Abstract: Microwave antennas and devices incorporating such antennas usable for performing procedures on or within a patient's body using a shaped microwave field.

Abstract: A medical device for tissue ablation may include a catheter shaft, an expandable member disposed on or coupled to the catheter shaft, and a plurality of elongate electrode assemblies each constructed as a flexible circuit. The expandable member may be configured to shift between an unexpanded configuration and an expanded configuration. The plurality of electrode assemblies may be disposed on an outer surface of the expandable member. Each of the plurality of electrode assemblies may include a temperature sensor aligned with two or more electrodes.

Abstract: A microwave ablation antenna assembly including a coaxial cable terminating in a radiating section, a first tubular member circumscribing the coaxial cable and spaced therefrom to permit fluid flow therebetween, and a second tubular member circumscribing the first tubular member and spaced therefrom to permit fluid flow therebetween. The microwave ablation antenna assembly further includes a hub configured to receive the coaxial cable, first tubular member, and second tubular member, the hub including a fluid inflow chamber and a fluid outflow chamber and an integrated hub divider and hub cap separating the fluid inflow chamber from the fluid outflow chamber and prohibiting fluid flow between the inflow chamber and outflow chamber except via the spacing between the coaxial cable and the first tubular member and between the first tubular member and the second tubular member.

Abstract: An energy concentration apparatus is disclosed. The energy concentration apparatus includes a body part; a loop antenna coil part disposed on the body part; and a cover part coupled to the body part in order to cover the loop antenna coil part. The cover part has a central hole and a micro-slit.

Abstract: Rather than rely solely upon pupillary occlusion or tracking of eye movement to protect the fundus from accidental exposure to electromagnetic radiation, the present invention also utilizes an electromagnetic radiation pathway with a profile such that the energy density at the iris is greater than the energy density at the posterior portion of the eye. This disparity in energy density allows for efficacy at the anterior iris treatment site, without injury to the fundus.

Abstract: An exemplary microwave ablation system is provided. The system may use a switching antenna for both microwave heating of target tissue and microwave radiometry to monitor the temperature of the heated tissue to ensure that the desired temperatures are delivered to adequately treat the target tissue and achieve therapeutic goals. The system may integrate switching components into the switching antenna, which eliminates error from heating of the reference termination and heating of the electrical cables.

Abstract: A method for handling longitudinal smoking rods for storing sausage-shaped products, comprising the steps of: providing a plurality of the rod-like elements having a length; providing a clipping machine configured to produce the sausage-shaped products; providing a hanging line configured to load the produced sausage-shaped products on the rod-like elements and comprising a measuring position for measuring the length of the rod-like elements, and a loading position for loading the sausage-shaped products on the rod-like elements; feeding one of the rod-like elements to the measuring position of the hanging line; measuring the length of the rod-like element; determining whether the length is within a tolerance range of a desired length; loading a predetermined number of the produced sausage-shaped products on the rod-like element, if the length is within the tolerance range; and discarding the rod-like element from the hanging line, if the length is not within the tolerance range.

Abstract: A device for inducing migration of cancer cells for cancer treatment includes an RF absorber including an antenna for irradiating a living tissue including cancer cells with an RF frequency of a specific band for cancer treatment.

Abstract: A surgical instrument includes a surgical effector having a wrist configured to manipulate objects at a surgical site, one or more robotically operable input controllers configured to open and close the wrist of the surgical effector, and a manual actuator configured to open and close the wrist of the surgical effector.

Abstract: A method that includes selectively positioning an ablation catheter system at a treatment site; and ablating tissue at the treatment site with the ablation catheter system using a power setting of approximately 90W applied to tissue for approximately four (4) second increments with a break period of approximately 4 seconds between applications.

Abstract: The invention relates to an ablation catheter for treatment of a patient's tissue, for example for a PVI procedure on a patient's heart, comprising an elongated catheter shaft and an ablation portion being arranged at a distal end of the catheter shaft with a plurality of electrodes accommodated along the ablation portion, wherein the ablation portion comprises at least two loop sections forming a three-dimensional spiral. In order to increase safety of ablation treatment, spare adjacent tissue (e.g. nerves, vessels, esophagus) and shorten ablation time, a pitch, or clearance of two neighboring loop sections is greater than an ionization threshold of the medium around the distal section, for example blood or gases resulted from electrolysis. The invention further relates to an operation method of such ablation catheter.

