CN113855244B - Surgical robot for treating pain - Google Patents

Surgical robot for treating pain Download PDF

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Publication number
CN113855244B
CN113855244B CN202111050095.4A CN202111050095A CN113855244B CN 113855244 B CN113855244 B CN 113855244B CN 202111050095 A CN202111050095 A CN 202111050095A CN 113855244 B CN113855244 B CN 113855244B
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electromagnetic tracking
mechanical arm
puncture
ultrasonic
tracking sensor
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CN113855244A (en
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曹晓建
李亮
常杰
刘宾
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Jiangsu Jiao Medical Engineering Cross Technology Co ltd
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Jiangsu Jiao Medical Engineering Cross Technology Co ltd
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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/30Surgical robots
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/20Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/20Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
    • A61B2034/2046Tracking techniques
    • A61B2034/2051Electromagnetic tracking systems
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/20Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
    • A61B2034/2046Tracking techniques
    • A61B2034/2065Tracking using image or pattern recognition

Abstract

The present invention provides a surgical robot for pain treatment, comprising: a mechanical arm; the tail end of the mechanical arm is provided with a mechanical arm tail end connecting piece; the first quick mounting device is fixedly connected with the mechanical arm tail end connecting piece; the first quick mounting device is provided with a puncture part and a first electromagnetic tracking sensor; the tail end of the puncture part is provided with a third electromagnetic tracking sensor; the second quick mounting device is adjustably connected with the mechanical arm tail end connecting piece; the second quick mounting device is provided with an ultrasonic part and a second electromagnetic tracking sensor; the control console is connected with the mechanical arm; the system also comprises an electromagnetic tracking system, an ultrasonic system, preoperative CT and MR fluoroscopy equipment, intraoperative CT fluoroscopy/X-ray scanning equipment and a display device which are connected with the control console. The invention combines the robot with magnetic navigation technology and ultrasonic imaging, thereby greatly improving the accuracy and safety of the operation.

Description

Surgical robot for treating pain
Technical Field
The invention relates to the technical field of surgical robots, in particular to a surgical robot for pain treatment.
Background
The spine-derived pain is a group of clinical symptoms of pain in head, neck, limbs, chest wall, waist, back and sacrococcygeal region caused by spondylopathy, and is one of the most common clinical symptoms of pain department, orthopedics department, rehabilitation department and other department patients. Spine-derived pain is mainly classified into cervical vertebra-derived, thoracic vertebra-derived, lumbar vertebra-derived and sacrococcygeal vertebra-derived pain, and although most of the pain can be alleviated by conservative treatment, there is evidence that early minimally invasive interventional therapy is superior to long-term conservative treatment patients in terms of pain alleviation and functional recovery.
The principle of the method is that medicine is injected into the extradural space of the intervertebral foramen or the outlet of the sacral foramen of nerve roots and diffuses along the spinal cord to achieve the effect of relieving pain. The common method for minimally invasive interventional therapy is intervertebral foramen puncture blocking under X-ray fluoroscopy, namely, repeatedly correcting the position of a puncture needle by X-rays in the operation process, puncturing to a target position and injecting nerve blocking medicines.
Present intervertebral foramen epidural/sacral foramen block art needs to relapse X line location, and radiation dose is great, and operation time is longer, and the product of present robot also need navigate the location through CT in the art, greatly increased the radiation volume in the art, the influence that causes art person and patient's health. Meanwhile, the relative position of the puncture needle can be judged only by the bone structure of the robot at present, but the position of the nerve can not be directly positioned, which is a great defect for pain treatment.
Disclosure of Invention
In view of the above prior art, the present invention provides a surgical robot for pain treatment.
The present invention provides a surgical robot for pain treatment, including:
a mechanical arm; the tail end of the mechanical arm is provided with a mechanical arm tail end connecting piece;
the first quick mounting device is fixedly connected with the mechanical arm tail end connecting piece; the first quick mounting device is provided with a puncture part and a first electromagnetic tracking sensor; the tail end of the puncture part is provided with a third electromagnetic tracking sensor;
the second quick mounting device is adjustably connected with the mechanical arm tail end connecting piece; the second quick mounting device is provided with an ultrasonic part and a second electromagnetic tracking sensor;
the control console is connected with the mechanical arm and used for controlling the mechanical arm to move and acquiring the positions of all joints of the mechanical arm and the position of the mechanical arm tail end connecting piece;
the electromagnetic tracking system is connected with the console and is used for tracking the positions of the first electromagnetic tracking sensor, the second electromagnetic tracking sensor and the third electromagnetic tracking sensor in a coordinate system of the magnetic field generating part;
the ultrasonic system is connected with the console and is used for acquiring an ultrasonic image of the ultrasonic part;
preoperative CT and MR fluoroscopy equipment which is connected with the console and used for acquiring preoperative fluoroscopy images;
the intraoperative C-arm perspective equipment is connected with the console and is used for acquiring intraoperative perspective images;
and the display device is connected with the console in a wired or wireless mode.
