EP4447842A1 - Surgical robot system and control method - Google Patents

Abstract

The present disclosure relates to a surgical robot system (1) for a surgical procedure on a patient (P), comprising: at least one patient fixation unit (2) adapted to be rigidly and directly attached to the patient (P), in particular to the head of a patient (P), in order to rigidly fix at least one body part of the patient (P), with the site of the surgery, relative to the patient fixation unit (2); and at least one controllable surgical robot (4) having a robot base (6) directly connected to the patient fixation unit (2), as well as a mobile robot arm (8), which is fastened to the robot base (6), and an end effector (10), in particular a surgical instrument (12), which is fastened to, in particular mounted on, the robot arm (8), in particular at an end of the robot arm (8). In addition, the present disclosure relates to a control method and to a computer-readable storage medium according to the additional independent claims.

Description

Robotic surgical system and control method

Description

technical field

The present disclosure relates to a robotic surgical system for surgical intervention in a patient in which a controlled end effector assists in the intervention. Furthermore, the present disclosure relates to a control method/assistance method and a computer-readable storage medium according to the preamble of the independent claims.

Technical background

Robot-assisted surgical systems for assisting a surgical intervention are widespread, particularly in the field of laparoscopic surgery. Surgical robots or robot systems are also being used more and more in neurosurgery, spinal surgery and ENT surgery. A disadvantage of the current robot systems, however, is that they are almost exclusively floor-mounted robot systems, and in exceptional cases also ceiling-mounted robot systems, the configuration of which has a disadvantageous effect on the actuation of an end effector that is used. In this context, floor-mounted or ceiling-mounted means that the robot is locally connected to the room-fixed system and thus to the patient with the corresponding intervention area, via the floor or via the ceiling of the operating room. In the case of floor-mounted robot systems, mobile units are known, for example, which can be placed in the operating room at different points in relation to the operating table on which the patient is lying, in order to realize different arrangements relative thereto.

A major disadvantage of these robotic systems, however, is that the

Accuracy due to inevitable movements between the robot base of the robot and the patient is severely limited and often does not meet the minimum requirements for precision. The further/longer the geometric, direct connection (with the corresponding flow of forces) between the patient on the one hand and the robot end effector on the other hand, the greater this inaccuracy due to, for example, elastic deflections, a lack of clarity with regard to a calculated position and other disadvantageous influencing factors. Although solutions of a robot system or a robot have been developed which can be attached to an operating table, these solutions are only suitable for an intervention to a limited extent, since at least the inaccuracy remains due to patient movement and insufficient attachment to the operating table.

Therefore, in the prior art there are also floor-mounted robot systems that are first positioned and then create an additional rigid reference connection between the robot base and a head holder of the patient in order to further increase accuracy. However, such floor-mounted robotic systems are complex, expensive to produce, and also take up a large area in the operating room. Furthermore, a long way of a power flow remains. In particular, these robots only guide a trajectory, for example to place a biopsy, while the surgeon continues to move the instrument manually. Although robot systems are also known from the prior art, with which instruments can be moved by remote control in neurosurgery, these systems are disadvantageously mounted on the floor, with an associated loss of precision, and it is also not possible to track a position of the instrument used in the intervention . Furthermore, robotic systems are known which track a position of an instrument with the aid of a (standard) navigation system which uses, for example, optical tracking by means of a rigid body or electromagnetic tracking (EM tracking). However, attaching a rigid body to the instrument itself degrades its ergonomics and increases a working volume. Furthermore, an EM system has the disadvantage of distortions from devices that emit electromagnetic radiation of similar wavelengths. This EM radiation can be generated by robots themselves, for example, which ultimately has a negative impact and impairs tracking accuracy. Summary of the Invention

It is therefore the object of the present disclosure to avoid or at least reduce the problems from the prior art and in particular to provide a surgical robot system that provides a particularly high precision of a controlled end effector during an intervention and is safe and easy to operate is. An improvement or shortening of an operation time should also be achieved and the user, in particular surgeons, should be provided with a high level of operating convenience. In addition, a subtask can be seen as making the configuration simple and modular and enabling cost-effective production. Another sub-task is to be able to place and align a robot even better and more flexibly in relation to an intervention area in order to be able to carry out the intervention even better and more easily.

The objects of the present disclosure are achieved according to the invention with regard to a generic surgical robot system by the features of claim 1, with regard to a generic (robot) control method according to the invention by the features of claim 14 and with regard to a computer-readable storage medium according to the invention by the features of claim 15.

A basic idea of the present disclosure can be seen in the fact that a geometric frame structure/fixation structure (patient fixation unit) is connected immediately and directly to the body part of the patient on which the surgical intervention takes place and is in particular rigidly statically fixed relative to a section of the human skeleton. In this way, when the patient moves, a relative transformation between a local coordinate system (KOS) of the patient or the surgical area on the patient on the one hand and a local KOS of the patient fixation structure on the other hand is not changed or only minimally changed and remains the same even when the fixed body section of the patient moves Maintain patient static. The surgical robot, in turn, is attached directly to this geometric fixation structure via its robotic base or coupled, so that a relative transformation between the patient with the surgical area and the robot base is kept constant and does not change when the patient is displaced on the operating table. This special configuration significantly increases precision during the intervention. So no floor-based robot, no ceiling-based robot and also no table-based robot is used, but to a certain extent a patient-supported robot in order to establish a direct connection with the patient without having to go over the operating table itself. It is therefore not the floor or the table that is used as a reference for the local coordinate system of the robot or the robot base, but (via the patient fixation system) the patient or the part of the patient’s body to be fixed.

