KR20180082479A - Methods for Percutaneous Surgery - Google Patents

Abstract

A method of performing a percutaneous operation on a patient to remove an object from a cavity within the patient is described. The method includes advancing the first alignment sensor through the lumen of the patient into the cavity. The first alignment sensor provides its position and orientation in free space in real time. The alignment sensor is operated until it is close to the object. A surgical tool is used to create a percutaneous opening in the patient, and the surgical tool includes a second alignment sensor that provides the position and orientation of the surgical tool in free space in real time. The surgical tool is moved toward the object using data provided from both the first and second alignment sensors.

Description

Methods for Percutaneous Surgery

Cross reference to related application

This application claims the benefit of U.S. Provisional Patent Application No. 62 / 248,737, filed October 30, 2015; U.S. Provisional Patent Application 62 / 248,851, filed October 30, 2015; And U.S. Provisional Patent Application No. 62 / 249,050, filed October 30, 2015, each of which is incorporated herein by reference in its entirety.

1. Technical Field

This description relates generally to surgical robots, and more particularly to performing lithotripsy using a surgical robotic system.

2. Description of Related Technology

Doctors conduct thousands of procedures annually to remove urinary tract stones from the patient's urinary tract. Urinary stones include kidney stones as well as kidneys and ureters as well as bladder stones. These urinary stones are formed by the accumulation of minerals and cause significant abdominal pain when they become large enough to interfere with the urine flow of the ureters and urethra. Urinary stones can be formed of calcium, magnesium, ammonia, uric acid, cysteine or other components.

The doctor inserts the ureter into the urethra through the urethra to remove urinary stones with bladder and ureter. Usually, the ureteroscope includes an endoscope at the distal end, allowing visualization of the urinary tract. The ureter also includes a lithotomy mechanism to trap or break urinary stones. During the procedure, one doctor controls the position of the ureter, while the other doctor controls the lithotomy mechanism. The control device of the ureter is located on the proximal handle of the ureter, making it difficult to hold it when the direction of the ureter is changed. Therefore, current contouring technology is a burden on the body and it relies on a non-ergonomic design.

To remove large kidney stones from the kidneys, doctors use percutaneous nephrolithotomy techniques to pierce the skin and insert the kidneys to break up and remove kidney stones. However, current percutaneous nephrolithography ("PCNL") techniques include the use of fluoroscopic techniques to locate kidney stones and accurately insert the kidneys. Fluorescent vision increases the cost of a new lithotripsy procedure because it costs not only the cost of the fluoroscopy itself, but also the input of a skilled technician to operate the fluoroscope. Fluoroscopy also exposes the patient to radiation for extended periods of time. Even with fluoroscopy, it is difficult and inaccurate to perform accurate skin incision to access kidney stones. In addition, the current new lithotripsy technique usually involves two or three days of hospitalization. Ultimately, current nephrocalcification techniques cause costs and problems for patients.

The present description includes methods and apparatus for more easily performing the uroflow test. The present disclosure also includes methods and apparatus for facilitating PCNL. In the yore examination, the basket device includes several independently operable pull wires to allow complete 360-degree movement of the basket, which facilitates stone capture. The central working channel of the basket device allows a variety of tools to be placed near the basket to break up the trapped stones. In addition, techniques to help prevent stones from escaping while the basket is closed in the urethroplasty test are described.

Various techniques and apparatus for using an alignment sensor instead of fluoroscopy to detect the location of stones in the kidney in PCNL are described. The alignment sensor can be used, for example, as an EM sensor in conjunction with an electromagnetic field generator located in the patient's vicinity and an associated CT (or other) scan to provide position and orientation information of the EM sensor in the patient's body. The alignment sensor is located in the ureter through a cavity such as the ureter and is used with the camera to identify the location of the stone. The alignment sensor provides a guidance mechanism that directs a percutaneous incision to access the stones in the kidney. In addition, since the endoscope has already been inserted at the present time of the PCNL procedure, other tools can be advanced using the operation channel of the endoscope to support the removal of the stones through the port generated by the PCNL. A description of how to remove stones via the PCNL port as well as the implementation of PCNL is described. Although this description is generally described in connection with the exemplary use cases of the ureteroscopy and PCNL and urinary stone and stone remnants, these explanations suggest that removal of the body of the patient, such as gallbladder removal or lung (lung / thoracic) And it includes any object that can be safely removed through the cavity of the patient (such as the esophagus, ureter, bowel, etc.) or through the transcutaneous approach.

1A shows an example of a surgical robot system according to one embodiment.
1B is a perspective view of a surgical robot system with a robotic arm mounted to a column according to one embodiment.
2 shows an example of a command console for an example surgical robot system 100 according to one embodiment.
3A illustrates multiple angles of endoscopic operation in accordance with one embodiment.
3B is a top view of an endoscope according to an embodiment.
3C is an isometric view of the distal end of an endoscopic reader in accordance with one embodiment.
Figure 3D is an isometric view of an instrument device manipulator of a surgical robot system according to one embodiment.
FIG. 3E is an exploded assembly isometric view of the instrument device actuator shown in FIG. 3D in accordance with one embodiment.
4A is a perspective view of a surgical robot system with an arm mounted on a column configured to approach the lower half of a simulated patient according to one embodiment.
4B is a top view of a surgical robot system with an arm mounted on a column configured to approach the lower half of a simulated patient according to one embodiment.
4C is a perspective view of a surgical robot system with an imaging device according to one embodiment and an arm mounted on a column configured to access a lower half of a patient.
4D is a top view of a surgical robot system with an imaging device according to one embodiment and an arm mounted on a column configured to access the lower half of the patient.
5A is a side view of a basket device according to one embodiment.
Figures 5B and 5C illustrate how a basket device may be used to capture kidney stones according to one embodiment.
5D illustrates a perspective view of a robotic steerable basket apparatus according to one embodiment.
5E shows a top view of a robotically steerable basket device on the assumption that it is straight along a plane perpendicular to the central axis of the outer shaft according to one embodiment.
5F shows a close-up view of the distal end of the outer shaft of the basket device according to one embodiment.
6A shows an embodiment in which the basket is rounded.
Figure 6B shows an embodiment in which the basket is shaped to be in the form of a jaws.
Figure 6C shows an embodiment in which the basket is of a spiral or spiral full wire.
FIG. 7A illustrates the incidence of a laser or optical fiber to break up captured stones in accordance with one embodiment.
Figure 7B illustrates the insertion of a mechanical drill to break up captured stones in accordance with one embodiment.
Figures 7C-7D illustrate the use of a chisel to fracture trapped stones in accordance with one embodiment.
7E illustrates the use of a high pressure fluid jet to break up captured stones in accordance with one embodiment.
Figures 8A-8C illustrate important problems that an operator may encounter during basket operation according to one embodiment.
FIGS. 8D to 8F illustrate a process of overcoming the problem of stones trapping using a basket according to an embodiment.
Figures 9A-9F illustrate the process of positioning and controlling the basket device to capture stones (and stone particles) during a robotic assisted contouring examination according to one embodiment.
FIGS. 10A-10E illustrate an example of a PCNL process including a prostate diameter with an electromagnetically coupled sensor for identifying the location of the stones according to one embodiment.
11A-11D illustrate examples of graphs showing matching an EM system in accordance with an embodiment with an on-the-fly approach to a 3D model of a tubular network internal path.
Various embodiments are specifically referenced and illustrative examples thereof are shown in the accompanying drawings. Note that similar or identical reference numerals may be used anywhere in the drawings and may indicate similar or equivalent functions. The drawings depict embodiments of the disclosed system (or method) solely for purposes of illustration. It will be readily understood by those skilled in the art that alternative embodiments of the structures and methods described herein can be applied without departing from the principles set forth herein.

I. Overview

I.A. Surgical Robot System

1A shows an embodiment of a surgical robot system 100. Fig. The surgical robot system 100 includes a base 101 coupled with one or more robot arms, such as a robot arm 102. The base 101 is in communication connection with the command console and is further described herein with respect to FIG. The base 101 is positioned so that the robot arm 102 provides access to the patient to perform surgical procedures and at the same time allows a user such as a doctor to conveniently control the surgical robot system 100 using a command console . In some embodiments, the base 101 may be associated with a surgical table or bed that can seat the patient. Although not shown in FIG. 1 for the sake of clarity, the base 101 may include control electronics, pneumatics, power supplies, optical sources, and such subsystems. The robot arm 102 includes a plurality of arm segments 110 connected by a joint 111. The robot arm 102 is provided with a plurality of degrees of freedom Lt; / RTI > The base 101 includes a control and sensor electronics 114 that includes components such as a power supply 112, an air pressure 113, a central processing unit (CPU), a data bus, control electronics, memory, Such as a motor, that moves the actuators 102. The electronic device 114 in the base 101 may process and transmit control signals in communication with the command console.

In some embodiments, the base 101 includes a wheel 115 for moving the surgical robot system 100. The mobility of the surgical robot system 100 is suitable for space-constrained operating room environments as well as helping to position and move the surgical device in place. Further, the robot arm 102 can be configured such that the robot arm 102 is not disturbed by a patient, a doctor, an anesthesiologist, or any other device through mobility. During the procedure, the user can control the robot arm 102 using a control device such as a command console.

In some embodiments, the robot arm 102 includes a set up joint that uses a combination of brake and counter-balance to maintain the position of the robot arm 102 intact. The counter-balance may comprise a gas spring or a coil spring. Brakes, such as fail-safe brakes, may consist of mechanical and / or electrical components. In addition, the robot arm 102 may be a gravity-assisted passive support type robot arm.

Each robot arm 102 may be coupled to an Instrument Device Manipulator (IDM) 117 via a Mechanism Changer Interface (MCI) IDM 117 can be removed and replaced with other types of IDM, such as a first type of IDM that manipulates an endoscope, or a second type of IDM that otherwise manipulates the laparoscope. The MCI 116 includes connectors for sending air pressure, power, electrical signals, and optical signals from the robotic arm 102 to the IDM 117. The MCI 116 may be a set screw or a base plate connector. IDM 117 may be a surgical instrument such as endoscope 118 using techniques such as direct drive, harmonic drive, gear drive, belt and pulley, magnetic drive, Also referred to as a surgical tool). The MCI 116 may be interchanged depending on the type of IDM 117 and may be tailored to certain types of surgical procedures. The robot arm 102 may include a joint level torque sensing portion and wrist at its distal end, such as a KUKA AG® LBR5 robot arm.

Endoscope 118 is a tubular soft surgical instrument that is inserted into a patient's anatomy to image anatomical structures (such as human tissue). In particular, the endoscope 118 includes one or more imaging devices (e.g., a camera or sensor) to take an image. The imaging device may comprise one or more optical components, such as an optical fiber, an array of optical fibers, or a lens. The optical component moves along the tip of the endoscope 118 so that the image taken by the imaging device can be changed in accordance with the movement of the end of the endoscope 118. [ An example of the endoscope 118 is IV. The endoscope section is further described with reference to Figs. 3A to 4B.

The robot arm 102 of the surgical robot system 100 operates the endoscope 118 using the elongated moving member. The elongated member may include a pull wire, a cable, a fibrous tissue, or a flexible shaft, also referred to as a push or pull wire. For example, the robot arm 102 actuates a plurality of pull wires coupled to the endoscope 118 to change the direction of the end of the endoscope 118. The pull wire may include both metals and non-metals such as stainless steel, Kevelar, tungsten, carbon fiber, and the like. When the force is applied by the elongated moving member, the endoscope 118 exhibits a nonlinear behavior. The nonlinear behavior will be due to the variability in stiffness or stiffness between the elongated moving members as well as the rigidity and compressibility of the endoscope 118.

1B is a perspective view of a surgical robot system 100A with an arm mounted on a column according to one embodiment. The surgical robot system 100A includes a robot arm 102, a column ring set, a table 119, a column 121 and a base 123. [

The table 119 supports the patient undergoing surgery using the surgical robot system 100. Generally, the table 119 is level with the floor, but the orientation and configuration of the table 119 may be altered to facilitate various surgical procedures. The table may be rotated about the patient's abscissa or may be tilted along the patient's longitudinal axis using one or more center points between the table (119) and the column (121). The table 119 may include a rotating portion, a folding portion, or both to change the configuration of the upper surface of the table 119 supporting the patient. Table 119 may include a trapdoor to facilitate drainage of bodily fluids or other fluids that occur during a surgical procedure.

