endoscope, or the like.
  • the two images can be displayed in a variety of different ways. In one way, the “wide angle” image can be displayed in a “smaller” window and the “narrow” field image can be displayed over a relatively larger area. The surgeon can then refer to the “smaller” window for referencing orientation, or the like. In another way, the “narrow” field image is displayed in a “smaller” window and the “wide angle” image is displayed over a relatively “larger” area to provide context to the surgeon to help him or her to remain oriented at the surgical site.
  • the surgeon wishes to change the image displayed on the viewer 14 .
  • This can be achieved, e.g., by rotation of the endoscope 24 relative to the site viewed.
  • this image can be caused to rotate together with rotation of the “live”, magnified image.
  • This can be achieved by causing the “still” image to be modified, for example, by means of computer control, so that the “still” image rotates to the same degree as the “live” image, so as to maintain, for example, context for the surgeon should the surgeon desire to rotate the endoscope during surgery.
  • the “still” image can be modified so that the “still” image preserves alignment, or registration, with a corresponding part of the “live” image.
  • the sources of two dimensional auxiliary information at 314 define auxiliary information to be displayed in the image at the viewer 14 and which is of a type which, when displayed in the image, is to be adjustable to vary not only its two-dimensional displayed position relative to the image of the surgical site captured by the endoscope, but also its displayed orientation in three dimensions relative to the displayed image of the surgical site.
  • One of the sources at 314 can contain preoperative information which is to be aligned or brought into register with the image of the surgical site. For example, a two dimensional CAT scan image of a surgical site particular to the patient on which the surgical procedure is to be performed can be obtained preoperatively and loaded into one of the sources at 314 .
  • Such a preoperative image can be obtained so as to correspond with an image to be captured by the endoscope, in other words, an image corresponding to the image which the endoscope is to capture during the surgical procedure from a specific vantage point. Instead, the preoperative image can be from a vantage point different to that of where the endoscope is to be during the surgical procedure.
  • the surgeon can then access the CAT scan information from the particular source at 314 and place it in the displayed image of the surgical site.
  • Such an image can then be adjusted in three dimensions so as to bring the preoperative CAT scan image generally into register with the image of the actual surgical site captured by the endoscope. Since the information from the sources 314 represent two dimensional information, there may be a limit to the amount of orientation change that can be tolerated before the information ceases to be of use to the surgeon.
  • a plurality of sources of three-dimensional information is indicated at 316 .
  • One of the sources can include, for example, a three-dimensional model corresponding to a surgical site on which a surgical procedure is to be performed.
  • a three-dimensional model can be, for example, raw volumetric images, such as point cloud or voxcel representations, or the like, a computer generated three-dimensional model or image, a segmented three-dimensional model obtained from CAT (Computer Aided Tomography) scans, MRI (Magnetic Resonance Imaging) techniques, or the like.
  • CAT Computer Aided Tomography
  • MRI Magnetic Resonance Imaging
  • the image corresponding to the auxiliary information in the form of the three-dimensional model can typically be superimposed, or merged with the image of the surgical site.
  • the brightness of the image of the three-dimensional model is typically adjustable so as to cause it selectively to fade relative to the actual image of the surgical site.
  • the image of the model can be positionally and orientationally adjusted, and typically scaled, so as to enable the surgeon to bring the preoperative image into register with the actual image of the surgical site.
  • the registration of the preoperative image can be made to remain in register with the surgical site. This can typically be accomplished by causing the control system of the surgical system 10 to fix the position of the preoperative image relative to a suitable reference frame once the surgeon has brought the preoperative image generally into register in the displayed image.
  • a suitable reference frame can be, for example, a reference frame attached relative to the cart 20 , or the patient, or the like.
  • registration is often effected visually by the surgeon, it may be that the registration is not entirely true or accurate. Thus, should the endoscope position be moved to capture an image of the surgical site from a different vantage point, it may be that the surgeon may again have to perform a slight adjustment to the registration should the preoperative image not be correctly registered with the actual image of the surgical site upon changing the endoscope position.
  • automatic registration of the preoperative image with the surgical site image can be achieved in accordance with known imaging techniques.
  • registration can be accomplished by enabling the surgeon, or operator, to perform an initial manual registration procedure, followed by an automatic registration procedure in accordance with conventional methods, to achieve a truer registration.
  • auxiliary information can include preoperative images as well as inter-operative images.
  • an inter-operative image, or preoperatively obtained model, and/or the like, of a beating heart can be registered with the actual image of the beating heart as captured by the endoscope, and/or the like.
  • the two dimensional information can typically be in the form of intrinsically two-dimensional information.
  • Such information can include two dimensional visual images, such as video images, x-ray images, ultrasonic images, and/or the like. These two-dimensional images can be in digital or analog format, or the like.
  • the information can be in the form of static images. Such static images can be in tiff, jpeg, and/or the like, file formats, for example.
  • the information can be in the form of moving images, such as, for example, streaming videos, as already mentioned. Such moving images can be in mpeg, digital video, analog video, such as NTSC or PAL, and/or the like, formats, for example.
  • the information can be textual, numeric, symbolic, and/or graphic in form.
  • the information sources can include sources of information in the form of words, numeric readouts, status icons, bargraphs, stripchart displays, and/or the like.
  • representations of blood pressure gauges, heartbeat rate, warning messages, notifications, warning lights, warning icons, or other warning signals related to system status for example, the time in the form of a representation of a digital or analog clock, e-mail messages, and/or the like, can be displayed.
  • numeric readouts can correspond to blood pressure, heartbeat rate, elapsed and absolute time, and/or the like.
  • Status icons can include icons indicating the status of the system 10 , the identification of the type of surgical instruments currently mounted on the robotic arms, and/or the like.
  • Bar graphs can correspond to patient specific information, such as, temperature, oxygen levels in the patient's blood, and/or the like. Bar graphs can also correspond to system specific information such as force magnitude, back-up battery status, and/or the like.
  • Strip charts can correspond to EEG, ECG, blood pressure, and/or the like.
  • Symbolic or graphic representations can correspond to clocks, warning indicators, and icons selectively activatable to provide access to sources of other auxiliary information, such as the three-dimensional and two-dimensional information, described above, menus, web pages and/or the like.
  • One, or more, of the sources may even comprise a separate computer operatively connected to the system 10 .
  • the computer can be a computer on which a surgeon has prepared preoperative information for a specific patient on which a surgical procedure using the system 10 is to be performed.
  • Such a computer may be remote from the system 10 .
  • the surgeon is able to access such preoperative information on the remote computer from the system 10 , so as selectively to display such information on the viewer 14 during the performance of the surgical procedure.
  • the surgeon from this source, can access information which may be resident on a computer screen within his or her office, for example.
  • the images derived from the sources at 312 , 314 and/or 316 may be stored images or may be real-time images. Accordingly, the system 10 may include dedicated memory on which the images can be recorded preoperatively if the images are patient or surgical site specific, for example, so as to be stored in resident memory of the system 10 . Instead, or in addition, the system 10 can have one or more input connectors, or jacks, to enable the system 10 to be operatively linked to a source of auxiliary information external to the system 10 . In this fashion, the system can be linked to an external source of auxiliary information, such as, for example, a remote computer as described above, an ECG source, computer networks such as Local Area Networks (LANS), the internet, and/or the like.
  • auxiliary information such as, for example, a remote computer as described above, an ECG source, computer networks such as Local Area Networks (LANS), the internet, and/or the like.
  • the sources 312 , 314 and 316 can be in the form of resident memory of the system 10 , on which memory the auxiliary information is stored, or can be in the form sources external to the system 10 , which external sources are connectable to the system 10 through the input connectors or jacks.
  • Sources of three-dimensional information are indicated at 316 . These sources represent information which is intrinsically three-dimensional. Such types of information can include, for example, segmented organ and/or vasculature models, patient specific and/or generic biomedical models, non-biological geometric shapes, markers, and/or the like. Such types of information can also include, for example, real time three-dimensional video, laser scans, and/or the like. Such types of information can yet further include landmarks, identifiers, or other markers that are attached to fixed locations in space. The use of such landmarks, identifiers, or other markers will now be described, by way of example.
  • the surgeon wishes to perform an anastomosis, for example, he or she can place a landmark, or identifier, or the like in the image displayed on the image display and then move the landmark or marker to correspond with the area where the anastomosis is to be performed.
  • the marker can then be attached to the area so that if the endoscope is moved, for example, the marker remains in a registered condition with the area to which it is attached.
  • the non-biological geometric shapes are typically used to place visible haptic constraints in the displayed image at the viewer 14 .
  • the purpose of placing such haptic constraints in the image is, for example, to inhibit the end effectors from moving beyond such constraints, containing end effector movement within such constraints, and/or the like.
  • the operator of the system can select an appropriately shaped geometric shape, or shapes, and, place it, or them, in the image, and then position the selected geometric shape, or shapes, in the image around an area, or organ, or tissue, for example, so as to protect that area, or organ, or tissue from invasion by the end effectors 60 , or to constrain end effector movement to remain within such shape or shapes, miter-box-fashion.
  • an appropriately shaped geometric shape, or shapes can be selected, placed in the scene of the surgical site and moved into a position in which the selected shape, or shapes, extend over the sensitive area.
  • a corresponding haptic constraint corresponding to the selected and placed geometric shape, or shapes, is initialized so as to inhibit the end effectors 60 from trespassing beyond the visible constraint, or constraints, as placed in the image by the surgeon thereby to protect the sensitive tissue, or organ, or the like.
  • the geometric shapes can be of any appropriate shape.
  • such shapes can include, for example, polyhedral shapes, NURBS (Non-Uniform Rational B-Spline), implicit surface shapes, planar shapes such as walls, and/or the like.
  • the geometric shapes can include volumetric shapes such as point cloud, voxcels, and/or the like.
  • the file formats used to store such geometric shapes can be .obj, .dxf, 0.3ds, VRML, and/or the like, for example. It will be appreciated that once an appropriate selected geometric shape, or shapes, is placed in the image, the surgeon can move the shape, or shapes, into a position covering or shrouding an area of sensitivity.
  • the control system of the system 10 can typically allocate coordinates to the placed shape, or shapes, relative to an appropriate frame, such as a frame attached to the cart 20 , or patient, or the like.
  • the system after having determined the coordinates corresponding to the placed shape, or shapes, then inhibits the end effectors from moving beyond such coordinates or constrains end effector movement to remain within such coordinates.
  • Geometric shapes can also be used to guide the surgeon or to assist in finding locations of particular interest.
  • haptic feedback can be used to indicate information about objects which may not be readily discernable visually. For example, sensitive areas can be given repulsive behavior so that the tools are not only inhibited from approaching the sensitive areas, but are restrained when approaching the sensitive areas at a predetermined distance from such areas.
  • Such geometric shapes can be provided with geometric description or additional information, and can contain information about appearance, e.g., via visual texture mapping, and/or the like, surface and volume properties, e.g., such as mass, density, impedance, and/or the like, in accordance with known methods in the field of haptics.
  • the shapes can also be derived from biological sources such as segmented MRIs.
  • Such additional information about geometric shapes can be used for visual representation, e.g., colors, patterns, textual maps, flashing appearances, and/or the like.
  • Such additional information can also be used with haptic rendering to provide, for example, stiffness, artificial friction, masses, vibrations, or other physical or non-physical force cues.
  • the various sources of information as indicated at 312 , 314 , and 316 are typically represented as icons on the display area of the video display 14 . Accordingly, the operator of the system can select any one or more of the desired sources by selecting the appropriate associated icon.
  • the step of selecting the desired source of auxiliary information is indicated by the blocks 318 , 320 , and 322 for the sources at 312 , 314 , and 316 , respectively.
  • Selection of a desired source typically takes place at the operator console 12 .
  • Such selection can be made in any appropriate manner, such as by using buttons, foot pedals, a mouse, and/or the like, for example.
  • selection is made by making use of one, or both, or either of the master controls 70 , 70 .
  • one, or both, or either, of the masters 70 , 70 can serve as a two-dimensional or three-dimensional mouse. Accordingly, one, or both, or either, of the masters can be arranged to perform functions relative to the displayed image in a manner analogous to a conventional mouse relative to a computer screen. Therefore, one, or both, or either, of the masters can be arranged to perform functions such as to point, highlight, move, select, and/or the like.
  • the masters each typically have at least six degrees of freedom of movement. Accordingly, when used as a three-dimensional mouse, such master can be arranged to control six variables, for example. Therefore, functions such as, shifting, rotating, panning, tilting, scaling, and/or the like, can be performed simultaneously when one, or both, or either, of the masters are used as a three-dimensional mouse, without another input being required.
  • any windows or overlays can be handled as “elastic” bodies, such that resizing, scaling, warping, and/or the like, can, for example, be controlled by pulling the masters apart, or the like.
  • the masters 70 , 70 are typically provided with force feedback.
  • the force feedback on the masters 70 , 70 can be arranged to provide functions related to auxiliary information selection, placement, orientational and positional movement, for example, to draw, or “suck”, the masters to an icon when an associated cursor is within a predetermined area around the icon, and/or the like.
  • the selection step is indicated in the block 324 at 326 and as indicated by the dashed lines 327 . It will be appreciated that the block 324 represents selection and regulation steps that are performed by means of the appropriate inputs, such as the master control devices 70 , 70 , at the surgeon's console 12 by the operator.
  • the selective placing of the auxiliary information from the sources 312 can be selectively caused to be displayed to extend at least partially across an image display area of the viewer 14 , such as in a localized window.
  • the position at which the information is displayed relative to the display area can be regulated or changed by the operator in two dimensions.
  • a desired source is selected by the operator by operation of an appropriate input at 326
  • the desired source is selected at 318 .
  • the information from that selected source is then forwarded to a two-dimensional transform indicated at 328 , as indicated by arrow 330 .
  • the information is fed to a video mix and fade step at 332 , as indicated by arrow 334 .
  • the information from the selected source at 312 is mixed with the video image captured by the endoscope 24 .
  • the video image captured by the endoscope 24 is indicated by arrow 336 .
  • the combined images are forwarded to the video display as indicated by arrow 338 so that both images are placed in the image at the viewer 14 .
  • an image comprising a combination or merger of the image from the endoscope and the selected source at 312 is indicated generally by reference numeral 311 .
  • An image derived from the source at 312 is indicated at 318 , and is shown as being overlaid on the image from the endoscope indicated at 317 .
  • a row of icons is indicated by reference numerals 315 .
  • the source at 312 was selected by actuating a corresponding one of the icons 315 .
  • the surgeon or operator of the system 10 can regulate the two-dimensional transform at 328 , as indicated at 342 .
  • This can be achieved in any appropriate manner, such as through appropriate input devices such as, for example, buttons, toggles, joysticks, mice, and/or the like.
  • one, or both, or either, of the master control devices 70 , 70 are used as the input device or devices whereby the two-dimensional transform 328 can be regulated.
  • the representation of the combined images can be presented such that the information from the selected source 312 is cropped in a localized window, as indicated in FIG. 12 of the drawings, in the image displayed at the viewer 14 .
  • the image 317 captured by the endoscope 14 is positioned to extend across at least a major part of the display area, the information from the selected source at 312 being positioned in a localized window overlaid on the image captured by the endoscope 24 .
  • the two-dimensional transform at 328 is regulated to cause the window displaying the information from the selected source at 312 , to be moved relative to the rest of the image, and to be placed where desired by the operator, as indicated by arrows J and K in FIG. 12 .
  • the size of the window can be varied, as well as its position relative to the rest of the image, as indicated by arrows L and M.
  • the video mix and fade step 332 is also regulatable by, for example, the operator at the operator console 12 , or by another person, at a different location, if appropriate.
  • An appropriate input for performing such regulation is indicated at 344 and is operatively connected as indicated by the dashed lines 345 to the video mix and fade block at 332 .
  • the input at 344 is also performed by means of one, or both, or either, of the master controls 70 , 70 .
  • these sources provide two dimensional information which, when displayed on the display area at the viewer 14 , can be regulated so as to change the position of such information relative to the display area at the viewer in three dimensions, as described in greater detail herein below.
  • An appropriate one of the sources of two-dimensional information at 314 can be selected in similar fashion to the selection of one of the sources at 312 . Accordingly, the operator can select information from a desired source at 314 by manipulating the appropriate input at 326 . The selection step is indicated at 320 . Once selected, the information from the desired source is forwarded to a two-dimensional to three-dimensional transform indicated at 346 . At the step 346 , the two-dimensional information from the selected source at 314 is converted to a three-dimensional representation. It is then passed through the three-dimensional transform indicated at 348 . The three-dimensional transform at 348 is regulatable by the operator as indicated at 350 and by the dashed line 352 . This can typically be achieved by means of any one or more of the inputs mentioned above.
  • the appropriate input is one, or both, or either, of the master controls 70 , 70 .
  • the input at 350 typically the position, orientation and scale of the two-dimensional information from the selected source at 314 , can be regulated to change its position, orientation and scale in three dimensions. It will be appreciated that, in this fashion, not only the position, but also the orientation of the two-dimensional image as displayed in the image as viewed at the viewer 14 can be changed.
  • the information is passed to block 354 , where the information is transformed from a three-dimensional representation into a two dimensional representation.
  • the two-dimensional transform is indicated at 356 .
  • the two-dimensional transform is regulatable by the operator through the input 342 so as to change the position of the information, as displayed in the image at the viewer 14 , in two dimensions. It will be appreciated that this corresponds to changing the position of the image of the auxiliary information from the source at 314 relative to the image of the surgical site.
  • the information is passed to a video mix and fade block at 358 , where it is mixed with the image from the endoscope 24 as indicated by arrow 336 .
  • the operator can cause the information to fade relative to the image captured by the endoscope 24 by means of the input at 344 .
  • the image 336 from the endoscope 24 is combined with the information from the selected source at 314 and is then forwarded to the viewer 14 to be displayed thereon.
  • an image comprising a combination or merger of the image from the endoscope and the selected source at 314 is indicated generally by reference numeral 321 .
  • An image derived from the source at 314 is indicated at 323 and is shown as being overlaid on the image from the endoscope indicated at 327 .
  • the image from the source 314 can be repositioned with reference to arrows J and K and can be adjusted in size as indicated by arrows L and M. This is achieved by the operator of the system 10 at 342 by means of the transform at 356 as indicated by dashed line 140 .
  • the image from the selected source at 314 is orientationally adjustable or regulatable. Accordingly, the image from the selected source 314 can be regulated so as to change its orientation in three dimensions with reference to the arbitrary reference frame indicated in dashed lines in FIG. 13A .
  • FIG. 13B the image from the source 314 is shown as having been adjusted angularly about an arbitrary y axis with reference to the reference frame in FIG. 13A , it will be appreciated that angular adjustment about the x and z axes can be performed in similar fashion.
  • Such angular regulation of the image from the selected source at 314 is achieved by the operator of the system 10 at 350 , so as to regulate the information from the selected source at 314 by means of the transform at 348 as indicated by dashed line 352 .
  • the image can also be moved “inwardly” and “outwardly” as indicated by arrows Q along the z-axis.
  • information from one or more of the sources can be selected by the operator by means of the input 326 and as indicated by the block 322 .
  • the three-dimensional information from the selected source at 316 is then passed to a three-dimensional transform as indicated at 362 .
  • the operator by using the input device at 350 , can then regulate this information in the three-dimensional transform at 362 so as to vary typically the orientation, position and scale of an image derived from the selected source and as displayed at the viewer 14 in similar fashion as described above with reference to FIGS. 13A and 13B .
  • the information is forwarded to a block 364 where the three-dimensional information is transformed from three dimensions to two dimensions.
  • the resultant two-dimensional information is then forwarded to a two-dimensional transform at 366 .
  • the information can then again be regulated by the operator by means of the input device at 342 as herein before described with reference to the two-dimensional transforms 328 , 356 .
  • the resultant information is then fed to a video mix and fade block as indicated at 368 where the information is mixed with the image from the endoscope and is then passed to the viewer.
  • the information can be caused automatically to register with a corresponding surgical site image captured by the endoscope, as already described herein above. Instead, as described above, registration can be manual only, or a combination of manual and automatic methods.
  • the above methods can be used with two-dimensional single channel video display or with three-dimensional dual channel video display.
  • the real time video source 336 can comprise two separate images for “right” and “left” channels for viewing by the right and left eyes of the surgeon.
  • Elements 354 and 364 can then provide two separate images from two distinct viewpoints for the right and left channels respectively.
  • the subsequent elements, or steps, can then be applied to both channels.
  • element 328 can be arranged to duplicate the signal 334 into a left and a right channel and to shift them relative to each other to place the original two-dimensional image in a three-dimensional viewer at variable apparent depths.
  • At least one of the master controls is operatively arranged to fulfill some, preferably all, of the functions in the block 324 . Accordingly, the operator need then not remove his hands from the master control devices 70 , 70 when selecting and changing the position, orientation and scale of the auxiliary information when displayed in the image at the viewer 14 . In this way, continuity of control of the surgical procedure is enhanced whilst still enabling the operator to access and place auxiliary information from one or more of the sources 312 , 314 and 316 .
  • the masters 70 , 70 are normally operatively associated with the slaves.
  • the masters are typically used selectively to place an image corresponding to auxiliary information from a selected source 312 , 314 , 316 in the image or scene of the surgical site.
  • the operative association between the master, or masters, and the slaves is temporarily interrupted.
  • the slaves are typically held or locked in stationary positions at the surgical site. Accordingly, the slaves are locked in the positions they occupied immediately before disassociation with the masters 70 , 70 .
  • the master or masters are then freed to enable them to be used to select and place the desired auxiliary information in the scene or image of the surgical site captured by the endoscope 24 and displayed across the display area of the image display or viewer 14 .
  • operative association between the masters 70 , 70 and the slaves is re-established to permit the operator to proceed with the surgical procedure with reference to the auxiliary information now displayed on the display area of the viewer 14 after having been selected and placed in the scene by means of one, or both, or either, of the masters 70 , 70 .
  • a cursor is typically generated in the image upon disassociation with the slaves. The cursor is then guided by movement of the master until the cursor is over the desired icon 315 . The master is then also typically used to actuate the icon to cause the desired auxiliary information to be accessed and placed in the image of the surgical site.
  • this can be achieved by squeezing the pincher formation 86 , “pressing” the icon, or the like.
  • the master, or both masters is then used to vary the position and/or orientation of the image corresponding to the selected auxiliary information relative to the image of the surgical site as described above, and where appropriate.
  • One or both masters may be used to vary the position and orientation of auxiliary information, overlays and windows in a manner similar to the way in which masters are used to vary the position and orientation of an image from an image capture device as described in co-pending application entitled “Image Shifting Apparatus and Method for a Telerobotic System,” previously incorporated herein by reference.
  • the present invention also encompasses other manners of manipulating auxiliary information, in addition to the preferred masters disclosed, such as by repositioning/rotating a joystick, using multiple input buttons to indicate the desired manipulation, or using a voice control/recognition system to command the system to manipulate the auxiliary information as desired.
  • the image displayed on the image display may be caused to shift and/or rotate in response to such image capture device movement.
  • the video image 336 can be caused to shift/rotate electronically, for example.
  • the two-dimensional and three-dimensional transforms 328 , 348 , 354 , 356 , 362 , 364 , 366 can be arranged to synchronize their operation with the change in the displayed image so as to cause the auxiliary information to appear attached to the displayed real time image.
  • the transforms can be arranged to ignore the change in the displayed real time image to cause the auxiliary information to appear attached to the image display and to drift relative to the changing real time image.
  • Such a source of auxiliary information can typically include an appropriate image gathering device such as one including a transmitter and receiver arrangement, as schematically indicated at 413 .
  • An example of such a device is an ultrasound transducer which will be used by way of example only in the description which follows. Accordingly, the invention is not to be limited to an ultrasonic device. Any appropriate device which can gather similar information falls within the scope of the invention.
  • Such a source can be used to obtain a preoperative or intraoperative two-dimensional or three-dimensional image, or model, corresponding to a surgical procedure to be performed. Accordingly, it can be either a two-dimensional source 312 , 314 or a three-dimensional source 316 depending on its application.
  • the ultrasonic transducer can be used to obtain a single ultrasound image.
  • a three-dimensional source it can be used to obtain a plurality of spaced ultrasonic images, or cuts, thereby to provide sufficient information for construction of a three-dimensional model. Accordingly, it can be arranged to move, or sweep, across a surgical site to capture such images, or cuts. This can typically be achieved, for example, in accordance with a pre-programmed sequence for moving the ultrasound transducer, manual movement of the ultrasound transducer, or the like.
  • the ultrasonic transducer can be mounted at an end of a shaft to enable it to be introduced to the surgical site through a relatively small aperture, in a minimally invasive manner.
  • the sweeping movement can be performed manually by moving an opposed end of the shaft positioned outside the body.
  • a handle can be provided on the opposed end of the shaft.
  • manually operable actuators can be provided at the handle to enable the ultrasonic transducer, or probe, to be moved relative to the end of the shaft on which it is mounted by manipulating the actuators.
  • the shaft can be mounted on a robotic arm, the movement being controlled through a master control device.
  • the movement of the ultrasonic transducer can be controlled by means of a computer program.
  • a plurality of separate images can be obtained and used to form a “mosaiced” surface of images in a fashion similar to that known in the satellite and undersea imaging industries, namely, by “painting” the sensor, or ultrasonic transducer, across the surface being viewed.
  • Said surface of images may be intrinsically two- or three-dimensional in nature depending on the movement of the sensor during the build-up of the image.
  • a different series of image “slices” may be constructed from a sensor that produces a planar image and that is moved substantially normal to the image plane to produce a series of slices, as is known, for example, in prenatal ultrasonic imaging practice. Taken together, these form an intrinsically three-dimensional or volumetric image.
  • Such a source can also be used inter- or post-operatively.
  • it can be used as a flow probe, or the like, to enable the surgeon, for example, to ascertain the degree of fluid flow through a vessel, or the like.
  • a surgeon, or operator, of the system may wish to determine whether or not the anastomosed vessels are allowing sufficient blood flow therethrough, whether or not one or more of the vessels has been damaged during the procedure so as to require further corrective surgery, and/or the like.
  • the flow probe, or ultrasonic transducer can then be used to establish this.
  • the ultrasonic transducer or other appropriate device, or flow probe, can be mounted on an end of a shaft 415 to permit it to be introduced into a patient body in similar fashion to the surgical instruments 28 , in a minimally invasive manner.
  • the ultrasonic transducer can be mounted on an end of the shaft by means of a wrist member 417 similar to the wrist member 52 , or more than one wrist member, which cooperate with each other, to enable it to be angularly displaced relative to the shaft in similar fashion to the end effector 60 , in multiple degrees of freedom of movement.
  • the mounting of the ultrasonic device on the end of the shaft 415 is preferably such as to provide the ultrasonic device with relatively large sweeping movement capability relative to the end of the shaft, as indicated by arrows 419 . Accordingly, it can have a relatively large lateral range of motion although narrow ranges of motion, or none at all, relative to the end of the shaft, fall within the scope of the present invention. Movement of the ultrasonic device relative to at least the end of the shaft is preferably controlled from outside the patient body, in use. For example, actuators positioned remote from the end on which the ultrasonic transducer is mounted may be used to control movement of the ultrasonic device relative to the end of the shaft from outside the patient body.
  • actuators can be provided to cause the ultrasonic transducer to scan an area of interest.
  • the shaft may have a handle at its proximal end, opposed from the flow probe, for manual control by means of manually controllable actuators, or it may be mountable on a robotic arm as described above for control by means of a master control device.
  • the ultrasonic device is mounted on a distal end of a robotic surgical tool of the type disclosed in U.S. Pat. No. 5,808,665, entitled “Endoscope Surgical Instrument and Method For Use,” the full disclosure of which is incorporated herein by reference.
  • Movement of the ultrasonic transducer across a desired area of interest could then be accomplished by a surgeon or operator of the system 10 by manipulation of a remotely controlled master control at the control station 12 as described in U.S. patent application Ser. No. 09/398,507.
  • the probe could be arranged to be releasably grasped by a surgical instrument having an appropriate complimentary end effector.
  • Another application of the information gathered by such an ultrasound probe, or the like, is to collect preoperative data on the patient, at the surgical site, for example.
  • Such preoperative data can then be used to determine a location of, for example, a stenosis, or blockage, or the like, in a blood vessel that is to be anastomosed during a heart bypass operation for example.
  • the auxiliary information can then be overlaid on the “live” image of the surgical site to indicate to the surgeon where the surgeon should conduct the anastomosis.
  • markers or identifiers can then be attached to the location of the stenosis such that, should the displayed image be changed, such as, for example by moving the endoscope, the markers or identifiers remain in a registered condition with the stenosis so that the location of the stenosis remains clearly indicated in the displayed image.
  • FIG. 15 shows a surgical instrument 28 extending through a cannula 429 mounted in an aperture extending into the patient body.
  • the image capture device can be in any appropriate form. For example, it can include optical fiber bundles, an annular image capturing ring, or a suitable microcamera, or the like.