In other words, a surgical robotic system for a surgical procedure on a patient is disclosed, comprising: at least one patient fixation unit adapted to be rigidly and directly connected/attached to the patient, in particular to a patient's head, to rigidly fix at least a portion of the patient's body with an engagement area relative to the patient fixation unit; at least one surgical robot that has a robot base, the robot base being connected directly and immediately to the patient fixation unit, in particular being fastened or coupled, and having a movable robot arm connected to the robot base and a robot arm attached to the robot arm, in particular on one end side of the Robotic arm, connected, in particular mounted, end effector, in particular a surgical instrument. This robot system allows a particularly precise and intuitive control of an end effector. For example, an instrument or a recording device such as a camera can be used as an end effector in the surgical robot system.

In this context, a direct connection means that the immediate (serial) geometric connection of the at least one surgical robot to the patient fixation unit takes place, and this connection is independent of a connection to an object in the operating room, such as an operating table or a floor. Although the patient fixation unit can also with the be connected to the operating table in order to achieve further stabilization, however, the (serial, shortest) connection between the patient and the end effector does not run via the operating table or via a floor-based system, but directly and solely via the patient fixation unit. In this way, a direct path between the end effector and the patient can be kept particularly short and as a result the precision and also the control can be improved.

In other words, the present disclosure relates to a miniaturized surgical robotic system for minimally invasive surgery, in which at least one robot is directly coupled/connected/connected to a patient fixation system with a patient fixation unit, one robot with a robot arm or multiple robots with respective robot arms is or are directly connected to the patient fixation unit itself. The robot arms each guide the end effectors, in particular surgical instruments and/or visualization devices. In other words, a surgical robot system for minimally invasive surgery is proposed, in which at least one robot with a robot arm, in particular two robots, is attached directly to a patient fixation unit and via the robot arm the at least one end effector, in particular the surgical instruments and/or or visualization devices.

Due to the special configuration, the robots with the robot arms can be designed to be particularly space-saving and structurally small and still deliver excellent precision during use. A particularly good articulation can also be ensured since the connection point of the robot base is particularly close to the intervention area.

The advantages of the present disclosure therefore lie in the improvement in precision, a reduction in operating time due to a simpler and faster intervention and an increase in operating comfort for a surgeon in minimal surgery, in particular in the fields of neuro, spinal and ENT surgery. The instruments do not have to be guided manually, but the movements are carried out by a robot that uses them Telemanipulation approach opened. The disclosure presented here is thus the first robotic surgical system that enables robotic telesurgery in neuro, spine and ENT surgery with miniaturized robotic arms working through a very small port.

Advantageous embodiments are claimed in the dependent claims and are explained in particular below.

According to one embodiment, the surgical robot system can also have: at least one optical recording unit, which is adapted to create an optical recording of the surgical area, in particular with an intracorporeal tissue of the patient, and an end effector tip, in particular an instrument tip, in the field of view of the recording unit and computer-readable /to provide digitally; a data supply unit, in particular a storage unit, which is adapted to provide digital 3D image data, in particular preoperative 3D image data such as computed tomography or magnetic resonance imaging, of the patient; a tracking system, in particular a surgical navigation system, which is provided and adapted to record at least the optical recording unit and at least directly or indirectly the body section of the patient, which is fixed in relation to the patient fixation unit, and to track it in space; and a control unit, which is provided and adapted to determine a position, in particular a position and orientation (i.e. a position), of the end effector tip, in particular the instrument tip, and a superimposition with the 3D recording data on the one hand and the correctly positioned superimposed position, in particular position-correct superimposed position and orientation, to generate the end effector tip on the other hand and output visually through a display device and / or to control the end effector on the basis of the overlay. On the one hand, the tracking system tracks the recording unit and determines a transformation between the KOS of the tracking system and the recording unit, and on the other hand, the tracking system determines a transformation between the KOS (the intervention area) of the patient and the KOS of the tracking system, so that a transformation between the recording unit and intended for the patient can be. In addition, the surgical robotic system is adapted to determine the position, in particular the position, of at least the end effector tip, in particular the instrument tip, and thus to determine an exact transformation between the position or position of the end effector tip and the patient. The 3D recording data of the virtual world can be correlated with the real world of the patient via the patient, so that the 3D recording data is superimposed on the one hand and the correctly positioned, in particular correctly positioned, integration of at least the end effector tip on the other hand. Based on this overlay, visual assistance can be provided in the form of an overlay display, in which at least the position of the end effector tip is shown in the 3D image data, or a (partially transparent) overlay display or side-by-side display of the real image and a corresponding view of the 3D image data is output , or based on the superimposition, the end effector can be controlled (via kinematic models, for example) along a predefined trajectory, for example. The term "position" means a geometric position in three-dimensional space, which is specified in particular by means of coordinates of a Cartesian coordinate system. In particular, the position can be given by the three coordinates X, Y and Z. The term "orientation" in turn indicates an alignment (e.g. at the position) in space. One can also say that the orientation indicates an orientation with indication of direction or rotation in three-dimensional space. In particular, the orientation can be specified using three angles. The term "position" includes both a position and an orientation. In particular, the location can be specified using six coordinates, three position coordinates X, Y and Z and three angular coordinates for orientation. In the present case, the term 3D defines that the recording data is spatial, ie three-dimensional. The patient's body or at least a partial area of the body with spatial extent can be present digitally as recording data in a three-dimensional space with approximately a Cartesian coordinate system (X, Y, Z). In other words, the surgical robotic system is preferably coupled to an optical imaging system (recording unit) in order to visualize and record the end effectors, in particular instruments, that work on the patient's tissue in the surgical area. This enables the position, in particular the location, of the end effector in particular instruments, and to superimpose its position, in particular position, on a, in particular pre-operative, 3D data set (3D recording data) such as computed tomography (CT) or magnetic resonance imaging (MRI) in order to visually assist the surgeon accordingly or a pre-operative carry out the intervention plan. In other words, the control unit can use the end effector localization, in particular instrument localization, to superimpose the position, in particular position, of the end effector, in particular instrument, in a preoperative 3D data set such as an MR or CT in order to provide the surgeon with assistance.

