Classifications

• • 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
  • A61B34/37—Leader-follower robots
• • 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
  • A61B34/70—Manipulators specially adapted for use in surgery
  • A61B34/74—Manipulators with manual electric input means
• • 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
  • A61B90/50—Supports for surgical instruments, e.g. articulated arms
• • B—PERFORMING OPERATIONS; TRANSPORTING
  • B25—HAND TOOLS; PORTABLE POWER-DRIVEN TOOLS; MANIPULATORS
  • B25J—MANIPULATORS; CHAMBERS PROVIDED WITH MANIPULATION DEVICES
  • B25J9/00—Programme-controlled manipulators
  • B25J9/16—Programme controls
  • B25J9/1679—Programme controls characterised by the tasks executed
  • B25J9/1689—Teleoperation
• • 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
• • 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
  • A61B34/70—Manipulators specially adapted for use in surgery
  • A61B34/74—Manipulators with manual electric input means
  • A61B2034/742—Joysticks
• • G—PHYSICS
  • G05—CONTROLLING; REGULATING
  • G05B—CONTROL OR REGULATING SYSTEMS IN GENERAL; FUNCTIONAL ELEMENTS OF SUCH SYSTEMS; MONITORING OR TESTING ARRANGEMENTS FOR SUCH SYSTEMS OR ELEMENTS
  • G05B2219/00—Program-control systems
  • G05B2219/30—Nc systems
  • G05B2219/45—Nc applications
  • G05B2219/45119—Telesurgery with local assistent, voice communication

Definitions

• the present invention relates to a robotic device for surgical intervention, in particular in the otolaryngological field, but not only.
• a robotic device comprising: an articulated arm with actuating motors; a surgical instrument carried by the articulated arm, having a proximal end for attachment to the articulated arm and a functional distal end; an articulated arm control device for movement of the functional distal end of the surgical instrument; and means for processing movement instructions provided by the control device to convert them into individual instructions for controlling each of the actuating motors of the articulated arm.
• Such a device is described in the article by Miroir et al, entitled “RobOtol: from design to evaluation of a robot for middle ear surgery", published on the occasion of the IEEE / RSJ International Conference on Intelligent Robots and Systems held October 18-22, 2010 in Taipei (TW). It has an architecture and kinematics that are particularly well suited to otological surgeries in the middle or inner ear of patients. These interventions are sensitive to false movements, so robotic assistance is a great help.
• a robotic surgical intervention device comprising: an articulated arm with actuating motors; a surgical instrument carried by the articulated arm, having a proximal end for attachment to the articulated arm and a functional distal end; an articulated arm control device for movement of the functional distal end of the surgical instrument; and means for processing movement instructions provided by the control device to convert them into individual instructions for controlling each of the actuating motors of the articulated arm.
• the processing means comprises an electronic flange configured to add further processing to the movement instructions provided by the control device of blocking any movement of the functional distal end of the surgical instrument with at least one degree of freedom in translation or rotation predefined as prohibited along or around at least one axis of a local Cartesian coordinate system linked to the surgical instrument.
• the electronic flange functions as a filter of movements which are predefined as undesired with respect to axes linked to the surgical instrument. In the aforementioned delicate situations, this prevents any deviation from the desired sensitive movements regardless of the instructions issued by the control peripheral.
• the electronic clamp is designed in accordance with this invention for blocking any movement of the functional distal end of the surgical instrument according to the degrees of freedom in translation and rotation along and around the two axes of the local Cartesian coordinate system linked to the surgical instrument other than that on which the engagement or linear disengagement is desired.
• the software flange to be programmed in accordance with the present invention to block any translation along the three axes of the local Cartesian coordinate system linked to the surgical instrument. More generally and depending on the precise gestures desired, it is advantageous to be able to prohibit, thanks to the present invention, certain displacements in translation or rotation along or around at least one axis of a local Cartesian coordinate system linked to the surgical instrument.
• control peripheral is a handle on a 6D base.
• a robotic surgical intervention device may include means for activating and deactivating the electronic bridle.
• the electronic flange comprises a blocking of any movement apart from a degree of freedom in translation and a degree of freedom in rotation along and around a main axis of the surgical instrument forming a first axis around which the local Cartesian coordinate system is defined.
