WO2022011538A1

WO2022011538A1 - Systems and methods for positioning access ports

Info

Publication number: WO2022011538A1
Application number: PCT/CN2020/101808
Authority: WO
Inventors: K V S Manoj Kumar Vadali; Premkumar JAGAMOORTHY; Sridharan Varadhan
Original assignee: Covidien Lp; Covidien (China) Medical Devices Technology Co., Ltd.
Priority date: 2020-07-14
Filing date: 2020-07-14
Publication date: 2022-01-20

Abstract

Systems (10) and methods for positioning access ports during a surgical procedure are provided. The positioning systems (10) include a camera (300) for capturing a real time image of a patient, a display (200) for viewing the real time image of the patient, and a processor (100) for providing an overlay of recommended access port positions on the real time image of the patient view on the display (200). The processor (100) creates the overlay based on information provided to the processor (100) by a clinician. The positioning methods include selecting a surgical procedure to be performed, capturing a real time image of a patient, displaying the real time image of the patient on a monitor, and displaying an overlay of one or more access positions on the real time image of the patient on the monitor.

Description

SYSTEMS AND METHODS FOR POSITIONING ACCESS PORTS

FIELD

The disclosure relates to systems and methods for use in minimally invasive surgical procedures, such as endoscopic and/or laparoscopic procedures and, more particularly, to systems and methods for positioning access ports through which the procedures will be performed.

BACKGROUND

Endoscopic surgery involves surgery through body walls, for example, viewing and/or operating on the ovaries, uterus, gall bladder, bowels, kidneys, appendix, etc. There are many common endoscopic surgical procedures, including arthroscopy, laparoscopy, gastroentroscopy, and laryngobronchoscopy, to name a few. In these procedures, trocars are utilized for creating incisions through which the endoscopic surgery is performed. Access ports, e.g., cannula assemblies, are received through the incision into a body cavity of the patient and left in place to provide access for endoscopic surgical tools. A camera or scope is inserted through a cannula assembly to permit the visual inspection and magnification of the body cavity. The clinician can then perform diagnostic and/or therapeutic procedures at the surgical site with the aid of specialized instrumentation, such as forceps, graspers, cutters, applicators, and the like, which are designed to fit through additional access ports.

Access port positioning is important in the performance of the surgical procedures. When the access ports are properly positioned relative to the patient and to each other, the angle the instruments inserted through the access ports make with the operative site and to each other mimics, as much as possible the natural relationship of the hands and eyes during conventional open surgery. Improper placement of the access ports may result in swording of the instruments during use and/or the creation of blind spots in which the clinician is unable to view. To compensate for the swording or blind spots, the clinician may need to adjust the camera settings and/or adjust the lighting that may delay the procedure. Improper access port placement may also result in the need to reposition the access ports, the need to place additional access ports, and/or the need to change the access port through which the instrument is inserted to another access port.

SUMMARY

A system for positioning access ports during a surgical procedure includes a camera for capturing a real time image of a patient, a display for viewing the real time image of the patient, and a processor for providing an overlay of recommended access port positions on the real time image of the patient view on the display. The processor creates the overlay based on information provided to the processor by a clinician.

A method of positioning one or more access ports for a surgical procedure includes selecting a surgical procedure to be performed, capturing a real time image of a patient, displaying the real time image of the patient on a monitor, and displaying an overlay of one or more access port positions on the real time image of the patient on the monitor.

In aspects of the disclosure, the positioning method further include inputting relevant information for the surgical procedure. The relevant information may include clinician preferences, patient demographics, and equipment placement in an operating room. The positioning method may further include identifying a posture of the patient using the real time image and confirming that the identified patient posture corresponds with recommended patient posture for the selected surgical procedure. The positioning method may further include notifying the clinician if the identified patient posture is different from the recommended patient posture for the selected surgical procedure.

In certain aspects of the disclosure, the positioning method further includes analyzing the relevant information to create the overlay. Displaying the overlay may include providing markings on the real time image of the patient on the monitor. Providing markings on the real time image of the patient on the monitor may include providing markings of different sizes to indicate access ports of different configurations.

BRIEF DESCRIPTION OF THE DRAWINGS

Various aspects of the disclosed systems and methods are described herein below with reference to the drawings, wherein:

FIG. 1 is a schematic view of a system for positioning access ports according to aspects of the disclosure and a patient supported on an operating table;

FIG. 2 is a flow chart of a method of positioning access ports according to aspects of the disclosure;

FIG. 3 is a schematic view of the positioning system and the patient in FIG. 1, with an image of the recommended access port positions overlaid on the patient;

FIG. 4 is a schematic view of the positioning system and the patient in FIG. 3, as a clinician marks the patient to indicate the recommended placement of the access ports; and

FIG. 5 is a schematic view of the positioning system and the patient in FIG. 4, subsequent to placement of an access port.

