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WO2017220822A1 - Système robotique chirurgical et procédé de manipulation d'un système robotique chirurgical - Google Patents

Système robotique chirurgical et procédé de manipulation d'un système robotique chirurgical Download PDF

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Publication number
WO2017220822A1
WO2017220822A1 PCT/ES2016/070475 ES2016070475W WO2017220822A1 WO 2017220822 A1 WO2017220822 A1 WO 2017220822A1 ES 2016070475 W ES2016070475 W ES 2016070475W WO 2017220822 A1 WO2017220822 A1 WO 2017220822A1
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WO
WIPO (PCT)
Prior art keywords
robotic
robotic arm
support
tool
surgical
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Ceased
Application number
PCT/ES2016/070475
Other languages
English (en)
Spanish (es)
Inventor
Rafael Medina Carnicer
Rafael MUÑOZ SALINAS
Enrique Bauzano Núñez
Mª CARMEN LÓPEZ CASADO
Víctor Fernando MUÑOZ MARTÍNEZ
Igone IDÍGORAS LEIBAR
Arantxa RENTERÍA BILBAO
José Miguel AZKOITIA ARTETXE
Alfonso DOMÍNGUEZ GARCÍA
Asier FERNÁNDEZ IRIBAR
María José REQUENA TAPIA
José Eduardo ARJONA BERRAL
Rosa María PAREDES ESTEBAN
Ángel SALVATIERRA VELÁZQUEZ
Ignacio MUÑOZ CARVAJAL
Javier BRICEÑO DELGADO
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Universidad de Malaga
Fundacion Tecnalia Research and Innovation
Universidad de Cordoba
Servicio Andaluz de Salud
Original Assignee
Universidad de Malaga
Fundacion Tecnalia Research and Innovation
Universidad de Cordoba
Servicio Andaluz de Salud
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Universidad de Malaga, Fundacion Tecnalia Research and Innovation, Universidad de Cordoba, Servicio Andaluz de Salud filed Critical Universidad de Malaga
Priority to PCT/ES2016/070475 priority Critical patent/WO2017220822A1/fr
Publication of WO2017220822A1 publication Critical patent/WO2017220822A1/fr
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/30—Surgical robots
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/25—User interfaces for surgical systems
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/30—Surgical robots
    • A61B34/37—Leader-follower robots
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/70—Manipulators specially adapted for use in surgery
    • A61B34/76—Manipulators having means for providing feel, e.g. force or tactile feedback
    • B—PERFORMING OPERATIONS; TRANSPORTING
    • B25—HAND TOOLS; PORTABLE POWER-DRIVEN TOOLS; MANIPULATORS
    • B25J—MANIPULATORS; CHAMBERS PROVIDED WITH MANIPULATION DEVICES
    • B25J13/00—Controls for manipulators
    • B25J13/02—Hand grip control means
    • B25J13/025—Hand grip control means comprising haptic means
    • B—PERFORMING OPERATIONS; TRANSPORTING
    • B25—HAND TOOLS; PORTABLE POWER-DRIVEN TOOLS; MANIPULATORS
    • B25J—MANIPULATORS; CHAMBERS PROVIDED WITH MANIPULATION DEVICES
    • B25J19/00—Accessories fitted to manipulators, e.g. for monitoring, for viewing; Safety devices combined with or specially adapted for use in connection with manipulators
    • B25J19/005—Accessories fitted to manipulators, e.g. for monitoring, for viewing; Safety devices combined with or specially adapted for use in connection with manipulators using batteries, e.g. as a back-up power source
    • B—PERFORMING OPERATIONS; TRANSPORTING
    • B25—HAND TOOLS; PORTABLE POWER-DRIVEN TOOLS; MANIPULATORS
    • B25J—MANIPULATORS; CHAMBERS PROVIDED WITH MANIPULATION DEVICES
    • B25J5/00—Manipulators mounted on wheels or on carriages
    • B25J5/007—Manipulators mounted on wheels or on carriages mounted on wheels
    • B—PERFORMING OPERATIONS; TRANSPORTING
    • B25—HAND TOOLS; PORTABLE POWER-DRIVEN TOOLS; MANIPULATORS
    • B25J—MANIPULATORS; CHAMBERS PROVIDED WITH MANIPULATION DEVICES
    • B25J9/00—Programme-controlled manipulators
    • B25J9/0084—Programme-controlled manipulators comprising a plurality of manipulators
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods
    • A61B17/28—Surgical forceps
    • A61B17/29—Forceps for use in minimally invasive surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/30—Surgical robots
    • A61B2034/301—Surgical robots for introducing or steering flexible instruments inserted into the body, e.g. catheters or endoscopes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/70—Manipulators specially adapted for use in surgery
    • A61B34/74—Manipulators with manual electric input means
    • A61B2034/742—Joysticks
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/06—Measuring instruments not otherwise provided for
    • A61B2090/064—Measuring instruments not otherwise provided for for measuring force, pressure or mechanical tension
    • A61B2090/065—Measuring instruments not otherwise provided for for measuring force, pressure or mechanical tension for measuring contact or contact pressure
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/36—Image-producing devices or illumination devices not otherwise provided for
    • A61B90/361—Image-producing devices, e.g. surgical cameras

Definitions

  • the present invention relates to the field of surgical instruments. More precisely, it refers to robots and robotic systems to perform surgical procedures.
  • surgeon may even remotely control the surgical instruments instead of moving them directly.
  • This remote control could be carried out, for example, through a direct telemanipulator or by computer control.
  • US Patent US8672880B2 discloses a remote controlled surgical insertion system that has a robotic device and a remote control mechanism.
  • the robotic device has a handle controller to receive and maintain the control handle or the proximal end of a medical device.
  • the medical device is capable of moving in up to six ranges of motion.
  • US patent application U S2006 / 0 00810A1 discloses a robotic surgical system for catheter surgery.
