EP1083840A1 - Übereinstimmungsverfahren und vorrichtung für die robotisierte chirurgie - Google Patents

Übereinstimmungsverfahren und vorrichtung für die robotisierte chirurgie

Info

Publication number
EP1083840A1
EP1083840A1 EP99923704A EP99923704A EP1083840A1 EP 1083840 A1 EP1083840 A1 EP 1083840A1 EP 99923704 A EP99923704 A EP 99923704A EP 99923704 A EP99923704 A EP 99923704A EP 1083840 A1 EP1083840 A1 EP 1083840A1
Authority
EP
European Patent Office
Prior art keywords
support element
elements
energy
insert
receiving
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Withdrawn
Application number
EP99923704A
Other languages
English (en)
French (fr)
Inventor
Fernand Badano
Jörg Fischer
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Fischer-Schnappauf-Stockmann GbR
Integrated Surgical Systems SA
Original Assignee
Fischer-Schnappauf-Stockmann GbR
Integrated Surgical Systems SA
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Fischer-Schnappauf-Stockmann GbR, Integrated Surgical Systems SA filed Critical Fischer-Schnappauf-Stockmann GbR
Publication of EP1083840A1 publication Critical patent/EP1083840A1/de
Withdrawn legal-status Critical Current

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/39—Markers, e.g. radio-opaque or breast lesions markers
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/36—Image-producing devices or illumination devices not otherwise provided for
    • A61B2090/363—Use of fiducial points
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/39—Markers, e.g. radio-opaque or breast lesions markers
    • A61B2090/3925—Markers, e.g. radio-opaque or breast lesions markers ultrasonic
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/39—Markers, e.g. radio-opaque or breast lesions markers
    • A61B2090/3925—Markers, e.g. radio-opaque or breast lesions markers ultrasonic
    • A61B2090/3929—Active markers
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/39—Markers, e.g. radio-opaque or breast lesions markers
    • A61B2090/3954—Markers, e.g. radio-opaque or breast lesions markers magnetic, e.g. NMR or MRI
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/39—Markers, e.g. radio-opaque or breast lesions markers
    • A61B2090/3954—Markers, e.g. radio-opaque or breast lesions markers magnetic, e.g. NMR or MRI
    • A61B2090/3958—Markers, e.g. radio-opaque or breast lesions markers magnetic, e.g. NMR or MRI emitting a signal
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/39—Markers, e.g. radio-opaque or breast lesions markers
    • A61B2090/3983—Reference marker arrangements for use with image guided surgery
    • 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
    • A61B34/10—Computer-aided planning, simulation or modelling of surgical operations
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/10—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges for stereotaxic surgery, e.g. frame-based stereotaxis

