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WO2023248005A1 - Compilation robotique de multiples marqueurs de navigation - Google Patents

Compilation robotique de multiples marqueurs de navigation Download PDF

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Publication number
WO2023248005A1
WO2023248005A1 PCT/IB2022/058991 IB2022058991W WO2023248005A1 WO 2023248005 A1 WO2023248005 A1 WO 2023248005A1 IB 2022058991 W IB2022058991 W IB 2022058991W WO 2023248005 A1 WO2023248005 A1 WO 2023248005A1
Authority
WO
WIPO (PCT)
Prior art keywords
surgical
markers
robotic
small
robotic arms
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/IB2022/058991
Other languages
English (en)
Inventor
Yossi Bar
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.)
Lem Surgical Ag
Original Assignee
Lem Surgical Ag
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 Lem Surgical Ag filed Critical Lem Surgical Ag
Publication of WO2023248005A1 publication Critical patent/WO2023248005A1/fr
Priority to US18/986,447 priority Critical patent/US20250114158A1/en
Anticipated expiration legal-status Critical
Ceased legal-status Critical Current

Links

Classifications

    • 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
    • A61B90/39—Markers, e.g. radio-opaque or breast lesions markers
    • 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
    • A61B34/20—Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
    • 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
    • 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
    • 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
    • A61B34/20—Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
    • A61B2034/2046—Tracking techniques
    • A61B2034/2055—Optical tracking 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
    • A61B34/20—Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
    • A61B2034/2046—Tracking techniques
    • A61B2034/2055—Optical tracking systems
    • A61B2034/2057—Details of tracking cameras
    • 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
    • A61B90/37—Surgical systems with images on a monitor during operation
    • A61B2090/376—Surgical systems with images on a monitor during operation using X-rays, e.g. fluoroscopy
    • 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
    • A61B90/37—Surgical systems with images on a monitor during operation
    • A61B2090/376—Surgical systems with images on a monitor during operation using X-rays, e.g. fluoroscopy
    • A61B2090/3762—Surgical systems with images on a monitor during operation using X-rays, e.g. fluoroscopy using computed tomography systems [CT]
    • 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
    • A61B90/39—Markers, e.g. radio-opaque or breast lesions markers
    • A61B2090/3983—Reference marker arrangements for use with image guided surgery

