HK1234633A1 - Robotized module for guiding an elongate flexible medical device - Google Patents

Abstract

The invention concerns a cassette comprising a sterile barrier (39) with attachment brackets (45), each attached to a guide member (24, 24') for guiding an elongate flexible medical device, and flexible portions (44) between two adjacent attachment brackets (45). The flexible portions are rigidly connected to the attachment brackets. The guide surfaces (46) of the attachment brackets come into contact with the elongate flexible medical device.

Description

Robotic module for guiding elongate flexible medical instruments

Technical Field

The present invention relates to a robot module for driving an elongated flexible medical instrument.

Background

Manual insertion of a catheter or guide into a patient is a relatively common surgical procedure. However, because the procedure is monitored using X-rays, the surgeon performing the procedure must be irradiated if the procedure is performed on a large number of patients.

In order to reduce the risk to the surgeon, attempts have been made to automate such insertion. This automation is complicated by the difficulty in clamping the catheter. The catheter is immersed in a preservation solution and maintained sterile. Furthermore, the translational and rotational motion of the catheter is controlled alternately and/or simultaneously. Reliability is a decisive criterion for such a robot system.

Recently a drive system for controlling the translational and rotational movement of the catheter has been proposed in US7,927,310. The conduit is placed on a plate that is rotatable relative to a base that is used to drive rotation. The plate itself includes a translation drive mechanism. In addition, remote motors fixed to the frame and systems for transferring motion to the catheter are used. For power, space and sterility reasons, it is preferable not to install a motor.

Although this arrangement is satisfactory, the simplicity of this type of mechanism is constantly sought, in particular for the purpose of increasing reliability.

Disclosure of Invention

To this end, according to the present invention, there is provided a robotic drive module for driving an elongate flexible medical instrument, comprising:

-a base for supporting the substrate,

a pair of drive members, each having a drive surface, the drive members being in a drive configuration in which their drive surfaces engage and are disposed on opposite sides of an elongate flexible medical instrument to be driven,

the pair of driving members are movably mounted between a first position and a second position relative to the base along the degree of freedom,

a control member adapted to control movement of the pair of drivers in the drive configuration relative to the base from the first position to the second position, thereby driving the elongate flexible medical instrument relative to the base,

-a disposable sterile barrier comprising a connecting bracket of each driver and a flexible portion between two adjacent connecting brackets, the flexible portion being connected to the connecting brackets, each driver being attached to a connecting bracket, the driving surfaces of the connecting brackets being to be in contact with the elongated flexible medical device.

With these arrangements, it is possible to drive elongate flexible medical instruments in a sterile manner, even over long, complex trajectories.

In a preferred embodiment of the invention, one and/or another of the following arrangements may also be utilized:

the pair of drive members being alternately in a drive configuration and a free configuration in which the drive surfaces of the pair of drive members are not engaged with the elongate flexible medical instrument,

the control member is adapted to control movement of the driver in the driving configuration from the first position to the second position relative to the base and movement of the pair of drivers in the free configuration from the second position to the first position relative to the base in a repetitive cycle without driving the elongate flexible medical instrument relative to the base;

-the base is a first base, the pair of drives is a first pair of drives, the robot module further comprising:

-a second base for receiving the second substrate,

a second pair of driving members, each having a driving surface, the pair of driving members being in a driving configuration in which the driving surfaces of the pair of driving members engage the elongate flexible medical instrument to be driven and are disposed on opposite sides thereof,

the second pair of driving members is movably mounted with respect to the base between a first position and a second position along one degree of freedom,

the control member is further adapted to control movement of the second pair of drivers in the drive configuration relative to the base from the first position to the second position, thereby driving the elongate flexible medical instrument relative to the second base,

the second pair of drivers is alternately capable of a driving configuration and a free configuration in which the driving surfaces of the second pair of drivers are not engaged with the elongate flexible medical instrument,

the control member is adapted to control movement of the driver in the driving configuration from the first position to the second position relative to the second base and movement of the pair of drivers in the free configuration from the second position to the first position relative to the second base in a repetitive cycle without driving the elongate flexible medical instrument relative to the base;

-the first base and the second base are connected together or are common;

the disposable sterile barrier comprises a connecting bracket for each of the second pair of drivers and a flexible portion between two adjacent connecting brackets, the flexible portion being connected to the connecting brackets, each driver of the second pair of drivers being attached to the connecting brackets, the driving surfaces of the connecting brackets being to be in contact with the elongated flexible medical device;

the sterile barrier further comprises a disposable continuous film comprising an attachment portion of each driver and a flexible portion between two adjacent attachment portions, each driver being attached to an attachment portion of the continuous film, the driving surface engaging the elongate flexible medical instrument through the continuous film;

-the sterile barrier further comprises a rigid housing, each connection bracket being assembled on the rigid housing by said flexible portion;

the rigid casing comprises a plurality of windows, each window being hermetically closed by a flexible portion;

-the connecting bracket is assembled to the driving member by a frangible zone connecting the driving surface in contact with the elongate flexible medical instrument to the assembly portion of the driving member;

the sterile barrier divides the space into two subspaces: a sterile sub-space housing the elongate flexible medical instrument, and a sub-space in which the drive member is disposed that is not necessarily sterile;

the robotic drive module comprises an enclosed housing enclosing the drive member and, where appropriate, the base, and including an upstream port and a downstream port through which the elongate flexible medical instrument extends;

the housing further comprises a connection connecting each drive member to the motor outside the housing;

the enclosure comprises a container and a lid which is movable relative to the container between a closed configuration in which access to the elongate flexible medical instrument within the enclosure is inhibited by an operator, and an open configuration in which access to the elongate flexible medical instrument within the enclosure is accessible by the operator;

the final part of the trajectory of the cover from its open configuration to its closed configuration is a translation movement;

in the closed configuration, in the vicinity of the drive member, a large free volume is available between the cap and the container, beyond which the free volume available between the cap and the container is reduced, enabling it to guide an elongate flexible medical instrument there;

the housing comprises a fixed base part carrying the drive and a disposable, consumable cassette, said cassette being assemblable or disassemblable from the base part, the cassette comprising at least a sterile barrier;

-the container comprises a base portion and a sterile barrier;

each connecting bracket is detachable from the respective driving member;

the robot module further comprises a rigid carrier carrying connection brackets, each connection bracket being temporarily assembled to the carrier;

the carrier further comprises a safety self-locking device portion preventing its assembly in an accidental direction;

-detaching the carrier from the sterile barrier;

-each attachment bracket comprises a flat wall having a front face and comprising a barrier system for restricting movement of the elongate flexible medical instrument, keeping the elongate flexible medical instrument facing the front face;

each barrier of the restraining barrier system comprises alternating recesses and projections.