  • an image extending along the length of the shaft 28 . 1 can be captured. This image can then be displayed selectively on the displayed image at the viewer. In this fashion, the surgeon can be provided with images from various vantage points which may provide him or her, with information otherwise not readily discernable. For example, by mounting such an image capture device directed along the shaft of the instrument, collisions between instrument shafts and the like can be avoided.
  • auxiliary information is provided to the surgeon to enable him or her to determine the orientation of the captured image displayed on the viewer relative to a frame of reference.
  • the auxiliary information can indicate to the surgeon which way is “up” relative to the displayed image or scene.
  • Such auxiliary information can be presented in any appropriate manner, for example, by means of an icon, image, representation, or the like.
  • One way of achieving this is by displaying a horizon “bar” or “line” in the image. Obviously, a horizon line will only be useful to a surgeon if the endoscope is not parallel to/coincident with the gravity vector. Otherwise, rotation of the endoscopic image will simply result in rotation of the image on a plane normal to gravity.
  • the top of the displayed image is either up, or down.
  • the icon will include an image to enable the surgeon to distinguish between “up” and “down,” such as a dot on the “up” side of the bar.
  • This type of absolute registration of the horizon line is not always necessary during surgery. If the image is changed, e.g., by rotating the endoscope, the bar is caused to rotate so as to indicate that “up” in the image no longer corresponds with gravitational “up”. Therefore, the surgeon can be shown where he or she is with respect to an artificial “horizon” bar or line overlayed on the image captured by the endoscope.
  • This line or bar is preferably displayed to be perpendicular to the direction of gravity and perpendicular to the endoscope line of sight at its viewing end.
  • H(endoscope) is the horizon vector in the endoscope reference frame.
  • H(endoscope) is the horizon vector in the endoscope reference frame.
  • Angle arctan ⁇ ( endoscope ⁇ H ⁇ ( y ) endoscope ⁇ H ⁇ ( x ) )
  • the artificial horizon or “bar” can then be displayed in the displayed image as indicated at 510 in FIG. 1 GA. If the endoscope is then rotated to rotate the displayed image in a clockwise direction as indicated by arrow B 1 , the line or bar 510 follows as indicated in FIG. 16B . Instead of a line or bar, an arrow corresponding with the direction of gravity can be used, in the manner of a virtual “plumb line” for example. Instead, and with reference to FIG. 17A , opposed indicators or cursors 520 , 522 can be used. As the image is rotated clockwise, as indicated by arrow B 2 , for example, the markers are moved along with rotation of the image as indicated in FIG. 17B . The surgeon can then determine orientation with reference to an imaginary line extending between the markers 520 , 522 .
  • auxiliary information that can be displayed on the displayed image is one or more force indicators to indicate to the operator the degree of force applied between the fingers of the end effectors 60 , for example.
  • This can be achieved by measuring associated motor current for example, and can be in the form of a graph (such as a bar graph) associated with each of the end effectors and displayed on the image for the surgeon to see.
  • the graph may include a variety of colors, with lighter forces indicated by both different colors as well as changes in magnitude of the graphic display.
  • the graphs may indicate force direction as well as magnitude for example.
  • a zeroing function can be included to negate effects of other forces on the end effectors such as if they contact tissue, or body walls, or the like.

Abstract

A method of performing a surgical procedure on a patient is provided. The method typically comprises positioning a surgical work station of a robotically controlled surgical system and a patient on which a surgical procedure is to be performed in close proximity relative to each other, directing a field of view of an image capture device of the surgical work station at a surgical site on the patient, at which site the surgical procedure is to be performed, and introducing at least one robotically controlled surgical instrument on the surgical work station to the surgical site so that an end effector of the surgical instrument is within the field of view of the image capture device. The method typically further comprises displaying an image of the surgical site and the end effector on a display area of an image display at an operator control station of the surgical system. The image display is typically operatively connected to the image capture device so as to display, on the display area, the image of the surgical site and the end effector captured by the image capture device. The method can further include permitting an operator of the surgical system to manipulate a master control at the operator control station whilst viewing the image of the surgical site on the image display, the master control being operatively associated with the surgical instrument thereby to cause the end effector to move in response to manipulation of the master control so as to perform at least part of the surgical procedure on the patient at the surgical site. The method yet further typically comprises operatively linking the image display to a source of selectively accessible auxiliary information related to the surgical procedure to be performed, enabling the operator selectively to access the source of auxiliary information from the operator control station so as to forward the auxiliary information to the image display, causing the auxiliary information to be displayed across the display area of the image display in response to the operator selectively accessing the source of auxiliary information at the operator control station and enabling the operator selectively to move the auxiliary information when displayed on the image display relative to the image of the surgical site displayed on the image display. The master control is typically operatively linked with the source of auxiliary information, enabling the operator selectively to access the source of auxiliary information then including permitting the operator selectively to disassociate the master control from the surgical instrument and to use the master control to access the source of auxiliary information so as to enable the auxiliary information to be displayed on the display area of the image display.

Description

    RELATED APPLICATIONS
  • This application is a continuation-in-part of co-pending U.S. patent application Ser. No. ______ , entitled “Image Shifting Apparatus and Method for a Telerobotic System,” filed Dec. 7, 1999 (Attorney Docket No. 17516-002710), the full disclosure of which is incorporated herein by reference. This application is also related to the following patents and patent applications, the full disclosures of which are incorporated herein by reference: PCT International Application No. PCT/US98/19508, entitled “Robotic Apparatus,” filed on Sep. 18, 1998; U.S. patent application Ser. No. 09/418,726, entitled “Surgical Robotic Tools, Data Architecture, and Use,” filed on Oct. 15, 1999; U.S. patent application Ser. No. 09/378,173, entitled “Stereo Imaging System for Use in Telerobotic Systems,” filed on Aug. 20, 1999; U.S. patent application Ser. No. 09/398,507, entitled “Master Having Redundant Degrees of Freedom,” filed Sep. 17, 1999; U.S. patent application Ser. No. 09/288,068, entitled “Aspects of a Control System of a Minimally Invasive Surgical Apparatus;” filed Apr. 7, 1999; U.S. patent application Ser. No. 09/373,678, entitled “Camera Referenced Control in a Minimally Invasive Surgical Apparatus,” filed Aug. 13, 1999; U.S. patent application Ser. No. 09/398,960, entitled “Repositioning and Orientation of Master/Slave Relationship in Minimally Invasive Telesurgery,” filed Sep. 17, 1999; and U.S. Pat. No. 5,808,665, entitled “Endoscopic Surgical Instrument and Method for Use,” issued on Sep. 15, 1998.
  • BACKGROUND OF THE INVENTION
  • The present invention is generally related to improved robotic devices, systems and methods, for use in telerobotic surgery.
  • Minimally invasive medical techniques are aimed at reducing the amount of extraneous tissue which may be damaged during diagnostic or surgical procedures, thereby reducing patient recovery time, discomfort, and deleterious side effects. Many surgeries are performed each year in the United States. A significant amount of these surgeries can potentially be performed in a minimally invasive manner. However, only a relatively small percentage of surgeries currently use minimally invasive techniques due to limitations of minimally invasive surgical instruments and techniques currently used and the difficulty experienced in performing surgeries using such traditional instruments and techniques.
  • Advances in minimally invasive surgical technology could dramatically increase the number of surgeries performed in a minimally invasive manner. The average length of a hospital stay for a standard surgery is significantly longer than the average length for the equivalent surgery performed in a minimally invasive surgical manner. Thus, expansion in the use of minimally invasive techniques could save millions of hospital days, and consequently millions of dollars annually, in hospital residency costs alone. Patient recovery times, patient discomfort, surgical side effects, and time away from work can also be reduced by expanding the use of minimally invasive surgery.
  • Traditional forms of minimally invasive surgery include endoscopy. One of the more common forms of endoscopy is laparoscopy, which is minimally invasive inspection or surgery within the abdominal cavity. In traditional laparoscopic surgery a patient's abdominal cavity is insufflated with gas and cannula sleeves are passed through small (approximately ½ inch) incisions in the musculature of the patient's abdomen to provide entry ports through which laparoscopic surgical instruments can be passed in a sealed fashion.
  • The laparoscopic surgical instruments generally include a laparoscope for viewing the surgical field and working tools defining end effectors. Typical surgical end effectors include clamps, graspers, scissors, staplers, and needle holders, for example. The working tools are similar to those used in conventional (open) surgery, except that the working end or end effector of each tool is separated from its handle by an approximately 12-inch long extension tube, for example, so as to permit the surgeon to introduce the end effector to the surgical site and to control movement of the end effector relative to the surgical site from outside a patient's body.
  • To perform surgical procedures, the surgeon typically passes these working tools or instruments through the cannula sleeves to the internal surgical site and manipulates the instruments or tools from outside the abdomen by sliding them in and out through the cannula sleeves, rotating them in the cannula sleeves, levering (i.e., pivoting) the instruments against the abdominal wall and actuating the end effectors on the distal ends of the instruments from outside the abdominal cavity. The instruments normally pivot around centers defined by the incisions which extend through the muscles of the abdominal wall. The surgeon typically monitors the procedure by means of a television monitor which displays an image of the surgical site via the laparoscopic camera. Typically, the laparoscopic camera is also introduced through the abdominal wall so as to capture an image of the surgical site. Similar endoscopic techniques are employed in, e.g., arthroscopy, retroperitoneoscopy, pelviscopy, nephroscopy, cystoscopy, cisternoscopy, sinoscopy, hysteroscopy, urethroscopy, and the like.
  • There are many disadvantages relating to such traditional minimally invasive surgical (MIS) techniques. For example, existing MIS instruments deny the surgeon the flexibility of tool placement found in open surgery. Difficulty is experienced in approaching the surgical site with the instruments through the small incisions. The length and construction of many endoscopic instruments reduces the surgeon's ability to feel forces exerted by tissues and organs on the end effector of the associated instrument. Furthermore, coordination of the movement of the end effector of the instrument as viewed in the image on the television monitor with actual end effector movement is particularly difficult, since the movement as perceived in the image normally does not correspond intuitively With the actual end effector movement. Accordingly, lack of intuitive response to surgical instrument movement input is often experienced. Such a lack of intuitiveness, dexterity and sensitivity of endoscopic tools has been found to be an impediment to the expansion of the use of minimally invasive surgery.
  • Minimally invasive telesurgical systems for use in surgery have been and are still being developed to increase a surgeon's dexterity as well as to permit a surgeon to operate on a patient in an intuitive manner. Telesurgery is a general term for surgical systems where the surgeon uses some form of remote control, e.g., a servomechanism, or the like, to manipulate surgical instrument movements, rather than directly holding and moving the tools by hand. In such a telesurgery system, the surgeon is typically provided with an image of the surgical site on a visual display at a location remote from the patient. The surgeon can typically perform the surgical procedure at the location remote from the patient whilst viewing the end effector movement during the surgical procedure on the visual display. While viewing typically a three-dimensional image of the surgical site on the visual display, the surgeon performs the surgical procedures on the patient by manipulating master control devices at the remote location, which master control devices control motion of the remotely controlled instruments.
  • Typically, such a telesurgery system can be provided with at least two master control devices (one for each of the surgeon's hands), which are normally operatively associated with two robotic arms on each of which a surgical instrument is mounted. Operative communication between master control devices and associated robotic arm and instrument assemblies is typically achieved through a control system. The control system typically includes at least one processor which relays input commands from the master control devices to the associated robotic arm and instrument assemblies and from the arm and instrument assemblies to the associated master control devices in the case of, e.g., force feedback, or the like.
  • One object of the present invention is to provide improved telesurgery systems, devices and methods for use in surgery. Another object of the invention is to provide a telesurgical system and method whereby auxiliary information related to a surgical procedure to be performed by the telesurgical system can be selectively displayed on a viewer of the system, together with an image of the surgical site captured by an image capture device, such as an endoscope, of the system, so as to enable an operator of the system selectively to reference such auxiliary information on the viewer during the performance of the surgical procedure. In this manner the surgical procedure can typically be performed with greater confidence, safety, efficacy and in some cases greater accuracy.
  • SUMMARY OF THE INVENTION
  • According to one aspect of the invention, there is provided a method of performing a surgical procedure on a patient. The method typically comprises positioning a surgical work station of a robotically controlled surgical system and a patient on which a surgical procedure is to be performed in close proximity relative to each other, directing a field of view of an image capture device of the surgical work station at a surgical site on the patient, at which site the surgical procedure is to be performed, and introducing at least one robotically controlled surgical instrument on the surgical work station to the surgical site so that an end effector of the surgical instrument is within the field of view of the image capture device.
  • The method typically further comprises displaying an image of the surgical site and the end effector on a display area of an image display at an operator control station of the surgical system. The image display is typically operatively connected to the image capture device so as to display, on the display area, the image of the surgical site and the end effector captured by the image capture device. The method can further include permitting an operator of the surgical system to manipulate a master control at the operator control station whilst viewing the image of the surgical site on the image display, the master control being operatively associated with the surgical instrument thereby to cause the end effector to move in response to manipulation of the master control so as to perform at least part of the surgical procedure on the patient at the surgical site.
  • The method yet further typically comprises operatively linking the image display to a source of selectively accessible auxiliary information related to the surgical procedure to be performed, enabling the operator selectively to access the source of auxiliary information from the operator control station so as to forward the auxiliary information to the image display, causing the auxiliary information to be displayed across the display area of the image display in response to the operator selectively accessing the source of auxiliary information at the operator control station and enabling the operator selectively to move the auxiliary information when displayed on the image display relative to the image of the surgical site displayed on the image display.
  • The master control is typically operatively linked with the source of auxiliary information, enabling the operator selectively to access the source of auxiliary information then including permitting the operator selectively to disassociate the master control from the surgical instrument and to use the master control to access the source of auxiliary information so as to enable the auxiliary information to be displayed on the display area of the image display.
  • According to another aspect of the invention, there is provided a method of performing a surgical procedure on a patient, the method comprising manipulating a master control whilst viewing a real time image of a surgical site on an image display, moving an end effector in response to manipulation of the master control so as to perform at least part of a surgical procedure at the surgical site and selectively accessing a source of auxiliary information by means of the master control. The method typically further comprises displaying the auxiliary information on the image display.
  • BRIEF DESCRIPTION OF THE DRAWINGS
  • The invention will now be described, by way of example only, and with reference to the accompanying diagrammatic drawings, in which:
  • FIG. 1 shows a three-dimensional view of an operator control station, or surgeon's console, and a surgical work station, or cart, of a telesurgical system in accordance with the invention, the cart carrying three robotically controlled arms, the movement of the arms being remotely controllable from the control station;
  • FIG. 2 shows, at an enlarged scale, a side view of a robotic arm and surgical instrument assembly of the surgical station shown in FIG. 1;
  • FIG. 3 shows, at an enlarged scale, a three-dimensional view of a typical surgical instrument of the system shown in FIG. 1;
  • FIG. 4 shows a schematic kinematic diagram corresponding to the side view of the robotic arm shown in FIG. 2, and indicates the arm having been displaced from one position into another position;
  • FIG. 5 shows, at an enlarged scale, a wrist member and an end effector of the surgical instrument shown in FIG. 3, the wrist member and the end effector being movably mounted on a working end of a shaft of the surgical instrument;
  • FIG. 6 shows a three-dimensional view of one of the master control devices of the control station shown in FIG. 1, the master control device including a hand-held part, or wrist gimbal, and an articulated arm portion on which the hand-held part is mounted;
  • FIG. 7 shows a schematic three-dimensional drawing indicating the positions of the end effectors relative to a viewing end of an endoscope on the surgical station and the corresponding positions of the master control devices relative to the eyes of an operator, typically a surgeon, at the control station;
  • FIG. 8 shows a schematic three-dimensional drawing indicating the position and orientation of an end effector relative to a camera Cartesian coordinate reference system at a viewing end of the endoscope;
  • FIG. 9 shows a schematic three-dimensional drawing indicating the position and orientation of a pincher formation of one of the master control devices relative to an eye Cartesian coordinate reference system at a viewer of the control station;
  • FIG. 10 shows a block diagram indicating control steps of a control system of the surgical system, the control system being arranged to effect control between master control device input and corresponding surgical instrument movement output;
  • FIG. 11 shows a flow diagram indicating control steps of a method, in accordance with the invention, whereby an operator of the telesurgical system can selectively access one or more sources of auxiliary information related to a surgical procedure to be performed by the telesurgical system, so as to display the information from the selected source or sources on an image display of the telesurgical system together with an image of the surgical site captured by an image capturing device, such as an endoscope, of the system;
  • FIG. 12 shows a schematic view of an image of a surgical site displayed on the image display of the telesurgical system and further shows an image corresponding to auxiliary information from a selected source of auxiliary information displayed in a window overlaid on the image of the surgical site;
  • FIGS. 13A and B show schematic views illustrating the adjustment in position and orientation of an image corresponding to auxiliary information from a selected source of auxiliary information, relative to an image of the surgical site from an image capturing device;
  • FIG. 14 shows a schematic diagram of an image displayed at a viewer of the system shown in FIG. 1, and further shows a probe gathering auxiliary information relating to a surgical procedure;
  • FIG. 15 shows a schematic side view of an image capturing device for capturing an image along a shaft of a surgical instrument of the system shown in FIG. 1, in accordance with the invention;
  • FIGS. 16A and 16B show schematic drawings indicating a rotational movement of a displayed image and a line or bar displayed in the image to indicate orientational position of a scene in the displayed image relative to a world reference frame, and
  • FIGS. 17A and 17B show schematic drawings indicating a rotational movement of a displayed image and opposed markers or indicators displayed in the image to indicate orientational position of a scene in the displayed image relative to a world reference frame.
  • DESCRIPTION OF THE PREFERRED EMBODIMENTS
  • Referring to FIG. 1 of the drawings, a minimally invasive telesurgical system, or robotically controlled surgical system, in accordance with the invention is generally indicated by reference numeral 10. The system 10 includes a control station, or surgeon's console, generally indicated by reference numeral 12. The station 12 includes an image display or viewer 14 where an image of a surgical site is displayed in use. A support 16 is provided on which an operator, typically a surgeon, can rest his or her forearms while gripping two master control devices, one of which is shown in FIG. 6 of the drawings, one in each hand. The master controls are positioned in a space 18 inwardly beyond the support 16. When using the control station 12, the surgeon typically sits in a chair in front of the control station 12, positions his or her eyes in front of the viewer 14 and grips the master controls one in each hand while resting his or her forearms on the support 16.
  • The system 10 further includes a surgical work station, or cart, generally indicated by reference numeral 20. In use, the cart 20 is positioned in close proximity to a patient requiring surgery and is then normally caused to remain stationary until a surgical procedure to be performed by means of the system 10 has been completed. The cart 20 typically has wheels or castors to render it mobile. The station 12 is typically positioned remote from the cart 20 and can be separated from the cart 20 by a great distance, even miles away, but will typically be used within an operating room with the cart 20.
  • The cart 20 typically carries at least three robotic arm assemblies. One of the robotic arm assemblies, indicated by reference numeral 22, is arranged to hold an image capture device 24, e.g., an endoscope, or the like. Each of the other two arm assemblies 26, 26 respectively, is arranged to hold a robotically controlled surgical instrument 28. The endoscope 24 has an object viewing end 24.1 at a remote end of an elongate shaft thereof. It will be appreciated that the endoscope 24 has an elongate shaft to permit its viewing end 24.1 to be inserted through an entry port in a patient's body so as to access an internal surgical site. The endoscope 24 is operatively connected to the viewer 14 to display an image captured at its viewing end 24.1 on a display area of the viewer 14. Each robotic arm assembly 26, 26 is normally operatively connected to one of the master controls. Thus, the movement of the robotic arm assemblies 26, 26 is controlled by manipulation of the master controls. The instruments 28 on the robotic arm assemblies 26, 26 have end effectors which are mounted on wrist members which are pivotally mounted on distal ends of elongate shafts of the instruments 28. It will be appreciated that the instruments 28 have elongate shafts to permit the end effectors to be inserted through entry ports in a patient's body so as to access the internal surgical site. Movement of the end effectors relative to the ends of the shafts of the instruments 28 is also controlled by the master controls. When a surgical procedure is to be performed, the cart 20 carrying the robotic arms 22, 26, 26 is wheeled to the patient and is normally maintained in a stationary position relative to, and in close proximity to, the patient, during the surgical procedure.
  • In FIG. 2 of the drawings, one of the robotic arm assemblies 26 is shown in greater detail, and on an enlarged scale. Each assembly 26 typically has a surgical instrument, schematically and generally indicated by reference numeral 28, releasably mounted thereon. FIG. 3 indicates the general appearance of a typical surgical instrument 28 in greater detail.
  • Referring now to FIG. 3 of the drawings, the surgical instrument 28 includes an elongate shaft 28.1. The wrist-like mechanism, generally indicated by reference numeral 32, is located at a working end of the shaft 28.1. A housing 34, arranged releasably to couple the instrument 28 to the robotic arm 26, is located at an opposed end of the shaft 28.1. In FIG. 2, and when the instrument 28 is coupled or mounted on the robotic arm 26, the shaft 28.1 extends along an axis indicated at 28.2. The instrument 28 is typically releasably mounted on a carriage 36, which can be driven to translate along a linear guide formation 38 of the arm 26 in the direction of arrows P.
  • The robotic arm 26 includes a cradle, generally indicated at 40, an upper arm portion 42, a forearm portion 44 and the guide formation 38. The cradle 40 is pivotally mounted on a plate 46 in a gimbaled fashion to permit rocking movement of the cradle 40 about a pivot axis 48. The upper arm portion 42 includes link members 42.1, 42.2 and the forearm portion 44 includes link members 44.1, 44.2. The link members 42.1, 42.2 are pivotally mounted on the cradle 40 and are pivotally connected to the link members 44.1, 44.2. The link members 44.1, 44.2 are pivotally connected to the guide formation 38. The pivotal connections between the link members 42.1, 42.2, 44.1, 44.2, the cradle 40, and the guide formation 38 are arranged to constrain the robotic arm 26 to move in a specific manner. The movement of the robotic arm 26 is illustrated schematically in FIG. 4.
  • With reference to FIG. 4 of the drawings, the solid lines schematically indicate one position of the robotic arm 26 and the dashed lines indicate another possible position into which the arm 26 can be displaced from the position indicated in solid lines.
  • It will be understood that the axis 28.2 along which the shaft 28.1 of the instrument 28 extends when mounted on the robotic arm 26 pivots about a pivot center or fulcrum 50. Thus, irrespective of the movement of the robotic arm 26, the pivot center 50 normally remains in the same position relative to the stationary cart 20 on which the arm 26 is mounted. In use, the pivot center 50 is positioned at a port of entry into a patient's body when an internal surgical procedure is to be performed. It will be appreciated that the shaft 28.1 extends through such a port of entry, the wrist-like mechanism 32 then being positioned inside the patient's body. Thus, the general position of the mechanism 32 relative to the surgical site in a patient's body can be changed by movement of the arm 26. Since the pivot center 50 is coincident with the port of entry, such movement of the arm does not excessively effect the surrounding tissue at the port of entry.
  • As can best be seen with reference to FIG. 4, the robotic arm 26 provides three degrees of freedom of movement to the surgical instrument 28 when mounted thereon. These degrees of freedom of movement are firstly the gimbaled motion indicated by arrows A, pivoting or pitching movement as indicated by arrows B and the linear displacement in the direction of arrows P. Movement of the arm 26 as indicated by arrows A, B and P is controlled by appropriately positioned actuators, e.g., electrical motors, or the like, which respond to inputs from an associated master control to drive the arm 26 to a required position as dictated by movement of the master control. Appropriately positioned sensors, e.g., potentiometers, encoders, or the like, are provided on the arm 26 to enable a control system of the minimally invasive telesurgical system 10 to determine joint positions, as described in greater detail herein below. It will be appreciated that whenever “sensors” are referred to in this specification, the term is to be interpreted widely to include any appropriate sensors, such as, for example, positional sensors, velocity sensors, or the like. It will be appreciated that by causing the robotic arm 26 selectively to displace from one position to another, the general position of the wrist-like mechanism 32 relative to the surgical site can be varied during the performance of a surgical procedure.
  • Referring now to FIG. 5 of the drawings, the wrist-like mechanism 32 will now be described in greater detail. In FIG. 5, the working end of the shaft 28.1 is indicated at 28.3. The wrist-like mechanism 32 includes a wrist member 52. One end portion of the wrist member 52 is pivotally mounted in a clevis, generally indicated at 54, on the end 28.3 of the shaft 28.1 by means of a pivotal connection 56. The wrist member 52 can pivot in the direction of arrows D about the pivotal connection 56. An end effector, generally indicated by reference numeral 60, is pivotally mounted on an opposed end of the wrist member 52. The end effector 60 is in the form of, e.g., a clip applier for anchoring clips during a surgical procedure, or the like. Accordingly, the end effector 60 has two parts 60.1, 60.2 together defining a jaw-like arrangement.
  • It will be appreciated that the end effector 60 can be in the form of any desired surgical tool, e.g., having two members, or fingers, which pivot relative to each other, such as, for example, scissors, pliers for use as needle drivers, or the like. Instead, it can include a single working member, e.g., a scalpel, cautery electrode, or the like. When a tool other than a clip applier is required during the surgical procedure, the tool 28 is simply removed from its associated arm 26 and replaced with an instrument bearing the required end effector, e.g., a scissors, or pliers, or the like.
  • The end effector 60 is pivotally mounted in a clevis, generally indicated by reference numeral 62, on an opposed end of the wrist member 52, by means of a pivotal connection 64. It will be appreciated that free ends 60.3, 60.4 of the parts 60.1, 60.2 are angularly displaceable about the pivotal connection 64 toward and away from each other as indicated by arrows E. F. It will further be appreciated that the members 60.1, 60.2 can be displaced angularly about the pivotal connection 64 to change the orientation of the end effector 60 as a whole, relative to the wrist member 52. Thus, each part 60.1, 60.2 is angularly displaceable about the pivotal connection 64 independently of the other, so that the end effector 60, as a whole, is angularly displaceable about the pivotal connection 64 as indicated in dashed lines in FIG. 5. Furthermore, the shaft 28.1 is rotatably mounted on the housing 34 for rotation as indicated by the arrows G. Thus, the end effector 60 has three degrees of freedom of movement relative to the arm 26, namely, rotation about the axis 28.2 as indicated by arrows G, angular displacement as a whole about the pivot 64 and angular displacement about the pivot 56 as indicated by arrows D. By moving the end effector 60 within its three degrees of freedom of movement, its orientation relative to the end 28.3 of the shaft 28.1 can selectively be varied. It will be appreciated that movement of the end effector 60 relative to the end 28.3 of the shaft 28.1 is controlled by appropriately positioned actuators, e.g., electrical motors, or the like, which respond to inputs from the associated master control to drive the end effector 60 to a required orientation as dictated by movement of the master control. Furthermore, appropriately positioned sensors, e.g., encoders, or potentiometers, or the like, are provided to permit the control system of the minimally invasive telesurgical system 10 to determine joint positions as described in greater detail herein below.
  • One of the master controls is indicated generally in FIG. 6 by reference numeral 70. A hand held part, or wrist gimbal, of the master control 70 is generally indicated by reference numeral 80. Part 80 has an articulated arm portion including a plurality of members or links 82 connected together by pivotal connections or joints 84. The surgeon grips the part 80 by positioning his or her thumb and index finger over a pincher formation 86. When the pincher formation 86 is squeezed between the thumb and index finger, the fingers or end effector elements 60.1, 60.2 of the end effector 60 close. When the thumb and index finger are moved apart, the fingers 60.1, 60.2 of the end effector 60 move apart in sympathy with the moving apart of the pincher formation 86. The joints 84 of the part 80 are operatively connected to actuators, e.g., electric motors, or the like, to provide for, e.g., force feedback, gravity compensation, and/or the like. Furthermore, appropriately positioned sensors, e.g., encoders, or potentiometers, or the like, are positioned on each joint 84 of the part 80, so as to enable joint positions of the part 80 to be determined by a control system of the surgical system 10.
  • The part 80 is typically mounted on an articulated arm 90. The articulated arm 90 includes a plurality of links 92 connected together at pivotal connections or joints 94. It will be appreciated that also the articulated arm 90 has appropriately positioned actuators, e.g., electric motors, or the like, to provide for, e.g., force feedback, gravity compensation, and/or the like. Furthermore, appropriately positioned sensors, e.g., encoders, or potentiometers, or the like, are positioned on the joints 94 so as to enable joint positions of the articulated arm 90 to be determined by the control system as described in greater detail herein below.
  • To move the orientation of the end effector 60 and/or its position along a translational path, the surgeon simply moves the pincher formation 86 to cause the end effector 60 to move to where he wants the end effector 60 to be with reference to the image viewed at the viewer 14. The end effector position and/or orientation can be arranged to follow that of the pincher formation 86.
