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Publication Number
US-9622684-B2
Publication Date
2017-04-18
Expiration Date
Abstract
A neural monitoring system includes an elongate medical instrument, a non-invasive mechanical sensor, and a processor. The elongate medical instrument has a distal end portion configured to extend within an intracorporeal treatment area of a subject, and a plurality of electrodes disposed on the distal end portion. Each electrode is respectively configured to provide an electrical stimulus. The non-invasive mechanical sensor is configured to be placed in mechanical communication with a muscle of the subject and to generate a mechanomyography output signal corresponding to a sensed mechanical movement of the muscle. The processor is provided in communication with the elongate medical instrument and the mechanical sensor, and is configured to receive the mechanomyography output signal, and determine a relative direction between a nerve and the distal end portion of the elongate medical instrument using the received mechanomyography output signal.
Core Innovation
The invention relates to a neural monitoring system that uses an elongate medical instrument having a distal end portion configured to extend within an intracorporeal treatment area of a subject. The elongate medical instrument includes a plurality of electrodes disposed on the distal end portion, where each electrode is configured to provide an electrical stimulus to a nerve innervating a muscle. The system also includes a non-invasive mechanical sensor placed in mechanical communication with the muscle to generate a mechanomyography output signal corresponding to sensed mechanical movement of the muscle.
A processor in communication with the elongate medical instrument and the mechanical sensor provides respective electrical stimulus to each of the plurality of electrodes having a predetermined current magnitude. The processor receives the mechanomyography output signal and triangulates a relative direction between the nerve and the distal end portion of the elongate medical instrument via an amplitude of the received mechanomyography output signal and a current magnitude of each respective electrical stimulus. The triangulated relative direction is derived from the relationship between the nerve, the distal end portion, the mechanomyography amplitude, and the current magnitude of the electrical stimulus.
The system further supports maintaining a three-dimensional nerve map based on triangulated relative direction between the nerve and the distal end portion and on monitored distal-end location within the intracorporeal treatment area. The invention provides visualization using display of the three-dimensional nerve map, and it can merge the nerve map with an anatomical image. In a robotic surgical context, the invention outputs the three-dimensional nerve map to a robotic controller to control or constrain motion, including using virtual barriers and adjusting motion speed based on proximity.
Claims Coverage
The partial content provides two independent claims. Both independent claims share the same core triangulation concept using mechanomyography amplitude together with a predetermined-current electrical stimulus delivered via distal electrodes, while differing mainly in electrode-count and minimum electrode-array structure.
Neural monitoring with distal electrode stimulation and mechanomyography-based triangulation
A neural monitoring system comprising an elongate medical instrument with a distal end portion configured to extend within an intracorporeal treatment area, the elongate medical instrument including a plurality of electrodes disposed on the distal end portion each configured to provide an electrical stimulus; a non-invasive mechanical sensor configured to be placed in mechanical communication with a muscle and to generate a mechanomyography output signal corresponding to sensed mechanical movement of the muscle; and a processor configured to provide a respective electrical stimulus to each of the plurality of electrodes having a predetermined current magnitude, receive the mechanomyography output signal, and triangulate a relative direction between a nerve and the distal end portion via an amplitude of the received mechanomyography output signal and a current magnitude of each respective electrical stimulus, wherein the nerve innervates the muscle.
Neural monitoring with at-least-four distal electrodes and mechanomyography-based triangulation
A neural monitoring system comprising an elongate medical instrument with a distal end portion configured to extend within an intracorporeal treatment area, the elongate medical instrument including at least four electrodes disposed on the distal end portion each configured to provide an electrical stimulus; a non-invasive mechanical sensor configured to be placed in mechanical communication with a muscle and to generate a mechanomyography output signal corresponding to sensed mechanical movement of the muscle; and a processor configured to provide a respective electrical stimulus to each of the at least four electrodes having a predetermined current magnitude, receive the mechanomyography output signal, and triangulate a relative direction between a nerve and the distal end portion via an amplitude of the received mechanomyography output signal and a current magnitude of each respective electrical stimulus, wherein the nerve innervates the muscle.
Across the independent claims, the inventive coverage centers on triangulating a relative direction between a nerve and a distal end portion using mechanomyography signal amplitude and current magnitude from electrical stimulation delivered through distal electrodes on an elongate instrument, with the second independent claim requiring at least four electrodes on the distal end portion.
Stated Advantages
Documented Applications
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