One end of the column 121 is coupled to the table 119 and the other end is coupled to the base 123. Typically, the column 121 has a cylindrical shape to accommodate one or more of the column rings 105 associated with the column 121; However, the column 121 may be another shape such as an ellipse or a rectangle. The column ring 105 is movably engaged with the column. For example, the column ring 105 may move vertically along the axis of the column 121, rotate horizontally about the axis of the column 121, or both. The column ring 105 is described in more detail below with respect to FIG. The column can be rotated about the base 123 about the center axis of the column using a rotating mechanism.

The base 123 is parallel to the floor and supports the column 121 and the table 119. The base 123 may include wheels, treads or other means for positioning or moving the surgical robot system 100. The base 123 can be received in a reservoir, such as a set of robotic arms 102, one or more column rings 105, or both, as part of the inactive configuration, removable housings (not shown). The base 123 may include a rail (not shown) as an alternative or supplement to the column ring 105, to which the robot arm 102 may be movably coupled.

Generally, the robotic arm set includes one or more robotic arms 102 associated with one or more column rings 105, such as column rings 105A. The robot arm 102 attached to the column 105 may be referred to as a robot arm 102 mounted on the column. The surgical robot system 100A uses the robot arm 102 to perform a surgical procedure on a patient lying on the table 119. [

Further description and construction of the table 119, the column 121, the base 123, the column ring 105 and the robotic arm 102 are described in U.S. Patent Application No. 15 / 154,765, filed May 13, No. 15 / 154,762, filed May 13, 2016, each of which is incorporated herein by reference. For example, an alternative surgical robot system includes a first robotic arm 102 mounted on a column ring 105 and a second robotic arm mounted on a rail included in the base 123.

2 shows an example of a command console 200 for an example of a surgical robot system 100 according to one embodiment. The command console 200 includes a console base 201, a display module 202 such as a monitor and a control module such as a keyboard 203 and a joystick 204. In some embodiments, one or more of the command module 200 functions may be integrated into the surgical robot system 100 or the base 101 of another system in communication with the surgical robot system 100. A user 205 such as a doctor remotely controls the surgical robot system 100 using the command console 200 in an ergonomic posture.

The console base 201 comprises a central processing unit responsible for analyzing and processing signals such as image and alignment sensor data received from the basic components of a computer system, such as the endoscope 118 shown in Figure 1, a memory device, Bus, and associated data communication ports. In some embodiments, both the console base 201 and the base 101 perform signal processing for load-balancing. The console base 201 may also process commands and instructions entered from the user 205 via the control modules 203, The control module captures hand gestures and finger movements (such as motion sensors or cameras) as well as the keyboard 203 and joystick 204 shown in FIG. 2, as well as a computer mouse, track pad, track ball control pad, Or other devices such as sensors for measuring the temperature of the liquid.

The user 205 may control the surgical instrument such as the endoscope 118 using the command console 200 set to the speed mode or the position control mode. In the speed mode, the user 205 directly controls the pitch, yaw movement at the distal end of the endoscope 118 using the control module based on direct manual control. For example, the movement of the joystick 204 may be mapped to the yaw, pitch movement of the distal end of the endoscope 118. The joystick 204 conveys haptic feedback to the user 205. For example, vibration occurs in the joystick 204 to indicate when the endoscope 118 can no longer move or rotate in a specific direction. The command console 200 may also provide visual feedback and / or audio feedback (such as a beep) when the endoscope 118 reaches a maximum of movement or rotation (such as a pop-up message).

In the position control mode, the command console 200 controls a surgical instrument such as the endoscope 118 using a three-dimensional (3D) map of the patient and a predetermined computer model of the patient. The command console 200 sends a control signal to the robot arm 102 of the surgical robot system 100 to manipulate the endoscope 118 to the target position. Since the position control mode relies on the 3D map, accurate anatomical mapping information of the patient is required.

In some embodiments, the user 205 may manually manipulate the robotic arm 102 of the surgical robot system 100 without using the command console 200. While setting the operating room, the user 205 may move the robot arm 102, the endoscope 118, and other surgical equipment to allow access to the patient. Surgical robot system 100 may rely on force feedback and inertial control of user 205 to properly configure robot arm 102 and equipment.

Display module 202 may include a virtual reality viewing device such as an electronic monitor, goggles, glasses, and / or other display device means. In some embodiments, the display module 202 may be integrated with a control module such as, for example, a tablet device with a touch screen. In addition, the user 205 may view the visual data using the integrated display module 202 and the control module and may input commands to the surgical robot system 100. Display module 202 enables display of a graphical user interface (GUI) that displays information regarding the location and orientation of various devices operating in the patient's body based on information provided by one or more alignment sensors. This information is received by an electrical wire or transmitter associated with the sensor and is transmitted to the console base 201, which processes the information to display information via the display module 202.

The display module 202 may display a 3D image using a stereoscopic device such as a visor or goggles. Provides a 3D image of a patient ' s anatomy, a computer 3D model, " endo view, " The " end view " provides the virtual environment within the patient's body and the expected location of the endoscope 118 within the patient. The user 205 can adapt to the environment by comparing the " end view " model with the actual camera captured image and determine whether the endoscope 118 is in the correct or nearly correct position within the patient. &Quot; Endo view " provides information about the anatomy, such as the shape of the patient's bowel and colon, around the distal end of the endoscope 118. The display module 202 may simultaneously display a 3D model and a computer tomography (CT) photograph of the anatomical structure around the distal end of the endoscope 118. In addition, the display module 202 may overlay the predetermined optimal navigation path of the endoscope 118 on the 3D model and the CT scan.

In some embodiments, the endoscope 118 model is shown with a 3D model to help indicate the status of the surgical procedure. For example, a CT scan identifies lesions that may require biopsy in anatomical structures. During the operation, the display module 202 can display a captured image of the endoscope 118 corresponding to the current position of the endoscope 118 as a reference. The display module 202 may automatically display different views of the endoscope 118 model according to user settings and certain surgical procedures. The display module 202 shows an overhead fluoroscopic view of the endoscope 118 during a navigational procedure where, for example, the endoscope 118 approaches the patient's surgical site.

I.B. Endoscope

3A shows a plurality of angles of endoscope 118 operation in accordance with one embodiment. The tip 301 of the endoscope 118 is oriented in zero deflection relative to the longitudinal axis 306 (also referred to as the roll axis 306), as shown in Figure 3A. To capture an image in the other direction of the tip 301, the surgical robot system 100 includes a tip 301 in a positive direction 302 of the yaw axis, a negative direction 303 in the yaw axis, 304) and biases the pitch axis about the negative direction (305) or the roll axis (306). The distal end 301 or body 310 of the endoscope 118 may be elongated or moved about a longitudinal axis 306, an x-axis 308, or a y-

The endoscope 118 includes a reference structure 307 for measuring the position of the endoscope 118. For example, the surgical robot system 100 measures the deflection of the endoscope 118 relative to the reference structure 307. The reference structure 307 may be located at the proximal end of the endoscope 118 and may include a key, a slot, and a flange. Reference structure 307 is coupled with a first drive mechanism for initial measurement and is coupled with a second drive mechanism, such as IDM 117, to perform surgical procedures.

3B is a top view of the endoscope 118 according to one embodiment. The endoscope 118 includes a tubular component leader 315 (or leadercope) that is vertically aligned with the tubular component sheath 311 and completely or partially overlaps inward . The sheath 311 includes a proximal sheath portion 312 and a distal sheath portion 313. The leader 315 is smaller in outer diameter than the sheath 311 and includes a proximal leader portion 316 and a distal leader portion 317. The sheath base 314 and the reader base 318 operate the distal sheath portion 313 and the distal leader portion 317, respectively, based on, for example, the control signal of the user of the surgical robot system 100. The sheath base 314 and the reader base 318 are, for example, part of the IDM 117 shown in FIG.

The sheath base 314 and the reader base 318 both control the pull wires coupled to the sheath 311 and the reader 315 Mechanism), as shown in FIG. For example, the sheath base 314 generates a tensile load on the pull wire coupled with the sheath 311 to change the direction of the distal sheath portion 313. Likewise, the reader base 318 generates a tensile load on the pull wires associated with the reader 315 to change the orientation of the distal leader portion 317. Both the sheath base 314 and the reader base 318 may also include couplings for delivering air pressure, power, electrical signals, or optical signals to the sheath 311 and the reader 314 at the IDM, respectively. The pull wire may include a steel coil pipe along the length of the pull wire inside the sheath 311 or the leader 315 which may cause axial compression with a source of load such as a sheath base 314 or a leader base 318 And pass it back.

Because of the multiple degrees of freedom provided by the pull wires coupled to the sheath 311 and the reader 315, the endoscope 118 relatively easily navigates the anatomy of the patient. For example, four or more pull wires may be used in the sheath 311 and / or the reader 315 and thus provide eight or more degrees of freedom. In another embodiment, up to three pull wires may be used and thus up to six degrees of freedom may be provided. The sheath 311 and the reader 315 can be rotated 360 degrees along the longitudinal axis 306 and thus provide more angular movement. When the rotation angle and the plurality of degrees of freedom are combined, the user of the surgical robot system 100 can more easily and intuitively control the endoscope 118.

3C is an isometric view of the distal end of the endoscope 118 reader 315 according to one embodiment. The reader 315 includes at least one working channel 343 and a pull wire extending through the conduit along the length of the wall. For example, the pull wire may include a helical portion that helps to alleviate the muscling and curve alignment phenomenon of the reader 315. The reader 315 may include an imaging device 349 such as a charge coupled device (CCD) or complementary metal oxide semiconductor (CMOS) camera, an imaging fiber bundle, etc.), a light emitting diode (LED) A light source 350 (such as an optical fiber), and at least one working channel 343 for other components. Other components include, for example, camera wires, injection devices, suction devices, electrical wires, optical fibers, ultrasonic transducers, electromagnetic (EM) sensing components, optical coherence tomography (OCT) sensing components. In some embodiments, the reader 315 includes a cavity extending along the longitudinal axis of the reader 315 to create a working channel 343 that accommodates insertion of other devices, such as surgical instruments.

I.C. Mechanism Device Actuator

3D is an isometric view of the instrumental device actuator 117 of the surgical robot system 100 according to one embodiment. The robot arm 102 is coupled to the IDM 117 through an articulating interface 301. The IDM 117 is coupled to the endoscope 118. The connection interface 301 receives the air pressure, the power signal, the control signal, and the feedback signal from the robot arm 102 and the IDM 117. The IDM 117 may include a gearhead, a motor, a rotary encoder, a power supply circuit, and a control circuit. The base 303, which receives control signals from the IDM 117, is coupled to the proximal end of the endoscope 118. In response to the signal, the IDM 117 operates the endoscope 118 by activating the output shaft, which will be described further below in conjunction with FIG. 3E.

FIG. 3E is an exploded assembly isometric view of the instrument device actuator shown in FIG. 3D in accordance with one embodiment. Endoscope 118 is configured to expose IDM 117 to expose output shafts 305, 306, 307, and 308, respectively, that can control independent pull wires or a basket device of endoscope 118, Lt; / RTI >

II. Subclavian surgery

4A is a perspective view of a surgical robot system 400A with an arm mounted on a column configured to approach the lower sieve of a simulated patient 408 according to one embodiment. The surgical robot system 400A includes a set of robot arms (including a total of five robot arms) and three sets of column rings. The first robot arm 470A and the second robot arm 470B are engaged with the first column ring 405A. The third robot arm 470C and the fourth robot arm 470D are engaged with the second column ring 405B. And the fifth robot arm 470E is engaged with the third column ring 405C. 4A shows a wireframe of a patient 408 lying on a table 401 during a surgical procedure, such as, for example, a contouring examination involving access to a subclavian portion of a patient 408. Fig. The legs of the patient 408 were not shown so as not to cover some of the surgical robot system 400A.

