RU2723762C1 - Surgical navigation and micromanipulation system - Google Patents

Abstract

FIELD: medicine.SUBSTANCE: invention refers to medicine, namely to surgical navigation and micromanipulation systems. System comprises a micromanipulator device for micromanipulation and a device for spatial orientation of the instrument for surgical navigation. Device of spatial orientation includes retainer (1), post of vertical movement (2) and levers of horizontal movement, at least main (5), intermediate (6), hinged (7), connected with possibility of displacement in parallel horizontal planes and equipped with links connecting. Retainer is fixed on the operating table and is made with possibility of rotation in one plane. Post has the possibility of reciprocal movement in the retainer. Post has composite rigid structure and consists of main bent component part (3) and additional vertical component part (4) with ring-limiter of vertical movement. Additional vertical component part is fixed by means of connecting rod pin (9) with lever of main horizontal movement. Limiting ring has the possibility of selecting required height of lever main position along additional vertical component part. Post has possibility of rotary movement in retainer. Main, intermediate and hinged levers are fixed to each other by connecting pin connectors. Hinged lever by means of connecting hinge-link (8) is rigidly connected with micromanipulator (10). Micromanipulator contains a support with a handle and a unit of movement transfer, including a lever of movement transfer with a handle and a setting lever with a handle, besides, each of these levers has fixing elements in the form of screws and nuts-hinges. Handle of movement transmission lever is fixed by nut-hinge on this lever and screw on support. Adjusting lever handle is fixed by nut-hinge on this lever and screw on movement transfer lever.EFFECT: higher accuracy of surgical navigation and micromanipulation, higher operational reliability of micromanipulator, as well as reduced duration of operation.1 cl, 4 dwg

Description

The invention relates to medicine, namely to a neurosurgical navigation system that provides real-time visualization of a surgical target, the exact spatial orientation of surgical instruments, as well as microsurgical manipulations in the field of a surgical target.

Known active positioning device of a surgical instrument for use on a mechanical arm, made in the form of a telescopic manipulator used in microsurgery, RU No. 2651886 C2, A61B 34/00, A61B 34/30, A61B 34/35, 04.24.2018.

A known holding and positioning device of a tool for microsurgery used in a surgical robotic system, RU No. 264281 C2, A61B 34/00, A61B 34/30, A61B 34/35, 02/08/2018.

Known manipulator for submicron movements, used in microsurgery, containing mechanisms for the controlled movement of objects with submicron accuracy, RU No. 2679260 C1, АВВ 34/00, B25J 7/00, 02/06/2019.

Known mechanical micromanipulator for positioning tools providing accurate spatial orientation and manipulation in the field of use, RU No. 2688487 C1, A61B 34/00, 05/21/2019.

Known fine adjustment mechanism used in micromanipulators and providing accurate movements in the entire range of rough movement, RU No. 2224152 C2, F16H 3/20, 02/20/2004.

A known micromanigulator drive designed to move a micro-tool with high-precision positioning in various devices: in biomedical devices, in electromechanical systems, RU No. 118244 U1, B25J 7/00, 20.07.2012; RU No. 96055 U1, B25J 7/00, 07.20.2010; RU No. 2266811 C1, B25J 7/00, 12/27/2005; RU No. 2175601 C12, B25J 7/00, 10/10/2001; RU No. 2149752 C1, B25J 7/00, 05.27.2000.

Known positioning devices of a surgical instrument, micromanipulators, as well as transmission and control devices for them, do not have technical solutions that match the technical features of the invention.

A device for surgical navigation is known, including a micromanipulator device for conducting micromanipulations and a spatial orientation device for a surgical navigation instrument, comprising a latch mounted on the operating table and configured to rotate in one plane, a vertical movement rack with the possibility of reciprocating movement in the latch, levers of horizontal movement, at least the main, intermediate, articulated, connected with the possibility of displacement in parallel horizontal planes and equipped with connecting links, RU No. 35969 U1, A61 B19 / 00, 02.20.2004.

This technical solution is made as the closest analogue of the present invention.

