CN114366309A - Surgical robot with nerve monitoring function - Google Patents
Surgical robot with nerve monitoring function Download PDFInfo
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- CN114366309A CN114366309A CN202210050059.6A CN202210050059A CN114366309A CN 114366309 A CN114366309 A CN 114366309A CN 202210050059 A CN202210050059 A CN 202210050059A CN 114366309 A CN114366309 A CN 114366309A
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
- A61B34/30—Surgical robots
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/16—Bone cutting, breaking or removal means other than saws, e.g. Osteoclasts; Drills or chisels for bones; Trepans
- A61B17/1659—Surgical rasps, files, planes, or scrapers
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
- A61B34/20—Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/24—Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
- A61B5/316—Modalities, i.e. specific diagnostic methods
- A61B5/388—Nerve conduction study, e.g. detecting action potential of peripheral nerves
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00017—Electrical control of surgical instruments
- A61B2017/00115—Electrical control of surgical instruments with audible or visual output
- A61B2017/00128—Electrical control of surgical instruments with audible or visual output related to intensity or progress of surgical action
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
- A61B34/20—Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
- A61B2034/2046—Tracking techniques
- A61B2034/2065—Tracking using image or pattern recognition
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
- A61B34/30—Surgical robots
- A61B2034/301—Surgical robots for introducing or steering flexible instruments inserted into the body, e.g. catheters or endoscopes
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
- A61B34/30—Surgical robots
- A61B2034/302—Surgical robots specifically adapted for manipulations within body cavities, e.g. within abdominal or thoracic cavities
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Abstract
The invention discloses a surgical robot with a nerve monitoring function, which comprises a main control system, a mechanical arm/control rod, an end effector, a surgical instrument matched with the end effector and a nerve function monitoring system, wherein the end effector and/or the surgical instrument are/is provided with a nerve monitoring element, the nerve function monitoring system detects and processes impedance signals and/or nerve electrophysiological signals of a surgical part of a patient through the nerve monitoring element and feeds the signals back to the main control system, and the main control system controls the movement or stop of the mechanical arm/control rod and/or the end effector or adjusts the movement track of the mechanical arm/control rod and/or the end effector according to the characteristics of the impedance signals and/or the existence, the strength or the signal characteristics of the nerve electrophysiological signals. The surgical robot provided by the invention can monitor the nerve electrophysiological signals in the operation, perform nerve function positioning and function evaluation, assist in guiding the operation, avoid injuring nerves and improve the safety of the operation.
Description
Technical Field
The invention belongs to the field of medical instruments, and particularly relates to a surgical robot with a nerve monitoring function.
Background
A surgical robot with a surgical navigation system is a comprehensive medical operation device integrating a plurality of technologies such as mechano-electronics, imaging, surgery and clinic, and is currently applied to operations such as nervous system, cardiovascular system, digestive system, urinary system, bone surgery, and the like. The operation navigation system accurately corresponds preoperative or intraoperative image data of a patient to the anatomical structure of the patient on an operation bed, tracks the surgical instrument during the operation and updates and displays the position of the surgical instrument on the image of the patient in real time in the form of a virtual probe, so that a doctor can clearly know the position of the surgical instrument relative to the anatomical structure of the patient, and the surgical operation is quicker, more accurate and safer.
However, in some neurosurgery or bone surgery, abundant nerve tissues exist at and near the operation position, the operation navigation system does not display nerve positioning, and even a carefully operated surgical robot is used, the risk of blindly cutting and accidentally injuring nerves exists.
Spinal stenosis is a condition in which the spinal cord or nerve roots are pressed due to abnormal stenosis of the spinal foramen or intervertebral foramen. Spinal stenosis is most commonly seen as lumbar spinal stenosis, followed by cervical spinal stenosis. Symptoms caused by spinal stenosis include pain, paresthesia, muscle weakness, difficulty walking in the lower extremities, progressive progression of symptoms, and in severe cases urinary incontinence, difficulty defecation, and sexual dysfunction. Spinal stenosis is caused by a number of factors, including degenerative disc disease (degenerative disc disease), spinal cord tumors, trauma, rheumatoid arthritis, and hereditary diseases. The most common degenerative lumbar spinal stenosis occurs, the incidence rate of people of 50-65 years old reaches 8%, and the incidence rate of people of more than 65 years old reaches 20%. The traditional open laminectomy decompression has the advantage of definite curative effect, but has great influence on the stability of the spine, often needs internal fixation and fusion, and has the defects of large surgical trauma, more complications and the like.