Abstract: Various cartridge assemblies for surgical instruments are provided. Cartridge assemblies can include active sensors for applying stimuli to a tissue clamped by an end effector of the surgical instrument and a circuit configured to determine a tissue type of the tissue according to a change in the tissue parameter detected by the sensor resulting from a stimulus from the active element. Cartridge assemblies can also include physical features and/or stored data that identify the cartridge. Surgical instruments further can be configured to resolve conflicts when the physical features and/or stored data are not consistent with each other in their identification of the cartridge type.

Abstract: A microwave ablation probe includes a cable comprising an antenna configured to deliver Radio Frequency (RF) energy to a target zone and a cooling path defined by a first channel and a second channel configured to circulate cooling fluid in the probe. The inner tube also comprises a choke formed thereon configured to reduce RF energy reflected away from the antenna.

Abstract: An electrosurgical instrument for delivering microwave energy to biological tissue, in which a pair of conductive tuning elements are mounted in a radiating instrument tip to shape a microwave radiation profile of the instrument so that the radiation profile is constrained around the instrument tip. Such tuning elements may result in a radiation profile that is substantially spherical around the instrument tip, providing a well-defined ablation volume. The tuning elements act to improve the efficiency with which microwave energy can be delivered into target tissue.

Abstract: A novel microwave ablation applicator includes a flexible tubular shaft and a partially encapsulated antenna. The applicator is adapted to be used with an endoscope in order to access remote targets deep within an organ of a patient. Microwave power is emitted from the antenna in a desired radiation pattern by circulating an attenuating liquid through the shaft and across a portion of the antenna. Microwave ablation systems and methods are described.

Abstract: An electrosurgical system comprising an end effector and a control circuit is disclosed. The end effector comprises a first jaw and a second jaw. At least one of the first jaw and the second jaw is movable to transition the end effector from an open configuration to a closed configuration to grasp tissue therebetween. The control circuit is configured to cause an application of two different energy modalities to the tissue simultaneously and separately during a tissue treatment cycle comprising a tissue coagulation stage and a tissue transection stage.

Abstract: Surgical robotic systems including synchronous and asynchronous networks and methods employing the same are provided. One surgical robotic system includes a networked computing node, a slave robot assembly, and first and second communication paths. The slave robot assembly includes subunits, communicatively coupled to one another by way of the first communication paths, thereby forming at least a portion of a synchronous network. The networked computing node and a subunit are communicatively coupled to one another by way of the second communication paths, thereby forming at least a portion of a second network, and are configured to communicate one or more packets to one another by way of the second network. The subunit is configured to communicate, with the other subunits via the synchronous network, data from the one or more packets. A clock rate of the synchronous network is independent from a clock rate of the second network.

Abstract: An ultrasonic device may include an electromechanical ultrasonic system defined by a predetermined resonant frequency, the electromechanical ultrasonic system having an ultrasonic transducer coupled to an ultrasonic blade. A method of compensating power delivered to the ultrasonic device may include determining an articulation angle of an articulatable ultrasonic blade coupled to the ultrasonic transducer, adjusting a complex impedance of the ultrasonic transducer to compensate for power lost as a function of the articulation angle, and adjusting, a power applied to the ultrasonic transducer based on the articulation angle. The ultrasonic device may include a generator and a control circuit configured to effect the method.

Abstract: A non-puncturing microwave ablation antenna, including an irradiator located at a front end of the antenna and an irradiator cover sleeved on the irradiator, where a front end of the irradiator cover is blunt. Because the front end of the irradiator cover is designed to be blunt, the special non-puncturing appearance of the irradiator cover enables the antenna to freely penetrate inside the lung tissue without puncturing blood vessels and bronchi in the lungs. In addition, blood vessels of tumor existing in the Ground-Glass Opacity (GGO) would not be damaged by the blunt head and bleed, thereby reducing a rate of surgery failure caused by that a lesion cannot be identified because of bleeding inside the lung, and in addition, avoiding a possibility that tumor cells spread through a puncturing passage or bleeding blood vessels.

Abstract: An energy delivery system includes an RF synthesizer circuit configured to generate an RF electric signal and a preamplification stage operably coupled to the RF synthesizer circuit. The preamplification stage has at least one attenuator. A board controller is operably coupled to the attenuator of the preamplification stage that is configured to modify a gain setting of the attenuator. An output connection is configured to provide a low-power signal or a high-power signal based on at least the RF electric signal and the gain setting. The low-power signal or high-power signal is provided to an RF applicator configured to couple an alternating RF electric field to animal tissue.

