WO1998025535A1 - Appareil de guidage et de guidage d'un instrument tel qu'un instrument chirurgical ou une sonde - Google Patents

Appareil de guidage et de guidage d'un instrument tel qu'un instrument chirurgical ou une sonde Download PDF

Info

Publication number
WO1998025535A1
WO1998025535A1 PCT/EP1997/006932 EP9706932W WO9825535A1 WO 1998025535 A1 WO1998025535 A1 WO 1998025535A1 EP 9706932 W EP9706932 W EP 9706932W WO 9825535 A1 WO9825535 A1 WO 9825535A1
Authority
WO
WIPO (PCT)
Prior art keywords
support
instrument
rotation
stereotactic frame
skull
Prior art date
Application number
PCT/EP1997/006932
Other languages
English (en)
Inventor
Luca Bosio
Cesare Giorgi
Original Assignee
Sm Scienzia Machinale S.R.L.
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 Sm Scienzia Machinale S.R.L. filed Critical Sm Scienzia Machinale S.R.L.
Publication of WO1998025535A1 publication Critical patent/WO1998025535A1/fr

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
    • A61B90/36—Image-producing devices or illumination devices not otherwise provided for
    • 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
    • A61B90/11—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 with guides for needles or instruments, e.g. arcuate slides or ball joints
    • 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
    • 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