• the main axis of the surgical instrument is that which connects a central point of its proximal fixing end to a central point of its functional distal end.
• the main axis of the surgical instrument is that of a rectilinear distal portion of this instrument, offset with respect to the axis which connects a central point of its proximal fixing end at a central point of the functional distal end of its straight distal portion.
• the instructions supplied by the control peripheral are expressed in a global reference linked to a fixed base of the robotic device;
• the processing means comprise a Jacobian converter of the instructions expressed in this global reference into individual instructions controlling each of the actuating motors of the articulated arm using Jacobian parameters stored in memory;
• the electronic flange is programmed for:
• the electronic flange comprises a blocking of any translation of the functional distal end of the surgical instrument in its local reference mark.
• the articulated arm has, from its base to its carrying end, three motorized prismatic links in series followed by three motorized rotary links in series, the three respective axes of rotation of the three rotary links being converging at the same central point of the functional distal end of the surgical instrument;
• the instructions provided by the control peripheral are expressed in a global reference linked to a fixed base of the robotic device;
• the processing means comprise a Jacobian converter of the instructions expressed in this global reference into individual instructions for controlling each of the actuating motors of the articulated arm using Jacobian parameters stored in memory;
• the electronic flange is designed to, after application of the Jacobian converter, suppress the individual instructions for controlling the actuating motors of the three prismatic links.
• a robotic surgical intervention device can be configured and sized for an intervention in middle or internal ear surgery of a patient, the surgical instrument itself being an instrument. intervention in the patient's middle or internal ear surgery.
• Figure 1 shows schematically the general structure of a robotic device for surgical intervention, according to one embodiment of the invention
• Figure 2 illustrates the successive steps of a method of surgical intervention using the robotic device of Figure 1, according to a first embodiment of the invention
• Figure 3 illustrates the successive steps of a method of surgical intervention using the robotic device of Figure 1, according to a second embodiment of the invention.
• a robotic device for surgical intervention comprises an articulated arm 10 with actuating motors carrying a surgical instrument 12.
• the non-limiting example illustrated in this figure is more precisely that of a robotic device for an application in otological surgery of the middle or internal ear of a patient, the architecture and kinematics of which are optimized in accordance with the teaching of the document by Miroir et al above.
• the articulated arm 10 thus has, from its base to its end carrying the surgical instrument 12, three motorized prismatic links in series followed by three motorized rotoidal links in series.
• a first prismatic connection L1, actuated by a first motor M1 allows the translational movement of a first member 14 of the articulated arm 10 along the axis Z1 (for example vertical) of a first local orthogonal Cartesian coordinate system ( X1, Y1, Z1) linked to the first motor M1.
• the first motor M1 is fixed to the robotic device so that the first local coordinate system (X1, Y1, Z1) has the same directions as a Global orthogonal Cartesian coordinate system (X0, Y0, Z0) linked to a fixed base of the robotic device.
• the axis of displacement of the first member 14 is therefore parallel to Z0.
• a second prismatic link L2, actuated by a second motor M2 carried by one end of the first member 14, allows the translational movement of a second member 16 of the articulated arm 10, along the axis Z2 of a second mark Local orthogonal Cartesian (X2, Y2, Z2) linked to the second motor M2.
• the second local coordinate system (X2, Y2, Z2) is flipped at a right angle to the Y1 axis of the first local coordinate system (X1, Y1, Z1) so that its Z2 axis is parallel to the X1 axis.
• the axis of movement of the second member 16 is therefore parallel to X0.
• a third prismatic link L3, actuated by a third motor M3 carried by one end of the second member 16, allows the translational movement of a third member 18 of the articulated arm 10, along the Z3 axis of a third mark Local orthogonal Cartesian (X3, Y3, Z3) linked to the third motor M3.
• the third local coordinate system (X3, Y3, Z3) is returned by a right angle with respect to the X2 axis of the second local coordinate system (X2, Y2, Z2) so that its Z3 axis is parallel to the Y2 axis. even parallel to the Y axis 1.
• the displacement axis of the third member 18 is therefore parallel to Y0.