Abstract: Catheter apparatuses, systems, and methods for achieving renal neuromodulation by intravascular access are disclosed herein. One aspect of the present technology, for example, is directed to a treatment device having a direct heating element configured to be delivered to a renal blood vessel. The treatment device is selectively transformable between a delivery or low-profile state and a deployed state. The direct heating element is housed within an occlusion element which is sized and shaped so that the direct heating element contacts an interior wall of the occlusion element, an outer wall of which is simultaneously in contact with the inner wall of a renal blood vessel when the treatment assembly is in the deployed state. The direct heating element is configured to apply thermal energy to heat neural fibers that contribute to renal function.

Abstract: Methods, systems and devices for evaluating the integrity of a uterine cavity. A method comprises introducing transcervically a probe into a patient's uterine cavity, providing a flow of a fluid (e.g., CO2) through the probe into the uterine cavity and monitoring the rate of the flow to characterize the uterine cavity as perforated or non-perforated based on a change in the flow rate.

Abstract: A surgical system is disclosed. The surgical system includes a monopolar return pad and a surgical hub wirelessly coupled to the monopolar return pad. The surgical hub includes a control circuit configured to determined a presence and a position of a patient on the monopolar return pad according to data received from the monopolar return pad.

Abstract: A medical device comprises a housing and a sheath having opposed proximal and distal ends and being attached from the proximal end to the housing. An end effector is attached to the distal end portion of the sheath. The end effector includes a pair of grasping jaws capable of be openable and closable with respect to one another. A movable shaft includes a distal end that being connected at to the end effector and configured to be movable with respect to the sheath so as to cause the paired grasping jaws to be opened or closed with respect to one another. A movable handle is configured to pivot with respect to the housing and having an input position where an operation is inputted so as to cause the handle to pivot. The movable shaft is changeable in an initial state before the operation is inputted at the input position.

Abstract: An image processing model generation method includes: inputting at least one training sample lesion image into an initial image processing model, the initial image processing model including a classification layer and a marking layer; calling the classification layer; calling the marking layer; obtaining a loss value of the at least one training sample lesion image in the initial image processing model; determining whether the loss value is within a preset range; if not, updating parameters of the initial image processing model, an image processing model with updated parameters being used as an initial image processing model in next training; and repeating above steps until the loss value is within the preset range.

Abstract: An endovascular near critical fluid based cryoablation catheter for creating an elongated lengthwise-continuous lesion in tissue can comprise an elongated shaft, a flexible distal tissue treatment section, and a distal tip. A plurality of flexible tubes can extend through the distal treatment section to transport a near critical fluid to and from the distal tip. The distal treatment section can also include a flexible fluid-sealed cover or barrier layer surrounding the delivery tubes. The cover and tubes can collectively define a space which is filled with a fluidic thermally conductive media. The thermally conductive media, fluid delivery tubes, and the cover can be arranged such that a flow of the near critical fluid through the tube bundle transfers heat between a target tissue and the distal treatment section of the catheter thereby creating the elongated lengthwise-continuous lesion in the tissue.

Abstract: An apparatus includes an interface and a processor. The interface is configured for exchanging signals with: (i) a probe, which is inserted into a body of a patient and includes a flexible distal-end assembly, wherein the distal-end assembly comprises a magnetic position sensor and two or more intra-body electrodes, and, (ii) multiple body-surface electrodes attached externally to the body of the patient. The processor is configured to estimate, based on the signals exchanged with the probe, a spatial displacement of the magnetic sensor between consecutive measurements, and to estimate a position of the distal-end assembly in the body based on (i) the signals exchanged with the intra-body electrodes and the body-surface electrodes, (ii) a-priori known spatial relationships between two or more of the intra-body electrodes of the probe and (iii) the estimated spatial displacement of the magnetic sensor.

Abstract: An unattended approach can increase the reproducibility and safety of the treatment as the chance of over/under treating of a certain area is significantly decreased. On the other hand, unattended treatment of uneven or rugged areas can be challenging in terms of maintaining proper distance or contact with the treated tissue, mostly on areas which tend to differ from patient to patient (e.g. facial area). Delivering energy via a system of active elements embedded in a flexible pad adhesively attached to the skin offers a possible solution. The unattended approach may include delivering of multiple energies to enhance a visual appearance.