  • The actuators and sensors associated with the robotic arms 26, 26 and the surgical instruments 28, 28 mounted thereon, and the actuators and sensors associated with the master control devices 70, 70 are operatively linked in the control system. The control system typically includes at least one processor, typically a plurality of processors, for effecting control between master control device input and responsive robotic arm and surgical instrument output and for effecting control between robotic arm and surgical instrument input and responsive master control output in the case of, e.g., force feedback, or the like.
  • In use, and as schematically indicated in FIG. 7 of the drawings, the surgeon views the surgical site through the viewer 14. The end effector 60 carried on each arm 26 is caused to perform positional and orientational movements in response to movement and action inputs on its associated master control. The master controls are indicated schematically at 70, 70. It will be appreciated that during a surgical procedure images of the end effectors 60 are captured by the endoscope 24 together with the surgical site and are displayed on the viewer 14 so that the surgeon sees the responsive movements and actions of the end effectors 60 as he or she controls such movements and actions by means of the master control devices 70, 70. The control system is typically arranged automatically to cause end effector orientational and positional movement as viewed in the image at the viewer 14 to be mapped onto orientational and positional movement of the pincher formation 86 of its associated master control 70, as will be described in greater detail herein below.
  • The operation of the control system of the surgical system or apparatus 10 will now be described. In the description which follows, the control system will be described with reference to a single master control 70 and its associated robotic arm 26 and surgical instrument 28. The master control 70 will be referred to simply as “master” and its associated robotic arm 26 and surgical instrument 28 will be referred to simply as “slave.”
  • The method whereby control between master movement and corresponding slave movement is achieved by the control system of the minimally invasive surgical apparatus will now be described with reference to FIGS. 8 to 10 of the drawings in overview fashion. For a more detailed description of control between master movement and corresponding slave movement refer to Applicant's co-pending U.S. application Ser. No. 09/373,678, entitled “Camera Referenced Control in a Minimally Invasive Surgical Apparatus,” filed Aug. 13, 1999, which is fully incorporated herein by reference as if part of this specification.
  • Control between master and slave movement is achieved by comparing master position and orientation in an eye Cartesian coordinate reference system with slave position and orientation in a camera Cartesian coordinate reference system. For ease of understanding and economy of words, the term “Cartesian coordinate reference system” will simply be referred to as “frame” in the rest of this specification. Accordingly, when the master is stationary, the slave position and orientation in the camera frame is compared with the master position and orientation in the eye frame, and should the position and/or orientation of the slave in the camera frame not correspond with the position and/or orientation of the master in the eye frame, the slave is caused to move to a position and/or orientation in the camera frame at which its position and/or orientation in the camera frame does correspond with the position and/or orientation of the master in the eye frame. In FIG. 8, the camera frame is generally indicated by reference numeral 110 and the eye frame is generally indicated by reference numeral 150 in FIG. 9.
  • When the master, or pincher formation 86, is moved into a new position and/or orientation in the eye frame 150, the new master position and/or orientation does not correspond with the previously corresponding slave position and/or orientation in the camera frame 110. The control system then causes the slave to move into a new position and/or orientation in the camera frame 110 at which new position and/or orientation, its position and orientation in the camera frame 110 does correspond with the new position and/or orientation of the master in the eye frame 150.
  • It will be appreciated that the control system includes at least one, and typically a plurality of processors which compute new corresponding positions and orientations of the slave in response to master movement input commands on a continual basis at a rate corresponding to the processing cycle rate of the control system. A typical processing cycle rate of the control system is about 1300 Hz. Thus, when the master is moved from one position to a next position, the corresponding movement of the slave to respond is computed at about 1300 Hz. Naturally, the control system can have any appropriate processing cycle rate depending on the processor or processors used in the control system.
  • The camera frame 110 is typically positioned such that its origin 112 is at the viewing end 24.1 of the endoscope 24. Conveniently, the z axis of the camera frame 110 extends axially along a viewing axis 114 of the endoscope 24. Although, in FIG. 8, the viewing axis 114 is shown in coaxial alignment with a shaft axis 115 of the endoscope 24, it is to be appreciated that the viewing axis 114 can be angled relative thereto. Thus, the endoscope can be in the form of an angled scope. Naturally, the x and y axes are positioned in a plane perpendicular to the z axis. The endoscope is typically angularly displaceable about its shaft axis. The x, y and z axes are fixed relative to the viewing axis 114 of the endoscope 24 so as to displace angularly about the shaft axis in sympathy with angular displacement of the endoscope 24 about its shaft axis 115.
  • To enable the control system to determine slave position and orientation, a frame is defined on, or attached to, the end effector 60. This frame is referred to as an end effector frame or slave tip frame, in the rest of this specification, and is generally indicated by reference numeral 116. Conveniently, the end effector frame 116 has its origin at the pivotal connection 64. However, depending on the type of end effector used, the origin may be offset relative to such a pivotal connection should an improved or more intuitive response between master input and slave output be achieved thereby. For the end effector 60 as shown in the drawings, one of the axes, e.g., the z axis, of the frame 116 is defined to extend along an axis of symmetry, or the like, of the end effector 60. Naturally, the x and y axes then extend perpendicularly to the z axis. It will be appreciated that the orientation of the slave is then defined by the orientation of the frame 116 having its origin at the pivotal connection 64, relative to the camera frame 110. Similarly, the position of the slave is then defined by the position of the origin 118 of the frame 116 relative to the camera frame 110.
  • Referring now to FIG. 9 of the drawings, the eye frame 150 is typically chosen such that its origin corresponds with a position 152 where the surgeon's eyes are normally located when he or she is viewing the surgical site at the viewer 14. The z axis typically extends along a line of sight of the surgeon, indicated by axis 154, when viewing the surgical site through the viewer 14. Naturally, the x and y axes extend perpendicularly from the z axis at the origin 152. Conveniently, the y axis is chosen to extend generally vertically relative to the viewer 14 and the x axis is chosen to extend generally horizontally relative to the viewer 14.
  • To enable the control system to determine master position and orientation in the viewer frame 150, an appropriate point, e.g., point 3A, is chosen on the master to define an origin 156 of a master or master tip frame 158. It will be appreciated that the point relative to the master at which the origin 156 of the master frame 158 is attached is chosen to enhance intuitive response between master and slave and can thus be at any appropriate location relative to the master. Conveniently, the z axis of the master frame 158 on the master extends along an axis of symmetry of the pincher formation 86 which extends coaxially along a rotational axis H of the pincher formation 86 relative to the rest of the master 70. The x and y axes then extend perpendicularly from the rotational axis H at the origin 3A. Accordingly, orientation of the master within the eye frame 150 is defined by the orientation of the master frame 158 relative to the eye frame 150. The position of the master in the eve frame 150 is defined by the position of the origin 156 at 3A relative to the eye frame 150.
  • Referring now to FIG. 10 of the drawings, a control system employed to cause the slave to track master input is generally and schematically indicated by reference numeral 200. The control method as indicated by reference numeral 200 assumes that the master and slave were at corresponding positions and the master has been moved into a new position and orientation. Accordingly, since the new position and orientation of the pincher formation 86 relative to the eye frame 150 no longer corresponds with the position and orientation of the end effector frame 116 relative to the camera frame 110, the end effector 60 is caused to move into a corresponding new position and orientation relative to the camera frame 110 at which it does correspond with the new position and orientation of the pincher formation 86 relative to the eye frame 150.
  • The new position and orientation of the pincher formation 86 is read in joint space as indicated by reference numeral 202. This is achieved by the processor by means of the sensors operatively associated with the joints on the master. From this joint space information, which determines the joint positions of the master, a corresponding new position and orientation of the master frame 158 relative to the eye frame 150 is determined in Cartesian space as indicated by reference numeral 204. In similar fashion, the current position and orientation of the end effector 60 in joint space is read as indicated by reference numeral 206. From this information the current position and orientation of the end effector frame 116 relative to the camera frame 110 in Cartesian space is computed, as indicated by reference numeral 208. The new position and orientation of the master frame 158 relative to the eye frame 150 in Cartesian space is then compared with the current position and orientation of the end effector frame 116 relative to the camera frame 110 as indicated at 210. An error between the end effector frame 116 current position and orientation relative to the camera frame 110 and the position and orientation of the end effector frame 116 relative to the camera frame 110 at which it would correspond with the new position and orientation of the master frame 158 relative to the eye frame 150 is then computed, as indicated at 212.
  • It will be appreciated that master orientational and positional movement variation need not necessarily correspond proportionally with responsive end effector orientational and positional movement variation. Accordingly, the system is typically arranged to provide for scaling so that the translational movement of the end effector in response to translational movement input on the master is scaled e.g., at a ratio 1 to 2, or the like.
  • From the error, corresponding end effector command signals are computed as indicated at 214. The end effector command signals are then forwarded to the slave actuators to cause them to move the end effector 60 to a new position and orientation relative to the camera frame 110 at which it corresponds with the new master position and orientation relative to the eye frame 150, as indicated at 216. For further detail, refer to the Ser. No. 09/373,678 application mentioned above.
  • A method and system whereby auxiliary information related to a surgical procedure to be performed by the system 10 can be selectively displayed on the viewer 14, together with an image of the surgical site captured by the endoscope 24, so as to enable the surgeon selectively to reference such information on the viewer 14 during the performance of the surgical procedure, in accordance with the invention, will now be described.
  • By displaying auxiliary information related to the surgical procedure in the image of the surgical site displayed at the viewer 14, the surgeon is able to reference such information without having to look at another source or display. For example, by displaying a patient's ECG signal in the image together with the image of the surgical site captured by the endoscope 24, the surgeon need not transfer his direction of view to a location removed from the image of the surgical site. This enables the surgeon to perform the surgical procedure with greater ease and confidence and with less distraction. Furthermore, the surgeon can prepare preoperative information specific to the surgical procedure to be performed, or specific to the patient on which the surgical procedure is to be performed, so as to enable the surgeon selectively to access such specific auxiliary information in the displayed image during the performance of the actual surgical procedure. When displaying the auxiliary information together with the image of the surgical site captured by the endoscope is referred to in this specification, such a description is to be interpreted to have a wide meaning including, for example, displaying the image in a discrete window overlaid on the image of the surgical site, displaying the auxiliary information so as to be merged with the image of the surgical site, such as merging a preoperative x-ray image with the image of the surgical site so that the surgeon can view hidden detail of the surgical site, displaying the auxiliary information selectively on the viewer instead of the image of the surgical site so that the surgeon is presented with an unobstructed view of the surgical site when performing the surgical procedure, the auxiliary information then being selectively displayable in the image at the viewer alternately with the image of the surgical site, and the like. It will be appreciated that the auxiliary information can be displayed on a separate image display or viewer where appropriate.
  • Referring to FIG. 11 of the drawings, a plurality of sources of two-dimensional information is generally indicated by reference numeral 312. Another plurality of sources of two-dimensional information is generally indicated by reference numeral 314.
  • The sources of two dimensional auxiliary information at 312 define auxiliary information to be displayed in the image at the viewer 14 and which is of a type which, when displayed in the image, is to be adjustable to vary its displayed position relative to the image of the surgical site captured by the endoscope. The imaged information from 312 is typically adjustable relative to the image of the surgical site in two dimensions only. Accordingly, the position of the imaged information can be varied to change its position across the image of the surgical site.
  • If the imaged information from 312 is displayed in a window overlaid on the image of the surgical site, the size of the window is typically also adjustable in two dimensions. The types of information selectively accessible from the sources 312 include, for example, a prerecorded streaming video of the surgical procedure to be performed so that the operator can follow the procedure as depicted in the video while displayed in the image at the viewer 14 together with the image of the surgical site. The types of information can further include, for example, a real time ECG signal so that the surgeon can monitor the patient's heart beat within the displayed image at the viewer 14.
  • Another type of auxiliary information can be in the form of a previously captured and stored image from the endoscope of the surgical site, wherein the pre-captured image was taken to provide a generally panoramic view of the surgical site and the surrounding scene. Such a pre-captured panoramic image can be obtained by the endoscope 24. In such a case, the image can be captured when the viewing end of the endoscope 24 is relatively far removed from the surgical site. After the panoramic image or view is captured in this fashion, the endoscope can be moved such that its viewing end is closer to the surgical site so as to obtain a more suitable real time image for use in the performance of the actual surgical procedure.
  • It will be appreciated that images other than a panoramic image of the surgical site and surrounding scene can be provided for selective reference on the image display at the viewer 14. Such other images can include, for example, generic or patient specific anatomical images for aiding the operator, or surgeon, for example, in identifying structures so as to determine the surgical site location relative to the patient anatomy. Furthermore, such images can include, for example, images showing the location of the entry ports, or incision points, the position of the surgical instrument shafts and/or the end effectors so as to provide the operator with visible information relating to the location of surgical instruments, or parts thereof. Such image can be computer generated where appropriate, or can be obtained from additional image capture devices, and/or the like. This can be useful to avoid collisions between the instrument shafts, for example. Furthermore, this can provide the operator with visible information enabling him to perceive how the instruments are interacting with each other and/or the patient, in addition to the real time image of the surgical site used to perform the actual surgical procedure. When this information is selected, the auxiliary information can be displayed, where appropriate, to surround or abut a generally closer view of the surgical site captured continually, or in real time, by the endoscope and which is used by the surgeon to monitor and control the surgical procedure. In this manner the surgeon, or operator, can be provided with the real time image from the endoscope at a preferably generally centrally disposed location in the viewed image, while the pre-captured, or real time, auxiliary image, e.g., a more panoramic view of the surgical site and surrounding scene, is displayed along the periphery of the real time image obtained from the endoscope 24. This can serve to provide the operator with a better idea of where he or she is operating relative to the area surrounding the surgical site. Instead of providing the auxiliary image to surround the real-time image of the surgical site, the auxiliary image can be displayed in a discrete window, or in a “picture in picture” arrangement, extending over the image of the real-time surgical site image. As another alternative, the auxiliary image can be displayed alternately with the actual real-time image. Thus, during the performance of a surgical procedure, the surgeon can intermittently switch between the image of the real-time surgical site image and the auxiliary image by means of any appropriate switching input device or method, such as, buttons, switches, voice command, and/or the like. When the information from 312 is displayed in a window overlaid on the image of the surgical site, the surgeon can typically vary the size of the window and place the window relative to the image of the surgical site so that the information is presented at a location which is comfortable to the surgeon and at which the window does not obstruct important detail of the surgical site image.
  • By way of example, a specific application of such a “picture in picture” arrangement will now be described. During the course of a surgical procedure, the displayed image of the surgical site is typically in the form of a “narrow” field of view image normally being live, e.g., continually updated, magnified and focused particularly on the surgical site. Such a “narrow” field of view typically provides the operator with a large image of a relatively small area in the patient. Such a “narrow” field image is typically captured in real time by means of the endoscope 24. It has been found advantageous to provide the operator with a “wide angle” image of the surgical site and surrounding scene, to assist the operator in determining where the surgical site and surgical tools are with reference to the surrounding scene. Such a “wide angle” image can be in the form of a “still” image captured by the same endoscope at a position further removed from the surgical site than at which it is normally positioned when capturing the real time image used by the operator as he or she performs the surgical procedure. Instead, the “wide angle” image can be captured in real time by another image capture device, or endoscope, or the like. The two images can be displayed in a variety of different ways. In one way, the “wide angle” image can be displayed in a “smaller” window and the “narrow” field image can be displayed over a relatively larger area. The surgeon can then refer to the “smaller” window for referencing orientation, or the like. In another way, the “narrow” field image is displayed in a “smaller” window and the “wide angle” image is displayed over a relatively “larger” area to provide context to the surgeon to help him or her to remain oriented at the surgical site.
  • It can happen that the surgeon wishes to change the image displayed on the viewer 14. This can be achieved, e.g., by rotation of the endoscope 24 relative to the site viewed. Where the “wide angle” image is a “still” image, this image can be caused to rotate together with rotation of the “live”, magnified image. This can be achieved by causing the “still” image to be modified, for example, by means of computer control, so that the “still” image rotates to the same degree as the “live” image, so as to maintain, for example, context for the surgeon should the surgeon desire to rotate the endoscope during surgery. In addition, or instead, if the surgeon desires to pan with the endoscope, the “still” image can be modified so that the “still” image preserves alignment, or registration, with a corresponding part of the “live” image.
  • The sources of two dimensional auxiliary information at 314 define auxiliary information to be displayed in the image at the viewer 14 and which is of a type which, when displayed in the image, is to be adjustable to vary not only its two-dimensional displayed position relative to the image of the surgical site captured by the endoscope, but also its displayed orientation in three dimensions relative to the displayed image of the surgical site. One of the sources at 314 can contain preoperative information which is to be aligned or brought into register with the image of the surgical site. For example, a two dimensional CAT scan image of a surgical site particular to the patient on which the surgical procedure is to be performed can be obtained preoperatively and loaded into one of the sources at 314. Such a preoperative image can be obtained so as to correspond with an image to be captured by the endoscope, in other words, an image corresponding to the image which the endoscope is to capture during the surgical procedure from a specific vantage point. Instead, the preoperative image can be from a vantage point different to that of where the endoscope is to be during the surgical procedure. During the surgical procedure, the surgeon can then access the CAT scan information from the particular source at 314 and place it in the displayed image of the surgical site. Such an image can then be adjusted in three dimensions so as to bring the preoperative CAT scan image generally into register with the image of the actual surgical site captured by the endoscope. Since the information from the sources 314 represent two dimensional information, there may be a limit to the amount of orientation change that can be tolerated before the information ceases to be of use to the surgeon.
  • Still referring to FIG. 11 of the drawings, a plurality of sources of three-dimensional information is indicated at 316. One of the sources can include, for example, a three-dimensional model corresponding to a surgical site on which a surgical procedure is to be performed. Such a three-dimensional model can be, for example, raw volumetric images, such as point cloud or voxcel representations, or the like, a computer generated three-dimensional model or image, a segmented three-dimensional model obtained from CAT (Computer Aided Tomography) scans, MRI (Magnetic Resonance Imaging) techniques, or the like. During the surgical procedure, the surgeon can then access the model and place it in the image of the surgical site. The image corresponding to the auxiliary information in the form of the three-dimensional model, can typically be superimposed, or merged with the image of the surgical site. The brightness of the image of the three-dimensional model is typically adjustable so as to cause it selectively to fade relative to the actual image of the surgical site.
  • Once placed in the image, the image of the model can be positionally and orientationally adjusted, and typically scaled, so as to enable the surgeon to bring the preoperative image into register with the actual image of the surgical site. Should the position of the endoscope be changed, for example, to obtain an image of the surgical site from a different vantage point, the registration of the preoperative image can be made to remain in register with the surgical site. This can typically be accomplished by causing the control system of the surgical system 10 to fix the position of the preoperative image relative to a suitable reference frame once the surgeon has brought the preoperative image generally into register in the displayed image. A suitable reference frame can be, for example, a reference frame attached relative to the cart 20, or the patient, or the like. Since registration is often effected visually by the surgeon, it may be that the registration is not entirely true or accurate. Thus, should the endoscope position be moved to capture an image of the surgical site from a different vantage point, it may be that the surgeon may again have to perform a slight adjustment to the registration should the preoperative image not be correctly registered with the actual image of the surgical site upon changing the endoscope position. Instead of manual registration as described above, automatic registration of the preoperative image with the surgical site image can be achieved in accordance with known imaging techniques. Advantageously, registration can be accomplished by enabling the surgeon, or operator, to perform an initial manual registration procedure, followed by an automatic registration procedure in accordance with conventional methods, to achieve a truer registration. Although reference has been made to a model, it will be appreciated that other auxiliary information can be used instead. Such other auxiliary information can include preoperative images as well as inter-operative images. For example, an inter-operative image, or preoperatively obtained model, and/or the like, of a beating heart can be registered with the actual image of the beating heart as captured by the endoscope, and/or the like.
  • Referring, again to the two-dimensional information at the sources 312, the two dimensional information can typically be in the form of intrinsically two-dimensional information. Such information can include two dimensional visual images, such as video images, x-ray images, ultrasonic images, and/or the like. These two-dimensional images can be in digital or analog format, or the like. The information can be in the form of static images. Such static images can be in tiff, jpeg, and/or the like, file formats, for example. The information can be in the form of moving images, such as, for example, streaming videos, as already mentioned. Such moving images can be in mpeg, digital video, analog video, such as NTSC or PAL, and/or the like, formats, for example. The information can be textual, numeric, symbolic, and/or graphic in form. For example, the information sources can include sources of information in the form of words, numeric readouts, status icons, bargraphs, stripchart displays, and/or the like. In this manner, for example, representations of blood pressure gauges, heartbeat rate, warning messages, notifications, warning lights, warning icons, or other warning signals related to system status, for example, the time in the form of a representation of a digital or analog clock, e-mail messages, and/or the like, can be displayed. Accordingly, numeric readouts can correspond to blood pressure, heartbeat rate, elapsed and absolute time, and/or the like. Status icons can include icons indicating the status of the system 10, the identification of the type of surgical instruments currently mounted on the robotic arms, and/or the like. Bar graphs can correspond to patient specific information, such as, temperature, oxygen levels in the patient's blood, and/or the like. Bar graphs can also correspond to system specific information such as force magnitude, back-up battery status, and/or the like. Strip charts can correspond to EEG, ECG, blood pressure, and/or the like. Symbolic or graphic representations can correspond to clocks, warning indicators, and icons selectively activatable to provide access to sources of other auxiliary information, such as the three-dimensional and two-dimensional information, described above, menus, web pages and/or the like.
  • One, or more, of the sources may even comprise a separate computer operatively connected to the system 10. The computer can be a computer on which a surgeon has prepared preoperative information for a specific patient on which a surgical procedure using the system 10 is to be performed. Such a computer may be remote from the system 10. When linked to the system 10 as a source of auxiliary information, in accordance with the invention, the surgeon is able to access such preoperative information on the remote computer from the system 10, so as selectively to display such information on the viewer 14 during the performance of the surgical procedure. Thus, the surgeon, from this source, can access information which may be resident on a computer screen within his or her office, for example.
  • The images derived from the sources at 312, 314 and/or 316, may be stored images or may be real-time images. Accordingly, the system 10 may include dedicated memory on which the images can be recorded preoperatively if the images are patient or surgical site specific, for example, so as to be stored in resident memory of the system 10. Instead, or in addition, the system 10 can have one or more input connectors, or jacks, to enable the system 10 to be operatively linked to a source of auxiliary information external to the system 10. In this fashion, the system can be linked to an external source of auxiliary information, such as, for example, a remote computer as described above, an ECG source, computer networks such as Local Area Networks (LANS), the internet, and/or the like. Accordingly, it will be appreciated that the sources 312, 314 and 316, can be in the form of resident memory of the system 10, on which memory the auxiliary information is stored, or can be in the form sources external to the system 10, which external sources are connectable to the system 10 through the input connectors or jacks.
  • Sources of three-dimensional information are indicated at 316. These sources represent information which is intrinsically three-dimensional. Such types of information can include, for example, segmented organ and/or vasculature models, patient specific and/or generic biomedical models, non-biological geometric shapes, markers, and/or the like. Such types of information can also include, for example, real time three-dimensional video, laser scans, and/or the like. Such types of information can yet further include landmarks, identifiers, or other markers that are attached to fixed locations in space. The use of such landmarks, identifiers, or other markers will now be described, by way of example. In the case where the surgeon wishes to perform an anastomosis, for example, he or she can place a landmark, or identifier, or the like in the image displayed on the image display and then move the landmark or marker to correspond with the area where the anastomosis is to be performed. The marker can then be attached to the area so that if the endoscope is moved, for example, the marker remains in a registered condition with the area to which it is attached.
  • The non-biological geometric shapes are typically used to place visible haptic constraints in the displayed image at the viewer 14. The purpose of placing such haptic constraints in the image is, for example, to inhibit the end effectors from moving beyond such constraints, containing end effector movement within such constraints, and/or the like. Accordingly, the operator of the system can select an appropriately shaped geometric shape, or shapes, and, place it, or them, in the image, and then position the selected geometric shape, or shapes, in the image around an area, or organ, or tissue, for example, so as to protect that area, or organ, or tissue from invasion by the end effectors 60, or to constrain end effector movement to remain within such shape or shapes, miter-box-fashion. Thus, should the site on which it is desired to perform a surgical procedure be close to a sensitive organ, or tissue, or the like, an appropriately shaped geometric shape, or shapes, can be selected, placed in the scene of the surgical site and moved into a position in which the selected shape, or shapes, extend over the sensitive area. When the shape, or shapes, is so placed, a corresponding haptic constraint, corresponding to the selected and placed geometric shape, or shapes, is initialized so as to inhibit the end effectors 60 from trespassing beyond the visible constraint, or constraints, as placed in the image by the surgeon thereby to protect the sensitive tissue, or organ, or the like. The geometric shapes can be of any appropriate shape. Accordingly, such shapes can include, for example, polyhedral shapes, NURBS (Non-Uniform Rational B-Spline), implicit surface shapes, planar shapes such as walls, and/or the like. The geometric shapes can include volumetric shapes such as point cloud, voxcels, and/or the like. The file formats used to store such geometric shapes can be .obj, .dxf, 0.3ds, VRML, and/or the like, for example. It will be appreciated that once an appropriate selected geometric shape, or shapes, is placed in the image, the surgeon can move the shape, or shapes, into a position covering or shrouding an area of sensitivity. When this has been done, the control system of the system 10 can typically allocate coordinates to the placed shape, or shapes, relative to an appropriate frame, such as a frame attached to the cart 20, or patient, or the like. The system, after having determined the coordinates corresponding to the placed shape, or shapes, then inhibits the end effectors from moving beyond such coordinates or constrains end effector movement to remain within such coordinates. For a more detailed description of a control system of the system 10 whereby such constraints can be imposed, refer to Applicant's co-pending application Ser. No. 09/288,068 filed Apr. 7, 1999 entitled “Aspects of a Control System of a Minimally Invasive Surgical Apparatus”. Geometric shapes can also be used to guide the surgeon or to assist in finding locations of particular interest. Furthermore, haptic feedback can be used to indicate information about objects which may not be readily discernable visually. For example, sensitive areas can be given repulsive behavior so that the tools are not only inhibited from approaching the sensitive areas, but are restrained when approaching the sensitive areas at a predetermined distance from such areas.
  • Such geometric shapes can be provided with geometric description or additional information, and can contain information about appearance, e.g., via visual texture mapping, and/or the like, surface and volume properties, e.g., such as mass, density, impedance, and/or the like, in accordance with known methods in the field of haptics. The shapes can also be derived from biological sources such as segmented MRIs. Such additional information about geometric shapes can be used for visual representation, e.g., colors, patterns, textual maps, flashing appearances, and/or the like. Such additional information can also be used with haptic rendering to provide, for example, stiffness, artificial friction, masses, vibrations, or other physical or non-physical force cues.
  • The various sources of information as indicated at 312, 314, and 316, are typically represented as icons on the display area of the video display 14. Accordingly, the operator of the system can select any one or more of the desired sources by selecting the appropriate associated icon. The step of selecting the desired source of auxiliary information is indicated by the blocks 318, 320, and 322 for the sources at 312, 314, and 316, respectively. Selection of a desired source typically takes place at the operator console 12. Such selection can be made in any appropriate manner, such as by using buttons, foot pedals, a mouse, and/or the like, for example. Advantageously, such selection is made by making use of one, or both, or either of the master controls 70, 70. In such a case, one, or both, or either, of the masters 70, 70 can serve as a two-dimensional or three-dimensional mouse. Accordingly, one, or both, or either, of the masters can be arranged to perform functions relative to the displayed image in a manner analogous to a conventional mouse relative to a computer screen. Therefore, one, or both, or either, of the masters can be arranged to perform functions such as to point, highlight, move, select, and/or the like.
  • The masters each typically have at least six degrees of freedom of movement. Accordingly, when used as a three-dimensional mouse, such master can be arranged to control six variables, for example. Therefore, functions such as, shifting, rotating, panning, tilting, scaling, and/or the like, can be performed simultaneously when one, or both, or either, of the masters are used as a three-dimensional mouse, without another input being required. In particular, for two-handed or two-master operation, any windows or overlays can be handled as “elastic” bodies, such that resizing, scaling, warping, and/or the like, can, for example, be controlled by pulling the masters apart, or the like. In this manner, the selected auxiliary information when displayed in the display image of the viewer 14 can be positionally and orientationally adjusted in three-dimensions in a three-dimensional environment, where appropriate, or where desired. The masters 70, 70 are typically provided with force feedback. The force feedback on the masters 70, 70 can be arranged to provide functions related to auxiliary information selection, placement, orientational and positional movement, for example, to draw, or “suck”, the masters to an icon when an associated cursor is within a predetermined area around the icon, and/or the like. Refer to Applicants co-pending U.S. patent application Ser. No. 09/398,507, entitled “Master Having Redundant Degrees of Freedom,” filed Sep. 17, 1999, the full disclosure of which is incorporated herein by reference, for further information in connection with master control. Whatever method and/or device used to make such selection, the selection step is indicated in the block 324 at 326 and as indicated by the dashed lines 327. It will be appreciated that the block 324 represents selection and regulation steps that are performed by means of the appropriate inputs, such as the master control devices 70, 70, at the surgeon's console 12 by the operator.