Definitions

  • the present invention relates essentially to a method and an apparatus for mapping for robotic surgery, as well as to a mapping device including application.
  • the invention relates to a method and an apparatus, as well as a device making it possible to match the anatomical structures of a patient with a robotic system for assisting the surgical gesture guided by preoperative images such as conventional radiology, computed tomography (CT), magnetic resonance (MRI) or positron emission imaging (PET) examinations.
  • CT computed tomography
  • MRI magnetic resonance
  • PET positron emission imaging
  • the device consists of energy transmitters / receivers, imaging markers and a signal processing unit.
  • the markers are suitable for different types of imagery and provide high contrast; they are placed on the patient in a predefined spatial arrangement near the anatomical region of interest on a part of the body giving a stable positioning over time (for example a bone structure).
  • the imaging examination shows the patient's anatomy and the markers, the coordinates of which can be determined in the image reference frame by various image processing means.
  • the energy transmitters / receivers are fitted in place of the markers.
  • the surgical assistance robot is also equipped with energy transmitters / receivers; the processing of the signals emitted by them makes it possible to locate the coordinates of the transmitters / receivers on the patient in the reference frame of the robot.
  • the spatial arrangement of the transmitters / receivers being the same as that of the markers, the anatomical structures can therefore be identified by the robot by matching the coordinates of the markers in the repository of images and the transmitters / receivers in the repository of the robot. .
  • This invention is part of the robotic surgery guided by the image. It is a device enabling the anatomical structures of a patient to be matched with a robotic surgical assistance system guided by preoperative images such as conventional radiology exams, computed tomography (CT scanner), of resonance magnetic (IRMN) or positron emission imaging (PET).
  • CT scanner computed tomography
  • IRMN resonance magnetic
  • PET positron emission imaging
  • the device consists of energy transmitters / receivers, imaging markers and a signal processing unit.
  • Image-guided surgery is a new approach aimed at improving the clinical results of the surgical procedure as well as enabling the implementation of new operating techniques for the benefit of the patient.
  • This approach is applied in particular to neurosurgery and orthopedic surgery; it consists in planning on preoperative images the optimal gesture from a clinical point of view and, once in the operating room, performing the operation according to the previously established plan.
  • This plan requires a very precise positioning of the tools in space as well as manipulations of a high degree of dexterity.
  • One of the difficulties encountered in the implementation of image-guided surgery is the mapping, during the operation, of the surgical field (also called "patient space”) with the planning shown on the preoperative images (or "image space”). This matching is particularly difficult to do mentally by the surgeon when the surgical procedure takes place in three dimensions of space.
  • the implementation of image-guided surgery uses tools used during the operation that assist the surgeon in the execution of the plan.
  • These tools can take various forms, and are commonly referred to as "navigation systems".
  • the navigation systems provide the surgeon with an automatic matching calculation from specific procedures and three-dimensional location sensors. From landmarks visible on the images and localizable by sensors during the operation, these systems are capable of displaying, on the preoperative images, the position of an instrument to guide the surgeon in the execution of the surgical plan.
  • the matching procedure requires the intervention of the surgeon to locate the markers visible in the images in the patient's space, which makes it difficult to set up the system.
  • the intervention of the surgeon can introduce into the mapping a source of error which affects its accuracy and therefore the clinical results of the operation.
  • Navigation systems can include robotic assistance to perform the gesture: the robot, programmed according to the plan established before the operation, performs the positioning and manipulation of the tools with great precision.
  • Robotic assistance also requires matching the robot with the patient's space, which is done with procedures similar to those of navigation systems. It should be emphasized that, in the case of robotic systems, the robot itself is sometimes used as a three-dimensional sensor but this technique is not applicable when the anatomical structures are not frozen in space throughout the operation.
  • image-guided surgery requires robotic assistance including real-time matching. This makes it possible to follow the movement of the parts of the body on which the intervention takes place.
  • the systems commonly used use optical sensors (infrared transmitters are located by CCD cameras), mechanical, magnetic or even ultrasonic sensors.
  • the optical sensors are complex and bulky and require both the measurement of the positioning of the patient and of the robotic arm.
  • the space between the transmitters and the cameras must be cleared so that the optical link can be established.
  • Mechanical sensors also clutter the operating field and require long matching procedures that are highly dependent on the operator.
  • magnetic sensors they make it possible to locate the position of a tool in three-dimensional space but they have a high sensitivity to disturbances in the magnetic field.
  • Ultrasonic measurement systems are commonly used in many three-dimensional measurement applications. These systems work by measuring the time of flight between an ultrasonic transmitter and receiver, which makes it possible to calculate the distance traveled by knowing the speed of sound propagation in the air. A multiplicity of transmitters / receivers makes it possible, by triangulation calculations, to make three-dimensional measurements. Ultrasonic measuring systems are compact and relatively economical, but their accuracy is affected by variations in air temperature and they are sensitive to ambient disturbances.
  • Ultrasound systems are already used in the field of image-guided surgery for matching the patient space with the image space.
  • some "browsers” are equipped with it; most of them consist of a ring with a multiplicity of receivers which receive the signals coming from transmitters mounted on specific tools.
  • These tools are either attached to an anatomical structure of the patient, either surgical intervention tools or pointers.
  • This arrangement implies distances between transmitters and receivers of around 2m, therefore relatively long (which amplifies potential measurement errors), and requires the intervention of the surgeon to locate (generally with a pointer) the imaging markers in order to perform the mapping.
  • document US-A-5,078,140 relates to a robotic stereotaxis system aided by an imaging device.
  • This device appears more suitable for surgery on almost immobile parts of the body during the operating procedure, which is generally the case in the context of a brain operation. On the other hand, this device does not appear to be suitable for surgery for which the elements of the body can move during the surgical procedure.
  • a surgical navigation system including reference and localization frames.
  • anatomical reference points are first used to create pre-procedure images of the anatomical structure on which the surgical procedure is envisaged.
  • a mechanical system supporting several transmitters is fixed directly or indirectly to a part of the body which is linked to the anatomical structure on which the operation is planned.
  • the transmitters transmit a signal which is received by receiving elements arranged opposite at a certain distance.
  • the signals received by the receiving devices are then processed in order to locate in space each transmitter and therefore the support system, which defines the benchmarks at the coordinates of the patient's space in which the operation actually takes place, which is therefore integral with the anatomical structure on which the operation was to be performed. It is understood that this reference system can be located at any time during the surgical procedure.
  • this document envisages on page 22, line 8 and following, in certain situations to replace the above-mentioned anatomical reference points with markers or fiducials ("fiducials”) for example fixed on the surface of the skin, allowing the transformation of the given set of preprocedure images into a given set of displaced images, that is to say of images of the operating field.
  • fiducials markers or fiducials
  • the detectors will receive this emission and make it possible to calculate the exact position of the head of the surgical instrument in the reference frame which has thus been defined.
  • the main object of the invention is to solve the new technical problem consisting of a solution which makes it possible to provide a compact matching system for robotic surgery guided by the image, without intervention on the part of the surgeon while allowing operation. in real time with monitoring of the patient's body movements during the surgical procedure itself.
  • Another main object of the invention is to solve the new technical problem consisting in providing a solution which makes it possible to radically simplify the matching procedure, and to minimize the risks of errors.
  • the present invention provides a matching device for robotic surgery, characterized in that it comprises at least one insert intended to receive at least two distinct support elements, namely a first support element comprising at least three marker elements arranged spaced apart and not aligned, made of a material visible in an image produced with an appropriate imaging device; and one second support element comprising at least three energy emitting or receiving elements, respectively, also arranged spaced apart and not aligned.
  • the aforementioned matching device preferably comprises a third support element comprising at least three energy receiving or emitting elements, respectively, capable of being mounted in a suitable position to be received or emitted relative to the aforementioned second support element comprising respectively the energy emitting or receiving elements.
  • this third support element is mounted directly or in a manner linked to a robotic arm preferably receiving a surgical tool.
  • the position of the energy-receiving or emitting elements on said arm is known, as well as the position of the surgical tool relative to this arm, which will be the case in practice to facilitate the implementation. correspondence.
  • the third support element be mounted directly or in a linked manner to a robotic arm preferably receiving the surgical tool.