Abstract: An implantable wireless lead includes an enclosure, the enclosure housing: one or more electrodes configured to apply one or more electrical pulses to a neural tissue; a first antenna configured to: receive, from a second antenna and through electrical radiative coupling, an input signal containing electrical energy, the second antenna being physically separate from the implantable neural stimulator lead; one or more circuits electrically connected to the first antenna, the circuits configured to: create the one or more electrical pulses suitable for stimulation of the neural tissue using the electrical energy contained in the input signal; and supply the one or more electrical pulses to the one or more electrodes, wherein the enclosure is shaped and arranged for delivery into a subject's body through an introducer or a needle.

Abstract: A laser surgical method for performing a corneal incision while maintaining iris exposure below a predetermined exposure limit includes determining an initial iris exposure based on an initial treatment scan, determining whether the initial iris exposure is less than the predetermined exposure limit, generating a revised treatment scan comprising one or more treatment scan modifying elements when the initial iris exposure is greater than the predetermined exposure limit, and scanning the focal zone of a pulsed laser beam according to the revised treatment scan, thereby performing the corneal incision, wherein the one or more treatment scan modifying elements causes the iris exposure to be smaller than the predetermined exposure limit.

Abstract: A power controller device and system allows verification, monitoring, and control of an arteriovenous (AV) fistula creation catheter which comprises a main housing having a power supply, an embedded electronic controller and a user interface display, and which is configured to allow connection to an intravascular catheter. When activated, the device verifies that a valid catheter is connected, downloads stored manufacturing calibration data from the catheter, and provides a user interface to allow initiation of AV fistula creation. Once creation of the AV fistula is initiated, the device provides closed loop control of the catheter heating element and provides a means of monitoring the catheter temperature and tip position to a prescribed parameter to automate the arteriovenous fistula creation procedure.

Abstract: Apparatus for delivering a therapeutic agent to a uterine cavity including an elongated member having a fluid channel for passage of the therapeutic agent into the uterine cavity, a dispensing member extending distally of the elongated member and having at least one perforation for passage of the therapeutic agent into the uterine cavity into contact with the endometrium. An infusion line is in communication with the fluid channel for passage of a fluid into the uterine cavity to assess leakage to determine integrity of the uterine cavity prior to passage of the therapeutic agent into the uterine cavity.

Abstract: Devices, systems, and methods are provided in which movement of a tool is controlled based on sensed parameters. In one embodiment, an electromechanical tool is provided having an instrument shaft and an end effector formed thereon. The electromechanical tool is configured to be mounted on an electromechanical arm, and the electromechanical tool is configured to move with or relative to the electromechanical arm and perform surgical functions. A controller is operatively coupled to the electromechanical arm and the electromechanical tool and is configured to retard advancement of the electromechanical tool toward a tissue surface based on a sensed amount of displacement of a tissue surface, a strain on the tissue of the patient, the temperature of the electromechanical tool, or the like.

Abstract: Disclosed are a deep body spread microwave hyperthermia device for personal uses and an operation method thereof. The operating method may include generating a control signal to control patches attached to the skin of a user, dividing the control signal into a first signal and a second signal having a phase different from a phase of the first signal, transmitting the first signal and the second signal to patches attached to different positions, among the patches, and producing hyperthermia in a body of the user by radiating radio waves based on the first signal or the second signal received by each of the patches.

Abstract: A system includes a probe, a processor, and a bubble detector. The probe is configured for insertion into a lumen of a patient and is coupled to an irrigation pump. The processor is configured to control delivery of irrigation fluid to the probe by turning on and controlling the irrigation pump. The bubble detector is coupled to a proximal portion of the probe. In response to the irrigation pump being turned on, the bubble detector is configured to automatically start detection of gas bubbles in the irrigated fluid, and transmit fail-safe signals indicating fail-safe bubble detection is operational. The processor is further configured to monitor the fail-safe signals and, in absence of fail-safe signals, to automatically disable delivery of the irrigation fluid.