  • the system is based on a control station for the operator located at a distance from an operating table, a which is coupled to an instrument control unit and the instrument by means of a mounting bracket of the instrument control unit.
  • a communication link transfers signals between the operator control station and the instrument control unit, which is designed to be placed on top of a patient lying on the table.
  • US Patent US71 18582B1 discloses a medical system that has various robotic arms that can move a corresponding surgical instrument. So that the robotic arms are in the same reference plane as the patient, they are mounted on the operating table. This limits the potential types of surgery to be performed with the system. Additionally, having robotic arms mounted on the operating table makes the approach to the patient difficult in case of emergency. It is not uncommon for an unexpected problem to arise during surgery, which requires immediate intervention by the surgeon or other qualified staff. Having complex robotic arms in a fixed position seriously complicates the approach, even involving irreversible consequences.
  • An object of the invention is to provide a robotic surgical system based on a plurality of independent robotic units that can be easily moved.
  • Each unit comprises a robotic arm configured to carry a surgical tool.
  • surgical tool is used throughout this text in a general way, referring to minimally invasive instruments, including not only the tools themselves, such as a knife or scalpels, but also equipment to assist surgery or equipment diagnostic, such as cameras, endoscopes, and so on.
  • the units are independent of each other because the location and movement of one of them does not affect the location and movement of the others.
  • the units are muitifunctional, since they can be used for different purposes, depending on the tool attached to it.
  • a robotic surgical system comprising: at least three robotic units configured to, during use of the system, be arranged close to an operating table on which a patient is lying, each being robotic unit independent of the other robotic units, each robotic unit comprising a support and a robotic arm assembly extending from said support; said support comprising movement means, said support being configured to change the position and orientation of the support with respect to the operating table; said robotic arm assembly comprising: a robotic arm having 6 degrees of freedom, a surgical tool gathered to the robotic arm through a tool adapter and a 6-axis force sensor configured to receive the measurement of the applied forces and torques by the surgical tool; a control console configured to remotely manage said robotic units from a location close to said operating table, said control console comprising: computing means configured to manage and execute force control and tool positioning control algorithms; a plurality of haptic devices, each providing 7 degrees of freedom, said haptic devices being configured to control the movement, spatial orientation and opening / closing of the distal end of the surgical tool fitted
  • the tool adapter preferably comprises a drive means and a force sensor, said drive means comprising a motor configured to open / close the surgical tool; said force sensor being configured to measure the grip / close force applied by said actuation means. Also preferably, the motor is driven and controlled by one of the degrees of freedom of said haptic devices.
  • the force sensor preferably comprises a degree of freedom to measure the grip / close force applied by said surgical tool and to feed back the measurement information to said haptic devices.
  • the movement means of said support are configured to bring the support closer to the operating table or to move it away from it or to reorient it during an operation.
  • the movement means preferably comprise a plurality of orientable wheels.
  • the support comprises braking means in order to immobilize the robotic unit during operation.
  • the support is L-shaped, with a lower part that is wider than its upper part, which allows the introduction of a lower part of the lower part than the upper part, below the operating table .
  • the support houses inside: at least one battery configured to allow the robotic unit to work wirelessly; a power supply configured to connect to the mains, which allows the robotic unit to work in a wired mode; a battery charger; and at least one current converter or a voltage converter.
  • the support houses inside, a control means configured to control the robotic arm associated with said support.
  • the support houses a communications module inside.
  • the support inside houses means for measuring the charge level of the batteries included in said support.
  • the support inside houses a communication box associated with said force sensor, said communication box being configured to control and process said force sensor.
  • control console comprises an adjustable support.
  • the selection means is a plurality of pedals.
  • a first pedal of said plurality of pedals is configured to activate two sets of robotic arms carrying respective instruments surgical; and a second pedal of said plurality of pedals is configured to activate a robotic arm assembly that carries an endoscope.
  • the configuration monitor is a touch screen.
  • the computing means is configured to receive input signals from said haptic devices, to calculate a corresponding movement of the surgical instruments and to provide corresponding output signals to move the sets of robotic arms (12) and the tools .
  • control console comprises computing means to determine, from the forces measured by said force sensor, what percentage of the contribution to the measurement is due to the interaction with the fulcrum point and what percentage of The contribution to the measurement is due to the interaction with the patient's internal tissue.
  • control console comprises computing means for sending a simulated force to at least one haptic device, where said simulated force is obtained from the contribution to said measurement due to the interaction with the patient's internal tissue, said simulated force becoming said at least one haptic device in a force in the corresponding hand of the surgeon.
  • the control console preferably comprises computing means for estimating the Cartesian position of the fulcrum point from the contribution to said measurement due to the interaction with the fulcrum point and from the modeled coordinates of said robotic arm, said estimation comprising the Cartesian position of the fulcrum point calculating the distance between the near end! of the surgical tool and the fulcrum point.
  • control console further comprises a voice recognition unit.
  • control console further comprises a second monitor configured to display said 3D image captured by said imaging means comprised in said endoscope fitted to a robotic arm.
  • a method for handling a robotic surgical system comprising: arranging at least three robotic units of said robotic surgical system close to an operating table on which a patient is laid, each being robotic unit independent of the other robotic units, each robotic unit comprising a support and a robotic arm assembly extending from said support, wherein said robotic arm assembly comprises a robotic arm having 8 degrees of freedom, a tool surgical cupped to the robotic arm through a tool adapter and an 8-axis force sensor; guiding the end of each robotic arm transporting said surgical tool towards a trocar and inserting the surgical tool into trocar, said trocar having previously been inserted into the patient's skin; controlling said robotic units from a control console from a location close to said operating table, said control comprising: receiving the measurement of the forces and torques applied by the surgical tool within the patient's skin; control with a plurality of haptic devices, each providing 7 degrees of freedom, movement, spatial orientation and opening the closure of the distal end of the surgical tool coupled to a corresponding robotic arm
  • the method preferably comprises receiving input signals from said haptic devices to calculate a corresponding movement of the surgical instruments and to provide corresponding output signals to move the robotic arm assemblies and tools.