The composition of the device of the closest analogue does not meet the requirements of overall rationality.

The vertical movement rack of the closest analogue is made vertical and has an external shape, which does not provide the possibility of its closer movement to the patient’s body, as well as to the operating table, which complicates the work of the surgeon.

The design of the closest analogue does not provide the necessary accuracy of the orientation of the surgical instrument and surgical manipulations, since after fixing its moving parts, the tip of the instrument is offset by 2-3 mm from the target target point. To increase accuracy, repeated, sometimes multiple, movements in the moving links of the closest analogue are required. This increases the operation time and reduces the accuracy of surgical navigation and manipulations.

The present invention is based on the solution of a problem that allows to simplify and unify the composition of the surgical navigation system, improve the accuracy of surgical navigation and micromanipulation, increase the operational reliability of the micromanipulator, simplify the work of the surgeon when using the system and reduce the duration of the operation.

The technical result of the present invention is to simplify the spatial orientation of the instrument for surgical navigation when making it miniature and mobile, to make levers and links to connect them unified, respectively, in the construction of the micromanipulator with the ability to quickly compensate for inevitably occurring deviations and inaccuracies in navigation and micromanipulations , in the operational reliability of the micromanipulator, in the execution of the vertical movement of the composite rigid.

According to the invention, this problem is solved due to the fact that the system of surgical navigation and micromanipulation includes a micromanipulator device for micromanipulation and a spatial orientation of the instrument for surgical navigation.

The device spatial orientation of the instrument for surgical navigation contains a latch, a rack of vertical movement, levers of horizontal movement.

The latch is mounted on the operating table and is made to rotate in the same plane.

The vertical movement rack has the possibility of reciprocating movement in the latch.

Levers of horizontal movement, at least the main, intermediate, articulated are connected with the possibility of displacement in parallel horizontal planes and are equipped with connecting links.

The vertical movement rack has a composite rigid structure and consists of a main curved component and an additional vertical component with a vertical movement restrictor ring.

An additional vertical component is fixed by means of a connecting pin with a lever of the main horizontal movement.

The limiter ring has the ability to select the required height of the main lever along an additional vertical composite rack.

In this case, the rack has the additional possibility of rotational movement in the latch.

The main, intermediate, articulated levers are fixed to each other by connecting pin links.

The articulated lever by means of a connecting joint-ball link is rigidly connected to the micromanipulator.

The micromanipulator contains a caliper with a handle and a motion transmission unit.

The motion transmission unit includes a motion transmission lever with a handle and an adjustment lever with a handle.

Each of the levers has fasteners in the form of screws and hinge nuts, respectively.

The gear lever is fixed with a pivot nut on this lever and a screw on the caliper.

The handle of the installation lever is fixed with a hinge nut on this lever and a screw on the motion transmission lever.

The applicant has not identified sources containing information about technical solutions identical to the present invention, which allows us to conclude that it meets the criterion of "novelty."

Due to the implementation of the distinguishing features of the invention (in conjunction with the features indicated in the restrictive part of the formula), important new properties of the object are achieved.

The implementation of the vertical movement rack composite rigid structure consisting of a main curved component and an additional vertical component with a ring-limiter of vertical movement, which allows to simplify the work of the surgeon when using the system.

The fastening of the levers of the main, intermediate, articulated to each other by connecting pin links allows you to simplify and unify the composition of the surgical navigation system, as well as increase its reliability.

The rigid connection of the articulated lever by means of a connecting joint-ball link with a micromanipulator allows to increase the accuracy of micro-manipulations, reduce the time of surgery and reduce the risk of operational complications that may occur during uncontrolled displacements in individual parts of the system.

The implementation of the micromanipulator with a motion transmission unit including a motion transmission lever and an installation lever, which are equipped with handles and fasteners in the form of screws and hinge nuts, respectively, allows to increase its operational reliability.

The applicant is not aware of any publications that would contain information on the influence of the distinguishing features of the invention on the achieved technical result. In this regard, according to the applicant, it can be concluded that the claimed technical solution meets the criterion of "inventive step".