The surgical robot system 400A constructs a robot arm to perform surgical procedures under the body of the patient 408. [ Specifically, the surgical robot system 400A configures the robot arm set to operate the surgical instrument 410. [ The robotic arm set inserts the surgical instrument 410 along the virtual rail 490 into the inguinal portion of the patient 408. Generally, the virtual rail 490 is a coaxial trajectory that moves a set of robotic arms along a surgical instrument (e.g., a telescoping instrument). The second robot arm 470B, the third robot arm 470C, and the fifth robot arm 470E are coupled as if they were holding the surgical instrument 410, for example. According to Fig. 4A, the first robotic arm 470A and the fourth robotic arm 470D are kept beside the system since they are not needed during the surgical procedure or at least during some surgical procedures. The robot arm is configured to manipulate the surgical instrument 410 away from the patient 408. This is an advantage because, for example, space closer to the patient's body is often limited, or there is a sterile boundary around the patient 408. [ In addition, there may also be sterile drapes around the surgical device. During the surgical procedure, only the sterilized object is allowed to cross the sterilization boundary. Thus, the surgical robot system 400A is still outside the sterilization boundary and can still use a robotic arm that is covered with sterile drapes for performing surgical procedures.

In one embodiment, the surgical robot system 400A constitutes a set of robotic arms for performing an endoscopic surgical procedure on the patient 408. [ The robot arm set holds an endoscope such as the surgical instrument 410, for example. The robotic arm set inserts the endoscope through the opening in the inguinal portion of the patient 408 into the patient ' s body. Endoscopes are narrow-gauge tubular instruments that include optical components such as cameras and optical cables. The optical component collects data representing an image of a portion of the patient's body. The user of the surgical robot system 400A assists in endoscopic surgery using the data.

4B is a top view of a surgical robot system 400A with an arm mounted on a column configured to approach the lower portion of a patient 408 according to one embodiment.

4C is a perspective view of a surgical robot system 400B and an imaging device 440 with an arm mounted on a column configured to approach the lower sieve of a patient 408 according to one embodiment. The surgical robot system 400B includes a pair of feet 420 that can support the feet of the patient 408 to expose the ingrown portion of the patient 408. [ Generally, the imaging device 440 captures an image of a body part or other objects in the body 408 of the patient. The imaging device 440 may be a C-arm or other type of imaging device, which is primarily used in surgical procedures using fluoroscopy and is also referred to as a mobile C-arm. The C-arm includes a generator, a detector, and an imaging system (not shown). The generator is associated with the bottom end of the C-arm and is oriented upwardly toward the patient 408. [ The detector is coupled with the upper end of the C-arm and is directed downward toward the patient 408. The generator emits x-ray waves toward the patient 408. The X-ray wave penetrates the patient 408 and is received by the detector. Based on the received x-ray wave, the imaging system 440 generates an image of the body part of the patient 408 or other objects. The rotating portion 210 of the table 119 is laterally rotated so that the ingrown portion of the patient 408 is aligned between the generator and the detector of the C-arm imaging device 440. The C-arm is a physically large appliance with the footprint placed under the patient during use. In particular, the generator of the C-arm is disposed under the surgical site of the patient, such as, for example, the abdominal portion. Usually columns in a surgical bed mounted on a column can interfere with positioning the C-arm generator because, for example, the column is also under the surgical site. Conversely, due to the ease of configuration of the rotating portion 210, the surgical robot system 400B may be configured to provide sufficient access to the C-arm, the robotic arm, and the user (e.g., a physician) The table 119 can be configured to have a range. In one exemplary use case, the table 119 is laterally moved along the longitudinal axis of the table 119 so that the robotic arm can access the inguinal or lower abdomen region of the patient on the table 119. In another exemplary use case, rotating the portion of rotation 210 away from the column 121, the generator of the C-arm 440 may be positioned below the inguinal portion of the patient 408. The rotating portion 210 can be rotated at least 15 degrees about the longitudinal axis of the table 119 without dropping the surgical robot system with the patient lying on the rotating portion 210. [ In particular, a surgical robot system does not fall because the center of gravity of the surgical robot system (such as at least the sum of the center of gravity of the table, bed, and base) is above the footprint of the base.

The surgical robot system 400B operates the surgical instrument 410 using an arm mounted on the column. Each of the robotic arms is coupled as if it were holding the surgical instrument 410, for example. The surgical robot system 400B inserts the surgical instrument 410 along the virtual rail 490 into the inguinal part of the patient using the robot arm.

4D is a top view of a surgical robot system 400B with an imaging device 440 according to one embodiment and an arm mounted on a column configured to approach the lower sieve of a patient 408. Fig.

III. Basket device

A robotically steerable basket device is described with reference to Figures 5A-5F. 5A is a side view of the basket device. Figures 5B and 5C illustrate how a basket device according to one embodiment is used to capture an object such as urinary stones. The robotic steerable basket device 500 is removably coupled operatively with any of the IDMs described herein and previously described, such as the IDM 117 described above. The robotically steerable basket device 500 may be advanced through the naturally or artificially created hole in the subject or patient to capture the subject or the patient's target object in the body of the patient. For example, the robotically steerable basket device 500 may be advanced through the urethra or optionally through the bladder, ureter, and / or kidney through the robotic surgery system 100 to capture kidney stones (ST) . In one example, a robotic steerable basket device 500 may be advanced into the gallbladder to capture gallstones. In some embodiments, the robotic steerable basket device 500 may be advanced through a catheter, a bore, an endoscope, or other working channel of a similar device (such as a working channel of diameter within 1.2 mm) have. In these embodiments, the addition of an endoscopic instrument provides axial support force and rigidity while also providing additional functions such as vision, seek and localization functions.

The robotic steerable basket device 500 may include a handle or tool base 510 adapted to removably and operatively engage the IDM 117. The tool base 510 includes a plurality of capstans 520 for engaging the drive shaft of the output shaft or IDM and the IDM can actuate the capstan 520 as well as other drive elements associated therewith. The basket device 500 includes a plurality of pull wires 530 (also referred to as tendons). One end of the pull wire 530 is coupled to the capstan 520. The pull wires 530 extend straight along the long axis of the apparatus 500 and prevent the outer support shaft 540 from sagging and kinking. The outer support shaft 540 may include a plurality of lumens and channels through which the pull wires 530 may move along the longitudinal axis of the device 500. The external support shaft 540 may be compliant so that the basket device 500 facilitates advancing the curved tube tissue or body passageway such as the urethra or ureter. The apparatus 500 may also include an inner shaft 560 for axial stiffness and bearing capacity. The device 500 may be configured to be inserted into a working channel of a device such as the endoscope 118.

The pull wires 530 may be coupled to each other at the distal-most distal end 552 of the basket device 500. For example, the basket device 500 may include two different pairs of pull wires 530, and the ends of the loops formed by each pair of pull wires are coupled together at a tip 552, The end exits through the peripheral channel or lumen 548 on the opposite side of the outer support shaft 540. The two ends of the pull wire loop may be coupled together in any number of ways. For example, soldering, squeezing, braiding, glueing, suturing or bundling with other seams. When coupled together, each pair of pull wires forming the loop may also be referred to as a single pull wire, as desired for a particular implementation.

When the tool base 510 is coupled with the IDM, the capstan 520 is pulled from the pull wire 530 so that the pull wire 530 can move in the proximal or distal direction along the axis (long axis) 530). The one or more pull wires 530 may be moved independently of each other, for example, by respective capstans 520.

The distal end of the pull wire 530 may extend from the distal end 544 of the outer support shaft 540 to form a distal wire basket 550. The distal end of the pull wire 530 may be retracted by the capstan 520 located at the proximal end 542 of the outer support shaft 540 such that the basket 550 may be folded into the outer support shaft 540. When the basket 550 is retracted into the external support shaft 540, the external shape of the basket device 500 is reduced to facilitate advancement of the basket device 500 into the tissue or body passage. In some embodiments, the device 500 may be disposed through a working channel of the endoscopic device, and similarly, the device 500 may be retracted relative to the endoscopic device to reduce the contour of the basket device 500. Conversely, the capstan 520 may be actuated to extend the pull wire 530 from the outer support shaft 540 to extend the basket 550. For example, the basket 550 can be expanded to capture the stones ST when the distal end 544 of the outer support shaft 540 is positioned near the stones ST.

The basket 550 may extend from the outer support shaft 540 by varying the length of the extension to vary the size of the basket 550. For example, as shown in FIGS. 5B to 5C, the basket 550 may be extended to an expanded size, and after the stones ST are captured into the basket 550, The basket 550 may be in a partially collapsed state (i.e., reduced in size) in order to secure the stones. As further described in FIG. 5B, the pull wire 530 may be selectively activated to steer or tilt the basket 550 to facilitate capture of the stones ST. The outer support shaft 540 may be brought into a fixed state relative to the pull wire 530 when the pull wire 530 is operated differentially. The basket 550 can be steered in any number of directions by differential operation of the pull wires 530 to have a 360 ° operating range. For example, one end of the individual pull wire 530 may remain floating, while the other end may be tilted so as to approach or move away from the moving end of the basket 550, respectively, by pulling or pushing movement. In another example, the individual ends of the pull wire 530 may be differentially pulled, pushed, or held in a floating state to impart a change in the angle and / or direction of tilting.

The angle of movement of the capstan 520 indicates the tilt angle and / or orientation of the basket 550, as well as the current size. Thus, in some embodiments, the robotic system, and in particular the IDM, may be coupled to the subject or patient body without visualization of the basket 550 based on feedback or information from the capstan 520, driver (s), or output shaft (s) May determine and / or track the current configuration of the located basket (550). Alternatively or in combination, the basket 550 may be visualized to determine and / or track the current configuration. The pull wire 530 may be formed of a shape memory material or a metal (e.g., a nickel titanium alloy such as Nitinol) so that the distal end of the pull wire 530 is in a stressed state and / . ≪ / RTI >

Figures 5D, 5E, 5F show another view of an embodiment intended for use within the working channel of an endoscopic device. Figure 5D shows a perspective view of the external support shaft of the basket device and Figure 5E shows a close-up side view of the external support shaft. As shown in FIG. 5E, the outer support shaft 540 may have a square or diamond-like cross-section. Various shapes such as circle, ellipse, egg shape, triangle, square, rectangle, pentagon, star, hexagon and other polygonal shapes are also considered as the cross-section of the outer support shaft 540. The outer support shaft 540 may include a central working channel 546 and a plurality of peripheral channels 548. The pull wire 530 may be located within the peripheral channel 548. [ A guide wire, an additional treatment device (such as laser fiber for lithotripsy), or a diagnostic device (such as an imaging device or a camera) may be used to provide a central channel 546 for reaching an object such as a target site or captured stone ST ≪ / RTI >

The outer support shaft 540 may also include a plurality of rounded corners or edges 543 through which the peripheral channels 548 are located and the pull wires 530 move. A side edge 541 with a slot in the outer surface of the outer support shaft 540 may be concave and at least partially into a curved edge 543 in which the peripheral channel 548 is located to define the outer support shaft 540 Thereby forming a plurality of elongated slots or channels. The slotted side edge 541 can facilitate advancement of the basket device 500 by inhibiting the phenomenon of tissue apposition at the edge of the outer support shaft. When the basket device 500 is positioned through the working channel of the tubing or body passageway or endoscope device, the slotted side edge 541 is positioned between the outer support shaft 540 and the inner wall of the body passageway or between the working channels / RTI > may provide sufficient space for fluid cleaning and / or aspiration functions.

5F is an enlarged perspective view of a robotic steerable basket device such as the device shown in FIG. 5D according to one embodiment to provide a pullout that extends out of the distal end 544 of the outer support shaft 540 and the perimeter channel 548. FIG. The wires are shown together.

Figures 6A-6C illustrate examples of shapes of an extended basket according to one embodiment. May have any number of shapes, such as the oval shape shown in FIG. 5A, when the basket 550 is expanded (e.g., not fully folded into the outer support shaft 540 or extending beyond the distal end of the endoscope device). Alternatively, FIG. 6A shows an embodiment in which the basket 550B is rounded. 6B shows an embodiment in which the pull wires are of a certain or full rigid serration 554 such that the basket 550B is shaped like jaws to improve the ability of the basket 550B to reach inside the curved anatomy. / RTI > As another alternative, Fig. 6C shows an embodiment in which basket 550C, as an alternative to the function reaching inside a curved anatomy, is constructed of a swirl-like or spiral full wire.