According to another feature, the present invention is directed to an arteriography robot that includes a container, an elongated flexible medical instrument at least partially contained within the container, and a robot drive module attached to the container and capable of driving the elongated flexible medical instrument out of the container.

According to another feature, the invention relates to a cassette comprising a sterile barrier comprising connection brackets respectively attachable to a drive of an elongated flexible medical instrument and a flexible portion between two adjacent connection brackets, the flexible portion being connected to the connection brackets, the drive surfaces of the connection brackets being intended to come into contact with the elongated flexible medical instrument.

Drawings

Further characteristics and advantages of the invention will become apparent from the following description of an embodiment thereof, set forth by way of non-limiting example with reference to the accompanying drawings.

With respect to the drawings:

figure 1a is a schematic side view of a robotic arteriography device.

Figure 1b is a top view of a portion of figure 1a,

FIG. 2 is a schematic top view of a robot used in the apparatus of FIGS. 1a and 1b,

figures 3a-3c are schematic views of the movement pattern of the member to be driven,

figure 4 is a schematic perspective view of a portion of the drive module in a free configuration,

figure 5a is a plan view of the surface of a module according to one embodiment,

figure 5b is a plan view from above of the module of figure 5a,

FIG. 6 is a view similar to FIG. 5a, without transparency, in an open configuration of the housing,

figure 7 is a schematic view of the surface of the driver,

figure 8 is a perspective view of an embodiment of the box (without the lid) seen from above,

figure 9 is a cross-sectional view along the line IX-IX of figure 8,

figure 10 is a perspective view of the box with the lid,

figures 11a and 11b are perspective views of the rear and end pieces of the connecting bracket respectively,

FIG. 12 is a view similar to FIG. 11a, with the end pieces assembled on the connecting bracket,

figure 13 is a perspective top view of a cassette containing a rack carrier,

FIG. 14 is a sectional view along the section IX-IX of the stent carrier,

figures 15a-15f are cross-sectional views from the side illustrating stages of assembling the bracket to the end piece according to one embodiment,

FIG. 16 is a perspective rear view illustrating one embodiment of the stand,

fig. 17 is a perspective rear view illustrating one embodiment of the connecting bracket.

In the drawings, like reference characters designate the same or similar elements.

Detailed Description

Fig. 1a shows an arteriography device 1 in accordance with a diagram. The arteriography device 1 is divided into two different positions, an operating room 2 and a control room 3. The control room 3 may be close to the operating room 2, separated from it by a simple partition 4 that is opaque under X-ray scanning, or remote from the operating room 2. The devices of the operating room 2 and the control room 3 are connected to each other in a functional manner, wired, wireless, networked or the like.

The operating room 2 comprises an operating table 5 which accommodates a patient 6. The operating room 2 may also comprise a medical imager 7, in particular an X-ray imager, comprising a source 8 and a detector 9 applied on both sides of the patient, possibly movable relative to the patient.

The arteriography apparatus 1 includes a robot 10 disposed in an operating room 2.

The arteriography apparatus 1 includes a control station 11 disposed in the control room 3. The control station 11 is capable of remotely controlling the robot 10. The arteriography device 1 can also include one or more remote controls 12 of the imager 7 disposed in the control room 3 in communication with the imager 7 for remote control of the imager. The arteriography device 1 can also comprise a screen 13, arranged in the control room 3, in communication with the imager 7, so as to enable the images acquired by the imager 7 to be seen in real time in the control room 3.

The robot 10 may include a container 14 adapted to contain an elongated flexible medical instrument 15, the elongated flexible medical instrument 15 to be introduced into a patient. For example, the elongate flexible medical device 15 may be a device to be introduced into the patient's vein and moved in the vein, in particular an artery or vein of the patient, with the access to the patient being kept open by the Desilet. In particular, the elongate flexible medical device may be a catheter. Alternatively, the elongate flexible medical device may be a guide for introducing a catheter. The diameter of the cross-section of the guide is typically smaller than the diameter of the catheter, which is typically hollow in the portion of the catheter proximal to the patient, or even throughout its length, so that the guide can move within the catheter, particularly within the patient. The guide may also include a curved end portion, as will be described in more detail below.

The robot 10 may include a drive module 16 for driving the elongate flexible medical instrument 15. The drive module 16 may be controlled from the control station 11 to drive the elongate flexible medical instrument relative to the patient in at least one degree of freedom, as will be described in more detail below. The drive module may comprise a communication unit 17 providing an interface with the control station 11. If desired, the robot 10 may include an indoor control unit 18 that controls the robot from the operating room 2, if necessary.

It should also be noted that all the controls and feedback available in the control room 3 are also available in the operating room 2 in view of the room operation, e.g. for viewing the images acquired by the imager 7, the control 19 of the imager and the screen 20.

The elongate flexible medical instrument 15 may be coupled to a connector 56, the connector 56 being capable of injecting a contrast agent that facilitates imaging within the elongate flexible medical instrument. The arteriography device may include a contrast agent injector 57 connected to the connector 56, which is controlled by a remote control 58 disposed in the control room 3. A controller 59 for the contrast injector may also be present in the operating room 2.

Fig. 2 illustrates in greater detail, purely by way of illustration, the container 14 housing the duct 15'. The container 14 maintains the conduit 15' in its optimal storage environment. The drive module 16 is adapted to drive the catheter 15'. In the example, the container 14 also houses a guide 15 ". The container 14 holds the guide 15 "in its optimal storage environment. The drive module 16' is adapted to drive the guide 15 ". The drive modules 16 and 16' may be the same or different depending on the application. Where appropriate, may be in accordance with one of the embodiments set out below. In the illustrated example, the guide 15 "may be introduced into the conduit 15 'at the rear end 15' b of the conduit 15 'and extend beyond the front end 15' a of the conduit, as shown.

In the following, reference numeral 15 is used to refer to a guide 15 ", a catheter 15' or generally an elongate flexible medical device to be introduced into a patient. For example, it may refer to an interventional catheter. Such interventional catheters may be smaller in diameter than catheters, so they may be guided coaxially within the catheter within the patient, and are hollow for guidance over a guide within the patient.