Preferably, the mechanical arm end connecting piece is a flange.
Preferably, the first electromagnetic tracking sensor is fixedly connected to the first quick mount device.
Preferably, the second quick-mounting means is connected to the end-of-arm linkage by a gimbal arm.
Preferably, a puncture needle is arranged on the puncture part.
Preferably, an ultrasonic probe is arranged on the ultrasonic part.
Preferably, the display device is a 2D display screen, a 3D display screen, a virtual reality device, an augmented reality device, or a mixed reality device.
Preferably, the control method of the robot includes the steps of:
s1, preoperative scanning: performing CT and MR image scanning on a preoperative patient, establishing a bone tissue model of the patient by using a CT image, establishing a soft tissue model of the patient by using an MR image, obtaining a soft and hard tissue anatomical structure of the preoperative patient by using CT and MR fusion, and planning a path in the CT and MR images before operation;
s2, intraoperative registration: taking a prone position of a patient in an operation, rigidly fixing a fourth electromagnetic tracker on bone tissue in an operation area, performing intraoperative normal lateral X-ray scanning or intraoperative CT scanning to enable the fourth electromagnetic tracker to be positioned in an imaging visual field, matching intraoperative normal lateral X-ray or CT images with preoperative CT and MR images, transmitting matched information to the console, and determining a relative position relation between a planned path and the first magnetic tracker;
s3, calibrating the relation between the mechanical arm and the electromagnetic positioning: the control platform acquires the position of a first electromagnetic tracking sensor under an electromagnetic tracking system coordinate system and the position of the first electromagnetic tracking sensor under a mechanical arm base coordinate system in the movement process, and the position relation between the electromagnetic tracking system coordinate system and the mechanical arm base coordinate system is calculated;
s4, positioning a mechanical arm moving target: the console tracks the fourth electromagnetic tracker, determines the target position of the planned path in an electromagnetic tracking system coordinate system, tracks the third electromagnetic tracking sensor, determines the puncture part position in the electromagnetic tracking system coordinate system, compares the error between the target position and the puncture part position, and controls the mechanical arm to move to carry the puncture part to reach the target position;
s5, puncture operation: the puncture needle feeding in the puncture part is operated, and the current position of the puncture needle in the CT image is displayed in real time by the console through the display device;
s6, ultrasonic observation and adjustment: after the puncture part is put in place, the position and the direction of the ultrasonic part are adjusted to be in contact with the body surface of a patient, the electromagnetic tracking system tracks the position and the posture of an ultrasonic probe on the ultrasonic part in real time through a second electromagnetic tracking sensor, a two-dimensional sector image, a CT image and an MR image which are obtained by the real-time detection of the ultrasonic probe are simultaneously displayed in a display device, the display device is utilized to observe the position of the ultrasonic sector and the CT and MR structures of the patient, and the ultrasonic probe is ensured to carry out ultrasonic imaging on a surgical area at the most proper visual angle;
s7, ultrasound-assisted puncture adjustment: the control console calculates the relative positions of the puncture needle and the puncture nerve under the second electromagnetic tracking sensor coordinate system by using the ultrasonic images, obtains the relative position relationship of the puncture needle and the puncture nerve under the electromagnetic tracking system, displays the relative position relationship on the display device, judges the quality of the position relationship between the puncture needle and the puncture nerve according to the relative position relationship, and adjusts the position of the puncture needle through advancing, retreating and rotating.
Preferably, in S2, the fourth electromagnetic tracker is rigidly fixed to the bone tissue of the surgical field by means of a k-wire.
Compared with the prior art, the invention has the beneficial effects that:
1. the invention creatively provides a robot pain treatment scheme, applies the surgical robot technology to pain treatment, and provides a new operation flow. The robot is specially used for intervertebral foramen and sacral foramen nerve block, and pioneers of pain treatment robots are created.