According to a further preferred embodiment, the control unit can be adapted to determine the optical recording of the end effector tip, the position, in particular the position and orientation (i.e. the location), of the end effector tip, in particular the instrument tip, relative to the recording unit by machine vision, and to determine the position, in particular the position, of the end effector tip in relation to the 3D recording data via the tracked position and orientation of the optical recording unit. In other words, the end effector, in particular the instrument, can preferably be localized in space by using the optical recording unit to determine the position, in particular location, by machine vision, with the recording device being aligned with the patient and also the end effector, in particular the instrument , has in the field of view. The robotic surgical system is thereby designed to enable port surgery in areas such as neuro, spine or ENT surgery with a small access where instruments and visualization devices need to be inserted through a small opening. In other words, an aspect of the present disclosure that may be independently claimable is a (miniaturized) robotic surgical system that includes one or more robots with robotic arms, wherein the at least one robot is attached to a patient fixation unit (a geometric frame structure) that is rigid with the patient connected is. The robotic system is also combined with an optical recording system (with a recording unit), which is tracked with/by a tracking system, in particular a navigation system, and a view of the patient's tissue with the end effector tip, generated in particular of the instrument tip in the field of view, with the control unit being adapted for this purpose, the specific position, in particular the location, of the end effector tip, in particular the instrument tip, particularly preferably of the entire instrument, is determined (is localized) by machine vision and correspondingly by the control unit for navigation is used.

The end effector, in particular the instrument, can preferably have a predefined optical marking pattern/marking element/marker, in particular in the form of rings spaced apart from one another along an end effector axis and/or in the form of a dot pattern and/or in the form of at least two squares and/or in the form of a QR code, and the control unit can be adapted to use image processing algorithms to determine the position, in particular the position, of the end effector tip, in particular of the entire end effector, on the basis of the optical marking pattern detected by the recording unit. In other words, the end effector, in particular the instrument, can be provided with optical markings/marking elements such as rings, dots, squares or QR patterns and the control unit can be adapted for this, using image processing algorithms to determine the position, in particular the location, of the end effector, in particular the instrument , to determine. In this way, an instrument tip can also be localized if it is covered by tissue. Furthermore, an instrument type can be automatically determined via a QR code, for which dimensions or geometric shapes are stored in a memory unit, which is used to determine the instrument tip. Image processing algorithms can also better determine the position, in particular location, of the end effector tip, for example by means of triangulation.

Furthermore, a rigid body can preferably be arranged on the at least one end effector as an optical marker, which the tracking system detects in order to determine the position and orientation of the end effector tip, in particular of the end effector. In other words, the (follow-up) tracking of the patient and the optical recording unit, in particular the microscope head of the surgical microscope, can take place using an optical navigation system Has camera, in which rigid body (rigid body) to be tracked objects such as the microscope head are provided. In particular, the optical marker can have four IR spheres spaced apart from one another, which the tracking system can detect. In particular, the tracking system can therefore be an optical navigation system with optical markers, with the optical markers being arranged on the objects to be tracked, in particular the recording unit and/or on the end effector.

According to one embodiment, the control unit can be adapted to determine a mean value based on the determined position, in particular location, of the tip of the end effector tip by machine vision (machine vision) and on the basis of the position detected by the tracking system, in particular location, in order to further increase precision.

According to a further embodiment, the at least one patient fixation unit can be a head holder from neurosurgery. In other words, the patient fixation unit (the patient fixation system) can preferably be designed in the form of a head holder that is used in neurosurgery. The head holder fixes the patient's head rigidly, thereby enabling precise surgery.

Preferably, the patient fixation unit may be adapted to be rigidly and directly connected or attached to a patient's head, or to a patient's hip, or to a patient's knee, or to a patient's ankle, to secure at least that portion of the patient's body to the surgical site to fix rigidly to the patient fixation unit.

In particular, the patient fixation unit can have a rail, in particular a circumferential rail, particularly preferably a ring-shaped rail, to which the at least one robot is attached via its robot base or can be moved in a translatory manner via its robot base at least in sections along the rail, in particular coupled and captive. In other words, the patient fixation unit has an annular base system or a An annular base attached to a base frame of the patient fixation unit, the annular base system surrounding the surgical site and serving as a base for the at least one robot attached thereto via its robotic base. The ring base makes it possible to choose and adjust an optimal position for the robot with its robotic arm, while the robot can be moved along the ring base. In particular, the patient fixation unit has a width, in particular a diameter of the ring base, which essentially corresponds to a height of the patient fixation unit. In particular, the base frame is U-shaped with two opposing legs, at the free ends of which the rail running around is rigidly attached as a ring or connected in one piece of material.

In particular, the material of the patient fixation unit is a sterilizable material, in particular stainless steel used in medical technology. In particular, the splint surrounds the surgical area and is positioned above the patient and above an operating table. In particular, the horizontal width of the patient fixation unit is at most 1 meter, preferably at most 50 cm, and the vertical height is at most 1 meter, preferably 50 cm.