DETAILED DESCRIPTION

The access port positioning systems and methods of this disclosure are described in detail with reference to the drawings, in which like reference numerals designate identical or corresponding elements in each of the several views. As used herein the term “distal” refers to that portion of the surgical instrument, or component thereof, farther from the user, while the term “proximal” refers to that portion of the surgical instrument, or component thereof, closer to the user. In addition, the term “laparoscopic” or “laparoscope” is used generally used to refer to endoscopic, laparoscopic, arthroscopic, and/or any other procedure conducted through small diameter incision or cannula. Further, the term “clinician” is used generally to refer to medical personnel including doctors, nurses, and support personnel. As used herein, the term “about” means that the numerical value is approximate and small variations would not significantly affect the practice of the disclosed aspects of the disclosure.

Disclosed are systems and methods for positioning access ports for use during laparoscopic procedures. As will be described in further detail below, the systems and methods utilize real time monitoring and a generated overlay of optimal access port positions to provide a recommendation of access port positions to a clinician. Proper access port positioning provides direct access to the target organ, provides an optimal view of the operative filed, and/or minimizes mental and/or muscular fatigue to the clinician.

FIG. 1 illustrates a schematic view of a system for positioning access ports, referred to generally as the positioning system 10. The positioning system 10 is shown in combination with a patient support structure, e.g., operating table 50, and a patient “P” supported on the operating table 50. The patient “P” is shown in a supine position, however, is envisioned that the patient “P” may be positioned in various other positions, including, for example, seated.

The positioning system 10 may be a stand alone unit, as shown, including a processor 100, a display 200 connected to the processor 100, and a camera 300. It is envisioned that the positioning system 10 may utilize an operating room monitor and/or operating room camera. The positioning software for providing the recommended access port positions may be part of the stand alone processor 100 or be incorporated into a computer system of the operating room.

The processor 100 of the positioning system 10 is configured for storing and processing relevant information regarding access port placement and providing the recommended access port positions as an overlay that is displayed on an image of the patient on the display200.

The processor 100 may include any suitable processor operably connected to a memory (not shown) , which may include one or more of volatile, non-volatile, magnetic, optical, or electrical media, such as read-only memory (ROM) , random access memory (RAM) , electrically-erasable programmable ROM (EEPROM) , non-volatile RAM (NVRAM) , or flash memory. The processor may be any suitable processor (e.g., control circuit) adapted to perform the operations, calculations, and/or set of instructions described in the disclosure including, but not limited to, a hardware processor, a field programmable gate array (FPGA) , a digital signal processor (DSP) , a central processing unit (CPU) , a microprocessor, and combinations thereof. Those skilled in the art will appreciate that the processor may be substituted for by using any logic processor (e.g., control circuit) adapted to execute algorithms, calculations, and/or set of instructions described herein.

The processor 100 of the positioning system 10 may include an interface 110 for entering information regarding the patient, e.g., demographics. The interface 110 may be include a touch screen and/or a keyboard, and/or may be voice activated. The interface 110 may be connected, wirelessly, or otherwise, to the processor 100. It is envisioned that the information provided to the processor 100 may be acquired from a network.

During initial use of the positioning system 10, the access port positions are recommended based on scientific knowledge and the position of the access ports in prior procedures. The recommended access port positions are pre-loaded into the positioning system 10, and are used by the clinician to position the access ports 5 (FIG. 5) . Experienced clinicians may utilize the positioning system 10 to provide their preferred access port position and/or their preferred positions for the operating room staff for the particular surgical procedure. In this manner, stress on the clinician may be reduced, and the clinician is able to focus on other aspects of the procedure.

The positioning software of the positioning system 10 includes an algorithm that develops the optimal access port positions based on actual access port positions taking into consideration the type of surgical procedure being performed, the duration of the surgical procedure, the demographics of the patient, the experience of the clinician, the clinician’s preferences, e.g., preferred position to stand relative to the patient “P” , the location of the operating room monitor, the placement of the sterile and non-sterile zones, the location of the instrument cluster, and/or the placement of the diagnostic systems.

Through machine learning, the positioning system 10 optimizes the recommended access port positions. More particularly, each surgical procedure provides additional information that may be used in subsequent surgical procedures to optimize the recommended access port position for a particular surgical procedure. In this manner, the recommended access port positions may be particularly tailored to the clinician and their experience and preferences, to the projected surgery duration, and/or to the demographics of the patient.

The data collected by the positioning system 10 regarding the recommended access port positions for optimal placement may be shared for use by other clinicians. The data may be shared between clinicians within the same hospital and/or with clinicians in other hospitals. The sharing of the data may be wirelessly. Different positioning systems 10 may connected directly with each other, and/or may be connected to a common platform, e.g., Medtronic Cloud.

FIG. 2 is a flow diagram of a method for positioning access ports according to an aspect of the disclosure. The method includes identifying the surgical procedure to be performed; displaying the recommended patient position (s) for the selected surgical procedure; acquiring a patient image; and overlaying the recommended access port position on the image of the patient. Various positioning methods may further include identifying the patient posture, determining if the identified patient posture is appropriate for the selected surgical procedure, and, if not, informing the clinician of the inconsistency.