2. The invention utilizes electromagnetic tracking and image navigation to rapidly assist ultrasonic positioning, and solves the problems that the ultrasonic imaging visual angle is not fixed, and the nerve tissues in complex anatomical structure regions such as vertebrae and the like are difficult to obtain a proper visual angle through ultrasonic observation. Firstly, the invention provides a scheme that the mechanical arm carries the flexible universal arm to assist the ultrasonic visual angle fixation, so that the ultrasonic can obtain a determined visual angle during the operation, and an operator only needs to concentrate on adjusting the puncture needle. The invention provides a method for tracking the visual angle of the ultrasonic probe in real time by using the electromagnetic tracking sensor and displaying the visual angle together with the CT and MR images, so that an operator can adjust the ultrasonic visual angle according to the anatomical structures given in the CT and MR images, the rapid adjustment of the ultrasonic visual angle is realized, and the position of a nerve root is accurately determined.
3. Compared with the traditional mode, the invention avoids the repeated operation of X-ray radiography in the operation and reduces the radiation in the operation. Meanwhile, the robot can greatly improve the accuracy and safety of the operation, and the operation time can be reduced by inserting the needle once.
4. Compared with the existing puncture robot navigation equipment, the invention reduces the radiation influence caused by CT fluoroscopy, increases the function of positioning nerve tissues under the assistance of ultrasound and further improves the safety.
5. The invention avoids the use of a three-dimensional C-arm machine in the operation, reduces the cost and lowers the operation threshold of an operator.
Drawings
Fig. 1 is a schematic structural diagram of an embodiment of the present invention.
In the figure, 1, a mechanical arm; 2. a flange plate; 3. a first quick mount device; 4. a puncture section; 5. a first electromagnetic tracking sensor; 6. a third electromagnetic tracking sensor; 7. a second quick mount device; 8. an ultrasonic part; 9. a second electromagnetic tracking sensor; 10. a console; 11. an electromagnetic tracking system; 12. an ultrasound system; 13. preoperative CT, MR fluoroscopy devices; 14. an intraoperative C-arm fluoroscopy device; 15. a gimbal arm.
Detailed Description
In order to make the technical means, the creation characteristics, the achievement purposes and the effects of the invention easy to understand, the invention is further explained below by combining the specific drawings.
Examples
As shown in fig. 1, a surgical robot for pain treatment includes: the system comprises a mechanical arm, a first quick mounting device, a second quick mounting device, a control console, an electromagnetic tracking system, an ultrasonic system, preoperative CT (computed tomography), MR (magnetic resonance) fluoroscopy equipment, intraoperative C-arm fluoroscopy equipment and a display device.
Wherein, the flange plate 2 is arranged at the tail end of the mechanical arm 1. The first quick mounting device 3 is fixedly connected with the flange plate 2, so that the first quick mounting device 3 has a determined position relation with the tail end of the mechanical arm 1, and the puncture part 4 and the first electromagnetic tracking sensor 5 are fixedly mounted on the first quick mounting device 3, so that the first electromagnetic tracking sensor 5 has a determined position relation with the tail end of the mechanical arm 1; a puncture needle is provided in the puncture part 4, a third electromagnetic tracking sensor 6 is fixedly mounted at the tip of the puncture part 4, and an electromagnetic tracking system 11 can track the position and direction of the tip of the puncture part 4.
Furthermore, the second quick mounting device 7 is connected with the flange plate 2 through a flexible adjustable universal arm 15, the ultrasonic part 8 and the second electromagnetic tracking sensor 9 are fixedly mounted on the second quick mounting device 7, and an ultrasonic probe is arranged on the ultrasonic part 8, so that when the ultrasonic part 8 is mounted on the second quick mounting device 7, the ultrasonic probe can be manually moved and rotated in space through the universal arm 15, after the ultrasonic probe is adjusted, the universal arm 15 can fix the relative position of the ultrasonic probe, and the position and the direction of the ultrasonic probe can be tracked through the second electromagnetic tracking sensor 9.
Further, a console 10 is connected to the robot arm 1 for controlling the movement of the robot arm 1 and acquiring the positions of the joints of the robot arm 1 and the position of the flange 2.
Further, an electromagnetic tracking system 11 is connected to the console 10 for tracking the position of each electromagnetic tracking sensor in the coordinate system of the magnetic field generating unit. The ultrasound system 12 is connected to the console 10 for obtaining an ultrasound image of the ultrasound part 8, and the positional relationship of the ultrasound probe can be obtained by the second electromagnetic tracking sensor 9. The preoperative CT and MR fluoroscopy device 13 is connected to the console 10 for obtaining preoperative fluoroscopy images. An intraoperative C-arm fluoroscopic apparatus 14 is connected to the console 10 for acquiring intraoperative fluoroscopic images. The display device is a virtual reality device and is in wireless connection with the console 10.