Fig. 3a shows the different degrees of freedom that may be present in the system. It shows a guide 15 "having a leading end 15", which leading end 15 "is slightly bent with respect to the longitudinal main axis of the guide and exits from the leading end 15'a of the guide tube 15'. The conduit 15' undergoes two different movements:

-a translational movement along its longitudinal axis,

-rotation about its longitudinal axis.

These movements can be generated in either direction.

Where applicable, the conduit 15' may be subjected to a movement which combines the two simple movements described above.

Where applicable, the duct 15' may be subjected to two movements which combine the two simple movements in different combinations.

What has been said above in relation to the catheter also applies to the guide.

The guide 15 "can undergo two different movements:

-a translational movement along its longitudinal axis,

-rotation about its longitudinal axis.

These movements can be generated in either direction.

Where applicable, the guide 15 "may undergo a movement that combines the two simple movements described above.

Where applicable, the guide 15 "may undergo two movements which combine the two simple movements in different combinations.

In some cases, the catheter itself has a curved end, either allowing navigation on the same principle as a guide, or allowing assistance in positioning at anatomical sites with specific curvatures.

Fig. 3b shows an artery 21 of a patient, comprising a main vessel 22 and two branches 23a, 23b leading to the main vessel. Fig. 3b illustrates translational movement of the elongate flexible medical instrument 15 (in this case the guide 15 ") between a retracted position, shown in phantom lines, and an advanced position, shown in solid lines. Fig. 3c illustrates that in the same artery the elongate flexible medical device 15 is rotated between a first position, indicated by dashed lines, in which the elongate flexible medical device is ready to move translationally towards branch 23a, and a second position, indicated by solid lines, in which the elongate flexible medical device is ready to move translationally towards branch 23 b.

The elongate flexible medical instrument is drivable by the drive member in accordance with the motion. The driving members may be provided in pairs.

According to one embodiment, a given drive member may be activated by the driver.

The drive system 55, 55', 55 ″ with the drive pawl 24 is thus illustrated in three separate spatial directions.

Fig. 4 illustrates a drive module 31 according to a first embodiment. The drive module 31 is adapted to drive an elongated flexible medical instrument 15 extending in a longitudinal direction X. It should be noted that the longitudinal direction X at the drive module 31 is not necessarily the same as the longitudinal direction of the elongate flexible medical instrument 15 at the distal end of the elongate flexible medical instrument, but that translation and/or rotation of the elongate flexible medical instrument 15 along/about the longitudinal direction X at the drive module 31 will result in translation and/or rotation of the elongate flexible medical instrument 15 along/about its longitudinal direction at its distal end, respectively.

The drive module 31 comprises a base 132 and at least one driver 24, the at least one driver 24 being movably mounted with respect to the base 132. For example, the driver 24 is movably mounted with respect to the base 132 in three degrees of freedom.

In the example shown, the drive module 31 further comprises a second drive member 24'. The drive member 24, hereinafter also referred to as first drive member, and the second drive member 24' together form a pair of drive members 33. The pair of drivers 33 includes two drivers that cooperate to cause movement of the elongate flexible medical instrument 15 relative to the base 132. In the example shown, the second drive member 24' is movably mounted relative to the base 132. For example, the second driving member 24' is movably mounted with respect to the base 132 in three degrees of freedom.

The first drive member 24 and the second drive member 24' are paired for simultaneous movement. For example, the first and second drivers 24, 24' may be controlled independently of each other, but in accordance with respective synchronization commands. Alternatively, a common command may be provided, which is propagated to the first and second drivers 24, 24' by means of a mechanical or electrical connection between the same control systems.

Each driver 24, 24 'has a respective drive face 34, 34'. The elongate flexible medical instrument 15 is disposed between the drive surfaces 34, 34 'of the designated pair of drive members 24, 24'. To clarify this point, the drive faces 34, 34' are spaced apart by a distance in the Y direction.

The pair of drive members 24, 24' can be in a free configuration, as shown in FIG. 4, wherein the drive surfaces 34, 34' of the drive members 24, 24' of the pair of drive members 33 are not engaged with the elongate flexible medical instrument 15.

The pair of drive members 33 can be in a drive configuration wherein the drive surfaces 34, 34' of the drive members of the pair of drive members engage the elongate flexible medical instrument 15 to be driven. For example, the force exerted by the driver on the elongate flexible medical device in this configuration is on the order of several newtons (5-30N, for example). For example, retraction means are provided to return the pair of driving members to a free configuration, for example in the event of a power interruption, which enables it to provide a safety function.

In order to bring the pair of driving members 33 alternately into the free configuration and into the driving configuration, the two driving members 24, 24' can be commanded to move relative to each other. For example, such movement may involve displacement of one of the drive members 24 relative to the base while the other drive member remains stationary. Alternatively, both driving members 24, 24' may be moved towards each other relative to the base.

In the example, a shift in the Y direction is envisaged.

In the embodiment shown, the two drive members 24, 24' are movable relative to the base along one degree of freedom. This degree of freedom is different from the degree of freedom that enables it to alternate the drive member between the free position and the drive position. In particular, the drive member 24, 24' is movable relative to the base along one degree of freedom when in its drive configuration. Thus, movement of the driver in one degree of freedom when in its driving configuration results in movement of the elongate flexible medical instrument relative to the base 132.

One example describes the generation of a translational motion of an elongate flexible medical instrument in a longitudinal direction X.

The starting position corresponds to the starting position of fig. 4 described above. First, the free configuration becomes the drive configuration. According to an example, the change is effected by a movement of the drive in the opposite direction along the Y direction. The magnitude of this motion depends on the elongate flexible medical instrument 15 to be driven. A guide having a smaller diameter than the catheter may require a greater amplitude of motion than a catheter starting from the same starting position.

In the drive configuration, the movement of the drive members is synchronized in the same direction along the longitudinal direction X in the first direction, which results in the same movement of the elongate flexible medical instrument 15.

The drive structure becomes a free structure. According to an example, the change is effected by the two drives moving in opposite directions in the Y direction, which is opposite to the direction of switching the drives from the free configuration to the drive configuration.

In the free configuration, movement of the drive member is synchronized (or otherwise) in the same direction along the longitudinal direction X in a second direction opposite the first direction, such that movement of the elongate flexible medical instrument 15 is not caused. The system then returns to the starting configuration.

The above steps may be repeated in a controlled loop manner to cause the elongate flexible medical instrument to translate along a long distance (e.g., on the order of several meters) along the longitudinal direction X in the first direction.

Displacement of the elongate flexible medical instrument along the longitudinal direction X along the long extent in the second direction may be achieved by a series of operations opposite to those just described.