Initially, using the interface 110 of the processor 100 of the positioning system 10, the clinician enters selects the type of surgical procedure being performed, e.g., organ resectioning, organ removal. The clinician may also enter other information for the particular procedure, including but not limited to the anticipated duration of the surgical procedure, the demographics of the patient, the experience of the clinician, the clinician’s preferences, e.g., preferred position to stand relative to the patient “P” , the location of the operating room monitor, the placement of the sterile and non-sterile zones, the location of the instrument cluster, and/or the placement of the diagnostic systems.

Following the entry of the data by the clinician, the camera 300 is used to acquire an image “I” of the patient “P” . The image “I” of the patient “P” is displayed on the display 200.

Optionally, the positioning method includes identifying the patient posture, determining if the identified patient posture is appropriate for the selected surgical procedure, and, if not, informing the clinician of the inconsistency.

Using pre-loaded positioning data and the acquired image “I” of the patient “P” , the processor 100 of the positioning system 10 to create an overlay 400 of the optimum access port positions for the particular surgical procedure being performed. It is envisioned that the recommended access port positions considers all of the information provide to the processor 100. In this manner, the more information provided to the processor 100 regarding the clinician, their preferences, and the patient, the greater the optimization of the access port placement.

FIG. 3 illustrates the overlay 400 created by the processor 100 and displayed on the image “I” of the patient “P” shown on the display 200. The overlay 400 may include one or more recommended markings 400a-e indicating the location of the one or more access ports. The recommend markings 400a-e may be of the same or different sizes. The recommended markings 400a-e may be sized and dimensioned to indicate the size and dimension of the cannula of the access port being inserted therethrough, and/or the size and dimension of the incision necessary to receive particular access port. The recommended markings 400a-e may be color coded. The recommended markings 400a-e may include a label “#” . The label “#” may indicate the position of the access port, the type of access port, the type of instrument to be inserted through the access port, or any other relevant information.

FIG. 4 illustrates the hand “H” of the clinician as the clinician identifies the location of the recommended marking 400b on the patient “P” using the image “I” of the patient “P” and the overlay 400 of the recommended access port positions displayed on the display 200. Real time capturing of the image “I” of the patient “P” and the overlay 400 provided on the display 200 allows the clinician to mark on the patient “P” , using a marker or other marking device or substance, the recommended access port positions. In this manner, the positioning system 10 provides real time guidance to track the clinician’s hand movement to accurately align actual markings 500a-e with the recommended markings 400a-e, and any deviation between the recommended markings 400a-e and actual markings 500a-e can be corrected in real-time using visual cues provided on the display 200.

The access port positions may be marked by the clinician all at the same time with the access ports then placed subsequently. Alternatively, the access ports may be placed after each marking by the clinician.

FIG. 5 illustrates the patient “P” with an access port 5 placed in the position identified the actual marking 500b. Additional access ports (not shown) may be placed in the position of the actual markings 500a, c-e.

The positioning system 10 may stay active during the access port placement, or may be stopped, and/or removed subsequent to the patient “P” being marked by the clinician.

The surgical procedure is then carrier out in the traditionally manner. The data collected during the surgical procedure may be recorded and uploaded for further use.

It will be understood that various modifications may be made to the disclosed methods and systems. Therefore, the above description should not be construed as limiting, but merely as exemplifications of aspects of the disclosure. Those skilled in the art will envision other modifications within the scope and spirit of the disclosure. For example, any and all features of one described aspect may be suitably incorporated into another aspect.

Claims

A system for positioning access ports during a surgical procedure, the positioning system comprising:

a camera for capturing a real time image of a patient;

a display for viewing the real time image of the patient; and

a processor for providing an overlay of recommended access port positions on the real time image of the patient view on the display, the processor creating the overlay based on information provided to the processor by a clinician.
A method of positioning one or more access ports for a surgical procedure, the positioning method comprising:

selecting a surgical procedure to be performed;

capturing a real time image of a patient;

displaying the real time image of the patient on a monitor; and

displaying an overlay of one or more access port positions on the real time image of the patient on the monitor.
The positioning method of claim 2, further including inputting relevant information for the surgical procedure.
The positioning method of claim 3, wherein the relevant information includes clinician preferences, patient demographics, and equipment placement in an operating room.
The positioning method of claim 2, further including identifying a posture of the patient using the real time image.
The positioning method of claim 5, further including confirming that the identified patient posture corresponds with recommended patient posture for the selected surgical procedure.
The positioning method of claim 6, further including notifying the clinician if the identified patient posture is different from the recommended patient posture for the selected surgical procedure.
The positioning method of claim 3, further including analyzing the relevant information to create the overlay.
The positioning method of claim 2, wherein displaying the overlay includes providing markings on the real time image of the patient on the monitor.
The positioning method of the claim 9, wherein providing markings on the real time image of the patient on the monitor includes providing markings of different sizes to indicate access ports of different configurations.
The positioning method of claim 2, further including storing port positions for future recollection.
The positioning method of claim 11, further including recalling the previously stored port positions.
The positioning method of claim 12, further including developing an overlay based on the previously stored port positions.
The positioning method of claim 13, wherein displaying the overlay of one or more access port positions on the real time image of the patient on the monitor includes displaying the overlay developed based on the previously stored port positions.