Definitions

  • the invention relates to systems and methods for surgical robotic navigation. More particularly, the invention relates to systems and methods for accurately tracking and compiling multiple small markers in the surgical field in the robotic surgery context.
  • the systems and methods of the inventive system relate to providing multiple small surgical markers that do not interfere with line of sight and do not otherwise disturb the surgical staff, while providing a convenient methodology for tracking and compiling the markers.
  • multiple robotic arms may be operating in the surgical field and may each be holding surgical tools, while all in close proximity to OR staff and the patient - in this context, multiple large surgical markers can be difficult to deploy and track and so the current invention relates to a system and methods for the deployment, tracking and compiling of multiple, small surgical markers by a multi arm surgical robotic system.
  • Surgical navigation and tracking technology incorporating a camera or sensor and tracked objects like markers or other locators is well known and implemented in several industries and specifically in surgical applications. This is a well-known aspect of many robotic surgical procedures including spinal robotic surgery.
  • markers or locators in robotic surgical procedures are driven and dictated by basic physical laws and are well known. For example, there is a direct correlation between the distance between the camera and the marker to the achieved tacking accuracy - the closer the camera and marker are to each other, the more accurate the tracking capabilities will be. Also, the size of the tracked markers/locators is important. The bigger the marker/locator is (in relation to the relevant body/anatomy/field and the distance from the camera) the more accurate will be the tracking results. In the medical and surgical fields, navigation/tracking technology is commonly used in multiple ways. One well established method in the surgical field is to place in the vicinity of the patient a camera/sensor on a designated cart or fixed somehow to the wall, ceiling etc.
  • a marker with a certain size and shape is attached/fixed to the relevant anatomy of the patient (e.g., skin, head, vertebrae etc.).
  • An additional marker with a specific shape and size can be attached to the surgical tool. In this way, the navigation/tracking system can track the correlation and relative location between the surgical tool and the relevant portion of anatomy.
  • the tracked markers In conventional medical and surgical applications, the tracked markers must be “big enough” (e.g., minimum 7-10 cm) in order to provide the required accuracy (e.g., l-2mm at tool tip) when the camera is placed at a standard distance from the patient (e.g., 1.5-2.5 meters). In a surgical field, having several of these large and bulky markers is very limiting and disturbing to the surgeon. Big markers can theoretically facilitate high accuracy but can also easily deflect (if for example they are placed on small vertebra) or if the surgeon accidently makes contact with them or by mere gravitational deflection.
  • Robotic spinal surgery is one example of an area that would benefit from this approach, but any surgical discipline where the presence of multiple large markers is disturbing will benefit from a smaller system and methods.
  • a multi-arm surgical robotic system comprising at least two robotic arms.
  • at least one arm is responsible for surgical tasks and at least one arm is used to carry and operate at least one camera as part of a robotic navigation system.
  • the at least two robotic arms are optimally mounted on a single chassis that houses a central controller that governs movement of the robotic arms.
  • several small markers may be deployed in the surgical field and may function as individual markers or as an array of markers that can be registered to the anatomical region and tracked by the navigation capabilities of the surgical robotic system.
  • the markers may be robotically and mathematically compiled such that they form one large marker in the surgical field but nevertheless each individual marker cause minimal interference or obstruction with the surgical operation.
  • a system for tracking and compiling multiple, small surgical markers comprises at least two robotic arms based on a single point of origin with a central control unit coordinating the movement of the arms. At least one of the robotic arms carries at least one surgical tool and at least one of the robotic arms carries at least one navigation camera/sensor.
  • at least one surgical marker may be placed on at least one arm carrying the surgical tool or on the surgical tool itself.
  • One or more small (e.g. 1- 5cm) surgical markers may be placed in the surgical field on the patient anatomy of interest. In one example, one or more small surgical markers are placed on multiple vertebrae or multiple vertebrae aspects.
  • the surgical navigation camera/sensor may be held and manipulated closer than conventional surgical navigation cameras, for example at 1 meter or less from the patient anatomy of interest.
  • This inventive system is able to track the patient anatomy of interest, and optionally a surgical tool, without unduly interfering with the surgical field or the surgeon’s view of the field, due to the use of several small markers.
  • a different multi-arm system for tracking and compiling multiple, small surgical markers.
  • the system comprises at least three robotic arms based on a single point of origin with a central control unit coordinating the movement of the arms. At least two of the robotic arms carries a surgical tool and one of the robotic arms carries a navigation/tracking camera/sensor.
  • a surgical marker may be placed on the arms carrying the surgical tools or on the surgical tools themselves.
  • One or more small surgical markers may be placed in the surgical field on the patient anatomy of interest. In one example, one or more small surgical markers are placed on multiple vertebrae or multiple vertebrae aspects.
  • the surgical navigation camera may be held and manipulated closer than conventional surgical navigation cameras, for example at 1 meter or less from the patient anatomy of interest.
  • the robotic arms holding surgical tools may be deployed into the surgical field to carry out various surgical procedures, including robotic spinal surgery procedures.
  • This inventive system is able to track the patient anatomy of interest, and optionally multiple surgical tools, without unduly interfering with the surgical field or the surgeon’s view of the field, due to the use of several small markers.
  • the inventive embodiments employ surgical navigation cameras held relatively close to the surgical field (1 meter or less from the anatomy of interest), it is still the case that the use of small markers can be constraining (one of skill in the art understands that larger surgical markers facilitate greater tracking accuracy).
  • multiple small markers may be mathematically compiled to virtually present one or more larger markers to the navigation camera.
  • small markers are used and placed on the patient anatomy of interest and, optionally, on surgical tools or on the robotic arms themselves - in this way, the small markers are not interfering with the view of the anatomy of interest.
  • the compilation of the small markers provides added accuracy because the navigation camera (held relatively close to the anatomy of interest, at 1 meter or less) “sees” a larger marker due to the mathematical compilation and, thus, greater accuracy is provided.