  • the method preferably comprises determining, from the forces measured by said force sensor, what percentage of the contribution to the measured forces is due to the interaction with the fulcrum point and what percentage of the contribution to the measured forces is It is due to the interaction with the patient's internal tissue. More particularly, the method comprises sending a simulated force to at least one haptic device, said simulated force being obtained from a contribution to said mediated forces due to interaction with the patient's internal tissue, said simulated force becoming said ai less a haptic device in a force in the corresponding hand of the surgeon.
  • the method preferably comprises estimating the Cartesian position of the fulcrum point from the contribution to said measured forces due to the interaction with the fulcrum point and the coordinates modeled from said robotic arm, said position estimation comprising Cartesian fulcrum point calculate the distance between the near end! of the surgical instrument and the fulcrum point.
  • a computer program product comprising program instructions / codes is provided computer to perform the method described above.
  • a computer-readable memory / medium that stores program instructions / codes to perform the method described above.
  • the system allows its easy integration into an operating room thanks to its compactness and the mobility of its robotic units, which do not interfere with the activity of the surgeon. What's more, an ad-hoc operating room is not required: on the contrary, the system can be used in any conventional operating room.
  • the system of the invention does not force the surgeon to be placed distance during surgical operation. He / she may, on the contrary, be near the operating table.
  • the surgeon is offered a sensation of sensation and touch (in general, tactile information) thanks to the sensors configured to measure the forces applied by the surgical tools attached to the robotic arms.
  • robotic arms Since robotic units are easily transported, the system adapts perfectly to different types of surgery. In an emergency, robotic surgery is immediately converted to traditional surgery simply by moving mobile robotic units away. Last but not least, different surgical tools can be attached to robotic arms. In other words, the surgical tool can be any conventional tool.
  • the robotic arm is not limited to ad-hoc surgical instruments, unlike well-known robotic systems. Additional advantages and features of the invention will be apparent from the detailed description that follows and will be particularly noted in the appended claims.
  • Figure 1 shows a schematic of a robotic surgical system according to an embodiment of the invention.
  • Figure 2 shows a view of a robotic unit according to a possible embodiment of the invention. It comprises a base support or housing and a robotic arm assembly.
  • Figure 3 shows a schematic of the architecture of a base support or housing illustrated in Figure 2.
  • the robotic arm of the robotic arm assembly is also indicated.
  • Figure 4A shows a robotic arm assembly according to a possible embodiment of the invention.
  • Figure 4B shows an exploded view of the robotic arm assembly of Figure 4A.
  • Figure 4C shows a perspective view of an exemplary implementation of a tool adapter for attaching a surgical tool to a robotic arm.
  • FIGS 5A and 5B show two views of a control unit configured to control the robotic surgical system in accordance with a possible embodiment of the invention.
  • the control unit functions as an interface between the robotic arm assemblies and the surgeon.
  • Figure 6 shows a pair of haptic devices according to a possible embodiment of the invention.
  • Figure 7 shows an example of the visual information provided by the configuration monitor.
  • Figure 8 shows an example of the visual information provided on the configuration screen of the configuration monitor.
  • Figure 9 schematically represents the flow of control signals and the units involved in the robotic surgical system according to an embodiment of the invention.
  • the term “approximately” and terms of your family should be understood as indicating values very close to those that accompany the aforementioned term. That is, a deviation within reasonable limits from an exact value should be accepted, because a person skilled in the art will understand that such a deviation from the indicated values is inevitable due to measurement inaccuracies, etc. The same applies to the terms “around” and “around” and “substantially.”
  • FIG 1 shows a diagram of a robotic surgical system 1 that can be used to perform minimally invasive surgery, such as iaparoscopic surgery, hysterectomy, mediastinoscopy or nephrectomy, among other types of minimally invasive surgery.
  • the robotic surgical system 1 is used to perform an operation on a patient 2 that is normally laid on an operating table 3. Near the operating table 3 there are at least two robotic units that each carry a robotic arm. One of the at least two robotic units is configured to carry an endoscope and the other is configured to carry a surgical tool itself.
  • the robotic units 4, 5, 6 are described in detail below, with reference to Figures 2 and 3, together with the devices carried by the robotic unit. In the illustrated embodiment, three robotic units 4, 5, 8 are shown.
  • Each robotic unit 4, 5, 8 can work wirelessly - without requiring any physical cables or wires for connection to other units or parts of the system or to a unit of power supply - or connect with wires.
  • it has a power supply unit integrated in its bottom that allows the robotic unit to work wirelessly.
  • each robotic unit 4, 5, 8 is arranged near the operating table 3 and an instrumentalist or surgical technician (or in general, the person in charge of the surgical tools) guides the end of the robotic arm (of each robotic unit) that carries the surgical tool 18 towards a trocar and inserts the surgical tool 18 into the trocar, which has been inserted previously in the skin of patient 2 through an incision cut.
  • the surgical tools 18, which, as already mentioned, can be a proper tool, such as a knife or scalpel, or a diagnostic element or support element, such as an endoscope, is inserted through cut incisions in the patient's skin 2.
  • the robotic arm is then ready to be used in the operation.
  • the robotic surgical system 1 can be configured with as many units (and therefore with as many robotic arms) as required for different surgical operations.
  • a robotic arm carries an endoscope (or in general, a camera) and two other robotic arms carry the respective surgical instruments necessary for the operation.
  • system 1 uses three robotic units 4, 5, 6. Although three units 4, 5, 6 are shown, it should be understood that system 1 can have any number of units and corresponding robotic arms .
  • FIG. 1 also shows a control console 7.