According to a further embodiment, the robot base can have a carriage with a clamping and/or latching element, which is adapted to be guided translationally along the rail and to fix the position of the robot base relative to the rail when the clamping and/or latching element is activated to set different positions of the robot relative to the patient restraint unit. In particular, the carriage is guided on the rail in a captive manner and embraces the rail, for example. The clamping and/or latching element can in particular be a manually operable button which is pretensioned in a clamping and/or latching state and only upon manual actuation against the pretension converts the carriage into a freely movable state. In particular, the position of the robot base on the rail, in particular the encircling rail, can be adjustable in order to set an optimal position for the robot.

Preferably, the robotic arm can have at least five degrees of freedom to align the end effector with a surgical entry trajectory, and/or the end effector (at a distal end of the robotic arm) can have at least one more having its own degree of freedom, in particular having a further joint with two degrees of freedom (2DOF) to allow further movement/articulation within the patient's body. In other words, the robotic arm (each) can have at least five or more degrees of freedom for aligning the end effector with the surgical entry path. In particular, the robot arm has five to seven degrees of freedom. In particular, the end effector at the distal end of the robotic arm can be equipped with additional degrees of freedom to enable articulation within the patient's body, in particular having a joint with two degrees of freedom (2-DOF joint) on the wrist of the robotic arm.

In one embodiment, the at least one optical recording device can also be a digital surgical microscope, which makes the optical recordings available to the control unit in computer-readable form, and more preferably a robot-controlled surgical microscope. In other words, the optical recording unit is in particular a surgical microscope, particularly preferably a digital microscope, which is moved in particular by a robot-guided microscope arm.

According to a further embodiment, the at least one optical recording device can also be an endoscope with a distal recording head in order to create an intracorporeal optical recording of the patient. Alternatively or additionally, an endoscope can also be used as the at least one optical recording unit, in which a recording head is located inside the body and can be inserted through the same working channel (port) as the instruments. If, for example, optical marking patterns are provided on the endoscope, a position, in particular position, of the distal recording head of the endoscope as an end effector tip can also be determined by means of a recording by a surgical microscope, using machine vision, as described above.

In particular, the surgical robotic system can have a surgical navigation system for navigating the end effector. The navigation system can preferably have a machine vision-based navigation system. In particular, the navigation system can use a surgical microscope as a camera to analyze an end effector, in particular an instrument, by means of image analysis recognize and to determine a position or situation of at least the end effector tip, in particular the instrument tip. A tracker is no longer necessary for image analysis.

Preferably, the robotic surgical system may be adapted to be used for operations through a port introduced into the patient's body used in neuro, spinal or ENT procedures.

According to one embodiment, the control unit can be adapted to integrate the specific position, in particular the location, of the end effector tip, in particular the instrument tip, in the 3D recording data in the overlay display and to output it via a display device.

More preferably, the surgical robotic system may further include a control panel (distant from the robot) adapted to transmit manual input from the user/surgeon to the at least one robotic end effector and remotely control the end effector accordingly. The at least one controlled end effector, in particular the instrument, can therefore be remotely controlled, in particular via a console that translates the operator's hand movements, or maneuvered autonomously using a preoperative plan. The surgical robotic system therefore preferably comprises a console unit/an input device/a control panel with input devices, which is used by the surgeon to transfer the manual movements of the hands to the robot-guided instruments. For example, a joystick can be provided for each hand in order to operate the respective end effector accordingly.

More preferably, a preoperative intervention plan can also be stored in the data provision unit of the surgical robotic system, and the control unit can be adapted to control/move the at least one end effector semi-autonomously or completely autonomously based on the superimposition and on the basis of the preoperative intervention plan, to perform the intervention. In particular, therefore, the surgical robotic system in which a preoperative Plan, in particular with stored, predefined kinematic models for the individual steps of the intervention to be carried out, enable the implementation of a preoperative plan and move the movement of the instruments by the robot semi- or completely anonymously.

In particular, the surgical robotic system can have a computer system with a display for showing the image of the optical recording unit and the position of the instrument, which is superimposed on a CT or MR.

The object of the present disclosure is achieved with regard to the control method in that it has the steps:

- Creating, by an optical recording device, an optical recording of an intervention area of the patient together with an end effector tip of a robot-guided end effector, in which the robot is directly connected to a patient fixation unit, and providing the optical recording;

- Provision, by a data provision unit, of digital 3D recording data of the patient;

- tracking, by a tracking system, of at least the optical recording unit and a body section of the patient, which is fixed relative to the patient fixation unit; and

- Determining, by a control unit, a position, in particular a position and orientation, of the end effector tip, in particular the instrument tip, relative to the recording unit, in particular by machine vision;

- Creation of an overlay with the 3D recording data on the one hand and the correct position, in particular position and orientation, of the end effector tip on the other hand; and

- Outputting the overlay as an overlay representation by a display device and/or controlling the end effector based on the overlay. By the control method according to the present disclosure with a corresponding position

With regard to a computer-readable storage medium, the objects are achieved in that this includes instructions that when executed by a Computer causing it to perform the method steps of the control method according to the present disclosure.

Any disclosure related to the robotic surgical system according to the present disclosure also applies to the control method of the present disclosure and vice versa. In particular, the control unit of the robotic system can be adapted to carry out the steps of the control method.

Brief description of the figures

The present disclosure is explained in more detail below on the basis of preferred embodiments with the aid of figures. Show it:

1 shows a perspective view of a surgical robot system according to a first preferred embodiment,

2 shows a perspective view of a surgical robot system according to a further, second preferred embodiment,

3 shows a detailed schematic perspective view from FIG. 2 with the robot-guided instrument, which has rings as a marking pattern, which is detected via the microscope head in order to determine the position of the instrument tip, and

4 shows a flow chart of a control method according to a preferred embodiment.