Abstract: Electrical instrument for applying radiofrequency and/or microwave frequency energy to tissue, comprising: a distal part comprising an instrument tip for applying radiofrequency and/or microwave frequency energy to tissue, the instrument tip comprising first and second conductive elements; a coaxial feed cable comprising an inner conductor, a tubular outer conductor coaxial with the inner conductor, and dielectric material separating the inner and outer conductors, the coaxial feed cable being for conveying radiofrequency and/or microwave frequency energy to the distal part; wherein: the inner conductor is electrically connected to the first conductive element and the outer conductor is electrically connected to the second conductive element through a rotatable connection between the distal part and the coaxial feed cable that allows rotation of the distal part relative to the coaxial feed cable; and the instrument comprises an actuator for rotating the distal part in a first rotational direction relative to

Abstract: A method of forming a microwave applicator comprising forming a body comprising dielectric material so that there is a void in the dielectric material, and depositing conductive material in the void to form a feed for coupling energy into the dielectric material.

Abstract: A modular energy system including a header module configured to removably connect to an energy module. The energy module can comprise a port configured to deliver one or more energy modalities to a surgical instrument connected thereto. The header module can comprise a display screen configured to display a user interface. The header module can further include a control circuit configured to detect attachment of energy modules to the modular energy system and control the display of the user interface to display UI portions for each connected module and reconfigure the displayed UI portions to accommodate the new UI portions as additional energy modules are connected to the modular energy system.

Abstract: The invention relates to a device (17) for treatment of body tissue, in particular for the permanent occlusion of varicose veins, preferably in the lower limbs, of varicocele and/or of vascular malformations and/or for the use in aesthetic surgeries, preferably laser assisted lipolysis, and/or for tumor treatment by means of laser induced thermotherapy and/or photodynamic therapy, by means of a light diffuser (13) circumferentially and endoluminally irradiating said tissue by laser light energy, said diffuser (13) being connected at its proximal end to a source (10) of laser light energy via a flexible wave guide (12) comprising a fiber optic core (1) covered by an optical cladding (2) having a refractive index smaller than that of the core (1), wherein in the cladding (2) and/or in the core (1) imperfections (18) are provided, designed as recesses and adapted to direct the light, preferably to refract and/or reflect the light propagating within the core (1) and/or its optical cladding (2) in generally radial

Abstract: At a distal portion of a shaft of a guide portion included in a medical device, a first portion is configured to be capable of coming into contact with an inner wall of a living organ. A second portion is disposed on a proximal side of the shaft with respect to the first portion. The second position is configured to be capable of coming into contact with the inner wall of the living organ at a position different from that of the first portion on a transverse cross section of the inner wall of the living organ. A treatment portion is movable in a lumen of the shaft in a state where at least a part of the first portion and at least a part of the second portion come into contact with the inner wall of the living organ.

Abstract: Electrical instrument for applying radiofrequency and/or microwave frequency energy to tissue, comprising: a distal part comprising an instrument tip for applying radiofrequency and/or microwave frequency energy to tissue, the instrument tip comprising first and second conductive elements; a coaxial feed cable comprising an inner conductor, a tubular outer conductor coaxial with the inner conductor, and dielectric material separating the inner and outer conductors, the coaxial feed cable being for conveying radiofrequency and/or microwave frequency energy to the distal part; wherein: the inner conductor is electrically connected to the first conductive element and the outer conductor is electrically connected to the second conductive element through a rotatable connection between the distal part and the coaxial feed cable that allows rotation of the distal part relative to the coaxial feed cable; and the instrument comprises an actuator for rotating the distal part in a first rotational direction relative to

Abstract: Aspects of the present disclosure include a surgical device comprising electrodes on the sides of an end of an effector to aide in sealing during various surgical procedures, such as a liver resection. During a sealing procedure, the surgeon may wipe the surgical site with the end effector, causing the electrodes to touch the fractured area. Electrosurgical energy may be applied to the electrodes during the wiping, causing coagulation of smaller vessels, such as tiny blood vessels and bile ducts in the parenchyma of the liver. In some cases, due to the nature of some smaller vessels, electrosurgical energy should be delicately applied to cause sealing but to avoid overly damaging the remaining tissue. In some embodiments, the thin design of the electrodes allows for an appropriate amount of electrosurgical energy to be applied to the fractured area.