  • The steps whereby the information from the information sources 312 is selected and then presented or placed in the image at the video display will now be described in greater detail.
  • As mentioned, the selective placing of the auxiliary information from the sources 312 can be selectively caused to be displayed to extend at least partially across an image display area of the viewer 14, such as in a localized window. When displayed on the display area, the position at which the information is displayed relative to the display area can be regulated or changed by the operator in two dimensions. Once a desired source is selected by the operator by operation of an appropriate input at 326, the desired source is selected at 318. The information from that selected source is then forwarded to a two-dimensional transform indicated at 328, as indicated by arrow 330. After the two-dimensional transform step at 328, the information is fed to a video mix and fade step at 332, as indicated by arrow 334. At the block 332, the information from the selected source at 312 is mixed with the video image captured by the endoscope 24. The video image captured by the endoscope 24 is indicated by arrow 336. When the information from the selected source at 312 is thus mixed with the image captured by the endoscope 24, the combined images are forwarded to the video display as indicated by arrow 338 so that both images are placed in the image at the viewer 14.
  • Referring to FIG. 12 of the drawings, an image comprising a combination or merger of the image from the endoscope and the selected source at 312 is indicated generally by reference numeral 311. An image derived from the source at 312 is indicated at 318, and is shown as being overlaid on the image from the endoscope indicated at 317. A row of icons is indicated by reference numerals 315. The source at 312 was selected by actuating a corresponding one of the icons 315.
  • Referring again to FIG. 11, and as indicated by the dashed line 140, the surgeon or operator of the system 10 can regulate the two-dimensional transform at 328, as indicated at 342. This can be achieved in any appropriate manner, such as through appropriate input devices such as, for example, buttons, toggles, joysticks, mice, and/or the like. Advantageously, one, or both, or either, of the master control devices 70, 70 are used as the input device or devices whereby the two-dimensional transform 328 can be regulated. The representation of the combined images can be presented such that the information from the selected source 312 is cropped in a localized window, as indicated in FIG. 12 of the drawings, in the image displayed at the viewer 14. Accordingly, the image 317 captured by the endoscope 14 is positioned to extend across at least a major part of the display area, the information from the selected source at 312 being positioned in a localized window overlaid on the image captured by the endoscope 24. By manipulation of the input at 342, the two-dimensional transform at 328 is regulated to cause the window displaying the information from the selected source at 312, to be moved relative to the rest of the image, and to be placed where desired by the operator, as indicated by arrows J and K in FIG. 12. Typically, the size of the window can be varied, as well as its position relative to the rest of the image, as indicated by arrows L and M.
  • The video mix and fade step 332 is also regulatable by, for example, the operator at the operator console 12, or by another person, at a different location, if appropriate. An appropriate input for performing such regulation is indicated at 344 and is operatively connected as indicated by the dashed lines 345 to the video mix and fade block at 332. By manipulation of the input at 344, the information from the source at 312 can be faded relative to the image from the endoscope 24. Advantageously, the input at 344 is also performed by means of one, or both, or either, of the master controls 70, 70.
  • Referring now to the information sources at 314, these sources provide two dimensional information which, when displayed on the display area at the viewer 14, can be regulated so as to change the position of such information relative to the display area at the viewer in three dimensions, as described in greater detail herein below.
  • An appropriate one of the sources of two-dimensional information at 314 can be selected in similar fashion to the selection of one of the sources at 312. Accordingly, the operator can select information from a desired source at 314 by manipulating the appropriate input at 326. The selection step is indicated at 320. Once selected, the information from the desired source is forwarded to a two-dimensional to three-dimensional transform indicated at 346. At the step 346, the two-dimensional information from the selected source at 314 is converted to a three-dimensional representation. It is then passed through the three-dimensional transform indicated at 348. The three-dimensional transform at 348 is regulatable by the operator as indicated at 350 and by the dashed line 352. This can typically be achieved by means of any one or more of the inputs mentioned above. However, advantageously, the appropriate input is one, or both, or either, of the master controls 70, 70. By means of the input at 350, typically the position, orientation and scale of the two-dimensional information from the selected source at 314, can be regulated to change its position, orientation and scale in three dimensions. It will be appreciated that, in this fashion, not only the position, but also the orientation of the two-dimensional image as displayed in the image as viewed at the viewer 14 can be changed.
  • Once the operator has regulated the two-dimensional information by means of the three-dimensional transform at 348, the information is passed to block 354, where the information is transformed from a three-dimensional representation into a two dimensional representation. The two-dimensional transform is indicated at 356. The two-dimensional transform is regulatable by the operator through the input 342 so as to change the position of the information, as displayed in the image at the viewer 14, in two dimensions. It will be appreciated that this corresponds to changing the position of the image of the auxiliary information from the source at 314 relative to the image of the surgical site. After regulation at 356, the information is passed to a video mix and fade block at 358, where it is mixed with the image from the endoscope 24 as indicated by arrow 336. As in the case with the video mix and fade block 332, the operator can cause the information to fade relative to the image captured by the endoscope 24 by means of the input at 344. The image 336 from the endoscope 24 is combined with the information from the selected source at 314 and is then forwarded to the viewer 14 to be displayed thereon.
  • Referring to FIG. 13A of the drawings, an image comprising a combination or merger of the image from the endoscope and the selected source at 314 is indicated generally by reference numeral 321. An image derived from the source at 314 is indicated at 323 and is shown as being overlaid on the image from the endoscope indicated at 327. As in the case with reference to FIG. 12, and as can best be seen in FIG. 13B of the drawings, the image from the source 314 can be repositioned with reference to arrows J and K and can be adjusted in size as indicated by arrows L and M. This is achieved by the operator of the system 10 at 342 by means of the transform at 356 as indicated by dashed line 140.
  • In addition, and with specific reference to FIG. 13B of the drawings, the image from the selected source at 314 is orientationally adjustable or regulatable. Accordingly, the image from the selected source 314 can be regulated so as to change its orientation in three dimensions with reference to the arbitrary reference frame indicated in dashed lines in FIG. 13A. Although in FIG. 13B the image from the source 314 is shown as having been adjusted angularly about an arbitrary y axis with reference to the reference frame in FIG. 13A, it will be appreciated that angular adjustment about the x and z axes can be performed in similar fashion. Such angular regulation of the image from the selected source at 314 is achieved by the operator of the system 10 at 350, so as to regulate the information from the selected source at 314 by means of the transform at 348 as indicated by dashed line 352. In similar fashion, the image can also be moved “inwardly” and “outwardly” as indicated by arrows Q along the z-axis.
  • Referring now to the three-dimensional information sources 316, information from one or more of the sources can be selected by the operator by means of the input 326 and as indicated by the block 322. The three-dimensional information from the selected source at 316 is then passed to a three-dimensional transform as indicated at 362. The operator, by using the input device at 350, can then regulate this information in the three-dimensional transform at 362 so as to vary typically the orientation, position and scale of an image derived from the selected source and as displayed at the viewer 14 in similar fashion as described above with reference to FIGS. 13A and 13B. Once the information has been regulated in this fashion, the information is forwarded to a block 364 where the three-dimensional information is transformed from three dimensions to two dimensions. The resultant two-dimensional information is then forwarded to a two-dimensional transform at 366. The information can then again be regulated by the operator by means of the input device at 342 as herein before described with reference to the two- dimensional transforms 328, 356. As before, the resultant information is then fed to a video mix and fade block as indicated at 368 where the information is mixed with the image from the endoscope and is then passed to the viewer. Where appropriate, the information can be caused automatically to register with a corresponding surgical site image captured by the endoscope, as already described herein above. Instead, as described above, registration can be manual only, or a combination of manual and automatic methods.
  • It will be appreciated that the above methods can be used with two-dimensional single channel video display or with three-dimensional dual channel video display. In the latter case, the real time video source 336 can comprise two separate images for “right” and “left” channels for viewing by the right and left eyes of the surgeon. Elements 354 and 364 can then provide two separate images from two distinct viewpoints for the right and left channels respectively. The subsequent elements, or steps, can then be applied to both channels. Furthermore, element 328 can be arranged to duplicate the signal 334 into a left and a right channel and to shift them relative to each other to place the original two-dimensional image in a three-dimensional viewer at variable apparent depths.
  • Advantageously, at least one of the master controls is operatively arranged to fulfill some, preferably all, of the functions in the block 324. Accordingly, the operator need then not remove his hands from the master control devices 70, 70 when selecting and changing the position, orientation and scale of the auxiliary information when displayed in the image at the viewer 14. In this way, continuity of control of the surgical procedure is enhanced whilst still enabling the operator to access and place auxiliary information from one or more of the sources 312, 314 and 316.
  • As already mentioned, the masters 70, 70 are normally operatively associated with the slaves. Typically, when one, or both, or either, of the masters are to be used selectively to place an image corresponding to auxiliary information from a selected source 312, 314, 316 in the image or scene of the surgical site, the operative association between the master, or masters, and the slaves is temporarily interrupted. When this occurs, the slaves are typically held or locked in stationary positions at the surgical site. Accordingly, the slaves are locked in the positions they occupied immediately before disassociation with the masters 70, 70. The master or masters are then freed to enable them to be used to select and place the desired auxiliary information in the scene or image of the surgical site captured by the endoscope 24 and displayed across the display area of the image display or viewer 14. Once the auxiliary information has been selected and placed, operative association between the masters 70, 70 and the slaves is re-established to permit the operator to proceed with the surgical procedure with reference to the auxiliary information now displayed on the display area of the viewer 14 after having been selected and placed in the scene by means of one, or both, or either, of the masters 70, 70. Refer to Applicant's co-pending U.S. patent application Ser. No. 09/398,960, entitled “Repositioning and Orientation of Master/Slave Relationship in Minimally Invasive Telesurgery,” filed Sep. 17, 1999, the full disclosure of which is incorporated herein by reference, for a more detailed explanation of how the operative association between the masters and the slaves is preferably reestablished.
  • When one of the masters is used to select the desired auxiliary information, a cursor is typically generated in the image upon disassociation with the slaves. The cursor is then guided by movement of the master until the cursor is over the desired icon 315. The master is then also typically used to actuate the icon to cause the desired auxiliary information to be accessed and placed in the image of the surgical site. Advantageously, this can be achieved by squeezing the pincher formation 86, “pressing” the icon, or the like. When placed, the master, or both masters, is then used to vary the position and/or orientation of the image corresponding to the selected auxiliary information relative to the image of the surgical site as described above, and where appropriate. One or both masters may be used to vary the position and orientation of auxiliary information, overlays and windows in a manner similar to the way in which masters are used to vary the position and orientation of an image from an image capture device as described in co-pending application entitled “Image Shifting Apparatus and Method for a Telerobotic System,” previously incorporated herein by reference. Of course, the present invention also encompasses other manners of manipulating auxiliary information, in addition to the preferred masters disclosed, such as by repositioning/rotating a joystick, using multiple input buttons to indicate the desired manipulation, or using a voice control/recognition system to command the system to manipulate the auxiliary information as desired.
  • Should, during the course of a surgical procedure, an image capture device generating a real time video image 336 be moved, the image displayed on the image display may be caused to shift and/or rotate in response to such image capture device movement. Instead, the video image 336 can be caused to shift/rotate electronically, for example. During such a change in the displayed real time image, the two-dimensional and three- dimensional transforms 328, 348, 354, 356, 362, 364, 366 can be arranged to synchronize their operation with the change in the displayed image so as to cause the auxiliary information to appear attached to the displayed real time image. Instead, the transforms can be arranged to ignore the change in the displayed real time image to cause the auxiliary information to appear attached to the image display and to drift relative to the changing real time image.
  • Another source of auxiliary information will now be described with reference to FIG. 14. Such a source of auxiliary information can typically include an appropriate image gathering device such as one including a transmitter and receiver arrangement, as schematically indicated at 413. An example of such a device is an ultrasound transducer which will be used by way of example only in the description which follows. Accordingly, the invention is not to be limited to an ultrasonic device. Any appropriate device which can gather similar information falls within the scope of the invention. Such a source can be used to obtain a preoperative or intraoperative two-dimensional or three-dimensional image, or model, corresponding to a surgical procedure to be performed. Accordingly, it can be either a two- dimensional source 312, 314 or a three-dimensional source 316 depending on its application. As a two-dimensional source, the ultrasonic transducer can be used to obtain a single ultrasound image. As a three-dimensional source it can be used to obtain a plurality of spaced ultrasonic images, or cuts, thereby to provide sufficient information for construction of a three-dimensional model. Accordingly, it can be arranged to move, or sweep, across a surgical site to capture such images, or cuts. This can typically be achieved, for example, in accordance with a pre-programmed sequence for moving the ultrasound transducer, manual movement of the ultrasound transducer, or the like. The ultrasonic transducer can be mounted at an end of a shaft to enable it to be introduced to the surgical site through a relatively small aperture, in a minimally invasive manner. The sweeping movement can be performed manually by moving an opposed end of the shaft positioned outside the body. To this end, a handle can be provided on the opposed end of the shaft. Conveniently, manually operable actuators can be provided at the handle to enable the ultrasonic transducer, or probe, to be moved relative to the end of the shaft on which it is mounted by manipulating the actuators. Instead, the shaft can be mounted on a robotic arm, the movement being controlled through a master control device. In another embodiment, the movement of the ultrasonic transducer can be controlled by means of a computer program. Accordingly, whether performed manually or automatically, a plurality of separate images can be obtained and used to form a “mosaiced” surface of images in a fashion similar to that known in the satellite and undersea imaging industries, namely, by “painting” the sensor, or ultrasonic transducer, across the surface being viewed. Said surface of images may be intrinsically two- or three-dimensional in nature depending on the movement of the sensor during the build-up of the image. A different series of image “slices” may be constructed from a sensor that produces a planar image and that is moved substantially normal to the image plane to produce a series of slices, as is known, for example, in prenatal ultrasonic imaging practice. Taken together, these form an intrinsically three-dimensional or volumetric image.
  • These built-up two- and three-dimensional images may then be introduced into the system to be selectively overlaid and positioned within the surgeon's field of view at the viewer. As can best be seen in FIG. 14, such an ultrasonic image, when in a two-dimensional format, may be displayed as indicated by reference numeral 411.
  • Such a source can also be used inter- or post-operatively. For example, it can be used as a flow probe, or the like, to enable the surgeon, for example, to ascertain the degree of fluid flow through a vessel, or the like. In such a case, when, for example, an anastomosis procedure has been performed, a surgeon, or operator, of the system may wish to determine whether or not the anastomosed vessels are allowing sufficient blood flow therethrough, whether or not one or more of the vessels has been damaged during the procedure so as to require further corrective surgery, and/or the like. The flow probe, or ultrasonic transducer, can then be used to establish this.
  • Advantageously, the ultrasonic transducer, or other appropriate device, or flow probe, can be mounted on an end of a shaft 415 to permit it to be introduced into a patient body in similar fashion to the surgical instruments 28, in a minimally invasive manner. Conveniently, the ultrasonic transducer can be mounted on an end of the shaft by means of a wrist member 417 similar to the wrist member 52, or more than one wrist member, which cooperate with each other, to enable it to be angularly displaced relative to the shaft in similar fashion to the end effector 60, in multiple degrees of freedom of movement. The mounting of the ultrasonic device on the end of the shaft 415, whether by means of one or more wrist members, or otherwise, is preferably such as to provide the ultrasonic device with relatively large sweeping movement capability relative to the end of the shaft, as indicated by arrows 419. Accordingly, it can have a relatively large lateral range of motion although narrow ranges of motion, or none at all, relative to the end of the shaft, fall within the scope of the present invention. Movement of the ultrasonic device relative to at least the end of the shaft is preferably controlled from outside the patient body, in use. For example, actuators positioned remote from the end on which the ultrasonic transducer is mounted may be used to control movement of the ultrasonic device relative to the end of the shaft from outside the patient body. Instead, or in addition, actuators can be provided to cause the ultrasonic transducer to scan an area of interest. The shaft may have a handle at its proximal end, opposed from the flow probe, for manual control by means of manually controllable actuators, or it may be mountable on a robotic arm as described above for control by means of a master control device. Accordingly, in a preferred embodiment, the ultrasonic device is mounted on a distal end of a robotic surgical tool of the type disclosed in U.S. Pat. No. 5,808,665, entitled “Endoscope Surgical Instrument and Method For Use,” the full disclosure of which is incorporated herein by reference. Movement of the ultrasonic transducer across a desired area of interest could then be accomplished by a surgeon or operator of the system 10 by manipulation of a remotely controlled master control at the control station 12 as described in U.S. patent application Ser. No. 09/398,507. Instead, the probe could be arranged to be releasably grasped by a surgical instrument having an appropriate complimentary end effector.
  • Another application of the information gathered by such an ultrasound probe, or the like, is to collect preoperative data on the patient, at the surgical site, for example. Such preoperative data can then be used to determine a location of, for example, a stenosis, or blockage, or the like, in a blood vessel that is to be anastomosed during a heart bypass operation for example. The auxiliary information can then be overlaid on the “live” image of the surgical site to indicate to the surgeon where the surgeon should conduct the anastomosis. Conveniently, and as already described, markers or identifiers can then be attached to the location of the stenosis such that, should the displayed image be changed, such as, for example by moving the endoscope, the markers or identifiers remain in a registered condition with the stenosis so that the location of the stenosis remains clearly indicated in the displayed image.
  • Another source of typically two-dimensional information will now be described with reference to FIG. 15 of the drawings. In FIG. 15, like reference numerals are used to designate similar parts unless otherwise stated. FIG. 15 shows a surgical instrument 28 extending through a cannula 429 mounted in an aperture extending into the patient body. At the end of the cannula 429, schematically indicated by reference numeral 431 is an image capture device. The image capture device can be in any appropriate form. For example, it can include optical fiber bundles, an annular image capturing ring, or a suitable microcamera, or the like. By means of the image capture device 431, an image extending along the length of the shaft 28.1 can be captured. This image can then be displayed selectively on the displayed image at the viewer. In this fashion, the surgeon can be provided with images from various vantage points which may provide him or her, with information otherwise not readily discernable. For example, by mounting such an image capture device directed along the shaft of the instrument, collisions between instrument shafts and the like can be avoided.
  • In accordance with another aspect of the invention, auxiliary information is provided to the surgeon to enable him or her to determine the orientation of the captured image displayed on the viewer relative to a frame of reference. For example, the auxiliary information can indicate to the surgeon which way is “up” relative to the displayed image or scene. Such auxiliary information can be presented in any appropriate manner, for example, by means of an icon, image, representation, or the like. One way of achieving this is by displaying a horizon “bar” or “line” in the image. Obviously, a horizon line will only be useful to a surgeon if the endoscope is not parallel to/coincident with the gravity vector. Otherwise, rotation of the endoscopic image will simply result in rotation of the image on a plane normal to gravity. Accordingly, when the “bar” is in a “horizontal” position in the image, the top of the displayed image is either up, or down. Preferably, the icon will include an image to enable the surgeon to distinguish between “up” and “down,” such as a dot on the “up” side of the bar. This type of absolute registration of the horizon line, however, is not always necessary during surgery. If the image is changed, e.g., by rotating the endoscope, the bar is caused to rotate so as to indicate that “up” in the image no longer corresponds with gravitational “up”. Therefore, the surgeon can be shown where he or she is with respect to an artificial “horizon” bar or line overlayed on the image captured by the endoscope.
  • This line or bar is preferably displayed to be perpendicular to the direction of gravity and perpendicular to the endoscope line of sight at its viewing end. This can be achieved by taking the cross product of the gravity vector expressed in a “world frame” with the optical (longitudinal) axis of the endoscope or camera rotation matrix, which is also expressed relative to the world frame. Therefore: world H = world [ 0 0 - 1 ] X world z endoscope
      • where H(world)=horizon vector in the world reference frame, and z(endoscope)=optical axis vector of endoscope.
  • This horizon vector, H(world), is preferably represented in the camera reference frame, T(endoscope)—the reference frame attached to the distal tip of the endoscope whose z—axis is its optical axis—by transposing the camera frame as follows:
    endoscope H=(world T endoscope)T·world H
  • where H(endoscope) is the horizon vector in the endoscope reference frame. In order to facilitate displaying the horizon line at any desired location on the image display screen, rather than with its origin at a particular image location such as the origin of the x and y axes of the camera/endoscope frame, only the angle relative to one of the x- and y-axes of the camera/endoscope frame—preferably the x-axis—need to be tracked. This angle can be determined by the geometric relationship between the x and y portions of H(endoscope) vector. Thus: Angle = arctan ( endoscope H ( y ) endoscope H ( x ) )
  • If it is desirable to distinguish between “up” and “down” in the image, calculation of the angle will also need to take into account whether either or both of the H(x) and H(y) values are positive or negative.
  • The artificial horizon or “bar” can then be displayed in the displayed image as indicated at 510 in FIG. 1 GA. If the endoscope is then rotated to rotate the displayed image in a clockwise direction as indicated by arrow B1, the line or bar 510 follows as indicated in FIG. 16B. Instead of a line or bar, an arrow corresponding with the direction of gravity can be used, in the manner of a virtual “plumb line” for example. Instead, and with reference to FIG. 17A, opposed indicators or cursors 520, 522 can be used. As the image is rotated clockwise, as indicated by arrow B2, for example, the markers are moved along with rotation of the image as indicated in FIG. 17B. The surgeon can then determine orientation with reference to an imaginary line extending between the markers 520, 522.
  • Another form of auxiliary information that can be displayed on the displayed image is one or more force indicators to indicate to the operator the degree of force applied between the fingers of the end effectors 60, for example. This can be achieved by measuring associated motor current for example, and can be in the form of a graph (such as a bar graph) associated with each of the end effectors and displayed on the image for the surgeon to see. The graph may include a variety of colors, with lighter forces indicated by both different colors as well as changes in magnitude of the graphic display. The graphs may indicate force direction as well as magnitude for example. A zeroing function can be included to negate effects of other forces on the end effectors such as if they contact tissue, or body walls, or the like.
  • While the above is a complete description of preferred embodiments of the invention, various alternatives, modifications and equivalents may be used. It should be evident that the present invention is equally applicable by making appropriate modifications to the embodiments described above. Therefore, the above description should not be taken as limiting the scope of the invention which is defined by the metes and bounds of the appended claims along with their full scope of equivalents.

Claims (17)

1-55. (canceled)
56. A medical robotic system comprising:
an ultrasound transducer;
a robotic arm mechanically coupled to the ultrasound transducer; and
a processor configured to controllably cause the robotic arm to move the ultrasound transducer according to a control input.
57. The medical robotic system according to claim 56, wherein the ultrasound transducer is disposed at a site within a patient.
58. The medical robotic system according to claim 57, further comprising a master control device, wherein the control input is received from the master control device and is indicative of manual movement of the master control device.
59. The medical robotic system according to claim 57, wherein the processor is configured to controllably cause the robotic arm to move the ultrasound transducer according to the control input during a minimally invasive surgical procedure.
60. The medical robotic system according to claim 56, wherein the control input includes a pre-programmed sequence of stored instructions.
61. The medical robotic system according to claim 60, wherein the stored instructions instruct the processor to cause the robotic arm to move the ultrasound transducer so that 2D ultrasound image slices captured by the ultrasound transducer provide information for the processor to generate a 3D computer model of at least part of a structure.
62. The medical robotic system according to claim 61, wherein the stored instructions instruct the processor to cause the robotic arm to move the ultrasound transducer so as to sweep across a surgical site including the structure.
63. The medical robotic system according to claim 61, wherein the stored instructions instruct the processor to cause the robotic arm to move the ultrasound transducer across a surface of the structure.
64. The medical robotic system according to claim 56, further comprising:
an endoscope camera for capturing images of a surgical site;
wherein the processor is configured to display the images captured by the endoscope camera in a picture section of a viewer and an ultrasound image captured by the ultrasound transducer within a picture-in-picture section of the viewer.
65. The medical robotic system according to claim 56, further comprising;
an elongated shaft; and
a wrist mechanism mechanically coupling the ultrasound transducer to the elongated shaft so as to allow angular movement of the ultrasound transducer relative to an axis running along a length of the elongated shaft.
66. A method for generating a 3D ultrasound image of an anatomic structure during a minimally invasive surgical procedure, comprising:
causing a robotic arm to move an ultrasound transducer to capture a sequence of 2D ultrasound image slices of an anatomic structure; and
processing the captured 2D ultrasound image slices to generate a 3D ultrasound image of the anatomic structure.
67. The method according to claim 66, wherein the causing of the robotic arm to move the ultrasound transducer comprises:
receiving a control input from a master control device; and
causing the robotic arm to robotically move the ultrasound transducer to capture the sequence of 2D ultrasound image slices of the anatomic structure in response to the control input.
68. The method according to claim 66, wherein the causing of the robotic arm to move the ultrasound transducer comprises: causing the robotic arm to robotically move the ultrasound transducer to capture the sequence of 2D ultrasound image slices of the anatomic structure in response to a pre-programmed sequence of stored instructions.
69. The method according to claim 66, wherein the causing of the robotic arm to move the ultrasound transducer comprises: causing the robotic arm to robotically move the ultrasound transducer to capture the sequence of 2D ultrasound image slices of the anatomic structure by sweeping across a surgical site including the anatomic structure.
70. The method according to claim 66, wherein the causing of the robotic arm to move the ultrasound transducer comprises: causing the robotic arm to robotically move the ultrasound transducer to capture the sequence of 2D ultrasound image slices of the anatomic structure by moving the ultrasound transducer across a surface of the anatomic structure.
71. The method according to claim 66, further comprising: displaying a camera image captured by an endoscope camera in a picture section of a viewer and a corresponding view of the 3D ultrasound image of the anatomic structure within a picture-in-picture section of the viewer.