• a fourth rotoidal link L4 actuated by a fourth cylindrical motor M4 and carried by one end of the third member 18, allows the rotational movement of a fourth member 20 of the articulated arm 10, around the axis Z4 of a fourth local orthogonal Cartesian coordinate system (X4, Y4, Z4) linked to the fourth motor M4.
• X6, Y6, Z6 a sixth Local orthogonal Cartesian coordinate system
• the three respective axes of rotation Z4, Z5 and Z6 of the three rotoidal links converge at a same central point of the functional distal end 24 of the surgical instrument 12, thus doing from this point a pivot point.
• any instruction to actuate at least one of the motors M4, M5, M6 of the rotoid links causes a rotation of the surgical instrument 12 around its pivot point without any displacement of the latter in the total reference (X0, Y0, Z0).
• the surgical instrument 12 has a proximal end 26 for fixing to the articulated arm 10, more precisely to a corresponding fixing end of the arm 10 linked to the motor M6.
• This fixing is for example advantageously carried out in accordance with the locking system described in patent FR 2 998 344 B1, but this is not an obligation. Any other fastening system suitable for the intended application is also suitable.
• the surgical instrument 12 may have a rectilinear shape so its main axis Zp, around which is defined a local Cartesian coordinate system (Xp, Yp, Zp) which is linked to it, is that which connects a central point of its end proximal 26 for attachment to the pivot point of its functional distal end 24.
• a local Cartesian coordinate system (Xp, Yp, Zp) which is linked to it, is that which connects a central point of its end proximal 26 for attachment to the pivot point of its functional distal end 24.
• the axis Zp merges with the axis Z6.
• FIG. 1 it may be a surgical instrument with deviated portions such as that described in patent application FR 3,066,378 A1.
• its main axis Zp around which the local Cartesian coordinate system (Xp, Yp, Zp) which is linked to it is always defined, is that of a rectilinear distal portion of this instrument, offset with respect to the Z6 axis. which always connects the central point of its proximal end 26 of attachment to the pivot point of its functional distal end 24.
• the robotic surgical intervention device further comprises a control peripheral 28 of the articulated arm 10, such as a handle on a 6D base (from the English "joystick 6D") or any other equivalent device, adapted to allow a displacement of the functional distal end 24 of the surgical instrument 12 according to three degrees of freedom in translation and three degrees of freedom in rotation by actuation of the six motors M1 to M6. It may also include a screen 30, in particular for displaying the monitoring and any movement of the surgical instrument 12 during the operating phase.
• a control peripheral 28 of the articulated arm 10 such as a handle on a 6D base (from the English "joystick 6D") or any other equivalent device, adapted to allow a displacement of the functional distal end 24 of the surgical instrument 12 according to three degrees of freedom in translation and three degrees of freedom in rotation by actuation of the six motors M1 to M6. It may also include a screen 30, in particular for displaying the monitoring and any movement of the surgical instrument 12 during the operating phase.
• the robotic surgical intervention device further comprises means for processing movement instructions provided by the control peripheral 28 to convert them into individual control instructions for each of the motors M1 to M6 of the articulated arm 10. These processing means take the form of an electronic circuit 32.
• the electronic circuit 32 is connected to the articulated arm 10 in order to transmit to it the individual control instructions of the motors M1 to M6 and to the control peripheral 28 in order to receive its movement instructions. These last are generally expressed in the total reference mark (X0, Y0, Z0).
• a central processing unit 34 such as a microprocessor designed to send to the articulated arm 10 the individual control instructions and to receive the control peripheral 28 the movement instructions
• a memory 36 in which is recorded at least one computer program carrying out the aforementioned conversion and intended to be executed by the central unit 34.
• Two computer programs 38 and 40, selectable according to a software switch 42 are shown in FIG. 1. They relate to two different applications of the present invention which implement two functionally different embodiments but which may be complementary. Only one of the two programs could be implemented without departing from the scope of the present invention.
• each of the two computer programs 38, 40 includes instructions for the implementation of a software flange programmed to add additional processing to the movement instructions provided by the control peripheral 28 consisting in blocking any movement of the functional distal end 24 of the surgical instrument 12 according to at least one degree of freedom in translation or rotation predefined as prohibited along or around at least one axis of the local coordinate system (Xp, Yp, Zp).