Detailed description of preferred embodiments

1 shows a schematic, perspective view of a surgical robot system 1 according to a first preferred embodiment of the present disclosure. In the present case, the surgical robot system 1 is used in a craniotomy used for a neurosurgical operation on a patient P's head in order to particularly accurately manipulate the patient P's brain tissue.

For the intervention, the head of the patient P, as the body part or body section to be fixed and on which the surgical intervention takes place, is rigidly connected to a patient fixation unit 2 . In this context, rigid means that the patient's cranium is in a fixed/fixed position relative to the patient fixation unit 2 and does not change. In this way, the surgical area on the patient is fixed statically in relation to the patient fixation unit 2, so that the geometric relative relationships are retained even if the patient P is moved on an operating table.

In this embodiment, the surgical robot system 1 has two miniaturized surgical robots 4 that can be actively controlled. These robots 4 are configured/designed in the same way and each have a robot base 6 which is directly and immediately firmly connected/attached to the patient fixation unit 2 on two opposite sides opposite the head of the patient P and the local connection point of the robot 4 to the patient fixation unit 2 represent.

A movable, multi-segmented robot arm 8 , in this case with four robot arm members, is articulated on the robot base 6 with a terminal/front end effector 10 in the form of a surgical instrument 12 . The robotic arm 8 can be actively controlled and guide the instrument 12 accordingly. Since the two robots 4 are fixed directly to the patient fixation system 2, on the one hand a distance between the head of the patient P (with the surgical area) and the surgical instrument 12 is minimized, which particularly improves the precision of an actuation, and on the other hand the two robots 4 be designed due to the immediate proximity to the intervention area so that the robotic arms 8 only require a short range, with associated smaller lever arms (thus lower leverage) and can thus be built more compactly and smaller. Several robots 4 , here two small ones, can also be integrated into the limited volume, which must also offer enough space for the surgeon to look inside or even for manual manipulation. This improves the engagement because now for each Hand of the operator an actuation arm of the robot 4 is ready and the surgeon can perform a dual simultaneous manipulation.

The surgical robot system 1 also has an optical recording unit 14 in the form of a robot-guided surgical microscope, which is configured to create and digitally provide an optical recording A of the surgical area of the patient P together with an intracorporeal tissue via an optical system and a recording sensor. In addition, the surgical instrument 12 is located in the field of view 16 of the recording unit 14, but at least one instrument tip 20 as an end effector tip 18, which carries out the manipulation of the tissue. The optical recording unit 14 records this instrument tip 20, which is guided by the surgeon in his field of view 16, in the recording A that has been created.

In order to navigate during the intervention via a port and with only a small visible opening and to correlate the recorded instrument tip 20 with respect to preoperative 3D recordings 3DA, the surgical robot system 1 also has a data supply unit 22 with a storage unit 24, in which digital preoperative 3D recording data 3DA of the patient P with at least the part of the body on which the intervention is to take place is stored in the form of magnetic resonance imaging (MRI) or computed tomography (CT). This data supply unit provides these 3D recording data 3DA digitally or in computer-readable form. In order to carry out a correlation between the real world with the patient P and the virtual world with the 3D recording data of the patient P, a tracking system 26 is also required, which in this embodiment is designed as a surgical navigation system with optical three-dimensional recognition. The tracking system 26 is adapted to spatially detect the optical recording unit 14, in particular a head of the optical recording unit, and to track it in space. The tracking system 26 is further adapted to spatially acquire the fixed head of the patient P indirectly via acquisition of the patient fixation system 2 with predefined points of contact to the patient P's head and forward determination accordingly. A relation of the head of the patient P to the patient fixation unit 2 can also be specified. Since the tracking system 26 spatially records both the instrument 12 and the head of the patient P with the surgical area, a specially adapted control unit 30 can correlate the preoperative 3D recording data 3DA with the head of the patient P and thus with the patient P, so that the real world with the virtual world, in particular the real recordings can be carried out with the virtual preoperative recordings and is provided to the surgeon for navigation during the intervention using the surgical robot system 1.

In this embodiment, the surgical robotic system 1 is specially configured to determine the position and orientation, i.e. the position, of the end effector tips 18, here the instrument tips 20, and to determine these instrument tips in an overlay or overlay display with, on the one hand, the 3D recording data 3DA of the surgical area and on the other hand to generate an overlaid superimposition in the correct position and to output it visually together by a display device 32 in the form of an operating room monitor. In this way, the surgeon is given a particularly advantageous navigation with the possibility of a corresponding control. Since the overlay display can be duplicated as desired, the surgeon can put on 3D glasses, in which the overlay display is displayed three-dimensionally, and control the robot 4 on the basis of his visual display while sitting on an external console with input devices far away from the surgical area. Also, the overlay can be used by the control unit 30 to control the instrument semi-autonomously or autonomously according to an intervention plan. In particular, the possibility of telemedicine is created with the present surgical robot system.

In this embodiment, the patient fixation unit 2 is firmly connected to an operating table 34 in order to ensure the necessary stability.

The optical recording unit 14 in the form of the surgical microscope has a terminal microscope head 36, which the optical system and the Includes recording sensor, and can be set via a multi-part robot-guided microscope arm 38 with multiple microscope arm segments 39 to maneuver during the operation in predetermined positions and to have the best possible view. In particular, the surgical microscope can move around a focus point in this way in order to enable different views. The microscope arm 38 is pivoted to a mobile trolley 40 which can be positioned at different locations in an operating room depending on the needs of a procedure.