The invention is illustrated by drawings:

In FIG. 1 - System of surgical navigation and micromanipulation, general view.

In FIG. 2 - System of surgical navigation and micromanipulation, micromanipulator, front view.

In FIG. 3 - System of surgical navigation and micromanipulation, micromanipulator, right view.

In FIG. 4 - System of surgical navigation and micromanipulation, general view, illustrative.

In FIG. 1 to 4 are presented:

Lock - 1.

Compound rigid rack of vertical movement - 2,

the main curved component (rack 2) - 3,

additional vertical component with a ring-limiter of vertical movement (rack 2) - 4.

The lever of the main horizontal movement - 5,

lever intermediate horizontal movement - 6,

articulated horizontal lever - 7.

Link connecting ball-joint (lever 7) - 8.

Connecting pin links (racks 2 and levers 5, levers 5 and 6, levers 6 and 7) - 9.

Micromanipulator - 10.

Caliper (micromanipulator 10) - 11,

carriage and guide (caliper 11) - 12,

handle (caliper 11) - 13.

Motion transmission unit (micromanipulator 10) -14.

The motion transmission lever (block 14) - 15,

screw (lever 15) - 16,

hinge nut (lever 15) -17,

handle (lever 15) - 18.

The adjusting lever (block 14) - 19,

screw (lever 19) - 20,

hinge-nut (of lever 19) - 21,

handle (lever 19) - 22.

The surgical navigation and micromanipulation system includes a micromanipulator 10 for micromanipulation and a spatial orientation of the instrument for surgical navigation.

The spatial orientation of the instrument for surgical navigation includes a latch 1, a rack 2 of vertical movement, horizontal levers 5. 6, 7.

The latch 1 is mounted on the operating table and is made to rotate in the same plane. The rack 2 vertical movement has the possibility of reciprocating movement in the latch 1. The levers of horizontal movement of at least the main 5, intermediate 6, articulated 7 are connected with the possibility of displacement in parallel horizontal planes and are equipped with connecting links 8 and 9.

The rack 2 vertical movement has a composite rigid structure and consists of a main curved component 3 and an additional vertical component 4 with a ring limiter vertical movement.

An additional vertical component 4 is fixed by means of a connecting pin pin 9 with a main lever 5 for horizontal movement.

The limiter ring has the ability to select the desired height of the main lever 5 along the additional vertical component 4.

In this case, the rack 2 has the additional possibility of rotational movement in the latch 1.

The levers of the main 5, intermediate 6, articulated 7 are also fixed to each other by links connecting pins 9.

The hinge lever 7 by means of a connecting joint ball joint 8 is rigidly connected to the micromanipulator 10.

The micromanipulator 10 comprises a caliper 11 with a handle 13 and a motion transmission unit 14.

The motion transmission unit 14 includes a motion transmission lever 15 with a handle 18 and an adjustment lever 19 with a handle 22.

Each of the levers 15 and 19 has fasteners in the form of screws 16 and 20 and hinge nuts 17 and 21, respectively.

The handle 18 of the motion transmission lever 15 is fixed with a hinge nut 17 on this lever 15 and a screw 16 on the caliper 11.

The handle 22 of the installation lever 19 is fixed by a hinge nut 21 on this lever 19 and a screw 20 on the motion transmission lever 15.

In neurosurgical operations, the system is used as follows.

The patient’s head is placed on the neurosurgical headrest.

The surgical field is prepared, an incision is made in the skin and soft tissues on the head, a bone window is formed in the bones of the skull with a diameter of at least 20 mm to allow placement of an ultrasonographic sensor (US sensor).

The latch 1 is rigidly fixed to the metal rail at the edge of the operating table at a distance of about 50 cm from the patient’s head.

In the latch 1, a curved component 3 is placed of the composite rigid stand 2 of vertical movement, so that its bend is located as low as possible and closer to the patient’s body, and the additional vertical composite stand 4 is as close as possible to the middle of the width of the operating table.

On the additional vertical component part 4 of the composite rigid rack 2, a limiter ring is installed and fixed on it to the required height. The limiter ring has the ability to select the required height of the main lever 5 along an additional vertical composite rack 4.