• the electronic circuit 32 as shown schematically in Figure 1 can for example be implemented in a computer device such as a conventional computer comprising a processor associated with one or more memories for the storage of files.
• data and computer programs whose instructions are intended to be executed by the processor, such as the instructions of programs 38, 40 and of the software switch 42 which can itself also constitute a computer program.
• These programs are shown as separate, but this distinction is purely functional. They could just as easily be grouped together in all possible combinations in one or more software. Their functions could also be at least partly programmed micro or micro wired in dedicated integrated circuits.
• the computer device implementing the electronic circuit 32 could be replaced by an electronic device composed only of digital circuits (without a computer program) for carrying out the same actions.
• the aforementioned software clamp is more generally an electronic clamp whose function can be implemented in hardware and / or software.
• the robotic surgical intervention device is optionally but advantageously provided with means 54 for activating and deactivating this electronic bridle.
• Any existing selection device can be envisaged, in particular a tactile or mouse-selectable button of the display screen 30, a specific device of the control peripheral 28, or even an independent selection device provided in another peripheral, for example at keyboard or using a pedal.
• the electronic flange in fact comprises two different functional flanges which prove to be particularly practical and clever in otological surgery.
• a first functional flange is programmed in computer program 38. It is designed to block any movement outside of a translational degree of freedom and a rotational degree of freedom along and around the main axis Zp of the surgical instrument 12 regardless of its straight or deflected shape. It corresponds to the possibility of operating in otology, simply and quickly and intuitively, a precise linear engagement or disengagement and without bad gesture of the surgical instrument 12 inside the ear of a patient.
• a second functional flange is programmed in the computer program 40.
• the computer program 38 comprises instructions 44 carrying out a conversion of the instructions supplied by the control peripheral 28, expressed in the global reference (X0, Y0, Z0), into local movement instructions expressed in the local coordinate system (Xp, Yp, Zp) of the surgical instrument 12.
• the computer program 38 comprises instructions 46, intended to be executed after the instructions 44, achieving the first functional flange, that is to say a deletion of the components of these local instructions for movement along and around axes Xp and Yp so as to keep only the degrees of freedom in translation and rotation along and around the main axis Zp of the surgical instrument 12. It will be noted that it is these instructions which can be generalized to implement other functional flanges with at least one degree of freedom in translation or rotation prohibited. This results in restricted local movement instructions.
• the computer program 38 comprises instructions 48, intended to be executed after the instructions 46, carrying out a reverse conversion of the restricted local movement instructions expressed in the local coordinate system (Xp, Yp, Zp) into restricted movement instructions expressed in the total reference (X0, Y0, Z0).
• the computer program 38 comprises instructions 50, intended to be executed after the instructions 48, or directly without execution of the instructions 44, 46 and 48 if no electronic clamp is selected, performing a Jacobian conversion of the flanged movement instructions (or not flanged if no electronic flange is selected) expressed in the global reference (X0, Y0, Z0) in individual control instructions for each of the motors M1 to M6 for actuating the articulated arm 10 to l using Jacobian parameters stored in memory.
• This Jacobian converter function is well known to those skilled in the art and will not be detailed.
• the individual control instructions supplied by execution of the computer program 38 are to be transmitted by the central unit 34 to the articulated arm 10.
• the second functional flange defined above could also be implemented by executing the computer program 38, as well as other possible functional flanges, with an adaptation of the instructions 46.
• the program 40 takes advantage of the The particular architecture and kinematics of the articulated arm 10 of FIG. 1 to simplify its implementation. Indeed, to achieve this second functional flange and as has been seen previously, it suffices to delete the individual instructions intended for motors M1, M2 and M3 and resulting from the aforementioned Jacobian conversion.
• the computer program 40 thus includes the aforementioned instructions 50 to directly perform the Jacobian conversion of the control instructions provided by the control peripheral 28.
• the individual control instructions provided by executing the computer program 40 are to be transmitted by the central unit 34 to the articulated arm 10.