  • the robotic arms carried by the respective robotic units 4, 5, 6 are operated remotely from the control console 7, Their movement is controlled by a surgeon 9, sitting or standing, from the control console 7.
  • This control console 7 has a monitoring means 701 configured to display a 3D image (from inside the body cavity) captured by a camera (or endoscope) contained in a robotic arm.
  • the monitoring means 701 is, for example, a monitor or screen.
  • the control console 7 can also have several user interfaces, as per example: a pair of haptic devices 8, such as handles or joysticks, each providing 7 degrees of freedom (DOF), configured to control the 8 DOF of each robotic arm that carries a surgical tool at its end and 1 DOF to control the opening / closing of the tool, by means of which the surgeon 9 can remotely control the movement and spatial orientation of the far end! of the equipment (tool or endoscope) collected in a corresponding robotic arm controlled by a haptic device 8 and the opening / closing of the tool.
  • Other possible user interfaces may be a pair of pedals, not shown in Figure 1, so that surgeon 9 selects which two robotic arms should be controlled at all times; and / or a voice recognition unit 52.
  • the system 1 also comprises a configuration monitor 61, preferably a touch screen, which is not shown in Figure 1 (shown in Figure 5A).
  • the robotic unit 4, 5, 8 does not require calibration before its operation, since during the operation each robotic arm (included in each robotic unit, as will be explained later) is calibrated with respect to its corresponding fulcrum point. This is done as follows: Information regarding the forces applied by the tool at the fulcrum point (point in the patient through which the tool is inserted into the body cavity) is used to calculate the distance from that point to The robot axis. In other words, the length of the tool portion that is outside the body is calculated. In this way, the robotic arm is already calibrated and its movements are based on that point. Also during the operation, the relative orientation of each robotic arm that sets the respective tools with respect to the corresponding robots shown on a monitor 701 is set.
  • the movement of the haptic devices corresponds to the movement of the robot shown on the monitor.
  • this is done manually, manually orienting each robotic arm (and the respective tool) with respect to the robot shown on the monitor. In an alternative embodiment, this is done by means of an external positioning system based on the vision and controlled by the control console 7.
  • FIG. 2 shows a robotic unit 4, 5, 6 according to a possible embodiment of the invention.
  • the devices or elements raised in the robotic unit are also illustrated.
  • the robotic unit 4, 5, 6 is formed by a base support or housing 11 and a robotic arm assembly 12 extending from the base support or housing 1 1.
  • Surgical tools 18 are removably coupled at the end of each robotic arm assembly 12.
  • the robotic arm assembly 12 comprises a robotic arm 15, an 8-axis force sensor 18, a tool adapter 19 and a surgical tool 18 coupled to the robotic arm 15 via the adapter of tool 19.
  • Non-limiting examples of surgical tools 18 that can be attached to the robotic arm 15 are scalpels, forceps, endoscopes, additional light probes, etc.
  • the base support or housing 1 is placed near or near the operating table 3, such that the robotic arms 15 and the surgical tools 8 coupled thereto are located next to patient 2 too.
  • the base support or housing 1 preferably has a plurality of wheels gears 21, usually 4 or 8 wheels, although any number of wheels is possible, in order to easily move the robotic unit 4, 5, 8, for example to bring it closer to the operating table or away from it, or to guide it better during the operation.
  • the wheels 21 preferably have brakes, not shown, in order to immobilize the robotic unit during operation.
  • the robotic unit 4, 5, 6 can be moved and relocated at any time during the operation or at any other time, provided that the tool 18 has been removed from the insert made in the patient's skin.
  • Each robotic unit 4, 5, 6 is independent of the others. Therefore, they can be moved independently by independently moving their respective support or base housing 1 1.
  • the base support 1 1 is preferably L-shaped, with a lower part that is wider than its upper part. This allows a closer approximation to the operating table by entering the lower part fraction wider than the upper part below the operating table. This saves space in the operating room.
  • FIG 3 shows a diagram of the architecture of the base support 1 1 in accordance with a possible embodiment of the invention.
  • the robotic arm 15 of the robotic arm assembly 12 is also shown.
  • the base support or housing 11 is made of any suitable material.
  • it can comprise aluminum. It is preferably covered with one or more sheets of a material suitable for use in the operating room.
  • the coating sheets can be made of a suitable plastic, such as ABS plastic (acrylonitriium butadiene styrene) or any other suitable material.
  • the design of the support 1 1 has been selected in order to minimize the space occupied in proximity to the operating table and maximize its stability, mobility and lifespan of the power supply.
  • the support 11 houses, inside, at least one battery that allows the operation of the robotic unit 4, 5, 6 wirelessly, that is, without the need for a physical connection to the network electric
  • It also includes a power supply configured to connect to the mains. This allows both the wired operation of the robotic unit 4, 5, 6 (that is, directly powered by the mains) and the charging of the at least one battery. In other words, the robotic unit 4, 5, 6 can work either wirelessly or wired.
  • Both the at least one battery and the power supply are represented together in Figure 3 and are referred to as number 23.
  • the support 1 1 also contains a battery charger 24 and at least one voltage converter or a current converter 25 .
  • the support 1 1 also houses an industrial computer 26 comprising specific software for robot-assisted surgery: general software for the conversion of movement between the joystick and the robotic arm, position control of the general tool, signal management of input / output, communication management between the robotic arms and the control console, general system management, error management, etc. It is a compact, powerful and low consumption industrial computer. It comprises at least two Ethernet ports and at least 4 USB ports.
  • the industrial computer 26 is the computational core of the robotic unit 4, 5, 6. It is responsible for executing any required algorithm, such as motion control algorithms and force control algorithms. It also manages the communication between the different elements that make up each robotic unit, as well as the communication with other robotic units and with the control console 7.
  • Computer 26 comprises two communication modules, not shown: one wired based on Ethernet and one based on Wi-Fi.