  • the inventor is referring to a mathematical transformation that, for navigation purposes, turns multiple small markers into one larger marker which can facilitate higher accuracy.
  • markers tracking In another embodiment of this invention, another form of small marker’s tracking can be described.
  • one of the significant drawbacks in the basic technique of markers tracking is the need to view all the relevant markers in one single camera frame. So as an example, in standard surgical technique, the camera needs to see in one view the patient markers, the robotic markers and the tools markers.
  • each marker size can be of a minimum of 1 Ocm and all three mentioned markers together creates now a very large array that the navigation camera needs to see in one image. This is a significant problem that is very cumbersome and does not allow the area of surgical navigation to progress. Moreover it forces the navigation system user to place the navigation camera relatively far (e.g., farther than 1.5m) which is again cumbersome and also effect accuracy.
  • the navigational arm can take several single images with each marker independently and robotically and mathematically compile it to one markers array. Meaning, no need to see all the markers in one single image.
  • the robotic navigation camera can take one image of a marker or more than robotically moves to take another image of the next or rest of the markers in the field. Since the coordinates systems are synchronized the controller can calculate the coordinate system transformation from one image to the other and compile it to one image.
  • the multiple small markers are not compiled to one marker but the over coordinates system is compiled to one coordinate system.
  • Figure 1 shows a multi arm robotic system with the use of navigation and markers according to an embodiment of the present invention.
  • Figure 2 shows the mathematical compilation of multiple surgical markers into one large marker according to an embodiment of the present invention.
  • the following novel system and method is comprised of a multi-arm surgical robotic system with an exemplary embodiment in Figure 1, in which at least one arm is responsible for the surgical tasks 101, 102 and at least one arm 103 is used to carry and operate at least one camera/sensor 104 as part of a navigation/tracking system.
  • the robotic arms are mounted on the same rigid mechanical chassis and are robotically calibrated, synchronized and coordinated in relation to each other and governed by one central controller.
  • each marker can function as a “stand alone marker” but also as part of an “array of markers” (201 in Fig 2). i.e., two or more markers can be compiled and comprise together one large marker.
  • the need is for large markers in order to achieve high accuracy but large markers disturb, deflect and by that are actually counter-productive.
  • the multi arm robotic system in which the robotic surgical arms are robotically synchronized with the robotic arm which holds the navigation camera several separate markers can be navigationally and mathematically compiled and can be used to comprise one large marker and even extremely large (e.g., bigger than 20 cm).
  • the robotic arms are equipped with single small markers and the robotic arms are positioning the markers in a precise and specific location in space that is creating a precise and predetermined pattern of a large compiled marker.
  • Each surgical robotic arm is equipped with at least one small marker. Regardless of its specific size, it can be said more generally that it is in such a size which may not be big enough to achieve the required accuracy if it would be used as a “stand alone marker” (for example, smaller than 5 cm) in some applications. Accordingly, when the robotic arm with camera is tracking one marker (placed on one surgical robotic arm), a certain level of accuracy is achieved. Having said that, in a certain coordinated robotic arm combination the robotic arm holding the camera places the camera in a certain precise position in space and also the two surgical robotic arms, each carrying at least one small marker, and the surgical arms with the small markers creates now an array of two markers that the controller can identify as one unified large marker, which of course now facilitates much higher tracking accuracy.
  • this compiled large marker created from several small markers (e.g., each single marker is smaller than 5 cm but the compiled marker can at least be bigger than 10 cm) will facilitate higher accuracy with its larger compiled size.
  • the robotic arms are sharing the same rigid chassis and being robotically calibrated and synchronized together to achieve the predetermined level of accuracy.
  • the controller can send the robotic arms to a nonrandom, predetermined deterministic positions in space in it the robots were calibrated in the factory and by that to use the “repeatable accuracy” of the robotic arms.
  • a ‘repeatable accuracy’ of industrial robots is much higher than in any random location in space what will insure very high accuracy of the positions of the arms.
  • a second representative embodiment is now provided incorporating the concept of a compiled single marker being made up of two smaller markers.
  • one small marker e.g., smaller than 5cm
  • spine surgery it is very limiting to place large markers on the delicate and flexible vertebrae.
  • one possible option is to place 2 or more small markers, for example one marker on one vertebra and a second small marker several vertebrae above or below.
  • each marker can be tracked by the camera as a ‘stand-alone’ marker with its relative accuracy coming from its relatively small size.
  • the camera is robotically maneuvered and controlled and registered to the anatomy together with the rest of the robotic arms (e.g., through CT, X-ray scan). Accordingly, the system controller knows the camera’s location in space and the markers’ location in space. Also at the beginning the controller will capture and save first preliminary position of the markers as basic reference.
  • the controller can position the robotic arm with the camera in a precise and specific location in space in relation to the two markers. In this specific location in space the two small markers create a specific pattern of the large compiled marker with a high accuracy. The controller knows and governs this and can captures this large marker.
  • a third representative embodiment is a possible combination of the two example above. Meaning, in the surgical field where there are one or more small markers fixed to the anatomy and registered to it, thus creating together a large compiled marker, one or more additional smaller markers are introduced by one or more surgical robotic arms which are also registered to the anatomy.
  • This compiled large marker can be even much larger and can be comprised of two, three, four or more markers covering a very large area and integrating together into a very large marker (larger than 20 cm).
  • a forth representative embodiment is not a compilation of a large marker from two or more small markers but rather a compilation of several coordinates systems of several small markers.
  • the single controller knows at any given point the location of all the robotic arms and markers. Knowing this, in this system the navigation camera doesn’t have to see all the markers together in a single image.
  • the robotic arm can position the camera in an optimal position to capture one or more small markers and then move it to capture the rest. This way the robotic system can capture several small markers and compile all their coordinate systems.