US11/496,958 1998-12-08 2006-08-01 Devices and methods for presenting and regulating auxiliary information on an image display of a telesurgical system to assist an operator in performing a surgical procedure Abandoned US20070038080A1 (en)

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US09/457,406 US6799065B1 (en) 1998-12-08 1999-12-07 Image shifting apparatus and method for a telerobotic system
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US10/314,001 US7107090B2 (en) 1998-12-08 2002-12-05 Devices and methods for presenting and regulating auxiliary information on an image display of a telesurgical system to assist an operator in performing a surgical procedure
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Cited By (98)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20050093847A1 (en) * 2003-09-16 2005-05-05 Robert Altkorn Haptic response system and method of use
US20050200324A1 (en) * 1999-04-07 2005-09-15 Intuitive Surgical Inc. Non-force reflecting method for providing tool force information to a user of a telesurgical system
US20060052687A1 (en) * 2002-10-17 2006-03-09 Jarmo Ruohonen Method for three-dimensional modeling of the skull and internal structures thereof
US20070239153A1 (en) * 2006-02-22 2007-10-11 Hodorek Robert A Computer assisted surgery system using alternative energy technology
US20080004603A1 (en) * 2006-06-29 2008-01-03 Intuitive Surgical Inc. Tool position and identification indicator displayed in a boundary area of a computer display screen
US20080065109A1 (en) * 2006-06-13 2008-03-13 Intuitive Surgical, Inc. Preventing instrument/tissue collisions
US20090192523A1 (en) * 2006-06-29 2009-07-30 Intuitive Surgical, Inc. Synthetic representation of a surgical instrument
US20090326553A1 (en) * 2008-06-27 2009-12-31 Intuitive Surgical, Inc. Medical robotic system providing an auxiliary view of articulatable instruments extending out of a distal end of an entry guide
US20090326556A1 (en) * 2008-06-27 2009-12-31 Intuitive Surgical, Inc. Medical robotic system providing computer generated auxiliary views of a camera instrument for controlling the positioning and orienting of its tip
US20090326318A1 (en) * 2008-06-27 2009-12-31 Intuitive Surgical, Inc. Medical robotic system providing an auxilary view including range of motion limitations for articulatable instruments extending out of a distal end of an entry guide
US20100166323A1 (en) * 2008-12-31 2010-07-01 Intuitive Surgical. Inc. Robust sparse image matching for robotic surgery
US20100168918A1 (en) * 2008-12-31 2010-07-01 Intuitive Surgical, Inc. Obtaining force information in a minimally invasive surgical procedure
US20100164950A1 (en) * 2008-12-31 2010-07-01 Intuitive Surgical, Inc. Efficient 3-d telestration for local robotic proctoring
US20100169815A1 (en) * 2008-12-31 2010-07-01 Intuitive Surgical, Inc. Visual force feedback in a minimally invasive surgical procedure
US20100217279A1 (en) * 2009-02-20 2010-08-26 Tyco Healthcare Group Lp Marking Articulating Direction For Surgical Instrument
WO2010117685A2 (en) * 2009-03-31 2010-10-14 Intuitive Surgical Operations, Inc. Synthetic representation of a surgical robot
US20100274087A1 (en) * 2007-06-13 2010-10-28 Intuitive Surgical Operations, Inc. Medical robotic system with coupled control modes
US20100318099A1 (en) * 2009-06-16 2010-12-16 Intuitive Surgical, Inc. Virtual measurement tool for minimally invasive surgery
US20100317965A1 (en) * 2009-06-16 2010-12-16 Intuitive Surgical, Inc. Virtual measurement tool for minimally invasive surgery
US20100331855A1 (en) * 2005-05-16 2010-12-30 Intuitive Surgical, Inc. Efficient Vision and Kinematic Data Fusion For Robotic Surgical Instruments and Other Applications
US20110050852A1 (en) * 2005-12-30 2011-03-03 Intuitive Surgical Operations, Inc. Stereo telestration for robotic surgery
US20110202068A1 (en) * 2010-02-12 2011-08-18 Intuitive Surgical Operations, Inc. Medical robotic system providing sensory feedback indicating a difference between a commanded state and a preferred pose of an articulated instrument
US20120141949A1 (en) * 2010-10-12 2012-06-07 Larry Bodony System and Apparatus for Haptically Enabled Three-Dimensional Scanning
US8792963B2 (en) 2007-09-30 2014-07-29 Intuitive Surgical Operations, Inc. Methods of determining tissue distances using both kinematic robotic tool position information and image-derived position information
US8903546B2 (en) 2009-08-15 2014-12-02 Intuitive Surgical Operations, Inc. Smooth control of an articulated instrument across areas with different work space conditions
US9084623B2 (en) 2009-08-15 2015-07-21 Intuitive Surgical Operations, Inc. Controller assisted reconfiguration of an articulated instrument during movement into and out of an entry guide
US9138129B2 (en) 2007-06-13 2015-09-22 Intuitive Surgical Operations, Inc. Method and system for moving a plurality of articulated instruments in tandem back towards an entry guide
US9216068B2 (en) 2012-06-27 2015-12-22 Camplex, Inc. Optics for video cameras on a surgical visualization system
US20160128781A1 (en) * 2014-10-31 2016-05-12 Lutz Blohm Method of automatically monitoring the penetration behavior of a trocar held by a robotic arm and monitoring system
US9469034B2 (en) 2007-06-13 2016-10-18 Intuitive Surgical Operations, Inc. Method and system for switching modes of a robotic system
US9486189B2 (en) 2010-12-02 2016-11-08 Hitachi Aloka Medical, Ltd. Assembly for use with surgery system
US9492927B2 (en) 2009-08-15 2016-11-15 Intuitive Surgical Operations, Inc. Application of force feedback on an input device to urge its operator to command an articulated instrument to a preferred pose
US9642606B2 (en) 2012-06-27 2017-05-09 Camplex, Inc. Surgical visualization system
US9782159B2 (en) 2013-03-13 2017-10-10 Camplex, Inc. Surgical visualization systems
US10008017B2 (en) 2006-06-29 2018-06-26 Intuitive Surgical Operations, Inc. Rendering tool information as graphic overlays on displayed images of tools
US10028651B2 (en) 2013-09-20 2018-07-24 Camplex, Inc. Surgical visualization systems and displays
US10507066B2 (en) 2013-02-15 2019-12-17 Intuitive Surgical Operations, Inc. Providing information of tools by filtering image areas adjacent to or on displayed images of the tools
US10555775B2 (en) 2005-05-16 2020-02-11 Intuitive Surgical Operations, Inc. Methods and system for performing 3-D tool tracking by fusion of sensor and/or camera derived data during minimally invasive robotic surgery
US10568499B2 (en) 2013-09-20 2020-02-25 Camplex, Inc. Surgical visualization systems and displays
US10702353B2 (en) 2014-12-05 2020-07-07 Camplex, Inc. Surgical visualizations systems and displays
US10918455B2 (en) 2017-05-08 2021-02-16 Camplex, Inc. Variable light source
CN112568864A (en) * 2020-12-03 2021-03-30 牡丹江医学院 Uterine cavity operation monitoring system
US10966798B2 (en) 2015-11-25 2021-04-06 Camplex, Inc. Surgical visualization systems and displays
US11154378B2 (en) 2015-03-25 2021-10-26 Camplex, Inc. Surgical visualization systems and displays
US11197728B2 (en) 2018-09-17 2021-12-14 Auris Health, Inc. Systems and methods for concomitant medical procedures
US11399858B2 (en) 2018-03-08 2022-08-02 Cilag Gmbh International Application of smart blade technology
US11423007B2 (en) 2017-12-28 2022-08-23 Cilag Gmbh International Adjustment of device control programs based on stratified contextual data in addition to the data
US11464511B2 (en) 2019-02-19 2022-10-11 Cilag Gmbh International Surgical staple cartridges with movable authentication key arrangements
US11464559B2 (en) 2017-12-28 2022-10-11 Cilag Gmbh International Estimating state of ultrasonic end effector and control system therefor
US11504192B2 (en) 2014-10-30 2022-11-22 Cilag Gmbh International Method of hub communication with surgical instrument systems
US11510741B2 (en) 2017-10-30 2022-11-29 Cilag Gmbh International Method for producing a surgical instrument comprising a smart electrical system
US11517309B2 (en) 2019-02-19 2022-12-06 Cilag Gmbh International Staple cartridge retainer with retractable authentication key
US11529187B2 (en) 2017-12-28 2022-12-20 Cilag Gmbh International Surgical evacuation sensor arrangements
US11540855B2 (en) 2017-12-28 2023-01-03 Cilag Gmbh International Controlling activation of an ultrasonic surgical instrument according to the presence of tissue
US11559308B2 (en) 2017-12-28 2023-01-24 Cilag Gmbh International Method for smart energy device infrastructure
US11559307B2 (en) 2017-12-28 2023-01-24 Cilag Gmbh International Method of robotic hub communication, detection, and control
US11564703B2 (en) 2017-10-30 2023-01-31 Cilag Gmbh International Surgical suturing instrument comprising a capture width which is larger than trocar diameter
US11564756B2 (en) 2017-10-30 2023-01-31 Cilag Gmbh International Method of hub communication with surgical instrument systems
US11571234B2 (en) 2017-12-28 2023-02-07 Cilag Gmbh International Temperature control of ultrasonic end effector and control system therefor
US11576677B2 (en) 2017-12-28 2023-02-14 Cilag Gmbh International Method of hub communication, processing, display, and cloud analytics
US11589888B2 (en) 2017-12-28 2023-02-28 Cilag Gmbh International Method for controlling smart energy devices
US11589915B2 (en) 2018-03-08 2023-02-28 Cilag Gmbh International In-the-jaw classifier based on a model
US11589932B2 (en) 2017-12-28 2023-02-28 Cilag Gmbh International Usage and technique analysis of surgeon / staff performance against a baseline to optimize device utilization and performance for both current and future procedures
US11589865B2 (en) 2018-03-28 2023-02-28 Cilag Gmbh International Methods for controlling a powered surgical stapler that has separate rotary closure and firing systems
US11596291B2 (en) 2017-12-28 2023-03-07 Cilag Gmbh International Method of compressing tissue within a stapling device and simultaneously displaying of the location of the tissue within the jaws
US11601371B2 (en) 2017-12-28 2023-03-07 Cilag Gmbh International Surgical network determination of prioritization of communication, interaction, or processing based on system or device needs
US11602393B2 (en) 2017-12-28 2023-03-14 Cilag Gmbh International Surgical evacuation sensing and generator control
US11612444B2 (en) 2017-12-28 2023-03-28 Cilag Gmbh International Adjustment of a surgical device function based on situational awareness
US11612408B2 (en) 2017-12-28 2023-03-28 Cilag Gmbh International Determining tissue composition via an ultrasonic system
US11659023B2 (en) * 2017-12-28 2023-05-23 Cilag Gmbh International Method of hub communication
US11666331B2 (en) 2017-12-28 2023-06-06 Cilag Gmbh International Systems for detecting proximity of surgical end effector to cancerous tissue
US11672605B2 (en) 2017-12-28 2023-06-13 Cilag Gmbh International Sterile field interactive control displays
US11678881B2 (en) 2017-12-28 2023-06-20 Cilag Gmbh International Spatial awareness of surgical hubs in operating rooms
US11696760B2 (en) 2017-12-28 2023-07-11 Cilag Gmbh International Safety systems for smart powered surgical stapling
US11701139B2 (en) 2018-03-08 2023-07-18 Cilag Gmbh International Methods for controlling temperature in ultrasonic device
US11701185B2 (en) 2017-12-28 2023-07-18 Cilag Gmbh International Wireless pairing of a surgical device with another device within a sterile surgical field based on the usage and situational awareness of devices
US11737668B2 (en) 2017-12-28 2023-08-29 Cilag Gmbh International Communication hub and storage device for storing parameters and status of a surgical device to be shared with cloud based analytics systems
US11744604B2 (en) 2017-12-28 2023-09-05 Cilag Gmbh International Surgical instrument with a hardware-only control circuit
US11751958B2 (en) 2017-12-28 2023-09-12 Cilag Gmbh International Surgical hub coordination of control and communication of operating room devices
US11771487B2 (en) 2017-12-28 2023-10-03 Cilag Gmbh International Mechanisms for controlling different electromechanical systems of an electrosurgical instrument
US11775682B2 (en) 2017-12-28 2023-10-03 Cilag Gmbh International Data stripping method to interrogate patient records and create anonymized record
US11779337B2 (en) 2017-12-28 2023-10-10 Cilag Gmbh International Method of using reinforced flexible circuits with multiple sensors to optimize performance of radio frequency devices
US11786245B2 (en) 2017-12-28 2023-10-17 Cilag Gmbh International Surgical systems with prioritized data transmission capabilities
US11786251B2 (en) 2017-12-28 2023-10-17 Cilag Gmbh International Method for adaptive control schemes for surgical network control and interaction
US11801098B2 (en) 2017-10-30 2023-10-31 Cilag Gmbh International Method of hub communication with surgical instrument systems
US11818052B2 (en) 2017-12-28 2023-11-14 Cilag Gmbh International Surgical network determination of prioritization of communication, interaction, or processing based on system or device needs
US11832840B2 (en) 2017-12-28 2023-12-05 Cilag Gmbh International Surgical instrument having a flexible circuit
US11832899B2 (en) 2017-12-28 2023-12-05 Cilag Gmbh International Surgical systems with autonomously adjustable control programs
US11857152B2 (en) 2017-12-28 2024-01-02 Cilag Gmbh International Surgical hub spatial awareness to determine devices in operating theater
US11864728B2 (en) 2017-12-28 2024-01-09 Cilag Gmbh International Characterization of tissue irregularities through the use of mono-chromatic light refractivity
US11871901B2 (en) 2012-05-20 2024-01-16 Cilag Gmbh International Method for situational awareness for surgical network or surgical network connected device capable of adjusting function based on a sensed situation or usage
US11890065B2 (en) 2017-12-28 2024-02-06 Cilag Gmbh International Surgical system to limit displacement
US11896443B2 (en) 2017-12-28 2024-02-13 Cilag Gmbh International Control of a surgical system through a surgical barrier
US11896322B2 (en) 2017-12-28 2024-02-13 Cilag Gmbh International Sensing the patient position and contact utilizing the mono-polar return pad electrode to provide situational awareness to the hub
US11903587B2 (en) 2017-12-28 2024-02-20 Cilag Gmbh International Adjustment to the surgical stapling control based on situational awareness
US11903601B2 (en) 2017-12-28 2024-02-20 Cilag Gmbh International Surgical instrument comprising a plurality of drive systems
US11911045B2 (en) 2017-10-30 2024-02-27 Cllag GmbH International Method for operating a powered articulating multi-clip applier
US11931027B2 (en) 2021-08-16 2024-03-19 Cilag Gmbh Interntional Surgical instrument comprising an adaptive control system

Families Citing this family (432)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CA2144973C (en) * 1992-09-23 2010-02-09 Graydon Ernest Beatty Endocardial mapping system
US8795332B2 (en) 2002-09-30 2014-08-05 Ethicon, Inc. Barbed sutures
US6241747B1 (en) 1993-05-03 2001-06-05 Quill Medical, Inc. Barbed Bodily tissue connector
US5931855A (en) 1997-05-21 1999-08-03 Frank Hoffman Surgical methods using one-way suture
US7901399B2 (en) * 1998-02-24 2011-03-08 Hansen Medical, Inc. Interchangeable surgical instrument
US7758569B2 (en) 1998-02-24 2010-07-20 Hansen Medical, Inc. Interchangeable surgical instrument
US8414598B2 (en) 1998-02-24 2013-04-09 Hansen Medical, Inc. Flexible instrument
US8303576B2 (en) * 1998-02-24 2012-11-06 Hansen Medical, Inc. Interchangeable surgical instrument
US7775972B2 (en) * 1998-02-24 2010-08-17 Hansen Medical, Inc. Flexible instrument
US7297142B2 (en) * 1998-02-24 2007-11-20 Hansen Medical, Inc. Interchangeable surgical instrument
US20020095175A1 (en) * 1998-02-24 2002-07-18 Brock David L. Flexible instrument
US7713190B2 (en) * 1998-02-24 2010-05-11 Hansen Medical, Inc. Flexible instrument
US7789875B2 (en) * 1998-02-24 2010-09-07 Hansen Medical, Inc. Surgical instruments
US7371210B2 (en) * 1998-02-24 2008-05-13 Hansen Medical, Inc. Flexible instrument
US7806829B2 (en) * 1998-06-30 2010-10-05 St. Jude Medical, Atrial Fibrillation Division, Inc. System and method for navigating an ultrasound catheter to image a beating heart
US6951535B2 (en) * 2002-01-16 2005-10-04 Intuitive Surgical, Inc. Tele-medicine system that transmits an entire state of a subsystem
US6398726B1 (en) 1998-11-20 2002-06-04 Intuitive Surgical, Inc. Stabilizer for robotic beating-heart surgery
US6852107B2 (en) 2002-01-16 2005-02-08 Computer Motion, Inc. Minimally invasive surgical training using robotics and tele-collaboration
US8527094B2 (en) 1998-11-20 2013-09-03 Intuitive Surgical Operations, Inc. Multi-user medical robotic system for collaboration or training in minimally invasive surgical procedures
US6659939B2 (en) 1998-11-20 2003-12-09 Intuitive Surgical, Inc. Cooperative minimally invasive telesurgical system
US6522906B1 (en) * 1998-12-08 2003-02-18 Intuitive Surgical, Inc. Devices and methods for presenting and regulating auxiliary information on an image display of a telesurgical system to assist an operator in performing a surgical procedure
EP1176921B1 (en) 1999-05-10 2011-02-23 Hansen Medical, Inc. Surgical instrument
US6702821B2 (en) 2000-01-14 2004-03-09 The Bonutti 2003 Trust A Instrumentation for minimally invasive joint replacement and methods for using same
US7635390B1 (en) 2000-01-14 2009-12-22 Marctec, Llc Joint replacement component having a modular articulating surface
US6785739B1 (en) * 2000-02-23 2004-08-31 Eastman Kodak Company Data storage and retrieval playback apparatus for a still image receiver
US7237197B2 (en) * 2000-04-25 2007-06-26 Microsoft Corporation Method and system for presenting a video stream of a video streaming device
FR2809048B1 (en) * 2000-05-18 2002-10-11 Commissariat Energie Atomique CONTROL ARM
EP2932884B1 (en) 2000-11-28 2020-09-09 Intuitive Surgical Operations, Inc. Endoscopic beating-heart stabilizer and vessel occlusion fastener
US6931602B1 (en) * 2000-12-22 2005-08-16 Cognex Corporation Approach facilitating the selection of various machine vision functionality from among different platforms
US6834207B2 (en) * 2001-02-08 2004-12-21 Kabushiki Kaisha Toshiba Operating guidance system for medical equipment
US20030135204A1 (en) 2001-02-15 2003-07-17 Endo Via Medical, Inc. Robotically controlled medical instrument with a flexible section
US20090182226A1 (en) * 2001-02-15 2009-07-16 Barry Weitzner Catheter tracking system
US8414505B1 (en) 2001-02-15 2013-04-09 Hansen Medical, Inc. Catheter driver system
US7766894B2 (en) 2001-02-15 2010-08-03 Hansen Medical, Inc. Coaxial catheter system
US7699835B2 (en) 2001-02-15 2010-04-20 Hansen Medical, Inc. Robotically controlled surgical instruments
US6817974B2 (en) 2001-06-29 2004-11-16 Intuitive Surgical, Inc. Surgical tool having positively positionable tendon-actuated multi-disk wrist joint
US7056331B2 (en) 2001-06-29 2006-06-06 Quill Medical, Inc. Suture method
US20060199999A1 (en) * 2001-06-29 2006-09-07 Intuitive Surgical Inc. Cardiac tissue ablation instrument with flexible wrist
US20060178556A1 (en) 2001-06-29 2006-08-10 Intuitive Surgical, Inc. Articulate and swapable endoscope for a surgical robot
US20050182298A1 (en) * 2002-12-06 2005-08-18 Intuitive Surgical Inc. Cardiac tissue ablation instrument with flexible wrist
US7708741B1 (en) 2001-08-28 2010-05-04 Marctec, Llc Method of preparing bones for knee replacement surgery
US6848152B2 (en) 2001-08-31 2005-02-01 Quill Medical, Inc. Method of forming barbs on a suture and apparatus for performing same
US6728599B2 (en) * 2001-09-07 2004-04-27 Computer Motion, Inc. Modularity system for computer assisted surgery
US7225115B2 (en) * 2001-10-04 2007-05-29 Novint Technologies, Inc. Coordinating haptics with visual images in a human-computer interface
DE10149795B4 (en) * 2001-10-09 2006-04-06 Siemens Ag Semiautomatic registration for overlaying two medical image data sets
US8010180B2 (en) 2002-03-06 2011-08-30 Mako Surgical Corp. Haptic guidance system and method
US11202676B2 (en) 2002-03-06 2021-12-21 Mako Surgical Corp. Neural monitor-based dynamic haptics
US7346381B2 (en) * 2002-11-01 2008-03-18 Ge Medical Systems Global Technology Company Llc Method and apparatus for medical intervention procedure planning
KR100500964B1 (en) * 2002-05-14 2005-07-14 한국과학기술연구원 Apparatus for measuring and fixing spatial position of medical instrument
US7778686B2 (en) * 2002-06-04 2010-08-17 General Electric Company Method and apparatus for medical intervention procedure planning and location and navigation of an intervention tool
DE10226853B3 (en) * 2002-06-15 2004-02-19 Kuka Roboter Gmbh Method for limiting the force of a robot part
JP2004042230A (en) * 2002-07-15 2004-02-12 Kawasaki Heavy Ind Ltd Remote control method and remote control system of robot controller
US20040162637A1 (en) 2002-07-25 2004-08-19 Yulun Wang Medical tele-robotic system with a master remote station with an arbitrator
US6925357B2 (en) * 2002-07-25 2005-08-02 Intouch Health, Inc. Medical tele-robotic system
US7593030B2 (en) * 2002-07-25 2009-09-22 Intouch Technologies, Inc. Tele-robotic videoconferencing in a corporate environment
US6773450B2 (en) 2002-08-09 2004-08-10 Quill Medical, Inc. Suture anchor and method
EP2070487B1 (en) * 2002-08-13 2014-03-05 NeuroArm Surgical, Ltd. Microsurgical robot system
US20040176751A1 (en) * 2002-08-14 2004-09-09 Endovia Medical, Inc. Robotic medical instrument system
US20040106504A1 (en) * 2002-09-03 2004-06-03 Leonard Reiffel Mobile interactive virtual reality product
US7331967B2 (en) * 2002-09-09 2008-02-19 Hansen Medical, Inc. Surgical instrument coupling mechanism
WO2004025963A1 (en) * 2002-09-13 2004-03-25 Karl Storz Imaging, Inc. Video recording and image capture device
US8100940B2 (en) 2002-09-30 2012-01-24 Quill Medical, Inc. Barb configurations for barbed sutures
US20040088003A1 (en) 2002-09-30 2004-05-06 Leung Jeffrey C. Barbed suture in combination with surgical needle
CN100389730C (en) 2002-12-06 2008-05-28 直观外科手术公司 Flexible wrist for surgical tool
US7158859B2 (en) * 2003-01-15 2007-01-02 Intouch Technologies, Inc. 5 degrees of freedom mobile robot
US7171286B2 (en) * 2003-02-24 2007-01-30 Intouch Technologies, Inc. Healthcare tele-robotic system with a robot that also functions as a remote station
US7158860B2 (en) * 2003-02-24 2007-01-02 Intouch Technologies, Inc. Healthcare tele-robotic system which allows parallel remote station observation
US7262573B2 (en) 2003-03-06 2007-08-28 Intouch Technologies, Inc. Medical tele-robotic system with a head worn device
GB0307077D0 (en) * 2003-03-27 2003-04-30 Univ Strathclyde A stereoscopic display
US7295893B2 (en) * 2003-03-31 2007-11-13 Kabushiki Kaisha Toshiba Manipulator and its control apparatus and method
US7736300B2 (en) * 2003-04-14 2010-06-15 Softscope Medical Technologies, Inc. Self-propellable apparatus and method
US7381183B2 (en) * 2003-04-21 2008-06-03 Karl Storz Development Corp. Method for capturing and displaying endoscopic maps
US7624487B2 (en) 2003-05-13 2009-12-01 Quill Medical, Inc. Apparatus and method for forming barbs on a suture
US20070084897A1 (en) 2003-05-20 2007-04-19 Shelton Frederick E Iv Articulating surgical stapling instrument incorporating a two-piece e-beam firing mechanism
US9060770B2 (en) 2003-05-20 2015-06-23 Ethicon Endo-Surgery, Inc. Robotically-driven surgical instrument with E-beam driver
US8007511B2 (en) * 2003-06-06 2011-08-30 Hansen Medical, Inc. Surgical instrument design
US7960935B2 (en) 2003-07-08 2011-06-14 The Board Of Regents Of The University Of Nebraska Robotic devices with agent delivery components and related methods
US7042184B2 (en) * 2003-07-08 2006-05-09 Board Of Regents Of The University Of Nebraska Microrobot for surgical applications
US7126303B2 (en) * 2003-07-08 2006-10-24 Board Of Regents Of The University Of Nebraska Robot for surgical applications
US20050261591A1 (en) * 2003-07-21 2005-11-24 The Johns Hopkins University Image guided interventions with interstitial or transmission ultrasound
US7813836B2 (en) 2003-12-09 2010-10-12 Intouch Technologies, Inc. Protocol for a remotely controlled videoconferencing robot
US20050154286A1 (en) * 2004-01-02 2005-07-14 Neason Curtis G. System and method for receiving and displaying information pertaining to a patient
US9615772B2 (en) * 2004-02-20 2017-04-11 Karl Storz Imaging, Inc. Global endoscopic viewing indicator
US20050204438A1 (en) * 2004-02-26 2005-09-15 Yulun Wang Graphical interface for a remote presence system
US7379790B2 (en) 2004-05-04 2008-05-27 Intuitive Surgical, Inc. Tool memory-based software upgrades for robotic surgery
WO2005117710A2 (en) * 2004-05-07 2005-12-15 Johns Hopkins University Image guided interventions with interstitial or transmission ultrasound
ES2638301T3 (en) 2004-05-14 2017-10-19 Ethicon Llc Suture devices
US8077963B2 (en) 2004-07-13 2011-12-13 Yulun Wang Mobile robot with a head-based movement mapping scheme
US20060036163A1 (en) * 2004-07-19 2006-02-16 Viswanathan Raju R Method of, and apparatus for, controlling medical navigation systems
US11890012B2 (en) 2004-07-28 2024-02-06 Cilag Gmbh International Staple cartridge comprising cartridge body and attached support
US20060052676A1 (en) * 2004-09-07 2006-03-09 Yulun Wang Tele-presence system that allows for remote monitoring/observation and review of a patient and their medical records
CA2522005A1 (en) * 2004-10-14 2006-04-14 Hill-Rom Services, Inc. Service head with accessory tracks
US7517314B2 (en) * 2004-10-14 2009-04-14 Karl Storz Development Corp. Endoscopic imaging with indication of gravity direction
US7811224B2 (en) 2004-11-09 2010-10-12 Karl Storz Development Corp. Method for dealing with singularities in gravity referenced endoscopic imaging
JP2008521453A (en) * 2004-11-25 2008-06-26 オプティスカン・ピーティーワイ・リミテッド End scope
CN101084528B (en) * 2004-12-20 2011-09-14 皇家飞利浦电子股份有限公司 A method and a system for integration of medical diagnostic information and a geometric model of a movable body
US7222000B2 (en) * 2005-01-18 2007-05-22 Intouch Technologies, Inc. Mobile videoconferencing platform with automatic shut-off features
US7763015B2 (en) * 2005-01-24 2010-07-27 Intuitive Surgical Operations, Inc. Modular manipulator support for robotic surgery
US7837674B2 (en) 2005-01-24 2010-11-23 Intuitive Surgical Operations, Inc. Compact counter balance for robotic surgical systems
US7221522B2 (en) * 2005-01-28 2007-05-22 Karl Storz Development Corp. Optical system for variable direction of view instrument
US20060259193A1 (en) * 2005-05-12 2006-11-16 Yulun Wang Telerobotic system with a dual application screen presentation
US8398541B2 (en) 2006-06-06 2013-03-19 Intuitive Surgical Operations, Inc. Interactive user interfaces for robotic minimally invasive surgical systems
WO2007030173A1 (en) 2005-06-06 2007-03-15 Intuitive Surgical, Inc. Laparoscopic ultrasound robotic surgical system
US11259870B2 (en) 2005-06-06 2022-03-01 Intuitive Surgical Operations, Inc. Interactive user interfaces for minimally invasive telesurgical systems
US9289267B2 (en) * 2005-06-14 2016-03-22 Siemens Medical Solutions Usa, Inc. Method and apparatus for minimally invasive surgery using endoscopes
EP3398728B1 (en) 2005-06-30 2019-11-27 Intuitive Surgical Operations Inc. Indicator for tool state communication in multi-arm robotic telesurgery
US8273076B2 (en) 2005-06-30 2012-09-25 Intuitive Surgical Operations, Inc. Indicator for tool state and communication in multi-arm robotic telesurgery
US7448271B2 (en) * 2005-08-17 2008-11-11 The Boeing Company Inspection system and associated method
US8784336B2 (en) 2005-08-24 2014-07-22 C. R. Bard, Inc. Stylet apparatuses and methods of manufacture