  • a non-limiting example of an industrial computer that can be used is Simatic ⁇ PC427D, from Siemens.
  • the support 11 additionally comprises a control means 27, such as a conventional control unit, configured to control the robotic arm 15. For example, it is responsible for providing means for programming the paths of the robotic arms, controlling the motors on each axis or control the different sensors included in the robotic arm.
  • the support 1 1 further comprises a communications module, which is not shown, comprising Tx / Rx means for transmitting / receiving control signals to / from the control console 7, preferably configured to work under a standard Ethernet based protocol, that can work both wirelessly and wired.
  • the support 1 1 also houses load measurement means 28 for measuring the charge level of the batteries and a communication box 29 associated with the force sensor 16 (see Figure 2) located in the last articulation of the robotic arm.
  • the communication box 29 controls and processes the force sensor 16.
  • the support 11 comprises means for transport and fixing 21, 22, 30 of the support 11.
  • Figure 4A shows a robotic arm assembly 12 in accordance with a possible embodiment of the invention, configured to extend from a support or base housing 11 as shown in Figures 2 and 3 or configured to engage said support or base housing 1 1.
  • the assembly 12 comprises:
  • robotic arm 15 It is the device that allows interaction with the surgical tool It has 8 degrees of freedom (DOF). It includes a security system capable of blocking in case of collision with human beings.
  • robotic arm 15 can be moved manually.
  • it can be programmed in real time through the Ethernet-based protocol with a sampling frequency of 125 Hz.
  • control means 27 housed inside support 1 1. This control means 27 manages all the movement of low level and planning orders received from the industrial computer 26.
  • a non-limiting example of robotic arm 15 that can be used is Universal Robots UR5.
  • a force sensor 16 It is configured to receive the measurement of forces and torques in 8 axes applied by the surgical tool 18, which is controlled by the robotic arm 15, on the patient's skin and on the internal walls and organs within The patient's cavity. It is located between the last axis of the robotic arm (articulation) and the tool adapter 19, since this situation allows the pure reception of the signals representing said applied forces.
  • the sensor 16 since the sensor 16 only measures the forces applied on its surface, it is ensured that other measurements are not captured (for example, the measurements of the forces applied by the robotic arm), capturing only the measurements generated due to the interaction of surgical tool 18 (whose weight and inertia must be filtered in order to obtain a reliable measurement).
  • robotic arm 15 that can be used is an ATI Gamma. - and a surgical tool 18 configured to, during use of the system, engage the robotic arm 15; Depending on the type of surgical tool 18, it may be required to engage the robotic arm 15 through a tool adapter 19.
  • the tool adapter 19 It is used when the surgical tool 18 cannot be directly coupled to the robotic arm 15, due to its specific design.
  • the tool adapter 19 is located between the robotic arm 15 and the surgical tool 18.
  • the tool adapter 19 is preferably located between the force sensor 16 (located at the far end of the robotic arm 15) and the surgical tool 18. The closer the force sensor 16 is to the surgical tool 18, the more reliable the signal picked up by the force sensor 16.
  • the tool adapter 19 allows any conventional surgical tool 18 to be attached to the robotic arm 15. In others words, unlike other well-known robotic surgical systems, which can only be used with ad-hoc surgical tools, the robotic arm 5 can be attached to almost any surgical tool thanks to the tool adapter 19.
  • the tool adapter 19 comprises a drive medium and a force sensor of 1 DOF (not shown).
  • the drive means or clamp drive means is based on a motor configured to open / close the surgical tool 18 (such as scalpels, forceps, scissors, etc.).
  • the engine is driven and controlled directly by one of the degrees of freedom of the haptic devices 8 located close to the control console 7 and connected thereto.
  • the means for controlling the motor is an axon EPOS2 mod control board. 390003.
  • the force sensor is configured to measure the grip / close force applied by the clamp.
  • the force sensor is an OIVID-2G-FF-800N.
  • Figure 4C illustrates an exemplary embodiment of a tool adapter 19 and a surgical tool 18 for attaching to a robotic arm 15 thanks to the tool adapter 19.
  • the tool adapter 19 is placed at the distal end of the robotic arm 15.
  • a An example of a surgical tool 18 to be coupled is any of the surgical instruments that are marketed under the "ClickLine" brand of Karl Storz (Germany).
  • the tool 18 preferably comprises a first tool piece 181 and a second tool piece 182.
  • the first tool piece 181 is hollow so that the second tool piece 182 can be moved back and forth through a channel in the first piece of tool 181. That is, the second tool piece 182 can be moved relative to the first tool piece 181.
  • the surgical tool 18 further comprises a tool head (not shown) moved by the second tool piece 182.
  • the tool adapter 19 it comprises a first base part 191 for detachably retaining the first tool part 181, and a second base part 192 that can be moved relative to the first base part 191 to detachably retain the second tool part 182.
  • the first base piece 191 comprises the components that retain or hold the first tool piece 181.
  • the second base piece 192 can be moved activated by a motor 193 and can be connected to the second tool piece 82 to move the second piece of tool 182. If the transmitted movement is a reciprocal movement, then the second piece of tool 182 will move from front to back and vic eversa
  • the first base piece 191 comprises a pusher 194 that can be moved relative to the first base piece 191 to separate the first tool piece 181
  • the second base piece 192 comprises a cover 195 that can be moved relative to the second base piece 192 to separate the second tool piece 182.
  • the robotic units 4, 5, 6 are connected to a control console 7 from which the control of the robotic arms 15 is managed / manipulated.
  • the control console 7 acts as the master system.
  • the robotic units 4, 5, 6 act as a slave system.
  • the robotic arms 15 in general, ios robotic arm assemblies 12
  • Figures 5A and 5B show two views of a control console 7 in accordance with a possible embodiment of the invention.
  • the control console 7 is the interface between the surgeon 9 and the sets of robotic arms 12.