In order to spatially detect and track the microscope head 36, a passive optical marker 42 in the form of a rigid body with a plurality (in particular four) spaced-apart IR marker spheres is arranged on its housing. A stereo camera 44 of the tracking system 26 captures this marker 42 and can use it to capture a position in space relative to the stereo camera 44 . In addition, an optical marker 42 with IR marking balls is attached to the last segment of the robot arm 2, i.e. immediately adjacent to the instrument 12, so that the stereo camera can also see the position of the last segment of the robot arm 2 and, due to the predefined relationship to the instrument 12, also can determine the position of the instrument 12 and an instrument tip 20 respectively. Finally, a corresponding marker 42 is also provided on the patient fixation unit 2 . The position and orientation of the instrument tip 20 is then correlated by the control unit 30 in accordance with the 3D close-up data 3DA.

In this embodiment, the data supply unit 22, the memory unit 24 and the control unit 30 are integrated in the trolley, but it is of course also possible to connect the surgical robot system 1 to a specially adapted computing unit via a local network connection, which is both decentralized and can be provided centrally.

For the rigid fixation of the head of the patient P, the patient fixation system 2 has a U-shaped frame 48 with two opposite legs, on which adjustable fixation pins 46 are provided, each facing one another, which can be screwed in towards one another in order to reduce the distance between the fixation pins 46 and clamp the head of the patient P between them accordingly. On the left-hand side in Fig. 1, a single protruding bolt-like fixing pin 46 with a front tip is provided, while on the opposite side there is a arc in the shape of a segment of a circle with at least two fixing pins 46 aligned radially inwards, the arc translationally inward via a screw thread towards the head and outwards away from the head and can be adjusted. In this way, the patient fixation unit 2 with the three fixation pins 46 can be adapted to different head sizes. The three fixation pins 46 allow the position of the head of the patient P to be fixed in relation to the fixation unit 2, without underdetermination or overdetermination.

FIG. 2 shows a perspective view of a surgical robot system 1 according to a further, second embodiment and FIG. 3 shows a detailed partial view of the corresponding surgical area. This embodiment differs from the first embodiment in the configuration for determining the position and orientation of the instrument tip 20 and in the connection of the robot 4 to the patient fixation unit 2.

In this embodiment, the patient fixation unit 2 has, on its U-shaped frame 48 on an upper side as viewed in FIG. Matching the rail 50 , the robot base 6 in this embodiment is designed as a carriage 52 which geometrically encompasses the rail 50 and can be guided along the longitudinal axis of the rail 50 . In this way, the position of the robot base 6 relative to the patient fixation unit 2 can be changed and easily adjusted for an intervention. Furthermore, the robot base 6 also has a clamping and latching element 54 which is adapted to clamp the carriage 54 resiliently relative to the rail 50 on the one hand and to additionally fix it via a latching mechanism on the other. In particular, the clamping and latching element 54 can be designed in the form of an actuating button, so that when this actuating button is pressed, the carriage 54 can slide along the rail 50 and when the actuating button is released, it springs elastically into its Starting position is pushed back, in which this clamps the carriage 54 to the rail 50 and locked with it. In particular, the robot base 6 can be designed so that it can be coupled and decoupled, so that it can be coupled to the rail 50 and, if necessary, also decoupled again. In this way, the number of robots 4 connected to the patient fixation unit 2 can be adapted to the intervention as required. In this embodiment, the surgical robot system 1 has two robots 4, similar to the first embodiment. Also, in an embodiment not shown, a motor is installed in the robot base to actively move the carriages 52 on the circular rail.

In contrast to the first embodiment, however, no optical markers 42 are provided on the terminal segments of the robot arms 8, but the position of the instrument tip 20 is determined by machine vision, as explained below. On the one hand, the KOS of the patient P is known to the control unit 30 and, on the other hand, the KOS of the trolley 40 of the surgical microscope is known. Based on the KOS of the trolley 40, the control unit 30 can determine the KOS of the microscope head 36 with the recording sensor via kinematic relations.

The microscope head 36 itself optically detects the instrument tip 20 of the instrument 12 via the optical recording A, and the control unit 30 is adapted to determine a position and an orientation of this instrument tip 20 via machine vision, even if only a 2D recording is provided. This has the advantage that an instrument tip can be determined particularly precisely and localized in relation to the 3D recording data 3DA. Furthermore, this configuration has the advantage that no optical markers have to be provided in the intervention area, which is already cramped.

For an explanation, Fig. 3 shows a schematic, detailed partial view of Fig. 2 with the microscope head 36 on the one hand and the instrument 12 on the other. For an even better determination of the position and orientation, the cylindrical surgical instrument 12 has concentric optical rings 62 spaced along its longitudinal axis , which are arranged in a specific pattern to one another and constitute an optical marking pattern/marking element 60 for determination. The control unit 30 can determine the position and orientation in the recording A even more precisely on the basis of the predefined optical pattern. If the instrument tip 20 is immersed in tissue of the patient, is covered by the tissue and is therefore not optically visible, the control unit 30 can still deduce the tip of the instrument 12 on the basis of the optical marking elements 60 . In addition, the robotic microscope head 36 can also be adapted to perform a small movement itself in order to create different views of the instrument 12 in order to further determine the position and orientation using computer vision.