US7669746B2 (en) 2005-08-31 2010-03-02 Ethicon Endo-Surgery, Inc. Staple cartridges for forming staples having differing formed staple heights
US11246590B2 (en) 2005-08-31 2022-02-15 Cilag Gmbh International Staple cartridge including staple drivers having different unfired heights
US9198728B2 (en) 2005-09-30 2015-12-01 Intouch Technologies, Inc. Multi-camera mobile teleconferencing platform
CN103251455B (en) 2005-10-20 2016-04-27 直观外科手术操作公司 Assistant images display on computer display in medical robotic system and manipulation
US11793518B2 (en) 2006-01-31 2023-10-24 Cilag Gmbh International Powered surgical instruments with firing system lockout arrangements
US8708213B2 (en) * 2006-01-31 2014-04-29 Ethicon Endo-Surgery, Inc. Surgical instrument having a feedback system
US7845537B2 (en) 2006-01-31 2010-12-07 Ethicon Endo-Surgery, Inc. Surgical instrument having recording capabilities
US8186555B2 (en) 2006-01-31 2012-05-29 Ethicon Endo-Surgery, Inc. Motor-driven surgical cutting and fastening instrument with mechanical closure system
US7769492B2 (en) * 2006-02-22 2010-08-03 Intouch Technologies, Inc. Graphical interface for a remote presence system
EP1844696B1 (en) * 2006-04-10 2010-08-04 Karl Storz Development Corp. Endoscopic imaging with indication of gravity direction
US8187189B2 (en) 2006-04-28 2012-05-29 The Invention Science Fund I, Llc Imaging via blood vessels
US7927271B2 (en) * 2006-05-17 2011-04-19 C.R. Bard, Inc. Endoscope tool coupling
CN101448468B (en) * 2006-05-19 2011-10-12 马科外科公司 System and method for verifying calibration of a surgical device
US20080021321A1 (en) * 2006-05-22 2008-01-24 Siemens Medical Solutions Usa, Inc. Contrast agent destruction or therapy event indication in ultrasound medical imaging
JP2009539509A (en) 2006-06-14 2009-11-19 マクドナルド デットワイラー アンド アソシエイツ インコーポレーテッド Surgical manipulator with right angle pulley drive mechanism
US20070291128A1 (en) * 2006-06-15 2007-12-20 Yulun Wang Mobile teleconferencing system that projects an image provided by a mobile robot
US8849679B2 (en) * 2006-06-15 2014-09-30 Intouch Technologies, Inc. Remote controlled robot system that provides medical images
US8560047B2 (en) 2006-06-16 2013-10-15 Board Of Regents Of The University Of Nebraska Method and apparatus for computer aided surgery
US9579088B2 (en) * 2007-02-20 2017-02-28 Board Of Regents Of The University Of Nebraska Methods, systems, and devices for surgical visualization and device manipulation
US8974440B2 (en) * 2007-08-15 2015-03-10 Board Of Regents Of The University Of Nebraska Modular and cooperative medical devices and related systems and methods
US8679096B2 (en) 2007-06-21 2014-03-25 Board Of Regents Of The University Of Nebraska Multifunctional operational component for robotic devices
CA3068216C (en) 2006-06-22 2023-03-07 Board Of Regents Of The University Of Nebraska Magnetically coupleable robotic devices and related methods
US20080004749A1 (en) * 2006-06-30 2008-01-03 Honeywell International, Inc. System and method for generating instructions for a robot
US20090287223A1 (en) * 2006-07-11 2009-11-19 Eric Pua Real-time 3-d ultrasound guidance of surgical robotics
US7761185B2 (en) * 2006-10-03 2010-07-20 Intouch Technologies, Inc. Remote presence display through remotely controlled robot
US7794407B2 (en) 2006-10-23 2010-09-14 Bard Access Systems, Inc. Method of locating the tip of a central venous catheter
US8388546B2 (en) 2006-10-23 2013-03-05 Bard Access Systems, Inc. Method of locating the tip of a central venous catheter
US9232959B2 (en) 2007-01-02 2016-01-12 Aquabeam, Llc Multi fluid tissue resection methods and devices
US8684253B2 (en) 2007-01-10 2014-04-01 Ethicon Endo-Surgery, Inc. Surgical instrument with wireless communication between a control unit of a robotic system and remote sensor
US8265793B2 (en) 2007-03-20 2012-09-11 Irobot Corporation Mobile robot for telecommunication
JP4916011B2 (en) * 2007-03-20 2012-04-11 株式会社日立製作所 Master / slave manipulator system
US20080255612A1 (en) 2007-04-13 2008-10-16 Angiotech Pharmaceuticals, Inc. Self-retaining systems for surgical procedures
WO2009034477A2 (en) * 2007-04-16 2009-03-19 The Governors Of The University Of Calgary Frame mapping and force feedback methods, devices and systems
US9160783B2 (en) 2007-05-09 2015-10-13 Intouch Technologies, Inc. Robot system that operates through a network firewall
WO2008141270A2 (en) * 2007-05-10 2008-11-20 Mora Assad F Stereoscopic three dimensional visualization system and method of use
US8931682B2 (en) 2007-06-04 2015-01-13 Ethicon Endo-Surgery, Inc. Robotically-controlled shaft based rotary drive systems for surgical instruments
US11857181B2 (en) 2007-06-04 2024-01-02 Cilag Gmbh International Robotically-controlled shaft based rotary drive systems for surgical instruments
US8444631B2 (en) 2007-06-14 2013-05-21 Macdonald Dettwiler & Associates Inc Surgical manipulator
US11849941B2 (en) 2007-06-29 2023-12-26 Cilag Gmbh International Staple cartridge having staple cavities extending at a transverse angle relative to a longitudinal cartridge axis
US8343171B2 (en) 2007-07-12 2013-01-01 Board Of Regents Of The University Of Nebraska Methods and systems of actuation in robotic devices
US20090024140A1 (en) * 2007-07-20 2009-01-22 Searete Llc, A Limited Liability Corporation Of The State Of Delaware Surgical feedback system
JP2010536435A (en) 2007-08-15 2010-12-02 ボード オブ リージェンツ オブ ザ ユニバーシティ オブ ネブラスカ Medical inflation, attachment and delivery devices and associated methods
US8116910B2 (en) * 2007-08-23 2012-02-14 Intouch Technologies, Inc. Telepresence robot with a printer
ES2488406T3 (en) 2007-09-27 2014-08-27 Ethicon Llc Self-retaining sutures that include tissue retention elements with enhanced strength
US20090088772A1 (en) * 2007-09-27 2009-04-02 Blumenkranz Stephen J Fiber optic in-situ chemical analysis in a robotic surgical system
EP2209595B1 (en) * 2007-10-19 2021-09-01 Force Dimension Technologies Sàrl Device for movement between an input member and an output member
US20090182196A1 (en) * 2007-10-30 2009-07-16 The Cleveland Clinic Foundation Method and apparatus for manually guiding an endoscope
US9521961B2 (en) 2007-11-26 2016-12-20 C. R. Bard, Inc. Systems and methods for guiding a medical instrument
US8849382B2 (en) 2007-11-26 2014-09-30 C. R. Bard, Inc. Apparatus and display methods relating to intravascular placement of a catheter
CN103750858B (en) 2007-11-26 2017-04-12 C·R·巴德股份有限公司 Integrated system for intravascular placement of a catheter
US10751509B2 (en) 2007-11-26 2020-08-25 C. R. Bard, Inc. Iconic representations for guidance of an indwelling medical device
US9649048B2 (en) 2007-11-26 2017-05-16 C. R. Bard, Inc. Systems and methods for breaching a sterile field for intravascular placement of a catheter
US8781555B2 (en) 2007-11-26 2014-07-15 C. R. Bard, Inc. System for placement of a catheter including a signal-generating stylet
US10449330B2 (en) 2007-11-26 2019-10-22 C. R. Bard, Inc. Magnetic element-equipped needle assemblies
US10524691B2 (en) 2007-11-26 2020-01-07 C. R. Bard, Inc. Needle assembly including an aligned magnetic element
US20090157059A1 (en) * 2007-12-14 2009-06-18 Searete Llc, A Limited Liability Corporation Of The State Of Delaware Surgical instrument navigation system
CN101902974B (en) 2007-12-19 2013-10-30 伊西康有限责任公司 Self-retaining sutures with heat-contact mediated retainers
US8916077B1 (en) 2007-12-19 2014-12-23 Ethicon, Inc. Self-retaining sutures with retainers formed from molten material
US8118834B1 (en) 2007-12-20 2012-02-21 Angiotech Pharmaceuticals, Inc. Composite self-retaining sutures and method
US8615856B1 (en) 2008-01-30 2013-12-31 Ethicon, Inc. Apparatus and method for forming self-retaining sutures
WO2009097556A2 (en) 2008-01-30 2009-08-06 Angiotech Pharmaceuticals, Inc. Appartaus and method for forming self-retaining sutures
US8478382B2 (en) 2008-02-11 2013-07-02 C. R. Bard, Inc. Systems and methods for positioning a catheter
BRPI0907787B8 (en) 2008-02-21 2021-06-22 Angiotech Pharm Inc method for forming a self-retaining suture and apparatus for raising the retainers in a suture to a desired angle
US8216273B1 (en) 2008-02-25 2012-07-10 Ethicon, Inc. Self-retainers with supporting structures on a suture
US8641732B1 (en) 2008-02-26 2014-02-04 Ethicon, Inc. Self-retaining suture with variable dimension filament and method
EP3622910A1 (en) 2008-03-06 2020-03-18 AquaBeam LLC Tissue ablation and cautery with optical energy carried in fluid stream
US10875182B2 (en) * 2008-03-20 2020-12-29 Teladoc Health, Inc. Remote presence system mounted to operating room hardware
US8155479B2 (en) * 2008-03-28 2012-04-10 Intuitive Surgical Operations Inc. Automated panning and digital zooming for robotic surgical systems
US8808164B2 (en) 2008-03-28 2014-08-19 Intuitive Surgical Operations, Inc. Controlling a robotic surgical tool with a display monitor
US9168173B2 (en) 2008-04-04 2015-10-27 Truevision Systems, Inc. Apparatus and methods for performing enhanced visually directed procedures under low ambient light conditions
US8179418B2 (en) 2008-04-14 2012-05-15 Intouch Technologies, Inc. Robotic based health care system
ES2709687T3 (en) 2008-04-15 2019-04-17 Ethicon Llc Self-retaining sutures with bi-directional retainers or unidirectional retainers
US8170241B2 (en) * 2008-04-17 2012-05-01 Intouch Technologies, Inc. Mobile tele-presence system with a microphone system
US9193065B2 (en) 2008-07-10 2015-11-24 Intouch Technologies, Inc. Docking system for a tele-presence robot
US8916134B2 (en) * 2008-07-11 2014-12-23 Industry-Academic Cooperation Foundation, Yonsei University Metal nanocomposite, preparation method and use thereof
US9842192B2 (en) 2008-07-11 2017-12-12 Intouch Technologies, Inc. Tele-presence robot system with multi-cast features
WO2010022370A1 (en) 2008-08-22 2010-02-25 C.R. Bard, Inc. Catheter assembly including ecg sensor and magnetic assemblies
DE102008041709A1 (en) * 2008-08-29 2010-03-04 Deutsches Zentrum für Luft- und Raumfahrt e.V. Medical workstation and operating device for manually moving a robotic arm of a medical workstation
US8340819B2 (en) 2008-09-18 2012-12-25 Intouch Technologies, Inc. Mobile videoconferencing robot system with network adaptive driving
US9005230B2 (en) 2008-09-23 2015-04-14 Ethicon Endo-Surgery, Inc. Motorized surgical instrument
US9339342B2 (en) 2008-09-30 2016-05-17 Intuitive Surgical Operations, Inc. Instrument interface
US9259274B2 (en) 2008-09-30 2016-02-16 Intuitive Surgical Operations, Inc. Passive preload and capstan drive for surgical instruments
US8437833B2 (en) 2008-10-07 2013-05-07 Bard Access Systems, Inc. Percutaneous magnetic gastrostomy
US10117721B2 (en) 2008-10-10 2018-11-06 Truevision Systems, Inc. Real-time surgical reference guides and methods for surgical applications
US9226798B2 (en) 2008-10-10 2016-01-05 Truevision Systems, Inc. Real-time surgical reference indicium apparatus and methods for surgical applications
US8781630B2 (en) * 2008-10-14 2014-07-15 University Of Florida Research Foundation, Inc. Imaging platform to provide integrated navigation capabilities for surgical guidance
RU2011120186A (en) * 2008-10-20 2012-11-27 Конинклейке Филипс Электроникс, Н.В. METHOD AND SYSTEM OF LOCALIZATION BASED ON IMAGES
US8996165B2 (en) * 2008-10-21 2015-03-31 Intouch Technologies, Inc. Telepresence robot with a camera boom
SG196767A1 (en) 2008-11-03 2014-02-13 Ethicon Llc Length of self-retaining suture and method and device for using the same
US8463435B2 (en) 2008-11-25 2013-06-11 Intouch Technologies, Inc. Server connectivity control for tele-presence robot
US9138891B2 (en) 2008-11-25 2015-09-22 Intouch Technologies, Inc. Server connectivity control for tele-presence robot
US8849680B2 (en) 2009-01-29 2014-09-30 Intouch Technologies, Inc. Documentation through a remote presence robot
US9173717B2 (en) 2009-02-20 2015-11-03 Truevision Systems, Inc. Real-time surgical reference indicium apparatus and methods for intraocular lens implantation
US8423182B2 (en) * 2009-03-09 2013-04-16 Intuitive Surgical Operations, Inc. Adaptable integrated energy control system for electrosurgical tools in robotic surgical systems
US8120301B2 (en) 2009-03-09 2012-02-21 Intuitive Surgical Operations, Inc. Ergonomic surgeon control console in robotic surgical systems
US8418073B2 (en) 2009-03-09 2013-04-09 Intuitive Surgical Operations, Inc. User interfaces for electrosurgical tools in robotic surgical systems
CN105596005B (en) * 2009-03-26 2019-01-22 直观外科手术操作公司 System for endoscope navigation
US10004387B2 (en) 2009-03-26 2018-06-26 Intuitive Surgical Operations, Inc. Method and system for assisting an operator in endoscopic navigation
US8337397B2 (en) 2009-03-26 2012-12-25 Intuitive Surgical Operations, Inc. Method and system for providing visual guidance to an operator for steering a tip of an endoscopic device toward one or more landmarks in a patient
US20100245557A1 (en) * 2009-03-31 2010-09-30 Luley Iii Charles Injection of secondary images into microscope viewing fields
US8897920B2 (en) 2009-04-17 2014-11-25 Intouch Technologies, Inc. Tele-presence robot system with software modularity, projector and laser pointer
US9532724B2 (en) 2009-06-12 2017-01-03 Bard Access Systems, Inc. Apparatus and method for catheter navigation using endovascular energy mapping
RU2691318C2 (en) 2009-06-12 2019-06-11 Бард Аксесс Системс, Инк. Method for positioning catheter end
US9125578B2 (en) 2009-06-12 2015-09-08 Bard Access Systems, Inc. Apparatus and method for catheter navigation and tip location
IT1395018B1 (en) * 2009-07-22 2012-09-05 Surgica Robotica S R L EQUIPMENT FOR MINIMUM INVASIVE SURGICAL PROCEDURES
EP2464407A4 (en) 2009-08-10 2014-04-02 Bard Access Systems Inc Devices and methods for endovascular electrography
US11399153B2 (en) 2009-08-26 2022-07-26 Teladoc Health, Inc. Portable telepresence apparatus
US8384755B2 (en) 2009-08-26 2013-02-26 Intouch Technologies, Inc. Portable remote presence robot
EP2477531A1 (en) * 2009-09-17 2012-07-25 FUJIFILM Corporation Propellable apparatus with active size changing ability
AU2010300677B2 (en) 2009-09-29 2014-09-04 C.R. Bard, Inc. Stylets for use with apparatus for intravascular placement of a catheter
US8504134B2 (en) * 2009-10-01 2013-08-06 Intuitive Surgical Operations, Inc. Laterally fenestrated cannula
FR2952573B1 (en) * 2009-10-02 2011-12-09 Commissariat Energie Atomique STRUCTURE OF ROBOT OR HAPTIC INTERFACE WITH PARALLEL ARM
US11103213B2 (en) 2009-10-08 2021-08-31 C. R. Bard, Inc. Spacers for use with an ultrasound probe
US8784443B2 (en) 2009-10-20 2014-07-22 Truevision Systems, Inc. Real-time surgical reference indicium apparatus and methods for astigmatism correction
US9766089B2 (en) * 2009-12-14 2017-09-19 Nokia Technologies Oy Method and apparatus for correlating and navigating between a live image and a prerecorded panoramic image
WO2011075693A1 (en) * 2009-12-17 2011-06-23 Board Of Regents Of The University Of Nebraska Modular and cooperative medical devices and related systems and methods
WO2011090628A2 (en) 2009-12-29 2011-07-28 Angiotech Pharmaceuticals, Inc. Bidirectional self-retaining sutures with laser-marked and/or non-laser marked indicia and methods
US11154981B2 (en) 2010-02-04 2021-10-26 Teladoc Health, Inc. Robot user interface for telepresence robot system
US20110187875A1 (en) * 2010-02-04 2011-08-04 Intouch Technologies, Inc. Robot face used in a sterile environment
KR101114235B1 (en) * 2010-02-19 2012-03-13 주식회사 이턴 Master manipulation device for robot and surgical robot using the same
US20110213342A1 (en) * 2010-02-26 2011-09-01 Ashok Burton Tripathi Real-time Virtual Indicium Apparatus and Methods for Guiding an Implant into an Eye
US8670017B2 (en) 2010-03-04 2014-03-11 Intouch Technologies, Inc. Remote presence system including a cart that supports a robot face and an overhead camera
US20110218550A1 (en) * 2010-03-08 2011-09-08 Tyco Healthcare Group Lp System and method for determining and adjusting positioning and orientation of a surgical device
JP5575534B2 (en) * 2010-04-30 2014-08-20 株式会社東芝 Ultrasonic diagnostic equipment
CN104706390B (en) 2010-05-04 2017-05-17 伊西康有限责任公司 Laser cutting system and methods for creating self-retaining sutures
US9014848B2 (en) 2010-05-20 2015-04-21 Irobot Corporation Mobile robot system
US8918213B2 (en) 2010-05-20 2014-12-23 Irobot Corporation Mobile human interface robot
US8935005B2 (en) 2010-05-20 2015-01-13 Irobot Corporation Operating a mobile robot
US10343283B2 (en) 2010-05-24 2019-07-09 Intouch Technologies, Inc. Telepresence robot system that can be accessed by a cellular phone
US10808882B2 (en) 2010-05-26 2020-10-20 Intouch Technologies, Inc. Tele-robotic system with a robot face placed on a chair
WO2011150376A1 (en) 2010-05-28 2011-12-01 C.R. Bard, Inc. Apparatus for use with needle insertion guidance system
WO2011150358A1 (en) 2010-05-28 2011-12-01 C.R. Bard, Inc. Insertion guidance system for needles and medical components
ES2615229T3 (en) 2010-06-11 2017-06-06 Ethicon, Llc Suture dispensing tools for endoscopic and robot-assisted surgery and procedures
US20140066704A1 (en) * 2010-06-18 2014-03-06 Vantage Surgical Systems Inc. Stereoscopic method for minimally invasive surgery visualization
US8968267B2 (en) 2010-08-06 2015-03-03 Board Of Regents Of The University Of Nebraska Methods and systems for handling or delivering materials for natural orifice surgery
CN103228219B (en) 2010-08-09 2016-04-27 C·R·巴德股份有限公司 For support and the covered structure of ultrasound probe head
KR101856267B1 (en) 2010-08-20 2018-05-09 씨. 알. 바드, 인크. Reconfirmation of ecg-assisted catheter tip placement
US11812965B2 (en) 2010-09-30 2023-11-14 Cilag Gmbh International Layer of material for a surgical end effector
US11925354B2 (en) 2010-09-30 2024-03-12 Cilag Gmbh International Staple cartridge comprising staples positioned within a compressible portion thereof
US9629814B2 (en) 2010-09-30 2017-04-25 Ethicon Endo-Surgery, Llc Tissue thickness compensator configured to redistribute compressive forces
US9788834B2 (en) 2010-09-30 2017-10-17 Ethicon Llc Layer comprising deployable attachment members
US10945731B2 (en) 2010-09-30 2021-03-16 Ethicon Llc Tissue thickness compensator comprising controlled release and expansion
US9320523B2 (en) 2012-03-28 2016-04-26 Ethicon Endo-Surgery, Llc Tissue thickness compensator comprising tissue ingrowth features
WO2012046202A1 (en) 2010-10-08 2012-04-12 Koninklijke Philips Electronics N.V. Flexible tether with integrated sensors for dynamic instrument tracking
DE102010042372A1 (en) 2010-10-13 2012-04-19 Kuka Laboratories Gmbh Method for creating a medical image and medical workstation
WO2012058461A1 (en) 2010-10-29 2012-05-03 C.R.Bard, Inc. Bioimpedance-assisted placement of a medical device
JP2014504894A (en) 2010-11-03 2014-02-27 アンジオテック ファーマシューティカルズ, インコーポレイテッド Indwelling suture material for eluting drug and method related thereto
WO2012064902A2 (en) 2010-11-09 2012-05-18 Angiotech Pharmaceuticals, Inc. Emergency self-retaining sutures and packaging
US9264664B2 (en) 2010-12-03 2016-02-16 Intouch Technologies, Inc. Systems and methods for dynamic bandwidth allocation
US9921712B2 (en) 2010-12-29 2018-03-20 Mako Surgical Corp. System and method for providing substantially stable control of a surgical tool
US9119655B2 (en) 2012-08-03 2015-09-01 Stryker Corporation Surgical manipulator capable of controlling a surgical instrument in multiple modes
US8930019B2 (en) 2010-12-30 2015-01-06 Irobot Corporation Mobile human interface robot
US8951266B2 (en) 2011-01-07 2015-02-10 Restoration Robotics, Inc. Methods and systems for modifying a parameter of an automated procedure
US20120191086A1 (en) 2011-01-20 2012-07-26 Hansen Medical, Inc. System and method for endoluminal and translumenal therapy
JP5905031B2 (en) 2011-01-28 2016-04-20 インタッチ テクノロジーズ インコーポレイテッド Interfacing with mobile telepresence robot
US9323250B2 (en) 2011-01-28 2016-04-26 Intouch Technologies, Inc. Time-dependent navigation of telepresence robots
FR2972132B1 (en) 2011-03-02 2014-05-09 Gen Electric DEVICE FOR ASSISTING THE HANDLING OF AN INSTRUMENT OR TOOL
WO2012129534A2 (en) 2011-03-23 2012-09-27 Angiotech Pharmaceuticals, Inc. Self-retaining variable loop sutures
US10769739B2 (en) 2011-04-25 2020-09-08 Intouch Technologies, Inc. Systems and methods for management of information among medical providers and facilities
US8900131B2 (en) 2011-05-13 2014-12-02 Intuitive Surgical Operations, Inc. Medical system providing dynamic registration of a model of an anatomical structure for image-guided surgery
US8827934B2 (en) 2011-05-13 2014-09-09 Intuitive Surgical Operations, Inc. Method and system for determining information of extrema during expansion and contraction cycles of an object
US9098611B2 (en) 2012-11-26 2015-08-04 Intouch Technologies, Inc. Enhanced video interaction for a user interface of a telepresence network
US20140139616A1 (en) 2012-01-27 2014-05-22 Intouch Technologies, Inc. Enhanced Diagnostics for a Telepresence Robot
US20130172931A1 (en) 2011-06-06 2013-07-04 Jeffrey M. Gross Methods and devices for soft palate tissue elevation procedures
JP6174017B2 (en) 2011-06-10 2017-08-02 ボード オブ リージェンツ オブ ザ ユニバーシティ オブ ネブラスカ In vivo vascular seal end effector and in vivo robotic device
US11911117B2 (en) 2011-06-27 2024-02-27 Board Of Regents Of The University Of Nebraska On-board tool tracking system and methods of computer assisted surgery
US9498231B2 (en) 2011-06-27 2016-11-22 Board Of Regents Of The University Of Nebraska On-board tool tracking system and methods of computer assisted surgery
CN106913366B (en) 2011-06-27 2021-02-26 内布拉斯加大学评议会 On-tool tracking system and computer-assisted surgery method
WO2013006817A1 (en) 2011-07-06 2013-01-10 C.R. Bard, Inc. Needle length determination and calibration for insertion guidance system
EP2732344B1 (en) 2011-07-11 2019-06-05 Board of Regents of the University of Nebraska Robotic surgical system
USD724745S1 (en) 2011-08-09 2015-03-17 C. R. Bard, Inc. Cap for an ultrasound probe
USD699359S1 (en) 2011-08-09 2014-02-11 C. R. Bard, Inc. Ultrasound probe head
CN103889360B (en) * 2011-10-21 2017-10-24 直观外科手术操作公司 Grasping force control for robotic surgical instrument end effector
US9211107B2 (en) 2011-11-07 2015-12-15 C. R. Bard, Inc. Ruggedized ultrasound hydrogel insert
US8836751B2 (en) 2011-11-08 2014-09-16 Intouch Technologies, Inc. Tele-presence system with a user interface that displays different communication links
EP2806941B1 (en) 2012-01-10 2021-10-27 Board of Regents of the University of Nebraska Systems and devices for surgical access and insertion
EP3351196A1 (en) 2012-02-29 2018-07-25 Procept Biorobotics Corporation Automated image-guided tissue resection and treatment
CN104334098B (en) 2012-03-28 2017-03-22 伊西康内外科公司 Tissue thickness compensator comprising capsules defining a low pressure environment
RU2014143258A (en) 2012-03-28 2016-05-20 Этикон Эндо-Серджери, Инк. FABRIC THICKNESS COMPENSATOR CONTAINING MANY LAYERS
US8902278B2 (en) 2012-04-11 2014-12-02 Intouch Technologies, Inc. Systems and methods for visualizing and managing telepresence devices in healthcare networks
US9251313B2 (en) 2012-04-11 2016-02-02 Intouch Technologies, Inc. Systems and methods for visualizing and managing telepresence devices in healthcare networks
US10383765B2 (en) * 2012-04-24 2019-08-20 Auris Health, Inc. Apparatus and method for a global coordinate system for use in robotic surgery
CA2871149C (en) 2012-05-01 2020-08-25 Board Of Regents Of The University Of Nebraska Single site robotic device and related systems and methods
EP2852475A4 (en) 2012-05-22 2016-01-20 Intouch Technologies Inc Social behavior rules for a medical telepresence robot
US9361021B2 (en) 2012-05-22 2016-06-07 Irobot Corporation Graphical user interfaces including touchpad driving interfaces for telemedicine devices
EP2861153A4 (en) 2012-06-15 2016-10-19 Bard Inc C R Apparatus and methods for detection of a removable cap on an ultrasound probe
EP3680071B1 (en) 2012-06-22 2021-09-01 Board of Regents of the University of Nebraska Local control robotic surgical devices
US20140001231A1 (en) 2012-06-28 2014-01-02 Ethicon Endo-Surgery, Inc. Firing system lockout arrangements for surgical instruments
US9226796B2 (en) 2012-08-03 2016-01-05 Stryker Corporation Method for detecting a disturbance as an energy applicator of a surgical instrument traverses a cutting path
CN112932672A (en) 2012-08-03 2021-06-11 史赛克公司 Systems and methods for robotic surgery
US9820818B2 (en) 2012-08-03 2017-11-21 Stryker Corporation System and method for controlling a surgical manipulator based on implant parameters
US9770305B2 (en) 2012-08-08 2017-09-26 Board Of Regents Of The University Of Nebraska Robotic surgical devices, systems, and related methods
EP2882331A4 (en) 2012-08-08 2016-03-23 Univ Nebraska Robotic surgical devices, systems, and related methods
US9552660B2 (en) 2012-08-30 2017-01-24 Truevision Systems, Inc. Imaging system and methods displaying a fused multidimensional reconstructed image
JP6385935B2 (en) 2012-09-17 2018-09-05 インテュイティブ サージカル オペレーションズ, インコーポレイテッド Method and system for assigning input devices to remotely operated surgical instrument functions
US10631939B2 (en) 2012-11-02 2020-04-28 Intuitive Surgical Operations, Inc. Systems and methods for mapping flux supply paths
US10864048B2 (en) 2012-11-02 2020-12-15 Intuitive Surgical Operations, Inc. Flux disambiguation for teleoperated surgical systems
US10231867B2 (en) * 2013-01-18 2019-03-19 Auris Health, Inc. Method, apparatus and system for a water jet
WO2014127271A1 (en) 2013-02-15 2014-08-21 Intuitive Surgical Operations, Inc. Systems and methods for proximal control of a surgical instrument
KR102274277B1 (en) 2013-03-13 2021-07-08 스트리커 코포레이션 System for arranging objects in an operating room in preparation for surgical procedures
EP2996611B1 (en) 2013-03-13 2019-06-26 Stryker Corporation Systems and software for establishing virtual constraint boundaries
EP2967623B1 (en) 2013-03-14 2021-07-21 SRI International Compact robotic wrist
US9888966B2 (en) 2013-03-14 2018-02-13 Board Of Regents Of The University Of Nebraska Methods, systems, and devices relating to force control surgical systems
US9743987B2 (en) 2013-03-14 2017-08-29 Board Of Regents Of The University Of Nebraska Methods, systems, and devices relating to robotic surgical devices, end effectors, and controllers
US9375844B2 (en) * 2013-03-15 2016-06-28 Intuitive Surgical Operations, Inc. Geometrically appropriate tool selection assistance for determined work site dimensions
EP2967521B1 (en) 2013-03-15 2019-12-25 SRI International Electromechanical surgical system
KR102540134B1 (en) 2013-03-15 2023-06-07 인튜어티브 서지컬 오퍼레이션즈 인코포레이티드 Inter-operative switching of tools in a robotic surgical system
EP3970604A1 (en) 2013-03-15 2022-03-23 Board of Regents of the University of Nebraska Robotic surgical devices and systems
US10105149B2 (en) 2013-03-15 2018-10-23 Board Of Regents Of The University Of Nebraska On-board tool tracking system and methods of computer assisted surgery
US10426345B2 (en) * 2013-04-04 2019-10-01 Children's National Medical Center System for generating composite images for endoscopic surgery of moving and deformable anatomy
WO2014201165A1 (en) 2013-06-11 2014-12-18 Auris Surgical Robotics, Inc. System for robotic assisted cataract surgery
CA2918531A1 (en) 2013-07-17 2015-01-22 Board Of Regents Of The University Of Nebraska Robotic surgical devices, systems and related methods
US10426661B2 (en) 2013-08-13 2019-10-01 Auris Health, Inc. Method and apparatus for laser assisted cataract surgery
EP3073910B1 (en) 2014-02-06 2020-07-15 C.R. Bard, Inc. Systems for guidance and placement of an intravascular device