Abstract: An on-body antenna is provided that overcomes mismatch loss problems associated with current on-body antennas and is capable of operating over a wide range of frequencies with low transmission loss. At least a first antenna element of the on-body antenna is configured to receive an oscillating electric current and to radiate an oscillating electromagnetic field over a predetermined range of frequencies. The first antenna element is made of non-electrically-conductive material having a first relative permittivity. At least a second material having a second relative permittivity can be disposed on or in the first antenna element. Disposing the second material provides the first antenna element with an effective permittivity that can be closely matched to a frequency-dependent permittivity of biological tissue of a subject. The first non-electrically-conductive material and the second material can be preselected to have relative permittivities that allow anisotropy to be achieved.

Abstract: Surgical devices and methods for utilizing optical coherence tomography (OCT) to monitor and control tissue sealing are disclosed. The surgical device includes an end effector assembly that includes first and second jaw members that are movable between a first, spaced-apart position and a second proximate position. An OCT system, at least a portion of which is incorporated into the end effector assembly, is configured to sense properties of the tissue, e.g., the structural density of the tissue, disposed between the first and second jaw members. A tissue-sealing energy source may be disposed within at least one of the jaw members and may provide tissue-sealing energy to tissue disposed between the jaw members. A controller, which is coupled to the OCT system and the tissue-sealing energy source, controls the tissue-sealing energy generated by the tissue-sealing energy source based on the properties of the tissue sensed by the OCT system.

Abstract: A pulsed laser skin treatment device is for laser induced optical breakdown of hair or skin tissue. The device has a light exit window to be placed against a surface to be treated such as skin during use. A feedback system is used for determining a state of contact between the light exit window and the surface. To this end the feedback system is capable of detecting a feedback signal representative for the state of contact. If the feedback signal or the state of contact is such that the risk of skin surface or device damage by the device operation is too high, the user or the device has a way to interrupt the treatment or to reduce light output to reduce or eliminate this risk.

Abstract: A control method is provided to manage a surgical robot having an arm configured to hold a medical tool. The method includes receiving a set of sensor signals from sensors on the arm, generating a profile based on the set of sensor signals, comparing the profile to at least one signature, determining a state of the arm based on results of the comparison, and changing operation of the arm based on the state of the arm. The state of the arm is indicative of a predetermined condition that has occurred or will likely occur eminently. Changing operation of the arm prevents the condition from occurring or continuing. The robot arm may hold a medical tool for using during surgery or another medical procedure.

Abstract: A wireless intraluminal imaging device and an associated system are provided. In one embodiment, the wireless intraluminal imaging device includes a flexible elongate member including a proximal portion and a distal portion; an ultrasound imaging component coupled to the distal portion of the flexible elongate member; a cable coupled to the ultrasound imaging component and extending along the flexible elongate member; and a wireless communication component coupled to the proximal portion of the flexible elongate member, the wireless communication component in communication with the ultrasound imaging component via the cable. The wireless communication component wirelessly transmits ultrasound echo signals collected by the ultrasound imaging component to an image processing system via a wireless link for image generation at the image processing component.

Abstract: The inventive concept relates to a needle tip for application of current, a hand piece, and a skin treatment apparatus that are equipped with a needle in which an electromagnetically-energized active region is formed as a partial region other than a tip end of the needle is exposed in a non-insulated state.

Abstract: An example method includes obtaining an image of a lead implanted in a patient, the lead including one or more electrodes positioned along a longitudinal axis of the lead and a plurality of orientation markers; determining, in the image, respective locations of the electrodes and respective locations of the orientation markers; obtaining a template model corresponding to the lead; determining a transform between the determined locations of the one or more electrodes and the plurality of orientation markers and locations of corresponding electrodes and orientation markers in the template model; and determining the rotational orientation of the lead based on the transform.

Abstract: A surgical apparatus system for minimally invasive surgery (MIS) which includes a wrist assembly. The wrist assembly includes a first jaw, a first actuation hub, and a cable redirecting hub operably coupled to the first actuation hub, a second jaw, a second actuation hub, a housing for the first and second jaws, a first cable, a second cable, a third cable, rotational position sensors, and a control system. The first and second jaws of the wrist assembly are movably opposed, and the cables are configured such that applying tensions upon them cables produces rotation about a jaw axis. The wrist assembly may further include a hinge-rotary assembly to configured to provide rotation about a pitch axis and/or a roll axis. The wrist assembly may further include a fourth cable configured such that applying tensions upon the fourth cable and the opposing cable produces rotation about a pitch axis.