• the software switch 42 allows to select the execution of the computer program 38 in its entirety, of the instructions 50 only of this computer program 38, or of the computer program 40, depending on whether one or the The other of the first and second electronic flanges is selected or not using the activation and deactivation means 54.
• Figure 2 illustrates the successive steps of a method of surgical intervention using the robotic device of Figure 1, according to a first embodiment of the invention consisting of applying the first electronic clamp.
• the first electronic clamp is activated and an operator initiates the movement of the functional distal end 24 of the surgical instrument 12 carried by the articulated arm 10 using the device of command 28.
• the central unit 34 executes the instructions 44, 46, 48 and 50 of the computer program 38 to convert the instructions provided by the control peripheral 28 into individual control instructions.
• motors M1 to M6 These restricted instructions allow only one displacement in translation or rotation along or around the axis Zp of the functional distal end 24 of the surgical instrument 12 so that, whatever the possible deviations introduced by manipulation of the control peripheral 28, only the engagement or desired linear disengagement is performed quickly and intuitively during this step.
• step 104 the first electronic clamp is deactivated. This makes it possible, for example during a following step 106 to initiate any additional displacement of the surgical instrument 12, according to all the degrees of freedom allowed by free actuation of the motors M1 to M6, by execution only of the instructions 50 of the program. computer 38. At any time, a return to step 100 is possible.
• Figure 3 illustrates the successive steps of a method of surgical intervention using the robotic device of Figure 1, according to a second embodiment of the invention consisting of applying the second electronic clamp.
• the second electronic clamp is activated and an operator initiates a movement of the surgical instrument 12 carried by the articulated arm 10 using the control device 28, to release an axis visualization towards the patient's ear.
• the central unit 34 executes the instructions 50 and 52 of the computer program 40 to convert the instructions supplied by the control peripheral 28 into individual instructions for controlling the motors M4 to M6.
• These clamped instructions only allow rotational movements around the Z4, Z5 and Z6 axes. Since these axes converge at the pivot point of the surgical instrument 12, the latter remains stationary regardless of any deviations introduced by manipulation of the control peripheral 28, only the desired visual release being performed quickly and intuitively during this step. .
• the second electronic clamp is deactivated. This makes it possible, for example during a following step 206 to initiate any additional displacement of the surgical instrument 12, according to all the degrees of freedom allowed by free actuation of the motors M1 to M6, by execution only of the instructions 50 of the program. computer 38 (or 40). At any time, a return to step 200 is possible.
• the surgical intervention methods of Figures 2 and 3 can easily be generalized to the implementation of other electronic clamps than the two considered above.

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• Health & Medical Sciences (AREA)
• Engineering & Computer Science (AREA)
• Life Sciences & Earth Sciences (AREA)
• Surgery (AREA)
• Robotics (AREA)
• Medical Informatics (AREA)
• Biomedical Technology (AREA)
• Heart & Thoracic Surgery (AREA)
• Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
• Molecular Biology (AREA)
• Animal Behavior & Ethology (AREA)
• General Health & Medical Sciences (AREA)
• Public Health (AREA)
• Veterinary Medicine (AREA)
• Mechanical Engineering (AREA)
• Oral & Maxillofacial Surgery (AREA)
• Pathology (AREA)
• Manipulator (AREA)

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• 2019
  • 2019-09-24 FR FR1910553A patent/FR3100970B1/fr active Active
• 2020
  • 2020-09-21 KR KR1020227013634A patent/KR20220069070A/ko active Pending
  • 2020-09-21 US US17/763,066 patent/US20220331031A1/en active Pending
  • 2020-09-21 AU AU2020356425A patent/AU2020356425A1/en active Pending
  • 2020-09-21 CN CN202080075303.3A patent/CN114760950A/zh active Pending
  • 2020-09-21 EP EP20785551.1A patent/EP4034026A1/de active Pending
  • 2020-09-21 WO PCT/FR2020/051636 patent/WO2021058899A1/fr not_active Ceased
  • 2020-09-21 CA CA3152347A patent/CA3152347A1/fr active Pending
  • 2020-09-21 JP JP2022519128A patent/JP7551742B2/ja active Active

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