Thus, as shown in FIGS. 1 through 3 above, small robots 4 with robot arms 8 are attached directly to a head mount system or patient fixation unit 2, which ensures a rigid connection between the robot base 6 and the patient P. The robotic arms 8 have five to seven degrees of freedom to orient the surgical instruments 12 within the surgical approach, particularly via a port in neurosurgery. In addition, the surgical instruments 12 themselves can have further degrees of freedom, for example in order to realize a curved tip that can move in the patient P's body. The surgical robot system 1 is combined with or has an optical imaging system such as an operating microscope. A tracking system 26, in particular a navigation system 28, is then used to track the patient P and the surgical microscope, for example using rigid bodies as optical markers, which are attached on the one hand to the patient fixation unit 2 (on the head holder) and on the other hand to the housing of the microscope head 36. The surgical instrument 12 is also tracked, either directly by attaching another rigid body as an optical marker to the robotic end effector or by performing a machine vision procedure. In the case of machine vision based on image processing, no rigid bodies are required on the robot or on the instrument 12 . Instead, the instrument tip 20, which is visible in the field of view of the optical imaging system 14, is provided with an optical pattern, in particular with rings, dots,

Squares or QR patterns - each allowing the type and position of the instrument 12 relative to the optical imaging system 14 to be identified. Since that optical imaging system 14 and the patient P are localized by the navigation system 28, the position, in particular the position and the orientation of the instrument 12 on a preoperative 3D data set or preoperative 3D recording data 3DA of the patient such as a CT recording or a MR image are displayed.

4 shows a flow chart of a control method according to a preferred embodiment. This control method can also be stored in a computer-readable storage medium in the form of instructions, which can be used in the robotic surgical system 1 of the first or second embodiment.

In a first step S1, the control method uses an optical recording device 14 to create an optical recording A of an intervention area of the patient P together with an end effector tip 18 of a robot-guided end effector 10.

In this case, the robot 4 is connected directly to a patient fixation unit 2 . The optical recording A is provided in a computer-readable manner in accordance with a control unit 30 .

In a step S2, the control unit 30 is also provided with digital 3D recording data 3DA of the patient P. This means that both real and virtual digital recordings of the patient p are available.

In a subsequent step S3, the optical recording unit 14 is then tracked directly by a tracking system 26, as well as a body section of the patient P, which is fixed relative to the patient fixation unit 2, via the patient fixation unit with a predetermined relation to the body section, in particular to a head of the patient. determined once or continuously in relation to the tracking system in space, so that a correlation of the virtual world (3D recording data) and the real world (optical recording; patient and other tracked objects) can be carried out. Then, in a step S4, the control unit 30 determines a position and orientation of the instrument tip (20) relative to the recording unit (14) by machine vision.

In a step S5, a correlation or overlay is determined or created with both the 3D close-up data on the one hand and the correct position and orientation of the instrument tip 20 on the other.

Finally, in a step S5, the overlay U is output as an overlay display by the surgical monitor in order to provide visual support to a user, and the instrument 10 is also semi-autonomously controlled on the basis of the overlay U. In this embodiment, an intervention plan has been determined before the operation and individual successive steps of this intervention plan have been defined in advance. The surgeon can confirm a first step of the control via a control console that is spaced apart from the robot, so that the instrument 12 independently carries out this first step. After the end of the first step, the surgeon can check the correct execution and, if necessary, carry out a local correction manually with a hand instrument, for example, and proceed to the next step of controlling the instrument 12 by means of a confirmation input. In this way, the intervention can finally be carried out, similar to a discrete, staged procedure. Here, the position and orientation of the instrument tip is continuously determined and used for appropriate control.