Figures 7A-7E illustrate various techniques for using a basket device to break trapped stones in accordance with one embodiment. Captured stones can be disrupted in a variety of ways.

FIG. 7A illustrates injection of a laser or optical fiber to break up trapped stones according to one embodiment. The captured stones ST can be broken down by laser or light energy, which is referred to as laser lithotripsy. In this use case, a laser or optical fiber 562 is advanced through the central working channel 546 such that it is introduced from the tool base or handle 510 and the laser tip or optical element is positioned at the proximal end of the basket 550. The central working channel 546 has an appropriate size to accommodate a laser or optical fiber, for example, with a diameter of 100-300 μm. A laser or fiber optic transmits a laser or light energy to break up stones (ST) that are trapped according to the instructions of the laser tip or optical element. Alternatively, or in combination, the fluid may be cleaned or aspirated through the central working channel 546. Alternatively, the fluid may be cleaned and / or sucked through the slotted side edge 541 as described in connection with FIG. 5E.

In addition, the captured stones ST can be broken by various mechanical methods. For example, ultrasonic waves may be applied through a central channel 546 (not shown). Alternatively, or in combination, the mechanical instrument can be advanced through the central channel 546 and the mechanical instrument can be used to crush the trapped stones.

Figure 7B illustrates the insertion of a mechanical drill to break up captured stones in accordance with one embodiment. The mechanical drill bit 564 is advanced through the central working channel 546 of the outer support shaft 540. A rotating motor located proximal to the tool base 510 rotates the drill bit 564 in the basket 550 to break up the trapped stones ST.

Figures 7C and 7D illustrate the use of a chisel to fracture trapped stones according to one embodiment. 7C, the chisel 566 is advanced through the central working channel 546 of the outer support shaft 540. As shown in FIG. The chisel 566 is actuated by a reciprocating motor (not shown) located proximal to the tool base 510. The reciprocating motor can drive the chutes 566 in the proximal and distal directions along the axis. 7D, the chisel 566 is provided in a different direction, such as in a distal direction, from the apparatus separated from the apparatus 500 to break up the trapped stones ST, and thus is advanced through the basket apparatus 500 It does not. In this case, the working channel 546 of the basket device 500 may be used to extract the stone pieces.

FIG. 7E illustrates the use of high-pressure fluid injection 580 to break up trapped stones in accordance with one embodiment. The high pressure fluid injection 580 may be water, saline or other liquid that is ejected from a fluid source. Fluid injection is an abrasive and may be composed of fine particles such as salt particles to facilitate stone breakage. In the exemplary run, a pressure of 400 psi and a central working channel 546 of 100 micrometers in diameter through which fluid jets may be directed towards stones (ST).

The captured stones ST can be steered by the basket 550 while the captured stones ST are crushed. When the trapped stones ST are crushed in any of the ways described, the stones ST which have been broken up are sucked through the central channel 546 and / or broken up (ST) And the basket is retracted from the target site (e.g., ureter, pelvis, gallbladder, etc.). In some embodiments, the shredded pieces of trapped stones ST can be inhaled while basket 550 tries to continuously capture and secure large portions of captured stones ST that have not yet been broken.

IV. The process of capturing absences in basket devices

IV. A. Problems

Basket use is a technique often used by urologists to remove urinary stones or stones from the urinary tract. Current state-of-the-art techniques usually require at least two skilled operators to simultaneously control ureteral and basket devices. If one or more operators do not have sufficient experience, they can negatively impact procedure time and clinical outcomes.

Current urinary stone removal procedures involve moving the urinary tract through the urethra or bladder to the ureter. Ureteroscopy is located near urinary stones. During the basket use stage of the surgery, the basket is advanced through the urinary tract and can be used to catch urinary stones using a basket to extract the stones. If the ureter stones are located in the stones, the urologist can choose among several possible workflows to move the stones. If the stones are small enough for the operator to capture the entire stones in the basket, both the ureter and the basket can be drawn out of the bladder or the subject's body. If the stone is too large to be taken in one pass, a laser (holmium or neodymium yttrium aluminum garnet laser (ND: YAG)) or electrohydraulic lithotripter (EHL) device passes through the central working channel of the ureter It can be used for crushing. One operator can then replace the laser fiber or EHL probe with a basket, and each piece of stone in turn can be removed into the bladder or into the patient's body. If the stone is located proximal to the ureter (center of the subject's body) or located within the kidney itself, sheath may be used to allow rapid extraction and urethral ligation and basket introduction.

This process requires two operators. The main manipulator controls the yaw diameter and the minor manipulator controls any other insertion tool, such as a basket or laser. Both the main operator and the minor operator can view the image data of the bore camera.

Figures 8A-8C illustrate important problems that an operator may encounter during basket operation according to one embodiment. 8A, the operator has advanced to the state where the ST is placed in the basket 802 opened (i.e., closed or not) by searching the basket in the basket use step, and the basket advances out of the yaw hole 805 . There is a great difficulty in shrinking the basket 802 so that the stones ST are trapped in the basket 802 when the basket 802 is shrunk despite the surrounding of the pre-shrink stone ST. The difficulty may arise because the center 811 of the basket 802 may contract laterally along the long axis of the basket when the operator closes the basket 802. In such a scenario, if the operator first places the basket 802 center 811 on the stalls ST (see FIG. 8A) and closes or collapses the basket 802 (see FIG. 8B) (See Fig. 8C) by shrinking past the stone ST (see movement of the center 811 of the basket 802).

IV. B. Manual process

FIGS. 8D to 8F illustrate a process of overcoming the problem of stones trapping using a basket according to an embodiment. In this process, the two operators cooperate to simultaneously advance the urine conduit 805 and / or the basket 802 while the basket 802 is closed to reliably capture the absences (ST). 8D shows a state in which the basket 802 is expanded and positioned to surround the stones ST. 8E shows the basket 802 as being folded while the basket device 805 or the basket device (not explicitly shown, but surrounded by the yaw hole 805) is advanced and thereby the position of the center 811 of the basket And shows a fixed state with respect to the stones ST. The urine conduit 805 or the basket can be moved relative to the pull wire entirely by either of the two devices by the operator. Fig. 8F shows a state in which the stones ST are securely trapped or trapped by the basket 802. Fig. The stones can be removed from the patient's body by contracting the basket and / or the urethra from the patient after capture.

The above procedure allows more reliable capture of the absences (ST), but these procedures usually require intensive collaboration of two or more skilled operators. For example, the first operator is responsible for folding the basket with the first controller and the second operator is responsible for advancing the basket device to the second controller.

IV.C. Robotic process

Robotic control simplifies the task of using the basket, reducing the complexity of the procedure and the time it takes to perform it. Robotic control also eliminates the need for more than one operator to prepare and achieve the basket usage phase.

Figures 9A-9F illustrate the process of positioning and controlling the basket device to capture stones (and stone fragments) during a robotic assisted shoulder procedure according to one embodiment. The surgical robot system 100 includes a roboticly controllable yawing radius 805 that itself includes a sheath component 815, a leader component (or leadercope) 825 and a basket 802 do. Throughout the process, suction and flush / fluid transfer may be performed through the interspace between the interrogator and the sheath and through the port 835 and / or through the operation channel of the urethra and may be performed as described above with respect to FIG. 5E Or through a slotted edge of the inserted basket device.

The system also includes two robotic arms 102A and 102B configured to control at least the position, orientation and tip direction of the sheath 815 and the reader 825 and is coupled to the sheath 815 via the bases 801A and 801B The reader 825 is each controlled. In this example, at least one robot arm 102C with an additional tool base 102C is configured to control the position of the basket 802 and the basket operation. The system 100 also includes a graphical user interface suitable for controlling the urine conduit 805 and the basket 802 and a control system suitable for servoing certain motors of the particular arm 102, do. The arms 102A-C, in particular the bases 801A-C, can be arranged in a virtual rail configuration.

To perform the surgical procedure, the system 100 uses the camera (not shown) mounted on the tip of the yaw tube 805 to position the robot yaw tube 805 (either automatically or by controller And through the input of the operator, which is received via the GUI and displayed via the GUI). 9B, the first 801A and the second 801B device bases each have a first and second arrows 830A and 830B relative to the patient, respectively, ) Display direction. The operation speed and size of the sheath 815 and the reader 825 may be different from each other, and these two parts can move independently of each other. The urinary tract 805 is advanced through the bladder BL and the urinary tract (UTR). As shown in Fig. 9C, the tool base 801C advances the basket 802 along the direction of the third arrow 830C out of the working channel of the borehole 805. As shown in Fig. As an example of a specific implementation of the process, a guide introducer, such as a stiff metal cystoscope, can be used to assist in inserting the urethral tube (sheath, leader, or both) into the patient's urethra.

As shown in Figure 9D, the system directs the basket 802 to open and places the basket 802 so that the stalls ST are centered in the basket 802. This is another arm / tool that advances one or more pull wires of the basket 802 using the tool base 801C or controls the pull wires separately from the rest of the basket device, as shown by the fourth arrow 830D, Can be achieved using a base (not shown). It is also possible to move the reader 825 forward with the second device base 801B as shown by the fifth arrow 830E and thereby change the position of the basket 802 to the advanced state out of the reader 825, ≪ / RTI >

As shown in FIG. 9E, the system then instructs the basket 802 to close. As shown by the sixth arrow 830F, this is also another arm / tool that retracts the pull wires of the basket 802 using the tool base 801C or controls the pull wires separately from the rest of the basket device, Can be achieved using a base (not shown). Either the device base 801B of the interrogator 825 or the tool base (not shown) of the basket device when the basket 802 is closed can be moved to the basket 802 while the basket ST is caught, It is possible to simultaneously advance the reader 825 or the basket 802 in the direction of the seventh arrow 830G in order to keep the center 802 at the center.

9E, when the stones ST are captured, the system moves along the eighth 830H and ninth 830I arrows using the tool base 801C and the device base 801B, respectively, to the basket device 802 ) And the reader 825 are removed or collected from the subject so that the stones (ST) are completely removed from the patient.

V. Procedure for percutaneous nephrolithotomy

V.A. problem

Some ureteral stones are too large to remove through the ureter. For example, the diameter of a stone may be greater than 2 centimeters, and the working channel of the ureter, which can be removed by passage of stone or stone, usually has a diameter of 1.2 millimeters. Although it is possible to break into smaller fragments to remove stones through the ureter, it is possible that residual remnants often lead to new stone formation, which in turn requires subsequent treatment.

Percutaneous renal lithotripsy (PCNL), on the other hand, is a procedure that removes stones from the kidneys (rather than through the ureters) and provides a larger port for stone removal. Because the ureteroscope is not used to identify the location of the kidney stones, the location of the stones should be identified by other mechanisms. Conventional techniques for identifying the location of the stones use conventional imaging functions such as x-ray computed tomography (CT) imaging or fluoroscopy using jugular vein nephrostomy.

After collecting this information, the urologist trained in removal of the stone will usually ask the radiologist to perform a percutaneous incision to remove the guide wire, which leads to a location close to the kidney stones, through the transcutaneous incision. The incision can be made by moving the needle into the patient's body, which consists of a probe and a cannula. After moving the needle into the patient, the probe can be removed and the cannula is left to form an open port to the location of the kidney stones. Then the urologist can position the guide wire through the cannula. The urologist then uses the guidewire to perform the remainder of the PCNL procedure to remove stones. It is common for the urologist to ask the radiologist instead of placing the guide wire directly because the radiologist can create and read CT scans, fluoroscopic scans and other types of images used to identify objects such as kidney stones It was because I was especially trained to do. They are also skilled in conceptualizing image information in three-dimensional (3D) space and are most skilled in locating objects such as stones in 3D space and consequently positioning guide wires according to the information.