The control method of the robot comprises the following steps:
s1, preoperative scanning: performing CT and MR image scanning on a preoperative patient, establishing a bone tissue model of the patient by using a CT image, establishing a soft tissue model of the patient by using an MR image, obtaining a soft and hard tissue anatomical structure of the preoperative patient by using CT and MR fusion, and planning a path in the CT and MR images before operation;
s2, intraoperative registration: taking a prone position of a patient in an operation, rigidly fixing a fourth electromagnetic tracker on bone tissues in an operation area by using a Kirschner wire, carrying out X-ray scanning on a positive side position in the operation, enabling the fourth electromagnetic tracker to be in an imaging visual field, matching a CT image and an MR image before the operation by using a positive side position X sheet in the operation, transmitting matched information into a control console 10, and determining a relative position relation between a planned path and a first magnetic tracker 5;
s3, calibrating the relation between the mechanical arm and the electromagnetic positioning: the magnetic field generator is adjustably connected with multiple degrees of freedom of the operating table through the mechanical arm, and an operator can manually adjust the spatial position and the posture of the magnetic field generator to enable a detection area of the magnetic field generator to cover an operation working area; fixing the mechanical arm 1, controlling the tail end of the mechanical arm 1 to move in multiple degrees of freedom under an electromagnetic tracking system, acquiring the position of a first electromagnetic tracking sensor 5 under an electromagnetic tracking system coordinate system and the position of the first electromagnetic tracking sensor 5 under a mechanical arm base coordinate system by a console 10 in the moving process, and solving the position relation between the electromagnetic tracking system coordinate system and the mechanical arm base coordinate system;
s4, positioning a mechanical arm moving target: the console 10 tracks the fourth electromagnetic tracker, determines a target position of the planned path under an electromagnetic tracking system coordinate system, the console 10 tracks the third electromagnetic tracking sensor 6, determines a puncture part position under the electromagnetic tracking system coordinate system, the console 10 compares errors between the target position and the puncture part position, and controls the mechanical arm 1 to move to carry the puncture part 4 to reach the target position;
s5, puncture operation: the puncture needle feeding in the puncture part 4 is operated, and the console 10 displays the position of the current puncture needle in the CT image in real time through a display device;
s6, ultrasonic observation and adjustment: after the puncture part 4 is put in place, the position and the direction of the ultrasonic part 8 are adjusted to be in contact with the body surface of a patient, the electromagnetic tracking system 11 tracks the position and the posture of an ultrasonic probe on the ultrasonic part 8 in real time through the second electromagnetic tracking sensor 9, the two-dimensional sector image and the CT acquired by the real-time detection of the ultrasonic probe are displayed simultaneously in the display device, the display device is used for observing the position of the ultrasonic sector and the CT of the patient, the MR structure is used for ensuring that the ultrasonic probe carries out ultrasonic imaging on the surgical regions such as intervertebral foramen and the like at the most appropriate visual angle, and therefore the real-time positions of the puncture needle and the puncture nerve under the ultrasonic image can be accurately and rapidly acquired.
S7, ultrasound-assisted puncture adjustment: the console 10 calculates the relative position of the puncture needle and the puncture nerve under the second electromagnetic tracking sensor coordinate system by using the ultrasonic image, obtains the relative position relationship of the puncture needle and the puncture nerve under the electromagnetic tracking system 11, and the relative position relationship is displayed on the display device, thereby helping an operator judge the position relationship between the puncture needle and the puncture nerve, and obtaining the best drug administration or ablation treatment means by adjusting the forward and backward movement and rotation of the puncture needle.
The above description is only an embodiment of the present invention, and not intended to limit the scope of the present invention, and all equivalent structures made by using the contents of the present specification and the drawings can be directly or indirectly applied to other related technical fields, and are within the scope of the present invention.