  • the main parts or devices included in the control console 7 are:
  • Adjbie column or support 41 allows the system to be used ergonomically, as it adapts to the height of the user 9 and allows the surgeon 9 to work either standing or sitting.
  • the computing medium which for clarity has also been referred to as 42, although it is actually housed inside the housing 42, is the core of the control console 7. It is composed of a personal computer or similar, a data acquisition unit (DAQ) for the capture of signals provided by the pedals, a communications switch and power supplies for the personal computer, haptic devices and screens (monitors).
  • the middle of Computing 42 executes the necessary algorithms, such as force control, and manages the operating parameters.
  • a plurality of control algorithms are executed. These control algorithms manage the communications and operations between each of the haptic devices 8 and their corresponding robotic arm assembly 12 (i.e., their corresponding robotic arm 15 and the surgical tool 18 coupled thereto). It is preferably located within a housing 42 comprising other elements, such as connection means.
  • Haptic devices 8 are one of the user interfaces of the control console 7. They are preferably implemented in the form of handles or joysticks 8. By means of the haptic devices 8, the surgeon 9 it can simultaneously control up to two surgical tools 18.
  • the haptic devices 8 are preferably mounted on a panel configured to install two control levers or handles. In a particular embodiment, the haptic devices 8 are fixed or coupled to the adjustable column 41.
  • the haptic devices 8 are preferably connected to the control console 7, in particular, to the computing medium housed in the housing 42, by means of a cable connection. In a particular embodiment, this connection is a USB interface.
  • each haptic device 8 is associated with a corresponding surgical tool.
  • the movement and positioning of the two surgical tools 18 fixed to a first and a second robotic arm 15 is controlled by the surgeon 9 by the use of a pair of haptic devices 8.
  • the surgeon 9 can select the mode of movement of robotic arm assemblies according to two modes different. In “A” mode, a movement of the haptic devices 8 implies a movement of the far end! of surgical tools 18. In “B" mode, a movement of haptic devices 8 implies a movement of the near end! of the surgical tools 18.
  • FIG. 6 shows a pair of haptic devices 8 according to a possible embodiment of the invention.
  • Haptic devices 8 are conventional and are outside the scope of the present invention.
  • the haptic devices 8 used in system 1 allow to control and detect the forces of 7 degrees of freedom.
  • - selection means 51 They allow the surgeon 9 to activate and deactivate the movement of the robot arm assemblies 12 and select which two robot arm assemblies must be controlled at all times.
  • the selection means are impregnated by pedals.
  • the pedals are one of the user interfaces of the control console 7.
  • the surgeon In order to move a robotic arm, the surgeon must step on the corresponding pedal 51 continuously (pressing continuously with the foot).
  • the pedals 51 work as a means of safety, since they prevent unwanted movement of any of the robot arms under the concept of dead man (dead-man concept). That is, the robot arms only move, in response to the haptic control, if the corresponding pedal is pressed.
  • the pedals are connected to a control board, such as a USB-DUX D DAQ, which has an interface, for example a USB port, with the computing medium housed in the housing 42.
  • a manual mode is activated, in which mode the robotic arm assembly can be moved / manipulated directly (with the hands) by a person .
  • the number of selection means may vary depending on the number of robot arm assemblies to be controlled, and that more than one surgeon (or medical personnel) may be needed to control the pedals (and devices haptics) if the number of sets of robotic arms is high. In the case of a large number of robot arm assemblies, the selection means can be set by means of a switching selector.
  • the voice recognition unit 52 is an optional feature.
  • the voice recognition unit referred to in Figure 1, as a microphone, is an optional user interface of the control console 7. It can be used to control the movement of an endoscope connected to a robotic arm .
  • the voice recognition unit 52 is connected to a control board that has an interface with the computing medium.
  • - monitor 701 It is a 3D screen that shows visual information. In particular, shows images of the patient's internal organs 2 taken by the camera (endoscope).
  • a non-limiting example of the 701 monitor is a Panasonic 26 ", designed to work in surgical environments. It is noted that additional 3D monitors can be used, as illustrated in Figure 1 and referred to like 10, to show the same images in different areas of the surgery room.
  • This additional monitor 61 is an additional user interface that allows the surgeon to access different control parts of the system. It is preferably a touch screen. For example, when the system is started, the status of all items and tools, including the camera, is displayed in a window. Figure 7 shows an example of the information shown in the status window of the configuration monitor 61.
  • the configuration monitor 61 provides menus, openings, system status, configuration options and the like.
  • each of the haptic devices 8 that can be manipulated by the surgeon has a master-slave relationship with one of the corresponding robotic arms 15, so that the movement of a device
  • the haptic 8 produces a corresponding movement of the surgical tool 18 attached to the corresponding robotic arm 15.
  • the computing means (housed in the housing 42) of the control console 7 receives input signals from the haptic devices 8.
  • the control means 27 associated with each robotic unit calculates a corresponding movement of the surgical tools 18 and provides output signals to move the sets of robotic arms 12 and the tools 18. In other paiabras, the surgeon 9 controls the movement and orientation of the tools 18 without actually supporting the extremes of these tools 8.
  • the haptic devices 8 measure the traits yectorias desired for each tool 18 and the control means 27 sends (through the algorithms of the computing medium 42) those paths to the corresponding robotic assembly 12.
  • the haptic devices 8 are further configured to apply forces on the respective hand of the surgeon 9, so that they transmit to the surgeon the forces measured by the tool adapter 19 (in particular, by its force sensor) in order to create in the surgeon a sensation of contact or pressure similar to that exerted by the tool 18 in the patient (for example, in his tissue).
  • Each haptic device 8 has 7 degrees of freedom (DOF), 6 DOF for the robotic arm and 1 DOF for the opening / closing of the tool, by means of which the surgeon 9 can remotely control the movement (position) and the spatial orientation of the distal end of the equipment (tool or endoscope) coupled to a robotic arm controlled by a corresponding haptic device 8 and the opening / closing of the tool.