To complete the PCNL, the urologist uses a guidewire positioned to pass the retracted balloon or expander along the wire. The urologist expands the balloon or expander to create a port of sufficient size to directly introduce a hollow suction tube, such as a cannula, into the kidney of the absent kidney. At this point, any one of the elongate or other devices may be introduced into the suction tube to assist in the removal of stones. For example, a crusher, a laser, an ultrasound, a basket, a grasper, a drain can be used to remove stones or pieces at the location. Drain tubes, such as ducts, can be placed along the suction line to lower the pressure in the kidney after PCNL progression and completion.

The advantage of PCNL is that it reduces the chance of recurrence, which requires similar treatments in the future, because it can remove larger stones and reduce the likelihood of residual stones depositing better and forming new stones. However, PCNL is also a more invasive procedure than bipolar surgery, requiring small operations and a longer recovery period. In addition, due to the general need for the radiologist to perform some of the procedures with a urologist, additional costs, complexity, and delays in managing the schedule are added to the ideal procedure that only urologists and related physicians need. In addition, PCNLs require the use of imaging technology that is cumbersome and affects practitioners involved in the procedure. For example, fluoroscopy requires hospital staff to wear a lead vest to reduce radiation exposure. The lead vest, however, does not completely remove the radiation, and it is cumbersome to wear for a long time and may cause orthopedic injuries to the medical staff if worn throughout the working life.

V.B. process

To address these problems, the next section describes a new process of PCNL, including an alignment sensor, to identify the location of absences or disturbances of interest. 10A to 10E show examples of corresponding processes in which the alignment sensor is an electromagnetic (EM) sensor (or probe). In this process, the EM sensor passes into the urinary tract (UTR) through the bladder (BL) and is introduced into the kidney (KD). The EM sensor may be attached to the bore diameter including the EM sensor 1010 at the proximal end of the bore diameter 1005. Alternatively, the EM sensor may be as simple as a coil connected to an electrical wire that extends as long as the bore length, and the urethral tube is connected to an external computing device that is configured to read electrical signals generated in the coil and delivered to the wire.

V.B.i. Preoperative segmentation and planning

The pre-operative planning process can be performed to plan the procedure and the navigation of the robot tool. The procedure involves performing a preoperative computerized tomography scan of the surgical site. The CT scan results produce a series of two-dimensional images used to generate the anatomical pathways and the three-dimensional models of the organs. The process of dividing the CT image (s) into components can be referred to as "segmentation ". The segmented image is then analyzed by the system 100 to identify the location in the three-dimensional coordinate space of the patient's interior or surface landmarks. In the case of PCNL, it can be used to treat skin, kidney stone (s), bone structure (e.g., ribs, vertebrae, pelvis, etc.), internal organs (e.g., kidney, liver, Skin patch sensors), which may include any one or more of the reference points. Once the segmentation process is complete, localization means (such as electromyographic detection or fluoroscopy during surgery as described below) can be used with the location of the identified reference point and the registration method to visually display the location of the medical device / instrument within the anatomy have.

V.B.ii. Electromagnetic detection

In general, an EM sensor such as a coil detects the change of the electromagnetic field by moving the EM sensor 1010 in the kidney (KD) while moving the distal end of the bore while the operator grasps the position of the stone (ST) do. The execution of the process using the EM sensor further includes a plurality of electron generators 1015 located externally of the patient. The electronic generator 1015 emits an electromagnetic field sensed by the EM sensor 1010. Other electronic generators 1015 can be modulated in a number of different ways such that when the emitted electromagnetic field is captured by the EM sensor 1010 and processed by an external computer, the signals are distinguished from each other, And can provide a distinctive triangulation location for the location of the EM sensor 1010, as well as the location of the stones (ST). For example, an electronic generator may use quadrature modulation so that it can be modulated in time or frequency, and each signal can be completely differentiated from other signals despite the possibility of overlapping time. In addition, the electronic generators 1015 may be arranged in a manner that allows the EM sensor 1010 to receive at least any signal from at least one of the electronic generators 1015 at any time, Orthogonal angles relative to one another in a Cartesian space. For example, each electronic generator may have a small offset angle (e.g., 7 degrees) from each of the other two electronic generators along an axis. As many electronic generators as desired can be used in the configuration to obtain accurate EM sensor position information.

V.B.iii. On-the-fly electromagnetic matching

The EM data is matched with the captured patient image to construct a coordinate system for the EM data, such as a CT scan, or a technique other than EM (or any mechanism used to capture alignment sensor data). Figures 11A-11D illustrate an EM system on-the-fly with a segmented 3D model generated by a CT scan of the path of a tubular tissue network (e.g., from the bladder to the inside of the urethra, into one kidney) Lt; RTI ID = 0.0 > ply < / RTI >

11A-11D illustrate exemplary graphs 1110 through 1140 illustrating matching an EM system on-the-fly with a segmented 3D model generated by a CT scan of a tubular tissue network path, in accordance with one embodiment. 11A to 11D, although the EM sensor is attached to the endoscope tip 1101, even when the EM sensor is attached to the guide wire and the 3D model is replaced by intraoperative fluoroscopy, the matching principles described with respect to the drawings The same applies. The 3D model described in the next section is replaced by fluoroscopic imaging in the implementation, and as the guidewire progresses inside the patient, the fluoroscopic image is updated and the patient's presentation is also updated. Therefore, inserting the guide wire toward the elongation and matching the guide wire to the external electronic generator occur at least partially simultaneously.

The search configuration system described herein allows the EM coordinates to be mapped on 3D model coordinates in an on-the-fly manner without the need for independent registration prior to endoscopic procedures. 11A shows a state where the coordinate system of the EM tracking system and the 3D model are not initially matched with each other, and the graph 1110 of FIG. 11A shows a planned search path 1102 that passes through a branched tubular network (not shown) (Or expected) position of the endoscope tip 1101 moving along the guide path 1101, and the planned path 1102 as well as the position of the tip of the instrument tip 1101 are derived from the 3D model. The actual location of the tip is repeatedly measured by the EM tracking system 505, resulting in a plurality of measurement location data points 1103 based on the EM data. As shown in FIG. 11A, the data point 1103 derived from the EM trace is initially located away from the expected position of the endoscope end 1101 of the 3D model, reflecting the state where the EM coordinate and the 3D model coordinate are not matched . There may be many reasons for this, for example, even if the endoscope tip moves relatively smoothly through the coronary network, there may still be noticeable scattering of EM measurements due to lung motion when the patient breathe. The points of the 3D model can be determined and adjusted based on the correlation between the 3D model itself, the image data received from the optical sensor (such as a camera) and the robot data from the robot command. The 3D transformation between this point and the collected EM data points will determine the initial match to the 3D model coordinate system of the EM coordinate system.

11B shows a graph 1120 of a later stage in time compared to graph 1110, according to one embodiment. More specifically, as indicated by the movement from the initial expected position of the device tip 1101 shown in FIG. 11A to the position shown in FIG. 11B, the graph 1120 shows the position of the tip of the endoscope 1101 predicted by the 3D model Indicating that the expected location has moved further along the pre-planned search path 1102. While EM tracing occurred between the generation of the graph 1110 and the generation of the graph 1120, additional data points 1103 were recorded by the EM tracking system, but the matching was not yet updated based on newly collected EM data. As a result, the data points 1103 of FIG. 11B are crowded along distinct paths 1114, but the paths are different in location and direction from the plan search path 1102 where the end of the endoscope must move in accordance with the operator's instructions. As a result, if sufficient data (e.g., EM data) is accumulated, a relatively more accurate estimate can be derived from the transform, as compared to using only the 3D model or the EM model, which is necessary to match the EM coordinates to the 3D model. The decision as to whether the amount of data is sufficient may be made on a threshold basis, such as total accumulation data or the number of direction changes. For example, in a branched tubular network such as a bronchial tree, it can be judged that sufficient data has accumulated when the two branches are reached.

FIG. 11C shows a graph 1130 immediately after the search configuration system according to an embodiment accumulates a sufficient amount of data to estimate the matching transform in 3D model coordinates in the EM. Results of Matching Transformation The data points 1103 in FIG. 11C have now moved in all of the locations shown in FIG. 11B. 11C, the data points 1103 derived from the EM data are now placed on the plan search path 1102 derived from the 3D model and the respective data points of the data points 1103 are now in 3D models Reflects the expected position measurement of the endoscope tip 1101 in the coordinate system. In some embodiments, if more data is accumulated, the match transformation may be updated to increase accuracy. In some cases, the data used to determine the match transformation so that the match can change over time may be a subset of the data selected by the moving window, thereby causing, for example, And the relative coordinates of the EM and 3D models change due to such changes.

11D shows an example of a graph 1140 in which the expected position of the endoscope tip 1101 has reached the end of the plan search path 1102 and has reached the target site in the tubular network, in accordance with one embodiment. As shown in FIG. 11D, the recorded EM data points 1103 now track the overall plan search path 1102, which represents the trajectory of the endoscope end during the procedure. Each data point reflects the converted position along with the 3D model matching update of the EM tracking system.

Each of the graphs shown in Figs. 11A to 11D can be sequentially displayed to the user through the display when the endoscope end advances in the tubular network. Additionally or alternatively, the processor can be configured to move the measurement path of the display as the measured data point is matched to the display, such that the user can maintain a fixed coordinate system and visually focus on the model and plan path shown on the display And may be configured with instructions from the search configuration system to maintain the displayed model in a generally fixed state.

Mathematical analysis of V.B.iv matching transform

For a specific analysis and method of matching (e.g., mathematical analysis), in some embodiments, matching matrices may be used to perform matching between the EM tracking system and the 3D model, e.g., Can be expressed. In an alternative embodiment, the rotation matrix and motion vector may be used to perform the matching.

라디안(radian) 방위각으로의 회전은 행렬 M₁으로 표현되며, φ 라디안 경사각으로의 회전은 행렬 M₂로 등등 표현될 수 있으며 추가적인 회전 행렬들이 회전 행렬의 결과물로서 기술될 수 있다. 마찬가지로, 이동 벡터 (

x

y

z)는 x, y, z 축의 원점을 각각

x,

y,

z만큼 이동하는 것을 표현하기 위해 선택될 수 있다. 정합 변환은 측정 EM 위치와 3D 모델에서의 추정 위치 간의 교차 상호상관행렬에 대한 특이값 분해(singular value decomposition)와 같은 방법으로 결정될 수 있다. 변환 행렬 성분은 그다음 예를 들어, 적절한 주성분을 식별함으로써 분해에서 추출될 수 있다. 결정된 변환의 잔차(residuals)로 인해 에러신호가 발생될 수 있으며 에러 신호의 크기는 위치의 신뢰 수준을 결정하는데 활용될 수 있다. 더 많은 데이터가 쌓이고 정합 변환이 좀 더 정확하게 결정되면 에러 신호는 감소하고, 해당 방식으로 추정한 위치에 대한 신뢰가 증가한다.In terms of mathematical reasoning, applying the matching transformation, for example, involves moving from one coordinate system (x, y, z) to a new coordinate system (x ', y', z '), Not only rotate in other 3D directions but also move the origin by an arbitrary amount in each dimension. E.g,

Rotation in the radian azimuthal angle is represented by the matrix M ₁ , rotations in the? Radian tilt angle can be expressed in the matrix M ₂ and so forth, and additional rotation matrices can be described as the result of the rotation matrix. Similarly, the motion vector (

x

y

z) are the origin points of the x, y, and z axes, respectively

x,

y,

z < / RTI > The matching transformation can be determined in the same way as the singular value decomposition for the cross-correlation matrix between the measured EM position and the estimated position in the 3D model. The transformation matrix component can then be extracted from the decomposition, for example, by identifying the appropriate principal component. An error signal may be generated due to the residuals of the determined transform and the magnitude of the error signal may be utilized to determine the confidence level of the location. When more data is accumulated and the matching transform is determined more accurately, the error signal decreases and confidence in the estimated position is increased.