In the prior art, in the process of a vertebral canal decompression operation, an operation approach enters from the vertebral plate, and surgical instruments such as a high-speed abrasive drill, vertebral plate rongeur and the like are used under an endoscope to cut off the bony structure of the vertebral plate, so that the aim of forming and decompressing the vertebral canal is fulfilled. However, the operation requires a high degree of precision, and the spinal cord is easily injured due to poor control.
Disclosure of Invention
Aiming at the defects of the prior art, the invention provides the surgical robot with the nerve monitoring function, which monitors the nerve electrophysiological signals in the operation, performs nerve function positioning and function evaluation, assists in guiding the operation, avoids damaging nerves and improves the safety of the operation.
The specific technical scheme of the invention is as follows:
a surgical robot with a nerve monitoring function comprises a main control system, a mechanical arm/control rod, an end effector, a surgical instrument matched with the end effector and a nerve function monitoring system, wherein the end effector and/or the surgical instrument are/is provided with a nerve monitoring element, the nerve function monitoring system detects and processes impedance signals and/or nerve electrophysiological signals of a surgical position of a patient through the nerve monitoring element and feeds the signals back to the main control system, and the main control system controls the movement or stop of the mechanical arm/control rod and/or the end effector or adjusts the movement track of the mechanical arm/control rod and/or the end effector according to the characteristics of the impedance signals and/or the existence, strength or signal characteristics of the nerve electrophysiological signals.
The main control system comprises a computer central control system, a mechanical driving host, a surgical operation monitor, a robot control monitor, an operating handle, an input/output device and the like. During operation, a surgeon can control the operating handle through the master control system, the hand motion is transmitted to the tip of the mechanical arm/operating rod, operation is completed, or the operation robot realizes automatic unmanned operation according to a preset program or an artificial intelligence system.
The nerve function monitoring system comprises a device or a module (such as an impedance monitor, a nerve function monitor or a module with the same function) for collecting, stimulating, calculating, analyzing and processing electrophysiological signals (such as impedance) or nerve electrophysiological signals.
The nerve monitoring element is capable of efferent and/or afferent signals, differentiating bone tissue, neural tissue or other soft tissue by detection of impedance signals; or the nerve electrophysiological signals generated by the nerve due to direct or indirect stimulation are detected, and the precise position of the nerve is positioned.
The nerve monitoring element is arranged at one or more of the end part, the surface or the outer edge of the surgical instrument, and the lead is embedded in the surgical instrument. The end effector is internally provided with a lead connected with a neural function monitoring system circuit, and the end effector is provided with an interface connected with the circuit of the neural monitoring element. Preferably, the interface for electrical connection is provided at a location where the end effector is in fixed contact with the surgical instrument.
The surgical robot of the invention can be a robot suitable for various surgical operations, and has an adaptive end effector and a matched surgical instrument according to different operation types, operation positions and operation requirements.
Furthermore, the nerve function monitoring system records and stores the impedance signals and/or the neuroelectrophysiological signals in the memory operation to form the nerve positioning information of the patient, and the main control system plans and adjusts the motion trail of the mechanical arm/control rod and/or the end effector according to the nerve positioning information.
Preferably, the surgical robot further comprises a surgical navigation system, and the main control system controls the movement or stopping of the mechanical arm/joystick and/or the end effector or adjusts the movement track of the mechanical arm/joystick and/or the end effector according to an image signal (such as a three-dimensional digital image) of the surgical navigation system and an impedance signal and/or a neuroelectrophysiological signal of the nerve function monitoring system.
The surgical navigation system includes a device or module for acquiring and processing images, such as an endoscope, ultrasound, X-ray, CT or MRI scanner or module, and a software system or module for processing images.
The nerve monitoring element is selected from one or more of electrodes, sensors, outer packaging films with sensing performance, patches or coatings with sensing performance and conduction paths made of media for conducting nerve signals, wherein the media include but are not limited to one or more of metal, light, sound, graphene, new media materials and the like.
The surgical instrument can be all surgical instruments which can be used for surgical robots in the field, and comprises tools, therapeutic instruments and diagnostic instruments, such as various forceps, scissors, clamps, knives, needles, tubes, tweezers, hooks, files, saws, wires, lines and the like.
Preferably, the surgical instrument may be an instrument for performing a surgical operation in bone surgery, such as a guide tube, a spreader, a rongeur, a reamer, a kirschner wire, a puncture needle, a guide wire, a bone file, a bone saw, and the like.