  • DOF degrees of freedom
  • Each DOF is capable of feedback and strength.
  • the haptic device 8 allows a set of movements similar to those performed by a human hand. They have means to compensate for gravity, which provides fine precision.
  • the haptic devices 8 are Omega 7 of Force Dimension.
  • Each surgical tool 18 is easily controlled not only thanks to the corresponding haptic device 8, but also to the combined synergistic advantages of its robotic arm assembly 12, its corresponding haptic device 8 and the control capabilities provided by the industrial computer 26.
  • the control order to move the surgical tool 18 as desired by the surgeon is transmitted from the haptic device 8 to the computing medium (located in the housing 42) and from this computing means 42 to the industrial computer 28.
  • the connection between the haptic device 8 and the computing medium 42 is preferably performed via USB.
  • His speed of Maximum sampling is preferably 2.5 kHz, enough to perform control by means of haptic force feedback.
  • images 72 of three tools are represented (a first surgical tool “tool_1", an endoscopic camera “camera” and a second surgical tool “tool_2”), corresponding to the three elements collected to three robotic arms.
  • a message 71 about its status is displayed. In this example, all three tools are "stopped.”
  • the images corresponding to a certain state are shown in a specific color. For example, if the tool is stopped, it is represented in red.
  • a configuration button 73 is also shown. In order to start moving a tool, it is necessary to press the corresponding pedal. When the pedal is pressed, if the initial position of the robotic arm is correct, the two tools shown change their status to "in use” and change their color, for example, they turn green. They can then be moved, powered by haptic devices.
  • this interface can display two warning messages: A first message informs about the speed of the haptic device. If the user moves the haptic device so quickly that the robotic arm cannot reach that speed, the user is warned about it, showing a warning in status message 71. The image preferably turns red. When the speed is reduced to an acceptable one, message 71 changes to "in use” and image 72 turns green again. A second message informs about an incorrect position of the tool, for example, a position in which you cannot continue working as planned, of In the same way that a manual movement is required (that is, a movement not controlled through the haptic device, but manually by a person). This warning is shown in status message 71 and the corresponding image 72 preferably turns red. When the problem is overcome (manually), the message 71 is changed back to "in use” and the image preferably turns green again.
  • the endoscopic camera shown 72 changes its state to "in use” and preferably changes its color, for example, it turns green. In this state it is not possible to move the robotic arms that control the surgical tools themselves even if their pedal is pressed. Only when the pedal corresponding to the haptic device that controls the camera is not pressed, can the tools themselves be moved.
  • the configuration button 73 In order to gain access to the system configuration, the configuration button 73 must be pressed in the main window (see Figure 7).
  • a new screen (a configuration window) is shown, as shown in Figure 8.
  • the "Movement speed” section refers to the rate between the speed of the haptic device and the speed of the robotic arm.
  • the "Left controller” and “Right controller” sections allow you to choose the tool that will be controlled through each haptic device. In other words, each robotic arm assembly must be associated with a corresponding haptic device (haptic controller).
  • the robotic arm that carries the endoscopic camera is associated with a desired haptic controller (left or right), but only when the corresponding pedal is pressed. By default, the endoscopic camera is associated with the right controller.
  • the "Tool decoupling” section is required when a tool has to be decoupled from the robotic arm on which it is attached.
  • the corresponding button must be pressed.
  • the "System Reset” button must be pressed in case the robotic arm assemblies do not move correctly.
  • the "Back” button is pressed after a configuration has been selected, saving the selected configuration.
  • Figure 9 schematically represents the flow of control signals exchanged between different units in the robotic surgical system 1 according to an embodiment of the invention.
  • the user (surgeon 9) interacts with the system 1 through the control console 7.
  • the control console 7 comprises an algorithm to determine, from the forces measured by the force sensor 16, what percentage of the contribution to the measurement is due to the interaction (of the surgical tool) with the fulcrum point and what percentage The contribution to the measurement is due to the interaction (of the surgical tool) with the patient's internal tissue. If the measurement of the forces provides a low value, then it is established that virtually all the measured force is due to the interaction with the fulcrum point. If the measurement of the forces provides a high value, then it is established that practically all the measured force is due to the interaction with the patient's infernal tissue. In an implementation example, which is not to be considered as limiting, the threshold between a "high value” and a "low value” is set at 2 Newtons.
  • the control console 7 receives the position ("P” in Figure 9) of the haptic devices 8 (position reached as a result of manipulation applied by the surgeon's hands).
  • the control console 7 sends a certain force ("F” in Figure 9) to the haptic devices 8 (force to be transferred in turn to the surgeon's hands).
  • This force "F” is the result of modeling the force detected by the robotic arm assembly. It is a simulated force that acts in a direction opposite to the movement of the haptic device 8.
  • This "F” force is simulated by means of an elastic-linear force reaction model that has some dynamic stiffness. This simulation is performed in an algorithm for stiffness estimation.
  • the control console 7 sends the information related to the position of the haptic devices 8 to the industrial computer 26 of the robotic unit.
  • the information is processed.
  • An order obtained as a result of said processing is sent to the control means 27 (which controls a corresponding robotic arm).
  • Haptic feedback is a feedback of 3 degrees of freedom (DOF), performed on the XYZ axis (no feedback on turns).
  • This feedback is calculated in the computing medium comprised in the control console 7 from the position and state of the proximal end of the surgical tool 18 (or from the position of the tool adapter 19, if there is one) and from of the force obtained from the force sensor.
  • the control console 7 also receives and sends the position ("P") and the state ("S") of the robotic arm 15.
  • the control console 7 also receives the force captured by the force sensor 16.
  • the force sensor 16 moves along with the final effector of the robotic arm. For this reason, the position and orientation of the force sensor 16 are determined by the state of the robotic arm joint.