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

Abstract

L'invention concerne des systèmes et des procédés de navigation robotique chirurgicale. L'invention concerne des systèmes et des procédés pour suivre et compiler avec précision de multiples marqueurs dans le champ chirurgical dans le contexte de chirurgie robotique. De multiples petits marqueurs chirurgicaux sont décrits qui n'interfèrent pas avec la ligne de visée et ne perturbent pas autrement le personnel chirurgical, tout en fournissant une méthodologie pratique et hautement précise pour le suivi et la compilation des marqueurs. Des systèmes de chirurgie robotique à bras multiples sont décrits dans divers modes de réalisation qui maintiennent des outils chirurgicaux et des caméras de navigation et utilisent de manière optimale plusieurs petits marqueurs chirurgicaux placés sur l'anatomie d'un patient d'intérêt, des outils chirurgicaux et les bras robotiques. Les petits marqueurs chirurgicaux sont compilés mathématiquement de telle sorte que les caméras de navigation voient un marqueur chirurgical plus grand, fournissant ainsi une plus grande précision. Les systèmes de l'invention sont déployés dans divers procédés chirurgicaux, y compris des procédures robotiques très précises dans la chirurgie rachidienne et d'autres disciplines chirurgicales.
PCT/IB2022/058991 2022-06-23 2022-09-22 Compilation robotique de multiples marqueurs de navigation Ceased WO2023248005A1 (fr)

Priority Applications (1)

Application Number Priority Date Filing Date Title
US18/986,447 US20250114158A1 (en) 2022-06-23 2024-12-18 Robotic compilation of multiple navigation markers

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US202263355016P 2022-06-23 2022-06-23
US63/355,016 2022-06-23

Related Child Applications (1)

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US18/986,447 Continuation-In-Part US20250114158A1 (en) 2022-06-23 2024-12-18 Robotic compilation of multiple navigation markers

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Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20030125622A1 (en) * 1999-03-16 2003-07-03 Achim Schweikard Apparatus and method for compensating for respiratory and patient motion during treatment
US20080201016A1 (en) * 2005-07-06 2008-08-21 Prosurgics Limited Robot and Method of Registering a Robot
CN105764442B (zh) * 2013-11-11 2019-08-16 阿斯卡拉波股份有限公司 外科的参照设备、外科的导航系统和方法
US20210244481A1 (en) * 2019-04-29 2021-08-12 Smith & Nephew, Inc. Multi-level positional tracking
WO2021250580A1 (fr) * 2020-06-10 2021-12-16 Mazor Robotics Ltd. Système robotique à bras multiples permettant une chirurgie endoscopique multiportail

Patent Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20030125622A1 (en) * 1999-03-16 2003-07-03 Achim Schweikard Apparatus and method for compensating for respiratory and patient motion during treatment
US20080201016A1 (en) * 2005-07-06 2008-08-21 Prosurgics Limited Robot and Method of Registering a Robot
CN105764442B (zh) * 2013-11-11 2019-08-16 阿斯卡拉波股份有限公司 外科的参照设备、外科的导航系统和方法
US20210244481A1 (en) * 2019-04-29 2021-08-12 Smith & Nephew, Inc. Multi-level positional tracking
WO2021250580A1 (fr) * 2020-06-10 2021-12-16 Mazor Robotics Ltd. Système robotique à bras multiples permettant une chirurgie endoscopique multiportail

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