In a specific example, the surgical robot is an orthopedic surgical robot, the surgical instrument is one or more of a guide tube, a guide wire or a linear bone file, the head end of the guide tube and the guide wire, and the surface of the linear bone file is provided with at least one nerve monitoring element.
Preferably, the linear bone file is in a flat belt shape, and has a working part and a traction part, wherein the surface of the working part has filing lines, such as frosted particles, dentations, twill lines and the like, and the back surface (the surface contacting with tissues of a non-operation part) is smooth. At least one nerve monitoring element is disposed on the surface of the working portion. The traction part is provided with a fixing hole or a fixing piece which is fixed with the end effector of the surgical robot, the lead of the nerve monitoring element can be connected with the circuit interface of the end effector of the surgical robot through the fixing hole or the fixing piece,
when the back-bone rasp is used, the surface of the working part of the linear bone rasp is attached to a bone, the traction part is drawn by an operator or a surgical robot, and the smooth back can ensure that nerves or other tissues are prevented from being injured by mistake when the bone (such as a vertebral plate) is rasped. The lead connected with the nerve monitoring element is embedded in the bone file and is connected with a surgical robot with an impedance monitoring and/or nerve function monitoring system when in use. The nerve monitoring element is capable of efferent and/or afferent signals, differentiating bone tissue, neural tissue or other soft tissue by detection of impedance signals; or the nerve electrophysiological signals generated by the nerve due to direct or indirect stimulation are detected, and the precise position of the nerve is positioned. When the working surface of the bone file detects an impedance signal or a neuroelectrophysiological signal of nerve tissue, the nerve monitoring element can transmit the detected signal to a main control system of the surgical robot, and the main control system controls the mechanical arm/control rod and/or the end effector to stop rasping.
The length and width of the rasp can be of various specifications.
The use of the surgical robot of the present invention will be described with reference to a guiding tube, a guide wire and a linear bone file, taking a spinal decompression operation as an example. The method comprises the following specific steps:
(1) penetrating the head end of the guide tube into the intervertebral foramen, and loosening the gap between the ligamentum flavum and the conical plate by using the hardness of the guide tube;
(2) fixing a guide wire and a linear bone file, wherein one end of the guide wire penetrates along the guide tube, and the bone file passes through the ligamentum flavum, the articular process and the intervertebral foramen along with the guide wire and then bends to pass through the conical plate;
(3) after the linear bone file reaches the operation position, the connection with the guide wire is released, the guide tube is firstly withdrawn, and the guide wire is withdrawn from the conical plate gap. The nerve monitoring elements on the guide tube, the guide wire and the linear bone file are used for monitoring in real time in the process of executing the operation;
(4) the fixing hole or the fixing piece of the linear bone file is fixed with the end effector of the surgical robot, and meanwhile, the nerve monitoring element is also connected with the nerve function monitoring system circuit of the surgical robot. When using surgical robot to utilize the bone file to grind the bone, the nerve monitoring element real-time supervision bone file touches the impedance and/or the neural electrophysiological signal of tissue, and when impedance signal shows for non-neural tissue or no neural electrophysiological signal, the arm drove the bone file work, and intervertebral foramen enlarges, reaches the decompression purpose, and in case detect the signal, the arm stops work immediately, avoids neural damage.
The invention has the advantages that:
1. the greatest risk of the surgical procedure is the accidental injury to the nervous system during operation, which results in permanent functional loss of the patient, such as paralysis and loss of lower limb walking motor function. The surgical robot provided by the invention is used for monitoring the impedance and/or the neuroelectrophysiological signal of a surgical part in real time while performing a surgical operation by using a surgical instrument, the mechanical arm/control rod and/or the end effector normally moves when the impedance signal of non-neural tissue or the non-neuroelectrophysiological signal is detected, and the operation is stopped immediately when the detection alarm is given out when the impedance signal or the neuroelectrophysiological signal of the neural tissue is detected. The nerve function monitoring system memorizes and records nerve electrophysiological signals in an operation to form nerve positioning information of a patient, the mechanical arm/control lever and/or the end effector can be adjusted to a new non-nerve tissue position according to the positioning information and then is operated, and meanwhile, a new motion track of the mechanical arm/control lever and/or the end effector is established according to the recorded nerve positioning information, so that the positioned nerve site is avoided, and the operation is smoother.