The frequency of the cycle is adjustable and controllable. In particular, low frequencies may be used for introducing the elongated flexible medical device into the patient, even at several levels of low frequencies, in order to allow slow navigation, especially in harsh environments. For example, a fast frequency may be used for revocation, or even for emergency revocation. The amplitude of the motion per cycle can also be adjusted.

For translational motion, the velocity may be 0.1 to 200 millimeters per second.

One example describes the generation of a rotational motion of an elongate flexible medical instrument about its longitudinal direction X.

The starting position corresponds to the starting position of fig. 4 described above. First, the free configuration becomes the drive configuration. According to an example, the change is effected by a movement of the drive in the opposite direction along the Y direction. This variation is the same as that described above.

In the drive configuration, synchronous movement of the drive member occurs in an opposite direction along a Z-direction, different from the Y-direction, transverse to the longitudinal direction X, which results in rotational movement of the elongate flexible medical instrument 15 about the longitudinal direction X. In particular, the elongate flexible medical instrument rolls, preferably without slipping, on the drive surfaces 34, 34 'of the drive members 24, 24'. Alternatively, only one of the two actuators may be moved, while the other actuator remains stationary.

The drive structure becomes a free structure. According to an example, said change is effected by the movement of the two driving members in the Y direction in opposite directions, opposite to the direction of switching the driving members from the free configuration to the driving configuration.

In the free configuration, the movement of the drive members is synchronized (or otherwise generated) in the direction Z, as opposed to the movement described above, so as not to cause movement of the elongate flexible medical instrument 15. The system then returns to the starting configuration.

The above steps may be repeated in a controlled cycle manner to cause the elongate flexible medical instrument to rotate in a first direction along a long path (e.g., 360 ° several times) about the longitudinal direction X.

Displacement of the elongate flexible medical instrument along a long distance about the longitudinal direction X in a second rotational direction opposite the first direction may be achieved by a series of operations opposite to those just described.

In both the above embodiments, a sequence of movements is described in which the movement of the drive member is expected to be completed in one direction, thereby initiating the other movement.

However, given that the drive members can be individually activated by different degrees of freedom by means of the three drive systems 55, 55', 55 "described above in an independent manner, the movement can be achieved by the drive members moving synchronously along the two degrees of freedom. For example, the movement of the drive element between the end of the drive process and the return to the initial position may comprise an intermediate phase between a first pure disengagement phase and a second pure return phase to the initial position, wherein the two movements are combined. A similar intermediate phase between the pure return phase back to the initial position and the pure approach phase is also possible between the disengaged position at the end of the drive sequence and the position assumed at the beginning of the drive sequence. To set the limits it is not possible to have more pure return phases, pure separation and pure approach phases back to the initial position, because of the risk of causing parasitic movements of the elongated flexible medical instrument.

In addition, although a purely translational motion and a purely rotational motion of the elongate flexible medical instrument are described separately, the two motions may be alternately combined. In the engaged configuration, it may be sufficient to combine appropriate movement of the drive member to produce both translation and rotation.

The foregoing examples include a single pair of drivers.

Alternatively, there may be multiple pairs of drives. For example, by way of illustration, there may be two pairs of drives. The drives 24 ", 24" ' of the second pair 33' may be similar to the first pair and may in particular comprise drive faces 34 ", 34" ' and are activated from the remote control station 11, or even from the local control unit 18, according to a similar embodiment to the first pair of drives. The first and second pairs 33, 33' of drivers may be offset from each other along the longitudinal axis X of the elongate flexible medical instrument. According to a first example, the two pairs 33, 33' may be coplanar in their free configuration. In other words, it may have two pairs of common bases 132 opposite. Alternatively, the bases 132, 132' of each pair may be independent, or even non-coplanar.

The two pairs may be activated simultaneously. For example, the activation of two pairs may result in two identical pairs of simultaneous movements.

Alternatively, the two pairs may be activated in a synchronized manner to produce coordinated offset motion. In other words, the first pair 33 may be in the driving configuration while the other pair is in the free configuration, or vice versa. For example, there will always be at least one pair in the drive configuration. This may be the first pair, the second pair, or even two pairs at each given time. This construction makes it possible to hold an elongated flexible medical device to be improved. In particular, when an elongate flexible medical device is moved by friction at the patient's anatomy, it must be able to ensure that it is held sufficiently to overcome the local resistance to motion. This is more difficult in the case of elongate flexible medical devices that are slippery, for example, because of being held in solution.

In the above embodiments, the drive member is disposed in a symmetrical manner relative to a generally median plane of the elongate flexible medical instrument.

Alternatively, however, the driver can be movably mounted relative to the base 132 to locally laterally move the elongate flexible medical instrument relative to its longitudinal neutral axis X'. By defining the longitudinal neutral axis X' by the longitudinal axis naturally occupied by the elongate flexible medical instrument, no stress is placed on the driver 24. Such lateral offset may be present by producing simultaneous movement of the driving members 24, 24' in the engaged configuration in the same direction along the lateral direction (Y-axis or Z-axis, or in combination along both axes) relative to the engaged configuration on the longitudinal neutral axis.

Where applicable, where pairs of drive members are employed, they may be arranged in an engagement formation according to different lateral offsets relative to the longitudinal neutral axis. Then, a "crank type" actuation may be employed.

Fig. 5a and 5b show a robot drive module 16 comprising a housing 35, said housing 35 covering the drives 24, 24', 24 "'. The housing 35 has an opening to allow the passage of the driving rod 27 (only the driving rod along Z is shown in fig. 5 a) and is rigidly connected at its other end to a driver (not shown). Alternatively, it should be noted that the rod illustrated with reference 27 in fig. 5b is not necessarily a driving rod, but may simply be a motion-transmitting rod, rigidly connected to one end of the driving member 24. In this case, it is the other end of the motion-transmitting rod that is driven by the drive system 55, 55', 55 ". The housing 35 further includes an upstream face 35a and a downstream face 35b, each including a port 36 for allowing passage of an elongate flexible medical instrument therethrough. The port 36 can be made in the form of a slot to enable emergency withdrawal of the elongate flexible medical instrument.

According to the example shown, if several pairs of actuators are used, offset from each other along the longitudinal axis X, two successive pairs of actuators 33, 33' can be separated by an intermediate portion 37 of the housing. The intermediate portion 37 may also include a port through which the elongate flexible medical instrument passes, the port being bounded by edges that may form a support region for the elongate flexible medical instrument.