EP3108792A4 (en) * 2014-02-19 2017-11-08 Olympus Corporation Display device
KR102358967B1 (en) 2014-03-17 2022-02-08 인튜어티브 서지컬 오퍼레이션즈 인코포레이티드 Systems and methods for control of imaging instrument orientation
US10166061B2 (en) 2014-03-17 2019-01-01 Intuitive Surgical Operations, Inc. Teleoperated surgical system equipment with user interface
EP3122232B1 (en) * 2014-03-28 2020-10-21 Intuitive Surgical Operations Inc. Alignment of q3d models with 3d images
KR102397254B1 (en) 2014-03-28 2022-05-12 인튜어티브 서지컬 오퍼레이션즈 인코포레이티드 Quantitative three-dimensional imaging of surgical scenes
EP3125807B1 (en) * 2014-03-28 2022-05-04 Intuitive Surgical Operations, Inc. Quantitative three-dimensional imaging of surgical scenes from multiport perspectives
EP3125808B1 (en) 2014-03-28 2023-01-04 Intuitive Surgical Operations, Inc. Quantitative three-dimensional visualization of instruments in a field of view
WO2015149043A1 (en) 2014-03-28 2015-10-01 Dorin Panescu Quantitative three-dimensional imaging and printing of surgical implants
KR102397670B1 (en) 2014-03-28 2022-05-16 인튜어티브 서지컬 오퍼레이션즈 인코포레이티드 Surgical system with haptic feedback based upon quantitative three-dimensional imaging
BR112016023807B1 (en) 2014-04-16 2022-07-12 Ethicon Endo-Surgery, Llc CARTRIDGE SET OF FASTENERS FOR USE WITH A SURGICAL INSTRUMENT
JP6636452B2 (en) 2014-04-16 2020-01-29 エシコン エルエルシーEthicon LLC Fastener cartridge including extension having different configurations
EP3868322A1 (en) 2014-09-12 2021-08-25 Board of Regents of the University of Nebraska Quick-release effectors and related systems
US10499999B2 (en) 2014-10-09 2019-12-10 Auris Health, Inc. Systems and methods for aligning an elongate member with an access site
US9924944B2 (en) 2014-10-16 2018-03-27 Ethicon Llc Staple cartridge comprising an adjunct material
JP6608928B2 (en) 2014-11-11 2019-11-20 ボード オブ リージェンツ オブ ザ ユニバーシティ オブ ネブラスカ Robotic device with miniature joint design and related systems and methods
US10123846B2 (en) * 2014-11-13 2018-11-13 Intuitive Surgical Operations, Inc. User-interface control using master controller
WO2016077552A1 (en) * 2014-11-13 2016-05-19 Intuitive Surgical Operations, Inc. Interaction between user-interface and master controller
US10973584B2 (en) 2015-01-19 2021-04-13 Bard Access Systems, Inc. Device and method for vascular access
US10213201B2 (en) 2015-03-31 2019-02-26 Ethicon Llc Stapling end effector configured to compensate for an uneven gap between a first jaw and a second jaw
US20160287279A1 (en) 2015-04-01 2016-10-06 Auris Surgical Robotics, Inc. Microsurgical tool for robotic applications
JP6289755B2 (en) * 2015-06-18 2018-03-07 オリンパス株式会社 Medical system
WO2016210325A1 (en) 2015-06-26 2016-12-29 C.R. Bard, Inc. Connector interface for ecg-based catheter positioning system
EP3325233A1 (en) 2015-07-23 2018-05-30 SRI International Inc. Robotic arm and robotic surgical system
CA2994823A1 (en) 2015-08-03 2017-02-09 Board Of Regents Of The University Of Nebraska Robotic surgical devices, systems and related methods
US9560959B1 (en) 2015-09-18 2017-02-07 Novartis Ag Control of scanning images during vitreoretinal surgery
US10105139B2 (en) 2015-09-23 2018-10-23 Ethicon Llc Surgical stapler having downstream current-based motor control
US11890015B2 (en) 2015-09-30 2024-02-06 Cilag Gmbh International Compressible adjunct with crossing spacer fibers
US11033340B2 (en) * 2015-10-01 2021-06-15 Sony Corporation Medical support arm apparatus and medical system
WO2017062393A2 (en) * 2015-10-09 2017-04-13 Covidien Lp Methods of using an angled endoscopic for visualizing a body cavity with robotic surgical systems
US10639108B2 (en) 2015-10-30 2020-05-05 Auris Health, Inc. Process for percutaneous operations
US9949749B2 (en) 2015-10-30 2018-04-24 Auris Surgical Robotics, Inc. Object capture with a basket
US9955986B2 (en) 2015-10-30 2018-05-01 Auris Surgical Robotics, Inc. Basket apparatus
JP6944939B2 (en) 2015-12-31 2021-10-06 ストライカー・コーポレイション Systems and methods for performing surgery on a patient's target site as defined by a virtual object
US11000207B2 (en) 2016-01-29 2021-05-11 C. R. Bard, Inc. Multiple coil system for tracking a medical device
US20170296173A1 (en) 2016-04-18 2017-10-19 Ethicon Endo-Surgery, Llc Method for operating a surgical instrument
CA3024623A1 (en) 2016-05-18 2017-11-23 Virtual Incision Corporation Robotic surgical devices, systems and related methods
US10139607B2 (en) * 2016-06-03 2018-11-27 Visionnaire Medtech Co., Ltd. Lightweight 3D stereoscopic surgical microscope
US11173617B2 (en) 2016-08-25 2021-11-16 Board Of Regents Of The University Of Nebraska Quick-release end effector tool interface
US10702347B2 (en) 2016-08-30 2020-07-07 The Regents Of The University Of California Robotic device with compact joint design and an additional degree of freedom and related systems and methods
JP2018075218A (en) * 2016-11-10 2018-05-17 ソニー株式会社 Medical support arm and medical system
WO2018098319A1 (en) 2016-11-22 2018-05-31 Board Of Regents Of The University Of Nebraska Improved gross positioning device and related systems and methods
JP7099728B2 (en) 2016-11-29 2022-07-12 バーチャル インシジョン コーポレイション User controller with user presence detection, related systems and methods
WO2018112199A1 (en) 2016-12-14 2018-06-21 Virtual Incision Corporation Releasable attachment device for coupling to medical devices and related systems and methods
US11202682B2 (en) 2016-12-16 2021-12-21 Mako Surgical Corp. Techniques for modifying tool operation in a surgical robotic system based on comparing actual and commanded states of the tool relative to a surgical site
JP7010956B2 (en) 2016-12-21 2022-01-26 エシコン エルエルシー How to staple tissue
GB201703878D0 (en) * 2017-03-10 2017-04-26 Cambridge Medical Robotics Ltd Control system
US10477190B2 (en) * 2017-03-14 2019-11-12 Karl Storz Imaging, Inc. Constant horizon 3D imaging system and related method
EP3595565A4 (en) * 2017-03-15 2021-04-14 Covidien LP Robotic surgical systems, instruments, and controls
US10792466B2 (en) 2017-03-28 2020-10-06 Auris Health, Inc. Shaft actuating handle
US10285574B2 (en) 2017-04-07 2019-05-14 Auris Health, Inc. Superelastic medical instrument
CN110602976B (en) 2017-04-07 2022-11-15 奥瑞斯健康公司 Patient introducer alignment
US10917543B2 (en) 2017-04-24 2021-02-09 Alcon Inc. Stereoscopic visualization camera and integrated robotics platform
US11083537B2 (en) 2017-04-24 2021-08-10 Alcon Inc. Stereoscopic camera with fluorescence visualization
US11862302B2 (en) 2017-04-24 2024-01-02 Teladoc Health, Inc. Automated transcription and documentation of tele-health encounters
US10299880B2 (en) 2017-04-24 2019-05-28 Truevision Systems, Inc. Stereoscopic visualization camera and platform
JP7300999B2 (en) * 2017-04-28 2023-06-30 アリネックス, インコーポレイテッド Systems and methods for locating blood vessels in the treatment of rhinitis
US10307170B2 (en) 2017-06-20 2019-06-04 Ethicon Llc Method for closed loop control of motor velocity of a surgical stapling and cutting instrument
CN110809452B (en) 2017-06-28 2023-05-23 奥瑞斯健康公司 Electromagnetic field generator alignment
CN110913788B (en) 2017-06-28 2024-03-12 奥瑞斯健康公司 Electromagnetic distortion detection
US10932772B2 (en) 2017-06-29 2021-03-02 Ethicon Llc Methods for closed loop velocity control for robotic surgical instrument
US10483007B2 (en) 2017-07-25 2019-11-19 Intouch Technologies, Inc. Modular telehealth cart with thermal imaging and touch screen user interface
US11636944B2 (en) 2017-08-25 2023-04-25 Teladoc Health, Inc. Connectivity infrastructure for a telehealth platform
US11723579B2 (en) 2017-09-19 2023-08-15 Neuroenhancement Lab, LLC Method and apparatus for neuroenhancement
JP7405432B2 (en) 2017-09-27 2023-12-26 バーチャル インシジョン コーポレイション Robotic surgical device with tracking camera technology and related systems and methods
US10464209B2 (en) 2017-10-05 2019-11-05 Auris Health, Inc. Robotic system with indication of boundary for robotic arm
US10016900B1 (en) 2017-10-10 2018-07-10 Auris Health, Inc. Surgical robotic arm admittance control
US11717686B2 (en) 2017-12-04 2023-08-08 Neuroenhancement Lab, LLC Method and apparatus for neuroenhancement to facilitate learning and performance
US10779826B2 (en) 2017-12-15 2020-09-22 Ethicon Llc Methods of operating surgical end effectors
US11273283B2 (en) 2017-12-31 2022-03-15 Neuroenhancement Lab, LLC Method and apparatus for neuroenhancement to enhance emotional response
EP3735341A4 (en) 2018-01-05 2021-10-06 Board of Regents of the University of Nebraska Single-arm robotic device with compact joint design and related systems and methods
CA3088304A1 (en) * 2018-01-12 2019-07-18 Peter L. BONO Robotic surgical control system
US11259882B1 (en) 2018-01-25 2022-03-01 Integrity Implants Inc. Robotic surgical instrument system
US11364361B2 (en) 2018-04-20 2022-06-21 Neuroenhancement Lab, LLC System and method for inducing sleep by transplanting mental states
US10617299B2 (en) 2018-04-27 2020-04-14 Intouch Technologies, Inc. Telehealth cart that supports a removable tablet with seamless audio/video switching
KR102579505B1 (en) 2018-06-07 2023-09-20 아우리스 헬스, 인코포레이티드 Robotic medical system with high-power instruments
US11399905B2 (en) 2018-06-28 2022-08-02 Auris Health, Inc. Medical systems incorporating pulley sharing
CN112566584A (en) 2018-08-15 2021-03-26 奥瑞斯健康公司 Medical instrument for tissue cauterization
CN112566567A (en) 2018-08-17 2021-03-26 奥瑞斯健康公司 Bipolar medical instrument
CN112672710A (en) * 2018-09-05 2021-04-16 纽文思公司 Systems and methods for spinal surgery
WO2020056418A1 (en) 2018-09-14 2020-03-19 Neuroenhancement Lab, LLC System and method of improving sleep
EP3813716A4 (en) 2018-09-26 2022-07-13 Auris Health, Inc. Systems and instruments for suction and irrigation
US11576738B2 (en) 2018-10-08 2023-02-14 Auris Health, Inc. Systems and instruments for tissue sealing
WO2020081373A1 (en) 2018-10-16 2020-04-23 Bard Access Systems, Inc. Safety-equipped connection systems and methods thereof for establishing electrical connections
DE102019132045A1 (en) * 2018-11-27 2020-05-28 Karl Storz Se & Co. Kg Viewing medical images
US11033344B2 (en) * 2018-12-13 2021-06-15 Cilag Gmbh International Improving surgical tool performance via measurement and display of tissue tension
JP2022516937A (en) 2019-01-07 2022-03-03 バーチャル インシジョン コーポレイション Equipment and methods related to robot-assisted surgery systems
CN113347938A (en) 2019-01-25 2021-09-03 奥瑞斯健康公司 Vascular sealer with heating and cooling capabilities
WO2020172394A1 (en) 2019-02-22 2020-08-27 Auris Health, Inc. Surgical platform with motorized arms for adjustable arm supports
US11534248B2 (en) 2019-03-25 2022-12-27 Auris Health, Inc. Systems and methods for medical stapling
US11786694B2 (en) 2019-05-24 2023-10-17 NeuroLight, Inc. Device, method, and app for facilitating sleep
DE102019114817B4 (en) 2019-06-03 2021-12-02 Karl Storz Se & Co. Kg Imaging system and method of observation
US11369386B2 (en) 2019-06-27 2022-06-28 Auris Health, Inc. Systems and methods for a medical clip applier
WO2020263949A1 (en) 2019-06-28 2020-12-30 Auris Health, Inc. Medical instruments including wrists with hybrid redirect surfaces
US11179214B2 (en) * 2019-07-16 2021-11-23 Asensus Surgical Us, Inc. Haptic user interface for robotically controlled surgical instruments
US11896330B2 (en) 2019-08-15 2024-02-13 Auris Health, Inc. Robotic medical system having multiple medical instruments
CN114641252B (en) 2019-09-03 2023-09-01 奥瑞斯健康公司 Electromagnetic Distortion Detection and Compensation
EP4034349A1 (en) 2019-09-26 2022-08-03 Auris Health, Inc. Systems and methods for collision detection and avoidance
WO2021064536A1 (en) 2019-09-30 2021-04-08 Auris Health, Inc. Medical instrument with capstan
US11737835B2 (en) 2019-10-29 2023-08-29 Auris Health, Inc. Braid-reinforced insulation sheath
CN114901200A (en) 2019-12-31 2022-08-12 奥瑞斯健康公司 Advanced basket drive mode
US11839969B2 (en) 2020-06-29 2023-12-12 Auris Health, Inc. Systems and methods for detecting contact between a link and an external object
US11357586B2 (en) 2020-06-30 2022-06-14 Auris Health, Inc. Systems and methods for saturated robotic movement
USD1013170S1 (en) 2020-10-29 2024-01-30 Cilag Gmbh International Surgical instrument assembly
US11806011B2 (en) 2021-03-22 2023-11-07 Cilag Gmbh International Stapling instrument comprising tissue compression systems
US11826012B2 (en) 2021-03-22 2023-11-28 Cilag Gmbh International Stapling instrument comprising a pulsed motor-driven firing rack
US11826042B2 (en) 2021-03-22 2023-11-28 Cilag Gmbh International Surgical instrument comprising a firing drive including a selectable leverage mechanism
CN113509266A (en) * 2021-04-01 2021-10-19 上海复拓知达医疗科技有限公司 Augmented reality information display device, method, readable storage medium, and apparatus
US20220378424A1 (en) 2021-05-28 2022-12-01 Cilag Gmbh International Stapling instrument comprising a firing lockout
US11832910B1 (en) 2023-01-09 2023-12-05 Moon Surgical Sas Co-manipulation surgical system having adaptive gravity compensation

Citations (36)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4672963A (en) * 1985-06-07 1987-06-16 Israel Barken Apparatus and method for computer controlled laser surgery
US4722056A (en) * 1986-02-18 1988-01-26 Trustees Of Dartmouth College Reference display systems for superimposing a tomagraphic image onto the focal plane of an operating microscope
US4791934A (en) * 1986-08-07 1988-12-20 Picker International, Inc. Computer tomography assisted stereotactic surgery system and method
US4837703A (en) * 1986-06-26 1989-06-06 Toshiba Kikai Kabushiki Kaisha Method for generating tool path
US4858149A (en) * 1986-09-03 1989-08-15 International Business Machines Corporation Method and system for solid modelling
US4984157A (en) * 1988-09-21 1991-01-08 General Electric Company System and method for displaying oblique planar cross sections of a solid body using tri-linear interpolation to determine pixel position dataes
US5079699A (en) * 1987-11-27 1992-01-07 Picker International, Inc. Quick three-dimensional display
US5086401A (en) * 1990-05-11 1992-02-04 International Business Machines Corporation Image-directed robotic system for precise robotic surgery including redundant consistency checking
US5098426A (en) * 1989-02-06 1992-03-24 Phoenix Laser Systems, Inc. Method and apparatus for precision laser surgery
US5099846A (en) * 1988-12-23 1992-03-31 Hardy Tyrone L Method and apparatus for video presentation from a variety of scanner imaging sources
US5142930A (en) * 1987-11-10 1992-09-01 Allen George S Interactive image-guided surgical system
US5170347A (en) * 1987-11-27 1992-12-08 Picker International, Inc. System to reformat images for three-dimensional display using unique spatial encoding and non-planar bisectioning
US5182641A (en) * 1991-06-17 1993-01-26 The United States Of America As Represented By The Administrator Of The National Aeronautics And Space Administration Composite video and graphics display for camera viewing systems in robotics and teleoperation
US5230623A (en) * 1991-12-10 1993-07-27 Radionics, Inc. Operating pointer with interactive computergraphics
US5235510A (en) * 1990-11-22 1993-08-10 Kabushiki Kaisha Toshiba Computer-aided diagnosis system for medical use
US5251127A (en) * 1988-02-01 1993-10-05 Faro Medical Technologies Inc. Computer-aided surgery apparatus
US5257203A (en) * 1989-06-09 1993-10-26 Regents Of The University Of Minnesota Method and apparatus for manipulating computer-based representations of objects of complex and unique geometry
US5261404A (en) * 1991-07-08 1993-11-16 Mick Peter R Three-dimensional mammal anatomy imaging system and method
US5368428A (en) * 1989-10-27 1994-11-29 Grumman Aerospace Corporation Apparatus and method for producing a video display
US5402801A (en) * 1991-06-13 1995-04-04 International Business Machines Corporation System and method for augmentation of surgery
US5417210A (en) * 1992-05-27 1995-05-23 International Business Machines Corporation System and method for augmentation of endoscopic surgery
US5531742A (en) * 1992-01-15 1996-07-02 Barken; Israel Apparatus and method for computer controlled cryosurgery
US5617858A (en) * 1994-08-30 1997-04-08 Vingmed Sound A/S Apparatus for endoscopic or gastroscopic examination
US5631973A (en) * 1994-05-05 1997-05-20 Sri International Method for telemanipulation with telepresence
US5762458A (en) * 1996-02-20 1998-06-09 Computer Motion, Inc. Method and apparatus for performing minimally invasive cardiac procedures
US5808665A (en) * 1992-01-21 1998-09-15 Sri International Endoscopic surgical instrument and method for use
US5855553A (en) * 1995-02-16 1999-01-05 Hitchi, Ltd. Remote surgery support system and method thereof
US5876325A (en) * 1993-11-02 1999-03-02 Olympus Optical Co., Ltd. Surgical manipulation system
US5911036A (en) * 1995-09-15 1999-06-08 Computer Motion, Inc. Head cursor control interface for an automated endoscope system for optimal positioning
US5931832A (en) * 1993-05-14 1999-08-03 Sri International Methods for positioning a surgical instrument about a remote spherical center of rotation
US6019724A (en) * 1995-02-22 2000-02-01 Gronningsaeter; Aage Method for ultrasound guidance during clinical procedures
US6096025A (en) * 1997-11-07 2000-08-01 Hill-Rom, Inc. Mobile surgical support apparatus
US6246200B1 (en) * 1998-08-04 2001-06-12 Intuitive Surgical, Inc. Manipulator positioning linkage for robotic surgery
US6292712B1 (en) * 1998-01-29 2001-09-18 Northrop Grumman Corporation Computer interface system for a robotic system
US6425865B1 (en) * 1998-06-12 2002-07-30 The University Of British Columbia Robotically assisted medical ultrasound
US6522906B1 (en) * 1998-12-08 2003-02-18 Intuitive Surgical, Inc. Devices and methods for presenting and regulating auxiliary information on an image display of a telesurgical system to assist an operator in performing a surgical procedure

Family Cites Families (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
ATE225964T1 (en) * 1993-03-31 2002-10-15 Luma Corp INFORMATION MANAGEMENT IN AN ENDOSCOPY SYSTEM
US5638819A (en) * 1995-08-29 1997-06-17 Manwaring; Kim H. Method and apparatus for guiding an instrument to a target
US6468265B1 (en) * 1998-11-20 2002-10-22 Intuitive Surgical, Inc. Performing cardiac surgery without cardioplegia

Patent Citations (39)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4672963A (en) * 1985-06-07 1987-06-16 Israel Barken Apparatus and method for computer controlled laser surgery
US4722056A (en) * 1986-02-18 1988-01-26 Trustees Of Dartmouth College Reference display systems for superimposing a tomagraphic image onto the focal plane of an operating microscope
US4837703A (en) * 1986-06-26 1989-06-06 Toshiba Kikai Kabushiki Kaisha Method for generating tool path
US4791934A (en) * 1986-08-07 1988-12-20 Picker International, Inc. Computer tomography assisted stereotactic surgery system and method
US4858149A (en) * 1986-09-03 1989-08-15 International Business Machines Corporation Method and system for solid modelling
US5142930A (en) * 1987-11-10 1992-09-01 Allen George S Interactive image-guided surgical system
US5230338A (en) * 1987-11-10 1993-07-27 Allen George S Interactive image-guided surgical system for displaying images corresponding to the placement of a surgical tool or the like
US5079699A (en) * 1987-11-27 1992-01-07 Picker International, Inc. Quick three-dimensional display
US5170347A (en) * 1987-11-27 1992-12-08 Picker International, Inc. System to reformat images for three-dimensional display using unique spatial encoding and non-planar bisectioning
US5251127A (en) * 1988-02-01 1993-10-05 Faro Medical Technologies Inc. Computer-aided surgery apparatus
US4984157A (en) * 1988-09-21 1991-01-08 General Electric Company System and method for displaying oblique planar cross sections of a solid body using tri-linear interpolation to determine pixel position dataes
US5099846A (en) * 1988-12-23 1992-03-31 Hardy Tyrone L Method and apparatus for video presentation from a variety of scanner imaging sources
US5098426A (en) * 1989-02-06 1992-03-24 Phoenix Laser Systems, Inc. Method and apparatus for precision laser surgery
US5257203A (en) * 1989-06-09 1993-10-26 Regents Of The University Of Minnesota Method and apparatus for manipulating computer-based representations of objects of complex and unique geometry
US5368428A (en) * 1989-10-27 1994-11-29 Grumman Aerospace Corporation Apparatus and method for producing a video display
US5086401A (en) * 1990-05-11 1992-02-04 International Business Machines Corporation Image-directed robotic system for precise robotic surgery including redundant consistency checking
US5235510A (en) * 1990-11-22 1993-08-10 Kabushiki Kaisha Toshiba Computer-aided diagnosis system for medical use
US5695500A (en) * 1991-06-13 1997-12-09 International Business Machines Corporation System for manipulating movement of a surgical instrument with computer controlled brake
US5445166A (en) * 1991-06-13 1995-08-29 International Business Machines Corporation System for advising a surgeon
US5402801A (en) * 1991-06-13 1995-04-04 International Business Machines Corporation System and method for augmentation of surgery
US5182641A (en) * 1991-06-17 1993-01-26 The United States Of America As Represented By The Administrator Of The National Aeronautics And Space Administration Composite video and graphics display for camera viewing systems in robotics and teleoperation
US5261404A (en) * 1991-07-08 1993-11-16 Mick Peter R Three-dimensional mammal anatomy imaging system and method
US5230623A (en) * 1991-12-10 1993-07-27 Radionics, Inc. Operating pointer with interactive computergraphics
US5531742A (en) * 1992-01-15 1996-07-02 Barken; Israel Apparatus and method for computer controlled cryosurgery
US5808665A (en) * 1992-01-21 1998-09-15 Sri International Endoscopic surgical instrument and method for use
US5417210A (en) * 1992-05-27 1995-05-23 International Business Machines Corporation System and method for augmentation of endoscopic surgery
US5931832A (en) * 1993-05-14 1999-08-03 Sri International Methods for positioning a surgical instrument about a remote spherical center of rotation
US5876325A (en) * 1993-11-02 1999-03-02 Olympus Optical Co., Ltd. Surgical manipulation system
US5631973A (en) * 1994-05-05 1997-05-20 Sri International Method for telemanipulation with telepresence
US5617858A (en) * 1994-08-30 1997-04-08 Vingmed Sound A/S Apparatus for endoscopic or gastroscopic examination
US5855553A (en) * 1995-02-16 1999-01-05 Hitchi, Ltd. Remote surgery support system and method thereof
US6019724A (en) * 1995-02-22 2000-02-01 Gronningsaeter; Aage Method for ultrasound guidance during clinical procedures
US5911036A (en) * 1995-09-15 1999-06-08 Computer Motion, Inc. Head cursor control interface for an automated endoscope system for optimal positioning
US5762458A (en) * 1996-02-20 1998-06-09 Computer Motion, Inc. Method and apparatus for performing minimally invasive cardiac procedures
US6096025A (en) * 1997-11-07 2000-08-01 Hill-Rom, Inc. Mobile surgical support apparatus
US6292712B1 (en) * 1998-01-29 2001-09-18 Northrop Grumman Corporation Computer interface system for a robotic system
US6425865B1 (en) * 1998-06-12 2002-07-30 The University Of British Columbia Robotically assisted medical ultrasound
US6246200B1 (en) * 1998-08-04 2001-06-12 Intuitive Surgical, Inc. Manipulator positioning linkage for robotic surgery
US6522906B1 (en) * 1998-12-08 2003-02-18 Intuitive Surgical, Inc. Devices and methods for presenting and regulating auxiliary information on an image display of a telesurgical system to assist an operator in performing a surgical procedure

Cited By (216)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20110105898A1 (en) * 1999-04-07 2011-05-05 Intuitive Surgical Operations, Inc. Real-Time Generation of Three-Dimensional Ultrasound image using a Two-Dimensional Ultrasound Transducer in a Robotic System
US20050200324A1 (en) * 1999-04-07 2005-09-15 Intuitive Surgical Inc. Non-force reflecting method for providing tool force information to a user of a telesurgical system
US10271909B2 (en) 1999-04-07 2019-04-30 Intuitive Surgical Operations, Inc. Display of computer generated image of an out-of-view portion of a medical device adjacent a real-time image of an in-view portion of the medical device
US10433919B2 (en) 1999-04-07 2019-10-08 Intuitive Surgical Operations, Inc. Non-force reflecting method for providing tool force information to a user of a telesurgical system
US9101397B2 (en) 1999-04-07 2015-08-11 Intuitive Surgical Operations, Inc. Real-time generation of three-dimensional ultrasound image using a two-dimensional ultrasound transducer in a robotic system
US9232984B2 (en) 1999-04-07 2016-01-12 Intuitive Surgical Operations, Inc. Real-time generation of three-dimensional ultrasound image using a two-dimensional ultrasound transducer in a robotic system
US8944070B2 (en) 1999-04-07 2015-02-03 Intuitive Surgical Operations, Inc. Non-force reflecting method for providing tool force information to a user of a telesurgical system
US20060052687A1 (en) * 2002-10-17 2006-03-09 Jarmo Ruohonen Method for three-dimensional modeling of the skull and internal structures thereof
US7720519B2 (en) * 2002-10-17 2010-05-18 Elekta Neuromag Oy Method for three-dimensional modeling of the skull and internal structures thereof
US20050093847A1 (en) * 2003-09-16 2005-05-05 Robert Altkorn Haptic response system and method of use
US8276091B2 (en) * 2003-09-16 2012-09-25 Ram Consulting Haptic response system and method of use
US20120278711A1 (en) * 2003-09-16 2012-11-01 Labtest International, Inc. D/B/A Intertek Consumer Goods North America Haptic response system and method of use
US11116578B2 (en) 2005-05-16 2021-09-14 Intuitive Surgical Operations, Inc. Methods and system for performing 3-D tool tracking by fusion of sensor and/or camera derived data during minimally invasive robotic surgery
US10842571B2 (en) 2005-05-16 2020-11-24 Intuitive Surgical Operations, Inc. Methods and system for performing 3-D tool tracking by fusion of sensor and/or camera derived data during minimally invasive robotic surgery
US10792107B2 (en) 2005-05-16 2020-10-06 Intuitive Surgical Operations, Inc. Methods and system for performing 3-D tool tracking by fusion of sensor and/or camera derived data during minimally invasive robotic surgery
US11478308B2 (en) 2005-05-16 2022-10-25 Intuitive Surgical Operations, Inc. Methods and system for performing 3-D tool tracking by fusion of sensor and/or camera derived data during minimally invasive robotic surgery
US11672606B2 (en) 2005-05-16 2023-06-13 Intuitive Surgical Operations, Inc. Methods and system for performing 3-D tool tracking by fusion of sensor and/or camera derived data during minimally invasive robotic surgery
US10555775B2 (en) 2005-05-16 2020-02-11 Intuitive Surgical Operations, Inc. Methods and system for performing 3-D tool tracking by fusion of sensor and/or camera derived data during minimally invasive robotic surgery
US8971597B2 (en) 2005-05-16 2015-03-03 Intuitive Surgical Operations, Inc. Efficient vision and kinematic data fusion for robotic surgical instruments and other applications
US20100331855A1 (en) * 2005-05-16 2010-12-30 Intuitive Surgical, Inc. Efficient Vision and Kinematic Data Fusion For Robotic Surgical Instruments and Other Applications
US20110050852A1 (en) * 2005-12-30 2011-03-03 Intuitive Surgical Operations, Inc. Stereo telestration for robotic surgery
US20070239153A1 (en) * 2006-02-22 2007-10-11 Hodorek Robert A Computer assisted surgery system using alternative energy technology
US20080065109A1 (en) * 2006-06-13 2008-03-13 Intuitive Surgical, Inc. Preventing instrument/tissue collisions