2. The surgical robot can also be used for cooperatively controlling the movement or stopping of the mechanical arm/operating rod and/or the end effector or adjusting the movement track of the mechanical arm/operating rod and/or the end effector by combining the image signal of the surgical navigation system and the impedance and/or the neuroelectrophysiological signal of the nerve function monitoring system.
3. The invention also provides an orthopedic surgery robot with a nerve signal detection function, which is used for orthopedic surgery such as spinal canal decompression surgery by matching with a guide tube, a guide wire and a linear bone file with a nerve monitoring element. The orthopedic surgery robot thoroughly changes the decompression operation with the highest risk of surgery into mechanical removal of bone tissue, changes into sheet-shaped rasp fitting bone tissue, and rubs the bone tissue little by little. The thickness of the removed bone tissue can be controlled in millimeter grade, the space requirement of operation of an operation tool is completely avoided, and the purpose of decompression operation is achieved on the premise of completely not damaging the spinal cord and the spinal nerve root. The design avoids the risk of nerve injury caused by the use of a high-speed abrasive drill and a vertebral plate rongeur to cut the vertebral plate in the prior art. The bone file is adopted to file the vertebral plate, the operation is simple, the working surface is only contacted with the vertebral plate, and the safety is higher.
Drawings
Fig. 1 is a schematic connection diagram of a surgical robot system according to the present invention.
Fig. 2 is a schematic structural diagram of the surgical robot according to the present invention.
Detailed Description
The following examples illustrate specific steps of the present invention, but are not intended to limit the invention.
Terms used in the present invention generally have meanings commonly understood by those of ordinary skill in the art, unless otherwise specified.
The present invention is described in further detail below with reference to specific examples and with reference to the data. It will be understood that these examples are intended to illustrate the invention and are not intended to limit the scope of the invention in any way.
In the following examples, various procedures and methods not described in detail are conventional methods well known in the art.
Example 1
As shown in fig. 1 and 2, a surgical robot with nerve monitoring function comprises a main control system 101, a mechanical arm/joystick 102, an end effector 103, a surgical instrument 104 matched with the end effector, a nerve function monitoring system 201 and a surgical navigation system 301, wherein the end effector 103 and/or the surgical instrument 104 is provided with a nerve monitoring element 105, the nerve function monitoring system 201 detects and processes impedance signals and/or neuro-electrophysiological signals of a surgical site of a patient through the nerve monitoring element 105 and feeds the signals back to the main control system 101, the surgical navigation system 301 forms image signals, the main control system 101 controls the movement or stop of the mechanical arm/joystick 102 and/or the end effector 103 according to the image signals of the surgical navigation system and the impedance signal characteristics and/or the neuro-electrophysiological signals of the nerve function monitoring system, or to adjust the motion trajectory of the arm/joystick 102 and/or end effector 103.
The main control system comprises a computer central control system, a mechanical driving host, a surgical operation monitor, a robot control monitor, an operating handle, an input/output device and the like. During operation, a surgeon can control the operating handle through the master control system, the hand motion is transmitted to the tip of the mechanical arm/operating rod, operation is completed, or the operation robot realizes automatic unmanned operation according to a preset program or an artificial intelligence system.
The nerve function monitoring system comprises a device or a module (such as an impedance monitor, a nerve function monitor or a module with the same function) for collecting, stimulating, calculating, analyzing and processing electrophysiological signals (such as impedance) or nerve electrophysiological signals. The nerve monitoring element is capable of efferent and/or afferent signals, differentiating bone tissue, neural tissue or other soft tissue by detection of impedance signals; or the nerve electrophysiological signals generated by the nerve due to direct or indirect stimulation are detected, and the precise position of the nerve is positioned.
The surgical navigation system includes a device or module for acquiring and processing images, such as an endoscope, ultrasound, X-ray, CT or MRI scanner or module, and a software system or module for processing images.
The nerve monitoring element is arranged at one or more of the end part, the surface or the outer edge of the surgical instrument, and the lead is embedded in the surgical instrument. The end effector is internally provided with a lead connected with a neural function monitoring system circuit, and the end effector is provided with an interface connected with the circuit of the neural monitoring element. Preferably, the interface for electrical connection is provided at a location where the end effector is in fixed contact with the surgical instrument.
The surgical robot of the invention can be a robot suitable for various surgical operations, and has an adaptive end effector and a matched surgical instrument according to different operation types, operation positions and operation requirements.
Furthermore, the nerve function monitoring system records and stores the impedance signals and/or the neuroelectrophysiological signals in the memory operation to form the nerve positioning information of the patient, and the main control system plans and adjusts the motion trail of the mechanical arm/control rod and/or the end effector according to the nerve positioning information.