The enclosure 35 includes an attachment system 38 that attaches the enclosure 35 to a support, for example, rigidly to the container 14. Any type of attachment is possible, removable or non-removable, for example by clamping or electromechanical locking.

The enclosure 35 also includes a sterile barrier 39, which will be described in more detail below. Specifically, the housing 35 includes a portion of the fixed base 101 and a disposable cartridge 102. The base portion 102 carries the drive members 24-24 "'. Cassette 102 may be assembled to and disassembled from portions of stationary base 101 by any suitable mechanism. As shown in fig. 8, in one example, the cassettes 102 interact in the fixed base 101 portion by nesting (complementarity of shape). Cassette 102 includes sterility barrier 39. A sterile barrier 39 may be attached to the enclosure 35. The sterile barrier 39 divides the space into two subspaces: a sterile subspace 40, in particular a sterile subspace in which the elongate flexible medical instrument 15 is accommodated, and a subspace 41 which is not necessarily sterile; in the example shown, the drive member 24, 24' is arranged in a sub-space 41 which is not necessarily sterile. In other words, the driving member 24, 24' interacts with the elongate flexible medical instrument through the sterile barrier 39.

For example, the sterility barrier 39 comprises a continuous film 42, said continuous film 42 comprising an attachment portion 43 for each driver 24, 24' and a flexible portion 44 between two adjacent attachment portions. For example, the flexible portion 44 is transparent. Each drive member 24, 24 'is attached to an attachment portion 43 of the continuous film 42, and the drive surfaces 34, 34' are engaged with the elongate flexible medical instrument 15 through the continuous film 42.

As can be seen in fig. 7, for example, it is envisaged to connect the flexible portion 44 to the connection bracket 45. For example, the flexible portion 44 is overmolded onto the attachment bracket 45. The attachment bracket 45 can be assembled to the drive member 24 by any suitable means, for example by clamping in a sub-space 41 which is not necessarily sterile, by means of an assembly part 54 (in this case a clamping part). The drive surface 46 of the attachment bracket 45 that contacts the elongate flexible medical instrument 15 can be particularly well suited to such contact. For example, it may be molded, striped, lined and/or provided with a coating suitable for such contact.

Flexible portion 44 is long enough and flexible enough so that driver 24, 24' can undergo relative movement as described above without obstructing sterile barrier 39 or degrading sterile barrier 39.

The attachment bracket 45 may include frangible regions 53, such as arms, that connect the drive face 46 to the clamp portion. After intervention, the frangible zone 53 is broken when the sterile barrier is removed. This mechanism provides a safety device that, where appropriate, prevents the reinstallation of sterile barriers for subsequent intervention.

According to an alternative, as shown in fig. 8, the sterile barrier 39 has a rigid casing 60 with a window 61. For example, each driver 24 has a window 61. Specifically, the window 61 is disposed in a side wall 79 of the channel 78 of the housing, extending generally in the X direction. Thus, the housing 60 comprises an upper wall 103, for example flat, in which the channel 78 is arranged, and a peripheral skirt 104, said peripheral skirt 104 being used to mount the housing 60 on a fixed part. The channel 68 has a windowed area 105 and a non-windowed area 106 adjacent to the windowed area 105, the two windows 61 being arranged in said windowed area 105 facing each other. In the present case, two pairs of drives are used, the channel having two windowed areas 105 and one windowless area 106 between said windowed areas 105. The tunnel also has a rear windowless region 106 and a front windowless region ("rear" and "front" these words are for the patient). The passage 68 may also include a partial relief valve 80 constituting a self-locking safety device. The dimensions of the window 61 in the X-direction and the Z-direction are significantly larger than the respective course of the drive member 24 in these two directions. The following description is given of one window 61, and of course, the same description applies to the other windows. A flexible membrane 42 is attached around the perimeter of each window and sealingly closes each window. The connecting bracket 45 extends into each window 61. The attachment bracket 45 is suspended from the housing 60 by the flexible membrane 42. The flexible membrane 42 is attached in a sealed manner around the perimeter of the attachment bracket 45. The flexibility of the flexible membrane 42 enables the connecting bracket 45 to move within a range of motion in each of the three spatial directions while maintaining the sealed assembly of the connecting bracket 45 with the housing 60. Thus, the connecting bracket 45 is sealingly connected to the housing 60 by the flexible portion 44.

Fig. 9 thus illustrates the attachment brackets 45 and 45 "at different positions along the X and Z axes. The connecting brackets 45 and 45 "are also in different positions along the Y-axis, which is not visible in this cross-sectional view. The flexibility of the flexible membrane 42 enables these movements.

Fig. 11a, 11b and 12 show an exemplary assembly of the connecting bracket 45 with the drive member 24. Fig. 11a illustrates the connecting bracket 45 (the flexible membrane 42 is not shown). The connecting bracket 45 comprises a flat wall 62, on the rear of which flat wall 62 the system, which is removably assembled with the driving member, is mounted. In front of the flat wall 62 is the drive surface 46 that contacts the elongate flexible medical instrument ("front" and "rear" are used with reference to the elongate flexible medical instrument). The knock-down assembly comprises a resilient tab 63 carrying two locking ears 64. The knock down system also includes a guidance system. The guidance system comprises two mutually symmetrical members arranged on either side of the elastic lamina 63. Each piece includes a guide wall 65 in parallel opposition to the flat wall 62. The removable assembly system is open at the bottom to allow assembly from the top of the end piece 66 of the driver 24.

The end piece 66 is illustrated in fig. 11 b. The end piece is rigidly connected to the distal end of the driver 24. The end piece comprises a front window 67 able to receive the elastic lamina 63. Two stops 68 are provided in the front window. Two transverse reinforcements 69 are provided on either side of the front window 67. The shape of the transverse stiffeners 69 supplement part of the guidance system.

The connecting bracket 45 is assembled on the end piece 66 by sliding from the top. The reinforcement 69 is inserted into the respective portions of the guide system, being sandwiched therebetween, and the elastic sheet 63 is inserted into the front window 67 by elastic deformation. Once the assembled position is reached, the resilient tab 63 is partially released so that the tab 64 can engage the stop 68. This engagement prevents upward movement of the connecting bracket relative to the end piece 66. The connecting bracket 45 and the end piece 66 are rigidly connected to each other.

In the above embodiment, since the flexible membrane 42 is flexible, it is necessary to assemble each attachment bracket 45 one by one on the corresponding end piece 66, which is difficult because of the small size of the components, the small space available, and the consideration that the flexible membrane 42 must not be damaged.