An additional vertical component 4 is connected to the main lever 5, then to the intermediate lever 6, which is connected to the hinged lever 7 by means of connecting pin pins 9.

The hinge lever 7 is rigidly connected to the micromanipulator 10, which has a wide degree of freedom of movement due to the ball joint.

On the guide 12 of the carriage with the rail of the micromanipulator 10, a holder with a US sensor is placed and the US sensor is installed on the dura mater covering the brain in the area of the bone defect. To improve the ultrasound image, the contact area of the US sensor with the dura mater is irrigated with sterile saline. On the screen of the ultrasound apparatus, an image of the brain is obtained.

Then, by tilting the US sensor in different directions, due to the spherical hinge, they achieve visualization on the monitor of the ultrasound device of the surgical target (for example, a brain tumor) and the central acoustic axis of the US sensor, indicated on the monitor of the ultrasound device, passes through the center of the surgical target. In this position, all the moving parts of the system are fixed. In this case, an inevitable displacement of the central acoustic axis of the US sensor arises. This stage provides primary (approximate) surgical navigation.

Within the visualized surgical target on the monitor of the ultrasound machine, the target point is selected and, using the capabilities of the micromanipulator, the acoustic axis of the sensor is oriented to the center of the target point. This is a secondary (expert) surgical navigation.

On the monitor of the ultrasonic apparatus, the distance between the US sensor and the selected target point is measured (the depth of the target point). After that, the holder with the US sensor is replaced, for example, with a holder with a neuroendoscope and this holder moves along the guide 12 to a known depth, thereby the tip of the neuroendoscope is inserted exactly at the target point. In this case, the axis of the endoscope will be identical to the acoustic axis of the US sensor, and its tip will occupy the spatial position corresponding to the target point.

Instead of a neuroendoscope, other instruments, such as a biopsy needle, a ventricular catheter, a brain spatula, etc., can be inserted into the target point.

During the operation, the instruments may change, while maintaining the identity of their axes with the calculated acoustic axis of the US sensor.

When a tool hits a target point, using a micromanipulator, strictly controlled surgical procedures are performed.

After micromanipulation is completed, the instrument is removed from the surgical wound.

The operation is completed according to the general rules of neurosurgery.

The proposed "System of surgical navigation and micromanipulation" is manufactured industrially and used in neurosurgical operations, which determines, according to the applicant, the invention meets the criterion of "industrial applicability"

The proposed invention allows:

- simplify the composition of the surgical navigation system;

- unify the composition of the surgical navigation system;

- improve the accuracy of surgical navigation and micromanipulation;

- increase the operational reliability of the micromanipulator;

- simplify the work of the surgeon when using the system;

- reduce the duration of the operation.

Claims (1)

A system of surgical navigation and micromanipulation, including a micromanipulator device for micromanipulation and a spatial orientation device for a surgical navigation instrument, comprising a latch mounted on the operating table and rotatable in one plane, a vertical movement stand with the possibility of reciprocating movement in the latch, levers of horizontal movement, at least the main, intermediate, articulated, connected with the possibility of displacement in parallel horizontal planes and provided with connecting links, characterized in that the vertical movement rack has a composite rigid structure and consists of a main curved component and an additional vertical component with a limiter ring for vertical movement, and the additional vertical component is fixed by means of a link connecting pin with a lever to the main horizontal movement, and the limiter ring has the ability to select the required height of the main lever along an additional vertical component, while the stand has the possibility of rotational movement in the latch, in addition, the main, intermediate and articulated levers are fixed to each other by connecting pin links, while the articulated lever through the connecting joint-ball link is rigidly connected to the micromanipulator, which contains a support with a handle and a motion transmission unit, including a motion transmission lever with a handle and an adjustment lever with a handle, each of these levers having fasteners in the form of screws and hinge nuts , respectively, while the handle of the transmission lever is fixed with a hinge nut on this lever and a screw on the caliper, and the handle of the installation lever is fixed with a hinge nut on this lever and a screw on the movement lever.

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