Claims (8)

1. A surgical robot for pain management, comprising:
a mechanical arm; the tail end of the mechanical arm is provided with a mechanical arm tail end connecting piece;
the first quick mounting device is fixedly connected with the mechanical arm tail end connecting piece; the first quick mounting device is provided with a puncture part and a first electromagnetic tracking sensor; the tail end of the puncture part is provided with a third electromagnetic tracking sensor;
the second quick mounting device is adjustably connected with the mechanical arm tail end connecting piece; the second quick mounting device is provided with an ultrasonic part and a second electromagnetic tracking sensor;
the control console is connected with the mechanical arm and used for controlling the mechanical arm to move and acquiring the positions of all joints of the mechanical arm and the position of the mechanical arm tail end connecting piece;
the electromagnetic tracking system is connected with the console and is used for tracking the positions of the first electromagnetic tracking sensor, the second electromagnetic tracking sensor and the third electromagnetic tracking sensor in a coordinate system of the magnetic field generating part;
the ultrasonic system is connected with the console and is used for acquiring an ultrasonic image of the ultrasonic part;
preoperative CT and MR fluoroscopy equipment which is connected with the console and used for acquiring preoperative fluoroscopy images;
the intraoperative C-arm perspective equipment is connected with the console and is used for acquiring intraoperative perspective images;
the display device is connected with the console in a wired or wireless mode;
the control method of the robot comprises the following steps: s1, preoperative scanning: performing CT and MR image scanning on a preoperative patient, establishing a bone tissue model of the patient by utilizing a CT image, establishing a soft tissue model of the patient by utilizing an MR image, obtaining a soft and hard tissue anatomical structure of the preoperative patient by utilizing CT and MR fusion, and planning a path in the preoperative CT and MR images;
s2, intraoperative registration: taking a prone position of a patient in an operation, rigidly fixing a fourth electromagnetic tracker on bone tissues in an operation area, performing intraoperative lateral X-ray scanning or intraoperative CT scanning to enable the fourth electromagnetic tracker to be positioned in an imaging visual field, matching intraoperative lateral X-ray or CT images with preoperative CT and MR images, transmitting matched information to the console, and determining a relative position relation between a planned path and the first electromagnetic tracking sensor;
s3, calibrating the relation between the mechanical arm and the electromagnetic positioning: the control platform acquires the position of a first electromagnetic tracking sensor under an electromagnetic tracking system coordinate system and the position of a first electromagnetic tracking sensor under a mechanical arm base coordinate system in the motion process, and the position relation between the electromagnetic tracking system coordinate system and the mechanical arm base coordinate system is calculated;
s4, positioning a mechanical arm moving target: the console tracks the fourth electromagnetic tracker, determines the target position of the planned path in an electromagnetic tracking system coordinate system, tracks the third electromagnetic tracking sensor, determines the puncture part position in the electromagnetic tracking system coordinate system, compares the error between the target position and the puncture part position, and controls the mechanical arm to move to carry the puncture part to reach the target position;
s5, puncture operation: the puncture needle feeding in the puncture part is operated, and the current position of the puncture needle in the CT image is displayed in real time by the console through the display device;
s6, ultrasonic observation and adjustment: after the puncture part is put in place, the position and the direction of the ultrasonic part are adjusted to be in contact with the body surface of a patient, the electromagnetic tracking system tracks the position and the posture of an ultrasonic probe on the ultrasonic part in real time through a second electromagnetic tracking sensor, a two-dimensional sector image, a CT image and an MR image which are obtained by the real-time detection of the ultrasonic probe are simultaneously displayed in a display device, the display device is utilized to observe the position of the ultrasonic sector and the CT and MR structures of the patient, and the ultrasonic probe is ensured to carry out ultrasonic imaging on a surgical area at the most proper visual angle;
s7, ultrasound-assisted puncture adjustment: the control console calculates the relative positions of the puncture needle and the puncture nerve under the second electromagnetic tracking sensor coordinate system by utilizing the ultrasonic image, obtains the relative position relation of the puncture needle and the puncture nerve under the electromagnetic tracking system, and the relative position relation is displayed on the display device, so that the quality of the position relation between the puncture needle and the puncture nerve is judged, and the position of the puncture needle is adjusted by advancing, retreating and rotating.
2. A surgical robot for pain management as claimed in claim 1, wherein the robotic arm end connector is a flange.
3. A surgical robot for pain management as claimed in claim 1, wherein the first electromagnetic tracking sensor is fixedly connected to the first quick mount.
4. A surgical robot for pain management as claimed in claim 1, wherein the second quick-mount means is connected to the robotic arm end-connector by a gimbaled arm.
5. A surgical robot for pain management as claimed in claim 1, wherein the piercing section is provided with a piercing needle.
6. A surgical robot for pain management as claimed in claim 1, wherein an ultrasound probe is provided on the ultrasound portion.
7. A surgical robot for pain management as claimed in claim 1, wherein the display means is a 2D display screen, a 3D display screen, a virtual reality device, an augmented reality device or a mixed reality device.
8. A surgical robot for pain management as claimed in claim 1, wherein in S2, the fourth electromagnetic tracker is rigidly fixed to the bone tissue in the surgical field using a k-wire.
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CN116019558B (en) * 2023-03-07 2023-10-17 内蒙古精劢医疗科技有限公司 Electromagnetic navigation puncture robot system and positioning method thereof
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US20140039314A1 (en) * 2010-11-11 2014-02-06 The Johns Hopkins University Remote Center of Motion Robot for Medical Image Scanning and Image-Guided Targeting
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