In an alternative, a carrier 87 is provided that temporarily holds the scaffold 45. According to this embodiment, the carrier utilizes removable guide plates 70. The guide plate 70 is illustrated in a median cross-sectional view in fig. 14. The shape of the guide plate 70 generally complements the shape of the housing 60, and in particular the central passage 78 of the housing 60. In a given unique position, may be received in the central passage 78 of the housing 60. Thus, there is a partial relief valve 81 (fig. 13) complementary to the relief valve 80 of the passage 68. The bracket 45 is held by two holding areas 71 of the guide plate, the two holding areas 71 being spaced apart from each other in the X direction. The bracket 45 is held in the Y direction by lugs 72, which lugs 72 are to be arranged on both sides of the flat wall 62. For example, a pair of ears 72 are provided per retention area. The stop 73 participates in holding the carriage 45 in the Z direction. Such a stopper 73 is provided in each holding area 71, for example. Each stop 73 engages a complementary stop 74 provided in the bracket 45.

The stop 73 is mounted on a flexible sheet 75. Thus, the guide plate 70 comprises a base body 76, on which two flexible foils 75 are resiliently mounted, able to undergo a certain degree of bending. The lifting lug 72 is disposed below the base body 75. The flexible foil 75 comprises a user accessible actuation portion 77, thereby creating a bending of the flexible foil 75.

The bracket 45 is thus held in position between the four lugs 72 while being supported at both lateral ends thereof by two stops 73, said stops 73 being engaged with the stops 74. The extension of the tab 72 on the rear side of the flat wall 62 is limited so as not to interfere with the attachment of the flexible membrane to the support 45.

The guide plate 70 is symmetrical about the X-Z plane. The flexible sheet 75 carries a further stop which engages a complementary stop of the facing bracket 45.

The system just described is reproduced for the other pair of supports 45 by translation along the X axis, both systems being made in a single piece by extending the base body 76.

The guide plate 70 thus defines a very precise position of each bracket 45 with respect to the base body, which position is thus defined with respect to the housing 60 if there is a separate mounting position of the guide plate 70 on the housing 60.

In the example shown, at rest, each end piece 66 is in a neutral position. This position corresponds to the position of assembly of the end piece 66 on the bracket 45, in which the bracket 45 is held in a determined position relative to the housing 60 by the guide plate 70.

In the delivery configuration, the guide plate 70 is therefore assembled on the casing 60 in a single position and supports the four supports 45 in defined positions.

The driver is in a stationary state so the end piece 66 is in a defined position.

The housing 60 is set in position relative to the fixed base portion 101 and the end piece 66 and bracket 45 are assembled together as described above.

This assembly is possible because the guide plate 70 precisely defines the position of the bracket 45 in space, and in particular the position in which it is positioned accurately for assembly on each end piece 66.

The guide plate 70 is then detached from the bracket 45 and can be removed by action on the drive portion 77.

The holder 45 is then mounted on the end piece 66, being held in a floating manner in a single operation by the flexible portion 44.

At the end of the operation, in order to detach the bracket 45 from the fixed base part 101, the elastic lamina 63 is grasped by the flexible film (which is transparent, if applicable, to facilitate this operation) and the lamina 63 is pulled so as to disengage the tab 64 from the stop 68. The sterile barrier may then be separated from the portion of the fixed base 101.

In variants employing a different number of brackets 45, a similar mechanism may be employed.

The enclosure 35 may include a container 47 and a cover 48 that is movable relative to the container 47 between a closed configuration in which access to the elongate flexible medical instrument 15 within the enclosure is prohibited to an operator, and an open configuration in which access to the elongate flexible medical instrument 15 within the enclosure is accessible to the operator. Fig. 6 illustrates an intermediate position, which may be intermediate between these structures. The port 36 may be open to allow this arrangement to be made with two different configurations. For example, the port 36 includes a first leg 49 having an L-shape including an opening 50 that allows the elongate flexible medical device 15 to be detached from the cap 48, and a second leg 51 including a support surface 52 that allows the elongate flexible medical device 15 to be in a closed configuration.

Fig. 10 shows the cover 48 according to one embodiment in a more precise manner. In this example, the lid 48 is connected to the sterile barrier and constitutes a separate consumable cartridge 102. In this example, the cover 48 is mounted to pivot relative to the housing 60 about a pivot 82.

The inner surface 48 of the cover includes a guide portion 83 having a shape that is partially complementary to the shape of the channel 78. In particular, in the windowless region 106 of the channel 78, the guide portion 83 tends to minimize the space available for the elongate flexible medical instrument. When the cap is in the closed configuration, the guide portion 83 and the channel 78 together define a space, in the windowless region 106, having a cross-section similar to that of the elongate flexible medical device. On both sides of the windowed area 105, at its end, the guide portion comprises a bifurcation 84. The bifurcation 84 includes two angled branches 85 joined together at an apex 86 that communicates with the space described above. The branches 85 are inclined so as to guide the elongate flexible medical instrument, the arrangement of which at the window towards the space is not constrained.

In the above example, the cover is mounted to pivot relative to the housing about a fixed pivot. Alternatively, the cover may be assembled to the housing in another motion by a suitable hinge mechanism. In particular when closing the lid, a final trajectory of the translational movement, in particular in the Z-direction, may be provided. Such movement is considered to be safe for preventing the elongate flexible medical instrument from collapsing between the housing and the cap when the cap is closed. In particular, a two-step closing approach path moving into an intermediate position, and a final path as described above, may be employed. The approach path may be translated along a different degree of freedom than the final path, e.g., pivoting about the X-axis, or translating along an axis other than the Z-axis. For example, the mechanism may involve a guide plate system that guides the movement of the cover relative to the housing along a desired trajectory.

Where appropriate, the housing 35 containing the drive member may be made disposable. Alternatively, as mentioned above, a split disposable system is made, comprising a sterile barrier, i.e. a housing, rigidly fixed to a connection bracket 45 of the housing and floating through a flexible portion 44 of the membrane, and possibly a cover, assembled in a sterile and sealed manner to the fixed part of the robot.

Alternatively, as shown in FIGS. 15a-15f, the removable guide plate 70 need not be used as a carrier for the mounting bracket 45. In this example, carrier 87 carrying the bracket remains fixed to housing 60, and may also be used to remove bracket 45 from end piece 66 after use. The carrier 87 carrying the bracket includes a mechanism 88 for removable attachment to the bracket 45. The detachable attachment mechanism 88 has a stop 89 that engages a complementary stop 90 of the stand 45 to hold the stand 45 and the carrier 87 carrying the stand together. The detachable attachment mechanism 88 also includes a flexible tab 91 that carries one of the stops 89, 90 to enable disengagement of the two stops and subsequent disengagement of the two components. For example, the flexible sheet 91 forms part of the detachable attachment mechanism 88.