  • the stiffness estimation algorithm which is executed from the control console 7, is responsible for dynamically estimating the stiffness of the tissue in contact with the distal end of the surgical tool 18. This is done by measuring forces and torques. due to the interaction between tool 18 and the patient's internal tissue.
  • the control console 7 comprises an algorithm to determine, from the forces measured by the force sensor 16, what percentage of the contribution to the measurement is due to the interaction (of the surgical tool) with the fulcrum point and what percentage of the contribution to the measurement is due to the interaction (of the surgical tool) with the patient's internal tissue.
  • the relationship between force and movement due to the interaction with the tissue is modeled by means of a linear model. Therefore, the stiffness of the patient's internal tissue is estimated and transmitted to the surgeon, so that the surgeon is able to feel through haptic devices 8, discriminating between soft or hard objects, similar to how he would feel With your own hands. From this estimate of stiffness, the simulated reaction force mentioned above is calculated. This simulated reaction force is proportional to the movement of the haptic device performed by the surgeon's hand. The position of the haptic device in which the forces / torques were measured for the first time as a result of the interaction between the tool and the tissue, is considered as a reference. The simulated reaction force is scaled in order to feel the contact in the hands naturally. This force is sent to the actuators of the haptic device.
  • the Cartesian position of the point of fulcrum is also used modeled robotic arm.
  • the outer distance (along an axis of the surgical tool) between the final effector of the robotic arm (proximal end of the surgical instrument) and the fulcrum point is calculated.
  • control console 7 can receive audio instructions from a user through a voice recognition unit 52.
  • the laparoscopic movements of the surgical tool 18 coupled to the robotic arm 15 are controlled by means of the haptic devices (haptic interface) 8.
  • haptic interface haptic interface
  • a group of algorithms has been developed to control the movements of the robotic arm 15 based on the response force.
  • the handling of the robotic surgical system 1 is done as follows:
  • the surgical tool 18 does not touch (or touch to a very limited extent) the tissue / wall of the hole in the patient's body through which the tool enters - through a trocar - in the patient's cavity.
  • the forces captured by force sensor 16 are very small. This means that the fulcrum point is in the expected position. If, on the contrary, the actual fulcrum point is not where it was intended, the movement generated with the robotic arm forces the surgical tool 18 to touch the tissue / wall of the hole in the patient's body through which the tool enters the patient's cavity.
  • the surgical tool 18 touches said tissue (skin, organs ...) forces are applied and those forces are captured by the force sensor 16.
  • Those force captures are used to return to determine the fulcrum point (or better, the distance between the end of the surgical tool 18 and the fulcrum point) and to apply a lateral movement of the tool 18 in a direction opposite to the force vector in order to minimize the magnitude of the force applied by the surgical tool 18.
  • Any movement of the surgical tool 18 (insertion, removal %) and any movement of the patient (breathing %) implies that the distance between the end of the surgical tool 18 and The fulcrum point varies. It is necessary to be aware of this distance in order to provide a correct movement of the tool within the patient's cavity.
  • the distance between the end of the surgical tool 18 and an estimate of the fulcrum point is calculated first. This distance is calculated thanks to the force sensor 16 fitted to the end of the robotic arm 15. Secondly, once this distance is known, an accommodative control or correction is applied, which manages to correct errors in the positioning of the surgical tool 18 with respect to the fulcrum point at which a minimum force is applied. The result of this correction minimizes the force applied at the fulcrum point. Therefore, the surgeon can move the robotic arm assembly by means of the haptic devices 8 while the system is capable of transmitting a sensation of force to the haptic device when the robotic arm assembly (or tool coupled to the robotic arm) collides. against an object.
  • a new robotic surgical system 1 has been provided, which can be easily integrated into an operating room and that does not interfere with the surgeon's movements. It does not require specific surgical rooms or facilities (that is, specific feeding systems). The surgeon can remain within the surgical area, that is, he does not need to remain at a distance from the table of operations.
  • the system offers the surgeon a sensation of touch or tactile information: thanks to its sensors, the force of touch and cut applied by the surgical tools is measured.
  • the system is flexible, which means that different configurations are possible: a different number of robotic arm assemblies (one, two, three or more) and / or different ways of moving / placing them.
  • the system is also flexible in terms of the surgical tool to be attached to the robotic arms: any tool can, in principle, be used, unlike conventional robotic systems, which require ad-hoc tools.

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  • Engineering & Computer Science (AREA)
  • Health & Medical Sciences (AREA)
  • Robotics (AREA)
  • Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Biomedical Technology (AREA)
  • Mechanical Engineering (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Human Computer Interaction (AREA)
  • Manipulator (AREA)

Abstract

L'invention concerne un système robotique chirurgical (1) comprenant : des unités robotiques, dont chacune est indépendante des autres et comprend un support (11) et un ensemble bras robotique (12); ledit support (11) comprenant des moyens de mouvement et étant conçu pour changer la position et l'orientation du support (11) par rapport à la table (3); ledit ensemble bras robotique (12) comprenant : un bras robotique (15), un instrument chirurgical (18) accouplé à ce dernier et un capteur de force (16) conçu pour recevoir la mesure des forces et des couples appliqués par l'instrument (18). Le système comprend en outre une console de commande (7) conçue pour manipuler à distance lesdites unités robotiques, comportant : un dispositif informatique (42); des dispositifs haptiques (8) conçus pour commander le mouvement, l'orientation spatiale ainsi que l'ouverture et la fermeture de l'extrémité distale de l'instrument (18), chaque dispositif haptique (8) étant conçu pour commander un bras robotique (15); des moyens de sélection (51) conçus pour activer et désactiver les bras robotiques (15); un moniteur (701) conçu pour présenter une image en 3D.
PCT/ES2016/070475 2016-06-23 2016-06-23 Système robotique chirurgical et procédé de manipulation d'un système robotique chirurgical Ceased WO2017220822A1 (fr)

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