V.B.v. Matching method using rigid reference points

The matching process may additionally or alternatively include a rigid homogeneous transformation (4x4) that includes a rotation matrix and a translation vector. The transformation is usually obtained by matching one or more point sets by generating a set of points via single value decomposition (SVD), iterative closest point (ICP) algorithm, or other similar algorithm. In the case of PCNL, generating a set of points with the input values of these algorithms may include: (i) setting up a set of first points during the segmentation process, such as ribs, proximal phalanges of the pelvis, vertebrae (e.g., (Ii) picking the reference points from the EM positioning system to the EM probe or pointer via the reference point search / contact to the second set of points during surgery, and / or (ii) To perform full matching. Kidney stone targets can also be used as reference points. In the case of kidney stones, the location of the stones can be captured via an EM sensor-based caliper or an EM probe attached to a guide wire. To reduce registration errors, weights may be given differently within the algorithm workflow for certain reference points. When kidney stones interfere with the path of the kidney, matching using rigid body reference points can be used independently.

In one embodiment, a combination of small EM probes, such as embedded or "clipped-on " EM based sensors, to identify identifiable outer rigid reference points, such as ribs, To capture match data during surgery, which does not interfere with the PCNL workflow. The calibration of a sensor or sensor embedded instrument is obtained by an axis check, which can determine the correlation between the position of the sensor and the tip of the probe. In some embodiments, the probe may have the shape and function of a marker pen.

V.B.vi. Locate absences based on electromagnetic and camera information

Referring again to FIG. 10A, if EM sensor data is matched to a CT scan and a guide wire with an EM-based caliper tip or EM sensor advances into the kidney (KD), the operator moves the caliber tip (or guide wire) It is possible to identify the location of kidney or stone in another organ of the patient. In the case of the ureter, referring back to the description of the tip relating to FIG. 3C in section I.C, above, the ureter may include a camera that captures an image of the FOV. Camera data captured in a video or image sequence allows the operator to navigate the kidneys to find absences. Simultaneously EM data provided from EM sensors coupled centrally to the urinary tract identify the location of the urinary tip in the kidney.

In some embodiments, the EM probe or guidewire may be placed under the working channel of the urethra to provide additional EM measurements for alignment. After placement, the EM probe or guidewire may extend beyond the working channel past the ipsilateral distal end to provide additional EM measurements. The EM measurement of the EM probe or guidewire can be used in conjunction with the EM data of the EM sensor mounted on the distal part of the Y axis to create a vector (including position and orientation information) that is the locus of the percutaneous needle approaching the surgical site / RTI >

Once the location of the stones is identified, for example, a percutaneous incision may be performed into the kidneys if they come into the camera viewing field of the tip. FIG. 10B illustrates an embodiment in which a needle is introduced to open a port of a patient inside the kidney (KD) by introducing a needle. In this process, the needle also includes an alignment sensor, such as an EM sensor, as well as a shoulder end or guide wire. Similar to the iris or guidewire, it is combined with a wire that runs along a needle that is electrically coupled with the computer system as a simple coil. The EM data received from the EM sensor of the needle can be received and processed similar to the EM data of the aforementioned diameter tip or guide wire.

FIGS. 10C and 10D illustrate sample views of a graphical user interface for virtually expressing a needle and bore diameter (or guide wire) in accordance with an embodiment. The EM data of the needle and the EM data of the uterine tip are processed together by an external computing system to create a graphical user interface that can be viewed by the operator to facilitate directing the needle to the location of the stones displayed by the quadrature EM data . As shown in FIG. 10C, according to one embodiment, the position of the needle provided by the needle EM sensor data is represented by a first graphic element such as a line in the graphic display 1060A, while the position of the needle The position is indicated by the second graphic element as a dot. As shown in FIG. 10D, when the operator injects the needle into the patient's body and then moves toward the stones, the graphic (line) of the needle in the display 1060B usually moves closer to the graphic (dot) of the stones. The position of the graphics will indicate whether the operator has successfully moved to absent or has left the target over time. At any point, the ureteral canal can be individually positioned so that the center of the viewing field is refocused on the stones, the orbital wall is moved closer to or farther away from the stones, or the alignment and movement of the needle relative to the stones is facilitated You can see stones from different angles.

Movement of the needle may be limited due to the surgical robot system performing the procedure or for design reasons. For example, if the needle only includes a single EM sensor, the needle may not be able to provide roll information about the needle about the long axis. In this case, the needle can usually move with five degrees of freedom (inward / outward) pitch +/-, yaw +/-, but no roll). In one embodiment, the X, Y, and Z axes of the system (and subsequently, via the GUI, the user) are located in the anatomy (preoperative CT and actual patient anatomy) The position of the needle tip in the space for. The pitch and yaw of the needle tip inform the system of the current direction of the needle. Using this information, the system can project the predicted path to the GUI, helping the physician to align the needle as it continues to insert the needle toward the target site.

In other embodiments, additional EM sensors or other types of alignment sensors may be added to allow more freedom in movement of the needle. In other embodiments, however, the needle may be passively delivered by the physician using the guidance provided through the GUI of the robotic system. For example, a roll freedom degree can be provided by introducing a second EM sensor to a needle oriented at an angle other than 0 for the first EM sensor, and the surgical robot system 100 is configured to allow the operator to perform a roll motion Or may be designed.

In addition to the basic GUI presented above, additional graphics or auditory notifications may be used to indicate whether the needle is close enough to the stones, the needle has entered the kidney, the needle has moved far enough away from the route, or any other arbitrary May be provided to indicate the trigger condition of the < / RTI > This notification may be a color change of the graphical user interface, a sound signal, or something else. The basic GUI may also be more comprehensive than that shown in Figures 10C and 10D. It may also include a contour of the kidney, which may look different depending on the direction of the 3D space of the needle and the needle tip. In addition, the profile of the renal vessels and / or the vasculature structure around the kidneys, as well as contours of other organs or critical anatomy can be included.

FIG. 10E illustrates a point at which a needle in a PCNL procedure punctures the kidney in the vicinity of the stones, according to one embodiment. Once the needle has reached the stones, a balloon can be used to inflate the port and a suction tube 1050 can be introduced to provide access for inserting a larger diameter tool into the kidney.

The PCNL process described above can be accomplished passively. In general, the urethra can be placed first near the stones by the first operator. The same or another operator then inserts the needle as a guide using the internal EM sensor. In some embodiments, an EM sensor may be used to locate a reference or indicia that assists a physician in returning to a position of absent or incarcerated so that the endoscope or guide wire may be removed and left within the patient for the same goal of achievement no need. Alternatively, manipulation of the bore diameter, guide wire, and needle may be accomplished by the surgical robot system 100.

In an alternate embodiment, the PCNL process may use a single "live" alignment sensor attached to the needle rather than two different " live "alignment sensors attached to the needle and / Can only be performed using According to one variation of this embodiment, the EM system can be matched using a pen or other in-vitro positioned EM sensor attached device. A fan can be used to identify the anatomical reference point of the patient and rotated to match the electronic generator. Through such matching and reference point information, the operator or surgical robot system is oriented with respect to the human body of the patient. The needle can then be searched for elongation (or other cavity) based on data provided by the EM sensor located on the needle, reference point position information, and registration information. The advantage of this approach is that it eliminates the need for a separate search for a device with an EM sensor inside the patient to determine the direction of movement of the needle. Accuracy loss of EM sensors located close to stones or other objects can be compensated at least in part in the reference point registration process.

The advantages of positioning the needle and associated port described above are significant. If needle guide or guidewire is used as a guide, needle penetration becomes low. A single operator or robotic system can perform this process. The fluoroscopic method may be omitted if desired.

In the above process, the alignment sensor is described as an EM sensor (and associated electronic generator), but in reality, other types of position-sensing sensors may be used instead. Examples include, but are not limited to, accelerometers, gyroscopes, magnetometers, fiber-optic sensors (such as Bragg gratings, Rayleigh scattering, interferometry or related techniques), and the like. Depending on the implementation, it may or may not be necessary to match in the form of a separate patient image, such as a CT scan, to provide a coordinate system for locating the absent location in the patient.

In addition, this procedure can be used in other surgery than PCNL, such as removal of gallbladder stones and lung (lung / thoracic) tumor biopsy. In general, any type of percutaneous procedure may be performed using a needle with an alignment sensor similar to an endoscope with an alignment sensor. In each of these processes, an endoscope tip with an alignment sensor that enters the patient's organ through the patient ' s cavity serves as a guide for injecting the needle with the alignment sensor. Additional examples include stomach surgery, esophagus and lung surgery, and the like. In addition, the object to be removed need not necessarily be urinary stone, and may be any object, such as a foreign object or an object created in the body.

V.B.v. Remove stones and carvings

A variety of techniques can be used to remove stones with the suction tube ready. Various devices can be inserted into the suction tube or the ipsilateral conduit to crush or remove stones and stone fragments. Examples include a basket device as described above, a laser or optical fiber that breaks up stones using lithotripsy, an ultrasonic device that breaks up stones through shock waves, a mill that breaks mechanically stones, a chisel or a drill, and so on. Alternatively, a variety of devices as described above may be combined or integrated with the suction tube to assist in the removal of kidney stones and debris to aid in suction using the suction tube.

In one embodiment, if the suction tube is located and the urethral tube is already in the vicinity of the stones, then any other devices occupying the working channel are withdrawn from the umbilical cistern. This may be, for example, the EM sensor itself or another device. Another catching device, such as a basket device or a grasper, as described in Section III above, may then be inserted into the working channel of the ureter and may extend past the umbilical tip near the stones.

When a basket device (or other similar device) captures the stones and places them near the openings at the distal end of the suction tube in the patient's organ, a device that is disposed along the working channel of the suction tube or ureter and coupled with the suction tube, Stones can be broken to aid in suction. Additionally or alternatively, lithotripsy can be performed (using a basket device, a laser tool inserted through the working channel of the urethra or placed under or attached to the suction tube) to break up the stones to a size suitable for passage through the suction tube have.

During the procedure, an inhaler (negative pressure) may be applied under the suction tube to aspirate any stone fragments or stones produced during the period of time during which the boreal or basket device continuously cleans the surgical site. Washing and aspiration are performed simultaneously to help maintain pressure in the patient's cavity. In an embodiment in which the ureteral wrist is composed of both a leader element such as a sheath element and a leader scope, a working channel of the leader element for placement of a tool such as a basket device or a grasser, which helps position and move the stones closer to the suction tube for suction, The cleaning fluid can be provided through the working channel of the sheath element.

As a result, any device that extends out of the yaw tube and the aspiration of the suction tube can be operated simultaneously to capture and remove the stones or pieces of kidney from the kidneys. With both simultaneous viewing of the surgical site provided by the camera at the tip of the spine, both the suction tube and the surgical tool, the basket device, or any other capture tool, the operator treats the stone removal with two "hands" It is possible to carry out stone removal effectively.

VI. Additional considerations

The process described above, particularly the cancer control of the surgical robotic system, the alignment sensor data processing for generating the position and orientation information of the alignment sensor and / or needle, and the graphical user interface creation process for displaying such information, May be embodied in computer program instructions stored on a storage medium and designed to be executed by one or more computer processors within one or more computer devices. Non-temporary computer readable storage media may be stored on any suitable computer readable medium, such as RAM, ROM, flash memory, EEPROM, optical device (CD or DVD), hard drive, floppy drive, or any suitable device . A processor is preferred as a computer-executable component, but alternatively or additionally, the instructions may be executed by any suitable dedicated hardware device.

It will be understood by those of ordinary skill in the art that the disclosure herein may be further understood by reference to the principles set forth herein before set forth with additional and alternative structural and technical designs. Thus, although specific embodiments and applications have been shown and described, it will be understood that the disclosed embodiments are not limited to the specific constructions and elements of the disclosure. The embodiments, operations and details of the method and apparatus of the present invention can be variously modified, changed and modified without departing from the spirit and scope of the present invention, and it will be understood by those of ordinary skill in the art .

Reference herein to " one embodiment " or " an embodiment " when used herein means that a particular element, function, structure or characteristic in connection with the embodiment may be included in at least one embodiment. Quot; in one embodiment " does not necessarily refer to the same embodiment.

Some embodiments may be described using terms such as " coupled " and " connected " with their derivatives. For example, some embodiments may be described using the term " coupled " to indicate that two or more elements are in direct physical or electrical contact. However, the term " coupled " may also mean that two or more elements are not in direct contact with each other, but may still cooperate or interact. The embodiments are not limited to this specification unless specifically stated otherwise.