Carrier 87 carrying the stent also includes a portion 92 for disengaging stent 45 from end piece 66. For example, the disengagement section 92 may be a wedge that may be inserted into the locking mechanism of the stent 45 and the end piece 66.

Fig. 15a also illustrates the initial position of the housing assembly on the robot mount, where the bracket 45 is assembled on the carrier (87) carrying the bracket.

During the assembly movement, as shown in fig. 15b, the bracket 45 is rigidly connected to the end piece 66 by clamping, as previously described. Continuing to move towards the bottom of the carrier 87 carrying the stent, as shown in fig. 15c, the stent 45 held on the end piece is released from the carrier 87 carrying the stent by elastic deformation of the flexible sheet 91. A robot may then be utilized.

When it is desired to remove the rack 45, the carrier 87 carrying the rack is subjected to a reverse movement, as shown in fig. 15 d. The disengagement section 92 is inserted between the flexible tab 63 of the carrier 45 and a complementary portion of the end piece 66 and deflects it, thereby disengaging the end piece 66 from the carrier 45. The stop 89 may be moved beyond the stop 90 by flexing of the flexible sheet 91. Continued movement of carrier 87 carrying the stent drives the stent 45 into the remote configuration of end piece 66 by pressing supports 93 of carrier 87 carrying the stent against facing portions 94 of stent 45 (fig. 15e and 15 f).

Fig. 16 shows another variant of the holder 45 to be engaged with the complementary end piece 66. The rear plate 95 extends parallel to the front plate 62, and an intermediate gasket 96 is disposed between the front plate 62 and the rear plate 95. The spacer 96 is shorter than the front and rear plates 62, 95 so as to define two guides 97, one on each side, whereby the carriage 45 is guided in its movement on the end piece 66. With respect to assembly, the resiliently deformable clip 63 extends downwardly from the back plate 95 and has a tab 64.

Other detachable attachment techniques than clamping, such as right-angle rotary locks, magnets or solenoids, are contemplated for the bracket 45 on the end piece 66.

According to one embodiment, as shown in FIG. 17, a barrier system 98 is disposed on the stand 45. The barrier system 98 functions to limit any movement of the elongated flexible medical device in the Z direction at the pair of brackets 45. Indeed, cycling of the elongate flexible medical device can result in loss of contact with the pair of stents 45. For the rack 45, the barrier system 98 includes an upper barrier 98₁And a parallel lower barrier 98₂. Where appropriate, each barrier 98 of the stent 45₁、98₂Are created in the form of alternating valleys 99 and lobes 100. The barriers and the barriers of the opposite holder are produced by inversion so that the recesses of one barrier correspond to the projections of the other barrier. Thus, the barrier is almost continuous when two of a given pair of brackets 45 are close to each other. This embodiment also enables a barrier function to be created by two identical parts placed facing each other, which facilitates the design, reducing the number of partsA small number of modules and a limited risk of installation errors.

The above described structure facilitates emergency withdrawal of the elongate flexible medical instrument 15 from the robotic module because the elongate flexible medical instrument can be easily removed from the module by manual manipulation at any stage of the movement.

The use of a sterile barrier between the elongate flexible medical instrument and the driver is particularly suitable for the above-described embodiment which envisages a small movement of the driver enabling it to attach the sterile barrier thereto and absorb the movement by deformation of the flexible portion. Alternatively, however, other embodiments are suitable in which a sterile barrier is provided directly between the elongate flexible medical instrument and the driver to enable a sterilization operation and/or to minimize the number of consumable products to be changed between the two operations. Alternatively, in connection with the invention, the sterile barrier may thus not be attached to the driver, but simply held in a suitable manner, the driver being subject to large movements.

Thus, independently of the above invention, it appears that another invention relates to a robotic module for driving an elongated flexible medical instrument, comprising:

-a base for supporting the substrate,

a pair of drive members having respective drive surfaces, the drive members being in a drive configuration in which the drive surfaces of the drive members engage the elongate flexible medical instrument to be driven and are disposed on opposite sides thereof,

the pair of driving members are movably mounted with respect to the base between a first position and a second position along one degree of freedom,

a control member adapted to control the movement of the pair of drive members in the drive configuration relative to the base, thereby driving the elongate flexible medical instrument relative to the base,

-a continuous membrane through which the drive surface is engaged with the elongate flexible medical instrument.

Claims (27)

1. A robotic drive module for an elongate flexible medical instrument, comprising:

-a base (132),

-a pair (33) of drive members (24, 24'), each having a drive surface (34, 34'), the pair (33) of drive members (24, 24') being capable of being in a drive configuration in which the drive surfaces (34, 34') of the pair (33) of drive members (24, 24') are in engagement with and disposed on either side of the elongate flexible medical instrument to be driven,

the pair (33) of driving members (24, 24') is movably mounted with respect to the base (132) between a first position and a second position along one degree of freedom,

-a control member (18, 11) adapted to control the movement of the pair (33) of drive members (24, 24') in a drive configuration relative to the base (132) from the first position to the second position, thereby driving the elongate flexible medical instrument relative to the base (132),

-a sterile barrier (39) for single use consumption comprising a connecting bracket (45) of each driving member (24, 24') and a flexible portion (44) between two adjacent connecting brackets (45), the flexible portion being connected to the connecting brackets, each driving member (24, 24') being attached to the connecting brackets (45), the driving surfaces (46) of the connecting brackets being intended to be in contact with the elongated flexible medical instrument.

2. The robotic module of claim 1, wherein the pair (33) of drive members (24, 24') are alternately in a drive configuration and a free configuration, the drive surfaces (34, 34') of the pair (33) of drive members (24, 24') not being engaged by the elongated flexible medical instrument when in the free configuration,

wherein the control member (18, 11) is adapted to control movement of the drive member (24, 24') in a drive configuration relative to the base (132) from the first position to the second position in a repetitive cycle, and movement of the pair (33) of drive members (24, 24') in the free configuration relative to the base (132) from the second position to the first position without driving the elongate flexible medical instrument relative to the base.