The nerve monitoring element is selected from one or more of electrodes, sensors, outer packaging films with sensing performance, patches or coatings with sensing performance and conduction paths made of media for conducting nerve signals, wherein the media include but are not limited to one or more of metal, light, sound, graphene, new media materials and the like.
The surgical instrument can be any surgical instrument that can be used in the art for surgical robotics, including but not limited to tools, therapeutic, and diagnostic instruments such as various forceps, scissors, clips, knives, needles, tubes, forceps, hooks, rasps, saws, wires, and the like.
In one example, the surgical instrument 104 is a linear bone file, and the present invention will be further described with reference to this example. Both ends of the linear bone file are fixed with the end effector 103 of the surgical robot, and the lead of the nerve monitoring element 105 can be connected with a circuit interface at the joint of the end effector 103 of the surgical robot.
When the back-bone rasp is used, the surface of the working part of the linear bone rasp is attached to a bone, the traction part is drawn by an operator or a surgical robot, and the smooth back can ensure that nerves or other tissues are prevented from being injured by mistake when the bone (such as a vertebral plate) is rasped. The lead connected with the nerve monitoring element is embedded in the bone file and is connected with a surgical robot with an impedance monitoring and/or nerve function monitoring system when in use. The nerve monitoring element 101 is capable of efferent and/or afferent signals, differentiating bone, neural or other soft tissue by detection of impedance signals; or the nerve electrophysiological signals generated by the nerve due to direct or indirect stimulation are detected, and the precise position of the nerve is positioned. When the file working surface detects an impedance signal of nerve tissue or a neuroelectrophysiological signal, the nerve monitoring element 105 can transmit the detected signal to the main control system 101 of the surgical robot, and the main control system 101 controls the mechanical arm/joystick and/or the end effector to stop rasping.
Claims (5)
1. A surgical robot with nerve monitoring function comprises a main control system, a mechanical arm/control rod, an end effector and a surgical instrument matched with the end effector, and is characterized by further comprising a nerve function monitoring system, wherein the end effector and/or the surgical instrument are provided with nerve monitoring elements, the nerve function monitoring system detects and processes impedance signals and/or neuroelectrophysiological signals of a surgical part of a patient through the nerve monitoring elements and feeds the signals back to the main control system, and the main control system controls the movement or stop of the mechanical arm/control rod and/or the end effector or adjusts the movement track of the mechanical arm/control rod and/or the end effector according to the characteristics of the impedance signals and/or the existence, strength or signal characteristics of the neuroelectrophysiological signals.
2. A surgical robot as claimed in claim 1, wherein the nerve function monitoring system records and stores intraoperative impedance signals and/or neuroelectrophysiological signals to form patient neuro-localization information, and the main control system plans and adjusts the motion trajectory of the manipulator/joystick and/or the end effector based on the neuro-localization information.
3. The surgical robot according to claim 1, further comprising a surgical navigation system, wherein the main control system controls the movement or stopping of the manipulator/joystick and/or the end effector or adjusts the movement track of the manipulator/joystick and/or the end effector according to the image signal of the surgical navigation system and the impedance signal and/or the neuroelectrophysiological signal of the nerve function monitoring system.
4. A surgical robot as claimed in any of claims 1-3, wherein said nerve monitoring element is selected from one or more of the group consisting of electrodes, sensors, outer coatings for sensing properties, patches or coatings for sensing properties, conductive pathways made of a medium for conducting nerve signals.
5. A surgical robot as claimed in claim 4, wherein the surgical instrument comprises a tool, therapeutic or diagnostic instrument, and one or more of the ends, surfaces or edges of the surgical instrument have nerve monitoring elements.
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| CN202210050059.6A CN114366309A (en) | 2022-01-17 | 2022-01-17 | Surgical robot with nerve monitoring function |
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Cited By (1)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN115137487A (en) * | 2022-07-13 | 2022-10-04 | 山东大学 | Spine endoscopic surgery robot system and method based on intraoperative physiological monitoring |
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| CN112656510A (en) * | 2020-12-21 | 2021-04-16 | 山东大学齐鲁医院 | Spinal surgery robot puncture early warning method and system based on electromyographic signals |
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| CN115137487A (en) * | 2022-07-13 | 2022-10-04 | 山东大学 | Spine endoscopic surgery robot system and method based on intraoperative physiological monitoring |
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