Systems and methods for performing minimally invasive surgery
Inventors
Kostrzewski, Szymon • Nussbaumer, Billy • Villard, Jimmy
Assignees
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Publication Number
US-12042243-B2
Publication Date
2024-07-23
Expiration Date
Abstract
Minimally invasive surgical techniques are used to obtain access to vertebrae while protecting soft tissues in the surrounding area. The dilators may be used to provide a working channel through which the operation is performed. Standard dilators may be used with a robotic surgical system to provide precise guidance of surgical tools. A dilator may be held by the robot and automatically repositioned when the surgeon adjusts a trajectory for performing the surgery. The dilator itself may be used as a surgical instrument guide along with dilator adaptors that adjust the diameter of a portion of the dilator to allow for different sized tools to be guided by the dilator. Alternatively, surgical instrument guides may also be held by the robotic arm such that tools are guided by a surgical instrument guide through the dilator to perform a medical procedure.
Core Innovation
The invention is directed to a robotic surgical system for performing minimally invasive surgery that uses a dilator stack to access a vertebrae through an incision. A first dilator defines a working channel, and one or more subsequent dilators slide over the preceding dilators to increase the size of the working channel. Each dilator except the last added dilator is configured to be removed from the patient, thereby leaving the last added dilator in patient tissue while access is maintained.
The system includes a dilator fixator adapted to be attached to an end effector so that the last added dilator is attached to the dilator fixator. A manipulator with at least four degrees of freedom allows robotically-assisted or unassisted positioning and/or movement of the end effector by a user. During the surgical procedure, the manipulator automatically adjusts an angle and/or position of the attached last added dilator with respect to the vertebrae and aligns an axis defined by the last added dilator with a desired trajectory without removal of the last added dilator from the patient tissue during repositioning.
The manipulator is programmed to be automatically repositioned in response to the user changing the desired trajectory during the surgical procedure. The system further supports constraining tool movement using guidance options in which the dilator and/or a surgical instrument guide constrains movement toward drill/tap/screw/awl/implant guide functions, and it includes elements for planning and assisting trajectory alignment with patient images and real-time feedback.
Claims Coverage
The provided independent claim defines five main inventive areas: a dilator stack with a last added dilator left in place, a dilator fixator coupling the last dilator to a robot end effector, a manipulator with at least four degrees of freedom that reorients the attached last dilator to align an axis with a desired trajectory without removal during repositioning, automatic manipulator repositioning when the user changes the desired trajectory, and a minimally invasive spinal workflow that accesses a vertebrae through an incision via a working channel defined and enlarged by dilators.
Dilator stack leaving a last added dilator in place
A first dilator accesses a vertebrae and defines a working channel, and one or more subsequent dilators sized and shaped to slide over the first dilator enlarge the working channel, where each dilator except the last added dilator is removed from the patient and the last added dilator remains.
Dilator fixator attaching the last added dilator to an end effector
A dilator fixator adapted to be attached to the end effector, where the last added dilator is configured to be attached to the dilator fixator.
Four-plus degree manipulator for axis alignment to a desired trajectory without removal
A manipulator with at least four degrees of freedom that allows robotically-assisted or unassisted positioning and/or movement of the end effector, automatically adjusting an angle and/or position of the attached last added dilator with respect to the vertebrae and aligning an axis defined by the last added dilator with a desired trajectory during the surgical procedure without removal of the last added dilator from the patient tissue during repositioning.
Automatic repositioning in response to user trajectory changes
The manipulator is programmed to be automatically repositioned in response to the user changing the desired trajectory during the surgical procedure.
Image-based trajectory determination and acknowledgement of desired trajectory
The system uses a processor and memory to store an image-to-anatomy transformation, determine an ideal implant trajectory, and display it on a graphical user interface so the surgeon can adapt the trajectory and acknowledge either the ideal or adapted path for storage as the desired trajectory.
Circumference-based dilator sizing relationship
Each subsequent dilator has a larger circumference than the first dilator, and as each additional dilator is added, the working channel size increases accordingly.
Tool guide tube for slidably guiding a surgical tool through the working channel
A tool guide tube attachable to an end effector alongside the last added dilator, sized to slidably guide a surgical tool through the working channel formed by the last dilator.
Surgical instrument guide selecting drill/tap/screw/awl/implant guide types
A surgical instrument guide configured to be at least one of a drill bit guide, tap guide, screwdriver guide, screw guide, awl guide, and implant guide.
Surgical instrument guide inserted into attached dilator along its axis
A surgical instrument guide is designed to be inserted into an attached dilator, and the guide is sized and shaped to fit at least partially inside the dilator along an axis defined by the dilator.
Overall, the claim coverage emphasizes leaving a last added dilator in place while it is mechanically coupled to a robot end effector, and using a four-plus degree-of-freedom manipulator to automatically align the dilator axis to a desired trajectory without removal during repositioning. Dependent features further cover dilator sizing relationships, additional guiding components, and a trajectory workflow involving image-to-anatomy transformation, ideal or adapted trajectory display, and acknowledgement and storage of a desired trajectory.
Stated Advantages
Aligns an axis defined by the last added dilator with a desired trajectory during a surgical procedure without removal of the last added dilator from patient tissue during repositioning.
Automatically repositions the manipulator in response to the user changing the desired trajectory during the surgical procedure.
Documented Applications
Robotic minimally invasive spinal surgery using dilators to access a vertebrae, form and enlarge a working channel, and prepare for a desired trajectory during surgery.
Planning and assisting an implant trajectory during minimally invasive spinal surgery using medical images and a graphical user interface for surgeon adaptation and acknowledgement or storage of the desired trajectory.
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