3. A robot module according to claim 2, characterized in that the base (132) is a first base, the pair (33) of drives (24, 24') is a first pair of drives, the robot module further comprising:

-a second base (132'),

-a second pair (33') of drive members (24 ", 24"') each having a drive surface (34 ", 34" '), the second pair (33') of drive members (24 ", 24" ') being in a drive configuration in which the drive surfaces (34 ", 34"') of the second pair (33') of drive members (24 ", 24"') are in engagement with and disposed on either side of the elongate flexible medical instrument to be driven,

the second pair (33') of actuating members (24 ' ) being movably mounted with respect to the second base (132') along one degree of freedom between a first position and a second position,

-the control member (18, 11) is adapted to further control the movement of the second pair (33') of driving members (24 ", 24"') in a driving configuration relative to the base (132') from said first position to said second position, thereby driving said elongated flexible medical instrument (132') relative to said second base.

4. A robot module according to claim 3, characterized in that the second pair (33) of driving members (24 ", 24" ') are alternately in a driving configuration and a free configuration, the driving surfaces (34 ", 34"') of the second pair (33') of driving members (24 ", 24"') not being engaged with an elongated flexible medical instrument when in the free configuration,

wherein the control member (18, 11) is adapted to control the movement of the drivers (24 ", 24" ') in a driving configuration relative to the second base (132') from the first position to the second position and the movement of the second pair (33') of drivers (24 ", 24" ') in a free configuration relative to the second base (132') from the second position to the first position in a repetitive cycle without driving the elongate flexible medical instrument relative to the base.

5. The robot drive module according to claim 3 or 4, characterized in that the first base (132) and the second base (132') are connected together or are common.

6. Robot module according to any of the claims 3-5, characterized in that a disposable sterile barrier (39) comprises a connection bracket (45) of each driving member (24 ", 24" ') of the second pair (33') and a flexible part (44) between two adjacent connection brackets (45), connecting the flexible part to the connection brackets, each driving member (24 ", 24" ') of the second pair being attached to a connection bracket (45), the driving surfaces (46) of which are to be in contact with the elongated flexible medical instrument.

7. The robotic drive module according to any of claims 1 to 6, wherein the sterile barrier comprises a disposable continuous film (42) comprising an attachment portion (43) of each driving member (24, 24') and a flexible portion (44) between two adjacent attachment portions (43), each driving member (24, 24') being attached to an attachment portion (43) of the continuous film (42), the driving surfaces (34, 34') being engaged with the elongated flexible medical instrument through the continuous film (42).

8. The robot drive module according to any of claims 1 to 7, characterized in that the sterile barrier (39) further comprises a rigid housing (60), each connecting bracket (45) being assembled to the rigid housing (60) by the flexible portion (44).

9. A robot module according to claim 8, characterized in that the rigid housing (60) comprises a plurality of windows (61), each window being sealingly closed by a flexible portion (44).

10. The robotic drive module according to any of claims 1 to 9, wherein the connecting bracket (45) is assembled to the drive member (24, 24') by a frangible zone connecting a drive surface (46) in contact with the elongate flexible medical instrument to an assembly portion (54) of the drive member.

11. Robot module according to any of claims 1-10, characterized in that the sterile barrier (39) divides the space into two subspaces: a sterile sub-space accommodating the elongate flexible medical instrument, and a sub-space in which the drive member (24, 24') is disposed and which is not necessarily sterile.

12. The robotic drive module according to any one of claims 1 to 11, comprising an enclosed housing (35) enclosing the drive member (24, 24') and, where appropriate, the base (132) and including an upstream port (36) and a downstream port (36), the elongate flexible medical instrument extending therethrough.

13. The robot drive module according to claim 12, characterized in that the housing (35) further comprises a connection (27) connecting either of the driving members (24, 24') to an electric motor outside the housing.

14. The robotic drive module according to claim 12 or 13, wherein the housing (35) comprises a container (47) and a cover (48) that moves relative to the container (47) between a closed configuration, in which an operator is prevented from accessing the elongated flexible medical instrument within the housing (35), and an open configuration, in which the operator has access to the elongated flexible medical instrument within the housing (35).

15. A robot module according to claim 14, characterized in that the final part of the trajectory of the cover (48) from its open configuration to its closed configuration is a translational movement.

16. Robot module according to claim 14 or 15, characterized in that in the closed configuration, in the vicinity of the drive element (24, 24'), there is a large free volume available between the cover (48) and the container (47), beyond which range the free volume available between the cover (48) and the container (47) decreases, enabling it to guide the elongate flexible medical instrument there.

17. Robot module according to one of claims 12 to 16, characterized in that the housing (35) comprises a remote base part (101) carrying the drive (24, 24') and a disposable cartridge (102) from which the cartridge can be assembled or disassembled, the cartridge comprising at least the sterile barrier (39).

18. Robot module according to claims 16 and 17, characterized in that the container (47) comprises the base part (101) and the sterile barrier (39).

19. A robot module according to any of the claims 1-18, characterized in that each connecting bracket (45) is detachable from the respective driving member (24, 24').

20. The robot module according to any of the claims 1 to 19, further comprising a rigid carrier (87) carrying connection brackets, each connection bracket (45) being temporarily assembled to the carrier (87).

21. Robot module according to claim 20, characterized in that the carrier (87) further comprises a safety self-locking part (80) preventing its assembly in an unintended direction.

22. Robot module according to any of the claims 20-21, characterized in that the carrier (87) is detached from the sterile barrier (39).

23. A robot module according to any of claims 1-22, characterized in that each connecting bracket (45) comprises a flat wall (62) having a front face and comprising a barrier system (98) for restricting the movement of the elongate flexible medical instrument keeping it facing the front face.

24. A robot module according to claim 23, characterized in that each barrier of the restraining barrier system (98) comprises alternating recesses (99) and protrusions (100).

25. An arteriography robot comprising a container (14), an elongated flexible medical instrument (15, 15', 15 ") at least partially housed in said container (14), and a robot drive module (16) according to one of claims 1 to 24, said robot drive module (16) being attached to said container (14) and adapted to drive said elongated flexible medical instrument (15, 15', 15") out of said container (14).

26. Cassette comprising a sterile barrier (39) comprising connection brackets (45) respectively attachable to a drive (24, 24') of an elongated flexible medical instrument and a flexible portion (44) between two adjacent connection brackets (45), the flexible portion being connected to the connection brackets, the drive surfaces (46) of the connection brackets being to be in contact with the elongated flexible medical instrument.

27. A cassette according to claim 26, further comprising any of the features of the cassette of any of claims 1 to 25.