Reference List

1 Surgical Robotic System

2 patient fixation unit

4 surgical robot

6 robot base

8 robotic arm

10 end effector

12 surgical instrument

14 recording unit

16 field of view recording unit

18 end effector tip

20 instrument tip 22 data supply unit

24 storage unit

26 tracking system

28 navigation system

30 control unit

32 display device

34 operating table

36 microscope head

38 microscope arm

39 arm segment

40 trolleys

42 optical marker

44 stereo camera

46 fixing pins

48 fixation frames

50 rail

52 sleds

54 clamping and fixing element

56 KOS patient

58 KOS microscope 60 marker patterns

62 rings

64 tissues

3DA 3D recording data

A optical recording

P patient

S1 Step Create optical recording

S2 Step Provide 3D recording data

S3 Step Tracking of acquisition unit and patient

S4 Step Determine position of instrument tip by computer vision

S5 Step Create overlay of 3D image data and location

instrument tip

S6 Step Output overlay representation and control instrument on basis

overlay

Claims

Expectations 1 . Surgical robotic system (1) for a surgical operation on a patient (P), comprising: at least one patient fixation unit (2) adapted thereto, rigidly and directly attached to the patient (P), in particular to a patient's (P) head to be fixed at least a body portion of the patient (P) with an engagement area rigidly with respect to the patient fixation unit (2); and at least one surgical, controllable robot (4) with a robot base (6) which is directly connected to the patient fixation unit (2), as well as a movable robot arm (8) connected to the robot base (6) and a robot arm (8) , In particular a terminal side of the robot arm (8), connected, in particular mounted, end effector (10), in particular a surgical instrument (12). 2. Surgical robot system according to claim 1, characterized in that the surgical robot system (1) further comprises: at least one optical recording unit (14) which is adapted to have a recording (A) of the surgical area and an end effector tip (18), in particular one In instrument tips (20), to create and make available in computer-readable form; a data supply unit (22), in particular a storage unit (24), which is adapted to provide digital 3D recording data (3DA), in particular preoperative 3D recording data (3DA), of the patient (P); a tracking system (26), in particular a surgical navigation system (28), which is provided and adapted for this purpose, at least the optical recording unit (14) and at least the body section of the patient (P), which is fixed relative to the patient fixation unit (2), in space to detect and track, and a control unit (30), which is provided and adapted to determine a position, in particular a position and orientation, of the end effector tip (18) and a superimposition (U) with the 3D recording data (3DA) on the one hand and the superimposed position in the correct position, in particular the superimposed position in the correct position On the other hand, to generate the position and orientation of the end effector tip (18) and to output it visually as an overlay display by a display device (32) and/or to control the end effector (10) on the basis of the overlay (U). 3. Surgical robot system (1) according to claim 2, characterized in that the control unit (30) is adapted to, via the optical recording (A) of the end effector tip (18), the position, in particular the position, of the end effector tip (18), in particular the instrument tip (20) relative to the recording unit (14) by machine vision, and using the position of the optical recording unit (14) tracked by the tracking system (26) to determine the position, in particular the position, of the end effector tip (18) relative to the 3D recording data (3DA) to determine. 4. Surgical robot system (1) according to claim 2 or 3, characterized in that the end effector (10), in particular the instrument (12), has a predefined optical marking pattern (60), in particular in the form of rings (62) spaced apart from one another an end effector axis and/or in the form of a dot pattern and/or in the form of at least two squares and/or in the form of a QR code, and the control unit (30) is adapted thereto on the basis of that recorded by the recording unit (14). optical marking pattern (60) to determine the position, in particular the location, of the end effector tip (18), in particular of the entire end effector (10). 5. Surgical robot system (1) according to one of Claims 2 to 4, characterized in that an optical marker (42) is arranged on the at least one end effector (10) or on a terminal link of the robot arm (8) which is monitored by the tracking system (26) is detected and tracked in order to determine the position and orientation of the end effector tip (18), in particular the end effector (10). 6. Surgical robot system (1) according to one of the preceding claims, characterized in that the at least one patient fixation unit (2) is a head holder from neurosurgery. 7. Surgical robot system (1) according to one of the preceding claims, characterized in that the patient fixation system (2) has a rail (50), in particular a peripheral rail (50), particularly preferably an annular rail (50), on which the at least a robot (4) is fixed via its robot base (6) or can be moved in a translatory manner at least in sections along the rail (50) via its robot base (6). 8. Surgical robot system (1) according to claim 7, characterized in that the robot base (6) has a carriage (52) with a clamping and/or latching element (54) which is adapted to translate along the rail (50) to be guided and to fix the position of the robot base (6) relative to the rail (50) when the clamping and/or locking element (54) is activated and to be freely movable again when the clamping and/or locking element (54) is deactivated, to set different positions of the robot (4) relative to the patient fixation unit (2) and thus relative to the patient (P). 9. Surgical robotic system (1) according to any one of the preceding claims, characterized in that the robotic arm (8) is configured in such a way that it has at least five degrees of freedom in order to align the end effector (10) with a surgical entry path, and/or the end effector (10) itself has at least one further degree of freedom, in particular having a further joint with two degrees of freedom, in order to enable additional articulation within the body of the patient (P), in particular in order to move from a straight longitudinal axis to an angled longitudinal axis of the end effector (10) switch. 10. Surgical robot system (1) according to one of the preceding claims 2 to 9, characterized in that the at least one optical recording device (14) is a digital surgical microscope, which provides the optical recordings (A) of the control unit (30) in computer-readable form and more preferably is a robot-controlled surgical microscope in order to actively control a microscope head (36) and adjust its position and/or orientation. 11 . Surgical robot system (1) according to one of the preceding claims, characterized in that the at least one optical recording device (14) is an endoscope with a distal recording head, which is adapted to create an intracorporeal optical recording (A) of the patient (P). . 12. Surgical robot system (1) according to one of the preceding claims, characterized in that the surgical robot system (1) also has an external control console separate from the patient fixation unit (2) with the at least one robot (4), which has manual gripping control means in order to transmit a manual input by a user to the at least one robot-guided end effector (10) and to remotely control the end effector (10) accordingly. 13. Surgical robot system (1) according to one of Claims 2 to 12, characterized in that a preoperative intervention plan is also stored in the data supply unit (22) of the surgical robot system (1), and the control unit (30) is adapted for this, to control the at least one end effector (10) semi-autonomously or completely autonomously on the basis of the preoperative intervention plan in order to carry out the intervention. 14. Control method for a surgical robot system, in particular for a surgical robot system (1) according to one of claims 1 to 13, characterized in that it has the steps: - Creating (S1), by an optical recording device (14), an optical recording (A) of a surgical area of the patient (P) together with an end effector tip (18) of a robot-guided end effector (10), the robot (4) directly with a is rigidly connected to the patient (P) connected patient fixation unit (2), and provide the optical recording (A); - Providing (S2), by a data providing unit (22), digital 3D recording data (3DA) of the patient; - tracking (S3), by a tracking system (26), of at least the optical recording unit (14) and a body section of the patient (P), which is fixed in relation to the patient fixation unit (2); and 31 - Determination (S4), by a control unit (30), on the basis of the optical recording (A) of a position, in particular a position and orientation, of the end effector tip (18), in particular the instrument tip (20), in relation to the recording unit (14). machine vision; - Creating (S5), by the control unit (30), an overlay (U) with the provided 3D recording data (3DA) on the one hand and the determined position, in particular position and orientation, of the end effector tip (18) on the other hand; and - Outputting (S6) the overlay (U) as an overlay representation by a display device (32) and/or controlling the end effector (10) on the basis of the overlay (U). 15. A computer-readable storage medium comprising instructions which, when executed by a computer, cause the computer to carry out the method steps of the control method according to claim 14.