Landscapes

  • Health & Medical Sciences (AREA)
  • Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Pathology (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Magnetic Resonance Imaging Apparatus (AREA)
EP99923704A 1998-06-09 1999-06-09 Übereinstimmungsverfahren und vorrichtung für die robotisierte chirurgie Withdrawn EP1083840A1 (de)

Applications Claiming Priority (3)

Application Number Priority Date Filing Date Title
FR9807234 1998-06-09
FR9807234A FR2779339B1 (fr) 1998-06-09 1998-06-09 Procede et appareil de mise en correspondance pour la chirurgie robotisee, et dispositif de mise en correspondance en comportant application
PCT/FR1999/001364 WO1999063899A1 (fr) 1998-06-09 1999-06-09 Procede et appareil de mise en correspondance pour la chirurgie robotisee

Publications (1)

Publication Number Publication Date
EP1083840A1 true EP1083840A1 (de) 2001-03-21

Family

ID=9527177

Family Applications (1)

Application Number Title Priority Date Filing Date
EP99923704A Withdrawn EP1083840A1 (de) 1998-06-09 1999-06-09 Übereinstimmungsverfahren und vorrichtung für die robotisierte chirurgie

Country Status (5)

Country Link
US (1) US6167292A (de)
EP (1) EP1083840A1 (de)
AU (1) AU4047699A (de)
FR (1) FR2779339B1 (de)
WO (1) WO1999063899A1 (de)

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