US9345387B2 (en) 2006-06-13 2016-05-24 Intuitive Surgical Operations, Inc. Preventing instrument/tissue collisions
US11638999B2 (en) 2006-06-29 2023-05-02 Intuitive Surgical Operations, Inc. Synthetic representation of a surgical robot
US10008017B2 (en) 2006-06-29 2018-06-26 Intuitive Surgical Operations, Inc. Rendering tool information as graphic overlays on displayed images of tools
US9801690B2 (en) 2006-06-29 2017-10-31 Intuitive Surgical Operations, Inc. Synthetic representation of a surgical instrument
US9789608B2 (en) 2006-06-29 2017-10-17 Intuitive Surgical Operations, Inc. Synthetic representation of a surgical robot
US9788909B2 (en) 2006-06-29 2017-10-17 Intuitive Surgical Operations, Inc Synthetic representation of a surgical instrument
US9718190B2 (en) 2006-06-29 2017-08-01 Intuitive Surgical Operations, Inc. Tool position and identification indicator displayed in a boundary area of a computer display screen
US10137575B2 (en) 2006-06-29 2018-11-27 Intuitive Surgical Operations, Inc. Synthetic representation of a surgical robot
US10730187B2 (en) 2006-06-29 2020-08-04 Intuitive Surgical Operations, Inc. Tool position and identification indicator displayed in a boundary area of a computer display screen
US10737394B2 (en) 2006-06-29 2020-08-11 Intuitive Surgical Operations, Inc. Synthetic representation of a surgical robot
US10773388B2 (en) 2006-06-29 2020-09-15 Intuitive Surgical Operations, Inc. Tool position and identification indicator displayed in a boundary area of a computer display screen
US11865729B2 (en) 2006-06-29 2024-01-09 Intuitive Surgical Operations, Inc. Tool position and identification indicator displayed in a boundary area of a computer display screen
US20090192523A1 (en) * 2006-06-29 2009-07-30 Intuitive Surgical, Inc. Synthetic representation of a surgical instrument
US20080004603A1 (en) * 2006-06-29 2008-01-03 Intuitive Surgical Inc. Tool position and identification indicator displayed in a boundary area of a computer display screen
US9333042B2 (en) 2007-06-13 2016-05-10 Intuitive Surgical Operations, Inc. Medical robotic system with coupled control modes
US9901408B2 (en) 2007-06-13 2018-02-27 Intuitive Surgical Operations, Inc. Preventing instrument/tissue collisions
US11751955B2 (en) 2007-06-13 2023-09-12 Intuitive Surgical Operations, Inc. Method and system for retracting an instrument into an entry guide
US11432888B2 (en) 2007-06-13 2022-09-06 Intuitive Surgical Operations, Inc. Method and system for moving a plurality of articulated instruments in tandem back towards an entry guide
US11399908B2 (en) 2007-06-13 2022-08-02 Intuitive Surgical Operations, Inc. Medical robotic system with coupled control modes
US9469034B2 (en) 2007-06-13 2016-10-18 Intuitive Surgical Operations, Inc. Method and system for switching modes of a robotic system
US10695136B2 (en) 2007-06-13 2020-06-30 Intuitive Surgical Operations, Inc. Preventing instrument/tissue collisions
US10188472B2 (en) 2007-06-13 2019-01-29 Intuitive Surgical Operations, Inc. Medical robotic system with coupled control modes
US9629520B2 (en) 2007-06-13 2017-04-25 Intuitive Surgical Operations, Inc. Method and system for moving an articulated instrument back towards an entry guide while automatically reconfiguring the articulated instrument for retraction into the entry guide
US8620473B2 (en) 2007-06-13 2013-12-31 Intuitive Surgical Operations, Inc. Medical robotic system with coupled control modes
US20100274087A1 (en) * 2007-06-13 2010-10-28 Intuitive Surgical Operations, Inc. Medical robotic system with coupled control modes
US10271912B2 (en) 2007-06-13 2019-04-30 Intuitive Surgical Operations, Inc. Method and system for moving a plurality of articulated instruments in tandem back towards an entry guide
US9138129B2 (en) 2007-06-13 2015-09-22 Intuitive Surgical Operations, Inc. Method and system for moving a plurality of articulated instruments in tandem back towards an entry guide
US8792963B2 (en) 2007-09-30 2014-07-29 Intuitive Surgical Operations, Inc. Methods of determining tissue distances using both kinematic robotic tool position information and image-derived position information
US9516996B2 (en) 2008-06-27 2016-12-13 Intuitive Surgical Operations, Inc. Medical robotic system providing computer generated auxiliary views of a camera instrument for controlling the position and orienting of its tip
US9089256B2 (en) 2008-06-27 2015-07-28 Intuitive Surgical Operations, Inc. Medical robotic system providing an auxiliary view including range of motion limitations for articulatable instruments extending out of a distal end of an entry guide
US11382702B2 (en) 2008-06-27 2022-07-12 Intuitive Surgical Operations, Inc. Medical robotic system providing an auxiliary view including range of motion limitations for articulatable instruments extending out of a distal end of an entry guide
US10258425B2 (en) * 2008-06-27 2019-04-16 Intuitive Surgical Operations, Inc. Medical robotic system providing an auxiliary view of articulatable instruments extending out of a distal end of an entry guide
US20090326553A1 (en) * 2008-06-27 2009-12-31 Intuitive Surgical, Inc. Medical robotic system providing an auxiliary view of articulatable instruments extending out of a distal end of an entry guide
US20090326318A1 (en) * 2008-06-27 2009-12-31 Intuitive Surgical, Inc. Medical robotic system providing an auxilary view including range of motion limitations for articulatable instruments extending out of a distal end of an entry guide
US9717563B2 (en) 2008-06-27 2017-08-01 Intuitive Surgical Operations, Inc. Medical robotic system providing an auxilary view including range of motion limitations for articulatable instruments extending out of a distal end of an entry guide
US11638622B2 (en) 2008-06-27 2023-05-02 Intuitive Surgical Operations, Inc. Medical robotic system providing an auxiliary view of articulatable instruments extending out of a distal end of an entry guide
US8864652B2 (en) 2008-06-27 2014-10-21 Intuitive Surgical Operations, Inc. Medical robotic system providing computer generated auxiliary views of a camera instrument for controlling the positioning and orienting of its tip
CN102076276A (en) * 2008-06-27 2011-05-25 直观外科手术操作公司 Medical robotic system providing an auxiliary view of articulatable instruments extending out of a distal end of an entry guide
US10368952B2 (en) 2008-06-27 2019-08-06 Intuitive Surgical Operations, Inc. Medical robotic system providing an auxiliary view including range of motion limitations for articulatable instruments extending out of a distal end of an entry guide
US20090326556A1 (en) * 2008-06-27 2009-12-31 Intuitive Surgical, Inc. Medical robotic system providing computer generated auxiliary views of a camera instrument for controlling the positioning and orienting of its tip
US8184880B2 (en) 2008-12-31 2012-05-22 Intuitive Surgical Operations, Inc. Robust sparse image matching for robotic surgery
US20100168918A1 (en) * 2008-12-31 2010-07-01 Intuitive Surgical, Inc. Obtaining force information in a minimally invasive surgical procedure
US8706301B2 (en) 2008-12-31 2014-04-22 Intuitive Surgical Operations, Inc. Obtaining force information in a minimally invasive surgical procedure
US9402690B2 (en) 2008-12-31 2016-08-02 Intuitive Surgical Operations, Inc. Efficient 3-D telestration for local and remote robotic proctoring
US8374723B2 (en) 2008-12-31 2013-02-12 Intuitive Surgical Operations, Inc. Obtaining force information in a minimally invasive surgical procedure
US8594841B2 (en) 2008-12-31 2013-11-26 Intuitive Surgical Operations, Inc. Visual force feedback in a minimally invasive surgical procedure
US8639000B2 (en) 2008-12-31 2014-01-28 Intuitive Surgical Operations, Inc. Robust sparse image matching for robotic surgery
US20100164950A1 (en) * 2008-12-31 2010-07-01 Intuitive Surgical, Inc. Efficient 3-d telestration for local robotic proctoring
US20100169815A1 (en) * 2008-12-31 2010-07-01 Intuitive Surgical, Inc. Visual force feedback in a minimally invasive surgical procedure
US20100166323A1 (en) * 2008-12-31 2010-07-01 Intuitive Surgical. Inc. Robust sparse image matching for robotic surgery
US8830224B2 (en) 2008-12-31 2014-09-09 Intuitive Surgical Operations, Inc. Efficient 3-D telestration for local robotic proctoring
US10070849B2 (en) 2009-02-20 2018-09-11 Covidien Lp Marking articulating direction for surgical instrument
US20100217279A1 (en) * 2009-02-20 2010-08-26 Tyco Healthcare Group Lp Marking Articulating Direction For Surgical Instrument
WO2010117685A3 (en) * 2009-03-31 2011-02-24 Intuitive Surgical Operations, Inc. Synthetic representation of a surgical robot
US10282881B2 (en) 2009-03-31 2019-05-07 Intuitive Surgical Operations, Inc. Rendering tool information as graphic overlays on displayed images of tools
US10984567B2 (en) 2009-03-31 2021-04-20 Intuitive Surgical Operations, Inc. Rendering tool information as graphic overlays on displayed images of tools
EP3246135A1 (en) * 2009-03-31 2017-11-22 Intuitive Surgical Operations Inc. Synthetic representation of a surgical robot
CN102448680A (en) * 2009-03-31 2012-05-09 直观外科手术操作公司 Synthetic representation of a surgical robot
JP2016101506A (en) * 2009-03-31 2016-06-02 インテュイティブ サージカル オペレーションズ, インコーポレイテッド Synthetic representation of surgical robot
WO2010117684A1 (en) * 2009-03-31 2010-10-14 Intuitive Surgical Operations, Inc. Synthetic representation of a surgical instrument
WO2010117685A2 (en) * 2009-03-31 2010-10-14 Intuitive Surgical Operations, Inc. Synthetic representation of a surgical robot
KR20120004479A (en) * 2009-03-31 2012-01-12 인튜어티브 서지컬 오퍼레이션즈 인코포레이티드 Synthetic representation of a surgical robot
KR101705921B1 (en) * 2009-03-31 2017-02-10 인튜어티브 서지컬 오퍼레이션즈 인코포레이티드 Synthetic representation of a surgical robot
US9492240B2 (en) 2009-06-16 2016-11-15 Intuitive Surgical Operations, Inc. Virtual measurement tool for minimally invasive surgery
US20100317965A1 (en) * 2009-06-16 2010-12-16 Intuitive Surgical, Inc. Virtual measurement tool for minimally invasive surgery
US9155592B2 (en) 2009-06-16 2015-10-13 Intuitive Surgical Operations, Inc. Virtual measurement tool for minimally invasive surgery
CN102458294A (en) * 2009-06-16 2012-05-16 直观外科手术操作公司 Virtual measurement tool for minimally invasive surgery
US20100318099A1 (en) * 2009-06-16 2010-12-16 Intuitive Surgical, Inc. Virtual measurement tool for minimally invasive surgery
US9492927B2 (en) 2009-08-15 2016-11-15 Intuitive Surgical Operations, Inc. Application of force feedback on an input device to urge its operator to command an articulated instrument to a preferred pose
US10271915B2 (en) 2009-08-15 2019-04-30 Intuitive Surgical Operations, Inc. Application of force feedback on an input device to urge its operator to command an articulated instrument to a preferred pose
US8903546B2 (en) 2009-08-15 2014-12-02 Intuitive Surgical Operations, Inc. Smooth control of an articulated instrument across areas with different work space conditions
US9084623B2 (en) 2009-08-15 2015-07-21 Intuitive Surgical Operations, Inc. Controller assisted reconfiguration of an articulated instrument during movement into and out of an entry guide
US9956044B2 (en) 2009-08-15 2018-05-01 Intuitive Surgical Operations, Inc. Controller assisted reconfiguration of an articulated instrument during movement into and out of an entry guide
US11596490B2 (en) 2009-08-15 2023-03-07 Intuitive Surgical Operations, Inc. Application of force feedback on an input device to urge its operator to command an articulated instrument to a preferred pose
US10772689B2 (en) 2009-08-15 2020-09-15 Intuitive Surgical Operations, Inc. Controller assisted reconfiguration of an articulated instrument during movement into and out of an entry guide
US10959798B2 (en) 2009-08-15 2021-03-30 Intuitive Surgical Operations, Inc. Application of force feedback on an input device to urge its operator to command an articulated instrument to a preferred pose
US9622826B2 (en) 2010-02-12 2017-04-18 Intuitive Surgical Operations, Inc. Medical robotic system providing sensory feedback indicating a difference between a commanded state and a preferred pose of an articulated instrument
US10537994B2 (en) 2010-02-12 2020-01-21 Intuitive Surgical Operations, Inc. Medical robotic system providing sensory feedback indicating a difference between a commanded state and a preferred pose of an articulated instrument
US8918211B2 (en) 2010-02-12 2014-12-23 Intuitive Surgical Operations, Inc. Medical robotic system providing sensory feedback indicating a difference between a commanded state and a preferred pose of an articulated instrument
US10828774B2 (en) 2010-02-12 2020-11-10 Intuitive Surgical Operations, Inc. Medical robotic system providing sensory feedback indicating a difference between a commanded state and a preferred pose of an articulated instrument
US20110202068A1 (en) * 2010-02-12 2011-08-18 Intuitive Surgical Operations, Inc. Medical robotic system providing sensory feedback indicating a difference between a commanded state and a preferred pose of an articulated instrument
US8849015B2 (en) * 2010-10-12 2014-09-30 3D Systems, Inc. System and apparatus for haptically enabled three-dimensional scanning
US20120141949A1 (en) * 2010-10-12 2012-06-07 Larry Bodony System and Apparatus for Haptically Enabled Three-Dimensional Scanning
US9486189B2 (en) 2010-12-02 2016-11-08 Hitachi Aloka Medical, Ltd. Assembly for use with surgery system
US11871901B2 (en) 2012-05-20 2024-01-16 Cilag Gmbh International Method for situational awareness for surgical network or surgical network connected device capable of adjusting function based on a sensed situation or usage
US11166706B2 (en) 2012-06-27 2021-11-09 Camplex, Inc. Surgical visualization systems
US10022041B2 (en) 2012-06-27 2018-07-17 Camplex, Inc. Hydraulic system for surgical applications
US9642606B2 (en) 2012-06-27 2017-05-09 Camplex, Inc. Surgical visualization system
US10555728B2 (en) 2012-06-27 2020-02-11 Camplex, Inc. Surgical visualization system
US9629523B2 (en) 2012-06-27 2017-04-25 Camplex, Inc. Binocular viewing assembly for a surgical visualization system
US9615728B2 (en) 2012-06-27 2017-04-11 Camplex, Inc. Surgical visualization system with camera tracking
US10925472B2 (en) 2012-06-27 2021-02-23 Camplex, Inc. Binocular viewing assembly for a surgical visualization system
US10925589B2 (en) 2012-06-27 2021-02-23 Camplex, Inc. Interface for viewing video from cameras on a surgical visualization system
US9492065B2 (en) 2012-06-27 2016-11-15 Camplex, Inc. Surgical retractor with video cameras
US9681796B2 (en) 2012-06-27 2017-06-20 Camplex, Inc. Interface for viewing video from cameras on a surgical visualization system
US9723976B2 (en) 2012-06-27 2017-08-08 Camplex, Inc. Optics for video camera on a surgical visualization system
US9216068B2 (en) 2012-06-27 2015-12-22 Camplex, Inc. Optics for video cameras on a surgical visualization system
US10231607B2 (en) 2012-06-27 2019-03-19 Camplex, Inc. Surgical visualization systems
US9936863B2 (en) 2012-06-27 2018-04-10 Camplex, Inc. Optical assembly providing a surgical microscope view for a surgical visualization system
US11129521B2 (en) 2012-06-27 2021-09-28 Camplex, Inc. Optics for video camera on a surgical visualization system
US11889976B2 (en) 2012-06-27 2024-02-06 Camplex, Inc. Surgical visualization systems
US11389146B2 (en) 2012-06-27 2022-07-19 Camplex, Inc. Surgical visualization system
US11806102B2 (en) 2013-02-15 2023-11-07 Intuitive Surgical Operations, Inc. Providing information of tools by filtering image areas adjacent to or on displayed images of the tools
US10507066B2 (en) 2013-02-15 2019-12-17 Intuitive Surgical Operations, Inc. Providing information of tools by filtering image areas adjacent to or on displayed images of the tools
US11389255B2 (en) 2013-02-15 2022-07-19 Intuitive Surgical Operations, Inc. Providing information of tools by filtering image areas adjacent to or on displayed images of the tools
US9782159B2 (en) 2013-03-13 2017-10-10 Camplex, Inc. Surgical visualization systems
US10932766B2 (en) 2013-05-21 2021-03-02 Camplex, Inc. Surgical visualization systems
US11147443B2 (en) 2013-09-20 2021-10-19 Camplex, Inc. Surgical visualization systems and displays
US10028651B2 (en) 2013-09-20 2018-07-24 Camplex, Inc. Surgical visualization systems and displays
US10881286B2 (en) 2013-09-20 2021-01-05 Camplex, Inc. Medical apparatus for use with a surgical tubular retractor
US10568499B2 (en) 2013-09-20 2020-02-25 Camplex, Inc. Surgical visualization systems and displays
US11504192B2 (en) 2014-10-30 2022-11-22 Cilag Gmbh International Method of hub communication with surgical instrument systems
US9936972B2 (en) * 2014-10-31 2018-04-10 Siemens Aktiengesellschaft Method of automatically monitoring the penetration behavior of a trocar held by a robotic arm and monitoring system
US20160128781A1 (en) * 2014-10-31 2016-05-12 Lutz Blohm Method of automatically monitoring the penetration behavior of a trocar held by a robotic arm and monitoring system
US10702353B2 (en) 2014-12-05 2020-07-07 Camplex, Inc. Surgical visualizations systems and displays
US11154378B2 (en) 2015-03-25 2021-10-26 Camplex, Inc. Surgical visualization systems and displays
US10966798B2 (en) 2015-11-25 2021-04-06 Camplex, Inc. Surgical visualization systems and displays
US10918455B2 (en) 2017-05-08 2021-02-16 Camplex, Inc. Variable light source
US11759224B2 (en) 2017-10-30 2023-09-19 Cilag Gmbh International Surgical instrument systems comprising handle arrangements
US11801098B2 (en) 2017-10-30 2023-10-31 Cilag Gmbh International Method of hub communication with surgical instrument systems
US11696778B2 (en) 2017-10-30 2023-07-11 Cilag Gmbh International Surgical dissectors configured to apply mechanical and electrical energy
US11911045B2 (en) 2017-10-30 2024-02-27 Cllag GmbH International Method for operating a powered articulating multi-clip applier
US11564703B2 (en) 2017-10-30 2023-01-31 Cilag Gmbh International Surgical suturing instrument comprising a capture width which is larger than trocar diameter
US11564756B2 (en) 2017-10-30 2023-01-31 Cilag Gmbh International Method of hub communication with surgical instrument systems
US11648022B2 (en) 2017-10-30 2023-05-16 Cilag Gmbh International Surgical instrument systems comprising battery arrangements
US11510741B2 (en) 2017-10-30 2022-11-29 Cilag Gmbh International Method for producing a surgical instrument comprising a smart electrical system
US11925373B2 (en) 2017-10-30 2024-03-12 Cilag Gmbh International Surgical suturing instrument comprising a non-circular needle
US11819231B2 (en) 2017-10-30 2023-11-21 Cilag Gmbh International Adaptive control programs for a surgical system comprising more than one type of cartridge
US11602366B2 (en) 2017-10-30 2023-03-14 Cilag Gmbh International Surgical suturing instrument configured to manipulate tissue using mechanical and electrical power
US11633237B2 (en) 2017-12-28 2023-04-25 Cilag Gmbh International Usage and technique analysis of surgeon / staff performance against a baseline to optimize device utilization and performance for both current and future procedures
US11857152B2 (en) 2017-12-28 2024-01-02 Cilag Gmbh International Surgical hub spatial awareness to determine devices in operating theater
US11601371B2 (en) 2017-12-28 2023-03-07 Cilag Gmbh International Surgical network determination of prioritization of communication, interaction, or processing based on system or device needs
US11918302B2 (en) 2017-12-28 2024-03-05 Cilag Gmbh International Sterile field interactive control displays
US11589932B2 (en) 2017-12-28 2023-02-28 Cilag Gmbh International Usage and technique analysis of surgeon / staff performance against a baseline to optimize device utilization and performance for both current and future procedures
US11602393B2 (en) 2017-12-28 2023-03-14 Cilag Gmbh International Surgical evacuation sensing and generator control
US11612444B2 (en) 2017-12-28 2023-03-28 Cilag Gmbh International Adjustment of a surgical device function based on situational awareness
US11612408B2 (en) 2017-12-28 2023-03-28 Cilag Gmbh International Determining tissue composition via an ultrasonic system
US11903601B2 (en) 2017-12-28 2024-02-20 Cilag Gmbh International Surgical instrument comprising a plurality of drive systems
US11903587B2 (en) 2017-12-28 2024-02-20 Cilag Gmbh International Adjustment to the surgical stapling control based on situational awareness
US11589888B2 (en) 2017-12-28 2023-02-28 Cilag Gmbh International Method for controlling smart energy devices
US11576677B2 (en) 2017-12-28 2023-02-14 Cilag Gmbh International Method of hub communication, processing, display, and cloud analytics
US11571234B2 (en) 2017-12-28 2023-02-07 Cilag Gmbh International Temperature control of ultrasonic end effector and control system therefor
US11659023B2 (en) * 2017-12-28 2023-05-23 Cilag Gmbh International Method of hub communication
US11666331B2 (en) 2017-12-28 2023-06-06 Cilag Gmbh International Systems for detecting proximity of surgical end effector to cancerous tissue
US11559307B2 (en) 2017-12-28 2023-01-24 Cilag Gmbh International Method of robotic hub communication, detection, and control
US11672605B2 (en) 2017-12-28 2023-06-13 Cilag Gmbh International Sterile field interactive control displays
US11678881B2 (en) 2017-12-28 2023-06-20 Cilag Gmbh International Spatial awareness of surgical hubs in operating rooms
US11896322B2 (en) 2017-12-28 2024-02-13 Cilag Gmbh International Sensing the patient position and contact utilizing the mono-polar return pad electrode to provide situational awareness to the hub
US11896443B2 (en) 2017-12-28 2024-02-13 Cilag Gmbh International Control of a surgical system through a surgical barrier
US11559308B2 (en) 2017-12-28 2023-01-24 Cilag Gmbh International Method for smart energy device infrastructure
US11696760B2 (en) 2017-12-28 2023-07-11 Cilag Gmbh International Safety systems for smart powered surgical stapling
US11890065B2 (en) 2017-12-28 2024-02-06 Cilag Gmbh International Surgical system to limit displacement
US11423007B2 (en) 2017-12-28 2022-08-23 Cilag Gmbh International Adjustment of device control programs based on stratified contextual data in addition to the data
US11701185B2 (en) 2017-12-28 2023-07-18 Cilag Gmbh International Wireless pairing of a surgical device with another device within a sterile surgical field based on the usage and situational awareness of devices
US11864845B2 (en) 2017-12-28 2024-01-09 Cilag Gmbh International Sterile field interactive control displays
US11712303B2 (en) 2017-12-28 2023-08-01 Cilag Gmbh International Surgical instrument comprising a control circuit
US11737668B2 (en) 2017-12-28 2023-08-29 Cilag Gmbh International Communication hub and storage device for storing parameters and status of a surgical device to be shared with cloud based analytics systems
US11744604B2 (en) 2017-12-28 2023-09-05 Cilag Gmbh International Surgical instrument with a hardware-only control circuit
US11540855B2 (en) 2017-12-28 2023-01-03 Cilag Gmbh International Controlling activation of an ultrasonic surgical instrument according to the presence of tissue
US11751958B2 (en) 2017-12-28 2023-09-12 Cilag Gmbh International Surgical hub coordination of control and communication of operating room devices
US11864728B2 (en) 2017-12-28 2024-01-09 Cilag Gmbh International Characterization of tissue irregularities through the use of mono-chromatic light refractivity
US11596291B2 (en) 2017-12-28 2023-03-07 Cilag Gmbh International Method of compressing tissue within a stapling device and simultaneously displaying of the location of the tissue within the jaws
US11771487B2 (en) 2017-12-28 2023-10-03 Cilag Gmbh International Mechanisms for controlling different electromechanical systems of an electrosurgical instrument
US11775682B2 (en) 2017-12-28 2023-10-03 Cilag Gmbh International Data stripping method to interrogate patient records and create anonymized record
US11779337B2 (en) 2017-12-28 2023-10-10 Cilag Gmbh International Method of using reinforced flexible circuits with multiple sensors to optimize performance of radio frequency devices
US11786245B2 (en) 2017-12-28 2023-10-17 Cilag Gmbh International Surgical systems with prioritized data transmission capabilities
US11786251B2 (en) 2017-12-28 2023-10-17 Cilag Gmbh International Method for adaptive control schemes for surgical network control and interaction
US11529187B2 (en) 2017-12-28 2022-12-20 Cilag Gmbh International Surgical evacuation sensor arrangements
US11844579B2 (en) 2017-12-28 2023-12-19 Cilag Gmbh International Adjustments based on airborne particle properties
US11818052B2 (en) 2017-12-28 2023-11-14 Cilag Gmbh International Surgical network determination of prioritization of communication, interaction, or processing based on system or device needs
US11464559B2 (en) 2017-12-28 2022-10-11 Cilag Gmbh International Estimating state of ultrasonic end effector and control system therefor
US11832840B2 (en) 2017-12-28 2023-12-05 Cilag Gmbh International Surgical instrument having a flexible circuit
US11832899B2 (en) 2017-12-28 2023-12-05 Cilag Gmbh International Surgical systems with autonomously adjustable control programs
US11589915B2 (en) 2018-03-08 2023-02-28 Cilag Gmbh International In-the-jaw classifier based on a model
US11844545B2 (en) 2018-03-08 2023-12-19 Cilag Gmbh International Calcified vessel identification
US11534196B2 (en) 2018-03-08 2022-12-27 Cilag Gmbh International Using spectroscopy to determine device use state in combo instrument
US11839396B2 (en) 2018-03-08 2023-12-12 Cilag Gmbh International Fine dissection mode for tissue classification
US11617597B2 (en) 2018-03-08 2023-04-04 Cilag Gmbh International Application of smart ultrasonic blade technology
US11707293B2 (en) 2018-03-08 2023-07-25 Cilag Gmbh International Ultrasonic sealing algorithm with temperature control
US11701139B2 (en) 2018-03-08 2023-07-18 Cilag Gmbh International Methods for controlling temperature in ultrasonic device
US11701162B2 (en) 2018-03-08 2023-07-18 Cilag Gmbh International Smart blade application for reusable and disposable devices
US11399858B2 (en) 2018-03-08 2022-08-02 Cilag Gmbh International Application of smart blade technology
US11678901B2 (en) 2018-03-08 2023-06-20 Cilag Gmbh International Vessel sensing for adaptive advanced hemostasis
US11678927B2 (en) 2018-03-08 2023-06-20 Cilag Gmbh International Detection of large vessels during parenchymal dissection using a smart blade
US11589865B2 (en) 2018-03-28 2023-02-28 Cilag Gmbh International Methods for controlling a powered surgical stapler that has separate rotary closure and firing systems
US11197728B2 (en) 2018-09-17 2021-12-14 Auris Health, Inc. Systems and methods for concomitant medical procedures
US11903661B2 (en) 2018-09-17 2024-02-20 Auris Health, Inc. Systems and methods for concomitant medical procedures
US11464511B2 (en) 2019-02-19 2022-10-11 Cilag Gmbh International Surgical staple cartridges with movable authentication key arrangements
US11751872B2 (en) 2019-02-19 2023-09-12 Cilag Gmbh International Insertable deactivator element for surgical stapler lockouts
US11517309B2 (en) 2019-02-19 2022-12-06 Cilag Gmbh International Staple cartridge retainer with retractable authentication key
US11925350B2 (en) 2019-02-19 2024-03-12 Cilag Gmbh International Method for providing an authentication lockout in a surgical stapler with a replaceable cartridge
CN112568864A (en) * 2020-12-03 2021-03-30 牡丹江医学院 Uterine cavity operation monitoring system
US11931027B2 (en) 2021-08-16 2024-03-19 Cilag Gmbh Interntional Surgical instrument comprising an adaptive control system

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