As used herein, the terms " comprises, " " including, " " including, " " including, " " . For example, a process, method, article, or apparatus that comprises a list of elements is not necessarily limited to these elements, but may include other elements not explicitly listed or inherent to the process, method, article, or apparatus It is possible. Further, unless the context clearly indicates otherwise, the word " or " is intended to be inclusive, " or " exclusive, For example, condition A or B is satisfied by either: A is true (or is present), B is false (or not present), A is false (or not present) and B is True (or present), and both A and B are true (or exist).

Also, the use of " a " and " an " are used to describe the components and components of this embodiment. This is to provide simple convenience and general feeling of invention. It should be read as including one or at least one and the singular also includes the plural unless the context clearly dictates otherwise.

Claims (120)

A basket device for removing an object from inside a patient,
A plurality of pull wires, each pull wire being physically coupled to another capstan configured to operate one pull wire individually;
An outer shaft including a plurality of channels through which the pull wires cross; And
Wherein the basket is positioned opposite the capstan at the outer shaft and the pull wires are attached together at a distal end located at a distal end of the basket device,
Containing
Basket device. The method according to claim 1,
Said plurality of pull wires including four pull wires coupled to form two loops. The method according to claim 1 or 2,
Wherein the pull wires forming each loop are weaved through channels located opposite the outer shaft. 4. The method according to any one of claims 1 to 3,
Wherein the plurality of pull wires intersect each other at least at one point to form a distal end of the basket. 5. The method according to any one of claims 1 to 4,
Wherein operation of the capstan controls the size of the basket. 6. The method according to any one of claims 1 to 5,
Wherein selective retraction of the different ones of the pull wires directs the basket in the direction of the relatively more contracted pull wire. 7. The method according to any one of claims 1 to 6,
Wherein the outer shaft comprises a working channel. 8. The method of claim 7,
Wherein the working channel is large enough to accommodate a guide wire, treatment device or imaging device. 10. The method according to any one of claims 1 to 8,
Wherein the outer shaft includes a plurality of side slots on an outer surface. 10. The method of claim 9,
Said side slot providing sufficient space between said outer shaft and surrounding lumen inner wall for fluid cleaning or suction. 11. The method according to any one of claims 1 to 10,
Wherein the outer shaft comprises a plurality of peripheral channels. 12. The method of claim 11,
Each of said peripheral channels comprising a rounded apex on an outer surface of said outer shaft. 15. The method according to any one of claims 1 to 12,
Wherein the basket is configured in at least one of an oval shape, a sphere shape, and a shape in which a pull wire forms a sawtooth shape, based on the shape of the pull wire. 15. The method according to any one of claims 1 to 13,
Wherein the outer shaft comprises a working channel,
Optical fiber or laser capable of performing lithotripsy - The optical fiber or laser is passed through a working channel -
Further comprising: 15. The method according to any one of claims 1 to 14,
Wherein the outer shaft comprises a working channel,
A mechanical drill capable of piercing an object, the mechanical drill being passed through the working channel,
Further comprising: 15. The method according to any one of claims 1 to 15,
Wherein the outer shaft comprises a working channel,
A chisel capable of breaking said object, said chisel being passed through said working channel,
Further comprising: 16. The method according to any one of claims 1 to 16,
Wherein the outer shaft comprises a working channel,
A fluid source capable of ejecting a high-pressure fluid jet toward the object through the working channel
Further comprising a basket device. 17. The method according to any one of claims 1 to 17,
Wherein the basket device is sized to fit and pass through the endoscope working channel of the endoscope. 19. The method of claim 18,
Wherein the endoscope includes a reader and a sheath, and the endoscope working channel is located within the reader. 20. The method of claim 19,
The capstan being coupled to the first robot arm;
The leader being controlled by a plurality of leader pull wires associated with a second robot arm;
Wherein the sheath is controlled by a plurality of sheath pull wires coupled with a third robot arm. 20. The method of claim 19 or 20,
Or disposed elastically within a sheath working channel located within the sheath; And
Wherein the basket is concentrically aligned within the sheath working channel located within the sheath. In the method of capturing an object in a cavity,
Advancing the endoscope into the cavity including the object;
Advancing the basket device through the working channel of the endoscope;
Opening the basket of the basket device in the cavity, the basket being controlled by a plurality of pull wires;
Selectively retracting or releasing the pull wire to position the basket to surround the object;
Folding the basket around the object; And
And withdrawing the basket from which the basket is captured, out of the cavity. 23. The method of claim 22,
The pairs of pull wires are attached to each other, and
Optionally shrinking or releasing the pull wire
And retracting the first pull wire of the first pair and releasing the second pull wire of the first pair to change the position of the basket so that the distal end of the basket is away from the stones. 24. The method of claim 23,
The method of selectively shrinking or releasing the pull wire
Further comprising retracting the second pair of third pull wires and releasing the second pair of fourth pull wires to change the position of the basket such that the distal end of the basket is away from the stones. 23. The method of claim 23 or 24,
Moving at least one of the basket, the basket device, and the endoscope such that the object is positioned between both ends of the basket. 26. The method of claim 25,
Retracting the first pair of second pull wires and releasing the first pair of first pull wires to change the position of the basket so that the object is positioned within the basket
Further comprising: 27. The method of claim 26,
Optionally shrinking or releasing the pull wire
And operating the tool base coupled to the first robot arm to control the pull wire. 28. The method of claim 27,
Moving the endoscope
And controlling operation of the endoscope at least in part by activating a device base associated with the second robot arm. 29. The method according to any one of claims 22 to 27,
Operating an optical fiber or laser to pass an optical fiber or laser through the working channel of the basket device and to perform lithotripsy to break the object;
Passing a mechanical drill through a working channel of the basket device and actuating a drill in contact with the object to break the object;
Passing the chisel through the working channel of the basket device and actuating the chisel in contact with the object to break the object; And
Further comprising at least one of passing fluid through the working channel of the basket device to the object to break the object. 29. A method according to any one of claims 22 to 29,
The object is at least one of the group consisting of kidney stones or stones formed from bladder stones, at least one element of calcium, magnesium, ammonia, uric acid, cysteine;
Wherein the cavity is a kidney in a patient or a renal vessel in a kidney of a patient; And
Wherein the endoscope is a ureter. In a method for capturing an object in a cavity,
Advancing the endoscope into the cavity including the object;
Advancing the basket tool through a working channel of the endoscope to open a basket tool within the cavity;
Positioning the basket tool to surround the object; And
And advancing the basket tool forward while simultaneously folding the basket tool so that the object can remain in the basket tool when the basket is closed around the object. 32. The method of claim 31, wherein forwarding the basket tool further comprises:
Further advancing the endoscope into the cavity and thereby further advancing the basket tool into the cavity. 32. The method of claim 31 or 32 further comprising retracting the basket holding the object out of the cavity. 32. The method according to any one of claims 31 to 33,
Wherein the basket tool is comprised of a plurality of pull wires and the distal end of each pull wire is coupled out of the cavity with a respective capstan configured to individually actuate one pull wire. 35. The method of claim 34, wherein advancing the basket tool to the working channel of the endoscope to open the basket tool in the cavity comprises:
Actuating the capstan to release the pull wire and thereby expanding the basket tool within the cavity. 37. The method of claim 35, wherein positioning the basket tool to surround the object
Selectively actuating the capstan to change the position of the basket tool about an object to wind and loosen the other pairs of pull wires. 35. A method according to any one of claims 34 to 36,
Folding the basket tool
Actuating the capstan to wind the pull wire and thereby reducing the size of the basket tool within the cavity. 33. A method according to any one of claims 31 to 37,
Advancing said endoscope into said cavity containing said object comprises:
Activating at least one device base or first robot arm to control movement of at least one of the sheath and the reader of the endoscope. 39. The method of claim 38, wherein advancing the basket tool through the working channel of the endoscope to open the basket tool within the cavity comprises:
Activating at least one tool base or second robot arm to control movement of the basket tool along a longitudinal axis of the basket tool and the endoscope. 39. The method of claim 38 or 39, wherein positioning the basket device to surround the object comprises:
Activating at least one of a tool base and a second robotic arm to control movement of the basket tool along a longitudinal axis of the basket tool and the endoscope. 41. The method of claim 40, wherein advancing the basket tool forward simultaneously comprises:
Actuating at least one of the second and third device bases or the third robot arm to further move at least one of the reader and the basket tool into the cavity, respectively. 40. The method of claim 40 or 41, wherein advancing the basket tool forward simultaneously
And actuating at least one of the second and third device bases or the third robot arm to relatively move one of the sheath and the leader relative to each other to further move the basket tool into the cavity. The method of any one of claims 31 to 42, wherein advancement of the endoscope into the cavity containing the object
Activating a first robot arm coupled to a device base or device base coupled to the endoscope, wherein the first robot arm is configured to control movement of the endoscope. 44. The method of claim 43, wherein advancing the basket tool through the working channel of the endoscope to open the basket tool in the cavity
And activating a second robot arm coupled to a tool base or tool base coupled to the basket tool, wherein the second robot arm is configured to control movement of the basket tool along a long axis of the basket tool and the endoscope. The method of claim 43 or 44, wherein positioning the basket to surround the object
And activating a second robot arm coupled to a tool base or tool base coupled to the basket tool, wherein the second robot arm is configured to control movement of the basket tool along a long axis of the basket tool and the endoscope. 46. The method of claim 45, wherein folding the basket tool simultaneously while advancing the basket tool
Operating at least one of a tool base and a second robotic arm to retract the basket tool into the endoscope; And
And actuating at least one of the device base and the first robotic arm to further move the endoscope into the cavity. 46. The method of claim 45 or 46 wherein folding the basket tool simultaneously while advancing the basket tool
Actuating at least one of a tool base, a device base, a first robot arm and a second robot arm to move the basket tool and the endoscope in opposite directions relative to each other. 31. The method according to any one of claims 31 to 47,
The endoscope comprising a sheath element coupled to the first robot arm and an interrogator scope coupled to the second robot arm,
The basket tool is coupled to the third robot arm. 49. The method of claim 48, wherein advancing the endoscope into the cavity containing the object
And actuating at least one of the first robotic arm and the second robotic arm to further move the basket tool into the cavity. 50. The method of claim 48 or 49 wherein advancing the basket tool through the working channel of the endoscope to open the basket tool within the cavity
Operating the third robot arm to control movement of the basket tool along the long axis of the basket tool and the endoscope. The method of any one of claims 48-50, wherein positioning the basket to surround the object
And activating a third robot arm coupled to a tool base or tool base coupled to the basket tool, wherein the third robot arm is configured to control movement of the basket tool along a long axis of the basket tool and the endoscope. 52. The method of claim 51 wherein folding the basket tool simultaneously while advancing the basket tool
Operating at least one of a tool base and a third robotic arm to retract the basket tool into the endoscope; And
And actuating at least one of the first robotic arm and the second robotic arm to further move the endoscope into the cavity. 52. The method of claim 51 or 52, wherein the basket tool is advanced while the basket tool is being folded
Activating at least one of a tool base, a third robot arm, a first robot arm, and a second robot arm to move the basket tool and the endoscope in opposite directions relative to each other. 33. The method according to any one of claims 31-53,
Passing an optical fiber or laser through a working channel of the basket tool; And
Further comprising the step of operating the optical fiber or laser to effect lithotripsy to fracture the object. A method according to any one of claims 31 to 54,
Passing a mechanical drill through a working channel of the basket tool; And
Further comprising the step of actuating a drill in contact with the object to fracture the object. 33. A method according to any one of claims 31 to 55,
Passing a chisel through a working channel of the basket tool;
Further comprising actuating a chisel in contact with the object to fracture the object. 31. The method of any one of claims 31 to 56,
Further comprising the step of passing fluid through the working channel of the basket device towards the object to fracture the object. 33. A method according to any one of claims 31 to 57,
Wherein the object is at least one of a kidney stone or a mass of stones formed from at least one element of bladder stones, calcium, magnesium, ammonia, uric acid, cysteine. 50. The method according to any one of claims 31-58, wherein the cavity is a kidney in the patient or a kidney in the patient's kidney. The method according to any one of claims 31 to 59, wherein the endoscope is a ureteroscope. A method of performing a percutaneous operation on a patient,
Advancing the first alignment sensor into the cavity through the lumen of the patient, said first alignment sensor providing in real time the position and orientation of the alignment sensor in free space,
Operating the first alignment sensor until the first alignment sensor is located close to an object to be removed from the cavity;
A second alignment sensor for providing the position and direction of the surgical tool in a free space in real time; And
And moving the surgical tool toward the object using data provided by both the first and second alignment sensors. 62. The method of claim 61, wherein advancing the first alignment sensor into the cavity
Wherein the distal end of the endoscope is advanced into the cavity and the distal end comprises a camera and a first alignment sensor to capture an image of the distal view of the observation field. 63. The method of claim 62, wherein operating the first alignment sensor until the first alignment sensor is located proximate the object
Manipulating the distal end of the endoscope until an object appears in the viewing field of the camera. 62. The method of any one of claims 61 to 63, wherein advancing the first alignment sensor
Advancing the guide wire into the cavity, wherein the guide wire comprises a first alignment sensor. 65. The method of claim 64, wherein operating the first alignment sensor until the first alignment sensor is located proximate the object
Performing a fluoroscopic method on the patient to generate fluoroscopic data including the position of the guide wire and the first alignment sensor in the patient; And
And manipulating the guide wire until the first alignment sensor is positioned proximate the object based on the fluoroscopic data. The method of any one of claims 61 to 65, wherein advancing the guide wire into the cavity
Advancing the urinary tract into the cavity, wherein the urethral tube comprises a working channel; And
Advancing the guide wire through the distal end of the urethra. 66. A method according to any one of claims 61 to 66, wherein the first and second alignment sensors receive an electric field emitted by a plurality of electromagnetic field generators located close to the patient with an electromagnetic induction (EM) sensor. 68. The method of claim 67, wherein each EM sensor comprises a coil of at least one conductive material. 67. The method of claim 67 or 68,
Obtaining a three-dimensional (3D) representation of the internal structure of the patient; And
Further comprising matching the data received from the first alignment sensor to a 3D representation to determine a coordinate system for data corresponding to the position and orientation of the patient in free space. 70. The method of claim 69, wherein the 3D representation is a CT scan. 70. The method of claim 69 or 70,
Dividing the 3D representation to identify a reference point; And
Further comprising aligning the position of the reference point via one or more alignment sensors to determine a coordinate system. The method of any one of claims 69 to 71, wherein matching the data
Integrating the positions of the reference points into at least one set of points; And
Determining a homogeneous transformation comprising a rotation matrix and a translation vector based on the set of points. 73. The method of claim 72, wherein at least one of the reference points is identifiable outside the patient ' s body; And
Wherein the first alignment sensor used to match the position of the reference point is located outside the patient's body to match the position. 77. The method of claim 73,
Wherein the first alignment sensor used to match the position of the reference point is coupled to a miniature tool. 72. The method according to any one of claims 72 to 74,
At least one reference point being identifiable during surgery; And
Wherein the first alignment sensor used to match the position of the reference point searches the interior of the patient to match the position. The method of any one of claims 67 to 75,
Obtaining a three-dimensional (3D) representation of the internal structure of the patient; And
Manipulating the first alignment sensor outside the patient's body to identify a first set of points that includes the location of identifiable reference points outside the patient's body;
Manipulating a second alignment sensor in a patient's body to identify a second set of points comprising a location of identifiable reference points in the patient's body;
Further comprising matching the first and second set of points to a 3D representation to determine a coordinate system for data corresponding to the position and orientation of the patient in free space. A method according to any one of claims 61 to 76,
Wherein each alignment sensor is electrically coupled to a conductive wire that transmits and processes sensor data to a computing system. 78. The method of claim 77,
Receiving data from the first and second alignment sensors in real time in a computer system;
A step of providing a graphic interface through a display device
Further comprising:
Wherein the graphical interface comprises:
A first figure element representing the position and orientation of the distal tip, and
A method for displaying a second geometric element representing a position and orientation of a surgical tool. 79. The method of claim 78, wherein using the data provided by both the first and second alignment sensors to move the surgical tool towards the object
Updating and displaying the first graphic element in the graphical interface corresponding to the movement of the distal end of the endoscope in the patient. 78. The method of claim 78 or 79, wherein moving the surgical tool toward the object using data provided by both the first and second alignment sensors
And updating and displaying the second graphic element in the graphical interface in response to the movement of the surgical tool in the patient. The method of any one of claims 78 to 80, wherein moving the surgical tool toward the object using data provided by both the first and second alignment sensors
And providing a notification that the surgical tool has reached the object in response thereto when the first and second alignment sensors are located sufficiently close together. 81. The method of any one of claims 61-81, wherein the steps of advancing the distal end of the endoscope, manipulating the distal end of the endoscope, creating a percutaneous opening, and moving the surgical tool toward the object are performed by a plurality of robotic arms Controlled manner. The method of any one of claims 61 to 82, wherein advancing the distal end of the endoscope
Receiving an input at a control module; And
Operating the plurality of robotic arms in response to the input
Wherein the operation of the robot arm advances the distal end of the endoscope. 83. The method of claim 83, wherein moving the surgical tool
Receiving a second input at a control module; And
Operating the plurality of robotic arms in response to a second input
Wherein the operation of the robot arm moves the surgical tool. The method of any one of claims 61 to 84, wherein the surgical tool is a needle including a balloon,
Expanding the balloon to create a port within the patient ' s cavity; And
Inserting the suction tube into the port
Wherein the suction tube has a diameter sufficient to remove an object or piece. 86. The method of claim 85,
Advancing the endoscope through the lumen of the patient in addition to the port, the endoscope including a working channel;
Cleaning the patient ' s cavity with fluid, the fluid passing through a working channel of an endoscope; And
Applying negative pressure to the suction pipe
Wherein the object is removed from the cavity through the suction tube through a combination of the fluid cleaning and the negative pressure. 87. The method of claim 86,
Operating the optical fiber or laser to pass a fiber optic or laser through the working channel and perform lithotripsy to break the object; And
Operating the endoscope tool to pass the endoscope tool through the working channel and position the object so that the object can be removed from the cavity through the suction tube
RTI ID = 0.0 > 1, < / RTI > 89. The method of claim 87, wherein the endoscopic tool is at least one of a basket device and a grasper. The method of any one of claims 61 to 88, wherein the object is at least one of kidney stones or lumps of bladder stones, stones formed from at least one element of calcium, magnesium, ammonia, uric acid, cysteine. The method of any one of claims 61 to 89, wherein the cavity is a kidney in a patient or a kidney in a patient's kidney. A method for removing an object from a patient,
Inserting the suction tube into the cavity through the port created by the percutaneous incision;
Advancing the endoscope through the lumen or other port of the patient into the cavity, the endoscope including a working channel;
Cleaning the cavity of the patient with a fluid, the fluid passing through a working channel of the endoscope; And
Applying a negative pressure to the suction tube to assist removal of the object from the cavity through the suction tube through a combination of the fluid wash and negative pressure. 92. The method of claim 91,
Moving the surgical tool through the port into the patient ' s cavity; And
Further comprising manipulating the surgical tool to assist removal of the object through the suction tube. 92. The method of claim 92, wherein the surgical tool is inserted into the suction tube. 92. The method of claim 92 or 93, wherein the surgical tool is a laser or an optical fiber, and manipulating the surgical tool to assist in removing the object through the suction tube
And performing lithotripsy to fracture the object. The method of any one of claims 92 to 94, wherein the surgical tool is a chisel or a drill, and manipulating the surgical tool to assist removal of the object through the suction tube
And using a chisel or a drill to fracture the object, respectively. The method of any one of claims 92 to 95, wherein the surgical tool is an ultrasonic instrument and manipulating the surgical tool to assist in removing the object through the suction tube
And operating the ultrasonic instrument to break the object with sound waves. 91. A method according to any one of claims 91 to 96, wherein the surgical tool configured to support removal of the object through the suction tube is incorporated into the suction tube. 97. The method of claim 97, wherein the surgical tool is a laser or an optical fiber, and manipulating the surgical tool to support removal of the object through the suction tube
And performing lithotripsy to fracture the object. 97. The method of claim 97 or 98, wherein the surgical tool is a chisel or a drill, and manipulating the surgical tool to assist removal of the object through the suction tube
And using a chisel or a drill to fracture the object, respectively. The method of any one of claims 97 to 99 wherein the surgical tool is an ultrasonic instrument and manipulating the surgical tool to assist in removing the object through the suction tube
And operating the ultrasonic instrument to break the object with sound waves. 100. The method according to any one of claims 91 to 100,
Inserting the surgical tool into the patient's cavity through a working channel of the endoscope; And
Further comprising manipulating the surgical tool to assist removal of the object through the suction tube. 102. The method of claim 101, wherein the fluid passes outside a surgical tool in a working channel of an endoscope. 101. The method of claim 101 or 102,
Wherein the surgical tool comprises a plurality of peripheral channels woven with an outer shaft and a pull wire as a basket device. The method of any one of claims 101 to 103, wherein the surgical tool is at least one of the group consisting of a laser or an optical fiber, an ultrasonic instrument, a chisel, a drill, and a grasper. A method according to any one of claims 101 to 104,
Wherein the surgical tool comprises a tool operation channel; And
Wherein said fluid passes through a tool working channel of a surgical tool. The method according to any one of claims 101 to 105,
The surgical tool is a basket device comprising a working channel;
Further comprising inserting a second surgical tool into the working channel of the basket device to assist in removing the object from the cavity through the suction tube. 107. The method of claim 106, wherein the second surgical tool is at least one of the group consisting of a laser or an optical fiber, an ultrasonic instrument, a chisel, and a drill. 107. The method according to any one of claims 101 to 107,
The surgical tool is a basket device and manipulating the surgical tool to assist in removing the object from the cavity through the suction tube
Trapping the object in the basket of the basket apparatus and locating the stones close to the suction pipe. A method according to any one of claims 101 to 108,
The surgical tool is a laser or an optical fiber, and manipulating the surgical tool to support removal of the object through the suction tube
And performing lithotripsy to fracture the object. The method according to any one of claims 101 to 109,
The surgical tool is a chisel or a drill, and manipulating the surgical tool to assist removal of the object through the suction tube
And using a chisel or a drill to fracture the object, respectively. The method of any one of claims 101 to 110, wherein the surgical tool is an ultrasonic instrument and manipulating the surgical tool to assist in removing the object through the suction tube
And operating the ultrasonic instrument to break the object with sound waves. 91. A method according to any one of claims 91 to 111,
Extending a leader scope disposed in a working channel of the endoscope over a distal end of the endoscope;
Inserting a surgical tool into a patient's cavity along a working channel in a reader scope; And
Further comprising manipulating the surgical tool to assist in removing the object through the suction tube. 115. The method of claim 112, wherein the surgical tool is at least one of a laser or an optical fiber, an ultrasonic instrument, a chisel, a drill, and a grasper. 113. The method of claim 112 or 113, wherein the fluid passes outside the leader scope in a working channel of the endoscope. 114. The method according to any one of claims 112 to 114,
The surgical tool is a laser or an optical fiber, and manipulating the surgical tool to support removal of the object through the suction tube
And performing lithotripsy to fracture the object. 113. The method of any one of claims 112 to 115,
The surgical tool is a chisel or a drill, and manipulating the surgical tool to assist removal of the object through the suction tube
And using a chisel or a drill to fracture the object, respectively. The method of any one of claims 112 to 116, wherein the surgical tool is an ultrasonic instrument and manipulating the surgical tool to assist in removing the object through the suction tube
And operating the ultrasonic instrument to break the object with sound waves. 91. A method according to any one of claims 91 to 117,
Inserting the suction tube into the port is performed by the first robot arm; And
Wherein advancing the endoscope through the cavity is performed by a second robotic arm. 91. A compound according to any one of claims 91 to 118,
The endoscope includes a sheath and a reader scope, and
Advancing the endoscope through the cavity is performed by a first robotic arm that advances the sheath and a second robot arm that advances the leader scope. The method of any one of claims 91 to 119, wherein the object is at least one of kidney stones or lumps of bladder stones, stones formed from at least one element of calcium, magnesium, ammonia, uric acid, cysteine.

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