Definitions

  • T_TJ_ E APPARATUS FOR GUIDING AND SUPPORTING AN INSTRUMENT SUCH AS A SURGICAL INSTRUMENT OR A PROBE.
  • the present invention generally relates to the field of medical apparatus, and more precisely it relates to an apparatus for guiding and supporting an instrument such as a surgical instrument or a probe . Description of the prior art
  • surgeon is guided by hardware systems which store the position of the instrument and trace such position in said reference system, run by a graphic computer.
  • the apparatus which stores the position of the surgical instrument has to detect continually every new position of the instrument during the operation.
  • the reference system which is common both to the morphological imaging and to the operation steps is normally a stereotactic frame kept integral to the skull of the patient.
  • such reference system is formed by reference points or reference surfaces which are common to both the steps of imaging and operation.
  • the calculation of the position of the instruments is carried out through three dimensional coordinates readers, having a mechanic structure with many degrees of freedom.
  • the calculation of the position of the instruments is carried out by means of optical systems which are able to determine the coordinates of reference points viewed by telecameras .
  • None of such existing apparatus is capable of reading the instrument position and, at the same time, to support it in the nearby of a predetermined location.
  • FIG. 1 shows diagrammatically an apparatus according to the invention, mounted on a stereotactic frame and connected to a computer;
  • - figure 2 shows a perspective side view of a preferred embodiment of the apparatus of figure 1;
  • - figure 3 shows a rear perspective view of the guide apparatus of figure 2 disengaged with respect to the stereotactic frame;
  • - figure 4 shows an elevational side view of the preferred embodiment of the apparatus according to the invention
  • - figure 5 shows a perspective elevational view of the apparatus of figure 4.
  • an apparatus for the guide of a surgical instrument for skull neurosurgery is combined with a stereotactic frame 1, belonging to a stereotactic appliance (see fig. 5), suitable for engaging with the skull of the patient 2 through known means not shown, and a support flange 3 for a surgical instrument 4.
  • Flange 3 is connected to the stereotactic frame 1 through a guide apparatus 5 according to the present invention.
  • guide apparatus 5 is connected to stereotactic frame 1 by means of a fastening device 6, which is easily releasable and comprises a pivot axis 6a about which an external part of it is able to rotate.
  • Pivot axis 6a in the present case, is substantially parallel to the plane of the stereotactic frame 1.
  • Releasable fastening device 6 comprises mechanical lock means of the rotation about pivot axis 6a at a precise reference position, to be set as zero position.
  • Flange 3 is then connected to fastening device 6 through a plurality of pivotal supports, respectively a first, a second, a third and a fourth pivotal support 7, 8, 9, 10, connected in turn to one another by means of stiff arms 11, 12, 13.
  • the fourth support 10 is connected directly to flange 3, preferably through a further arm 14.
  • supports 7, 8, 9 and 10 permit the rotation of their proximal parts with respect to their distal parts about respective axes 7a, 8a, 9a and 10a, as indicated by the corresponding arrows.
  • instrument 4 whose axis is indicated with numeral 15, has four degrees of freedom, one for each support, and can then be guided in many positions with respect to the skull 2 of the patient.
  • guide apparatus 5 has a further degree of freedom given by the rotation about axis 6a (fig. 3), which normally is not used except at the beginning or end of an operation step when moving the instrument towards or away from the patient.
  • Each support 7, 8, 9 and 10 have, in addition to the possibility of rotation between a proximal element and a distal element, a sensor of the angular position between the proximal and the distal element as well as a brake for locking the rotation of the distal element with respect to the proximal element.
  • a preferred embodiment of the third support 9 is illustrated in figure 4 and described below.
  • the signal responsive to the angular positions both of releasable fastening device 6, which has the function of zero reference, and of each support 7, 8, 9, 10, is sent to a computer 20 connected to a monitor 21 on which the position of instrument 4 is traced with respect to a plurality of maps imaged in a known way by a preliminar morphological analysis of the patient, as above synthetically described.
  • stereotactic frame 1 is set integral to the patient 2.
  • the surgeon has unlocked the rotation of the supports 7, 8, 9, 10 (for example by a pedal not shown) he can guide instrument 4 freely and with minimum effort. Then, the surgeon can lock the guide apparatus in a chosen position where he can use correctly the instrument 4 in the direction of operation.
  • the corresponding signals which are sent to computer 20 are responsive the position of the image of the instrument shown on monitor 21 calculated with reference to both stereotactic frame 1 and the stored maps.
  • Apparatus 5 permits the movement of instrument 4 with respect to only a portion of skull 2, that is a spherical area, for example +/- 40 degrees about a central position initially fixed when setting fastening device 6 to stereotactic frame 1. Therefore, in order to operate in different areas of the skull, a plurality of connection points 16 are provided for in different positions of the stereotactic frame 1, shown in figure 2 and comprising hole 17 for a socket not shown and a reference tooth 18. Alternatively, bayonet connections may be provided for. In the example of figure 2 only eight different connection points 16 of apparatus 5 have been provided for, of which only five are shown in addition to that to which the apparatus is actually fixed.
  • the apparatus 5 can be easily set in a position of minimum encumbrance with respect to the skull 2 of the patient, simply rotating it about axis 6a of fastening device 6. In the position of figure 3, moreover, apparatus 5 can be removed or it can be later set again in he position of figure 2 to start a new step of the operation on skull 2.
  • the point of incidence of the axes 7a and 8a is located at the centre of the skull of the patient. In this way the free end of the instrument 4 describes a spherical portion concentric to the skull .
  • the length and the shape of arms 11, 12 and 13 is chosen in such a way that the straight line of the resultant of the weight forces of the apparatus 5 passes through point O.
  • the straight line BO is vertical
  • the moments of the weight forces of all the supports is equal to zero, further reducing the forces acting on the apparatus when locked. Therefore, since the moments of the weight forces do not stress the supports, the weight of all the instrument 4, which can be low or also high, weighs directly on the stereotactic frame 1, thus not affecting the braking capability of supports 7,8,9,10.
  • a particular advantage of the preferred embodiment of figures 4 and 5 is that the distances AO, BO and AB of figure 4 are constant, as well as the angles of triangle OAB are constant, thus allowing to apparatus 5 to guide specifically instrument 4 about the skull 2.
  • the supports 9 and 10 have point of incidence B on the axis 15 of instrument 4. Therefore, the rotation about axes 9a and 10a is actually a movement of instrument 4 inside a cone having vertex at point B which is located on axis 15. Vertex B, therefore, describes a spherical portion having centre in O, and the apparatus 5 obtains the result of correctly guiding instrument 4 during skull neurosurgery.
  • a preferred embodiment of the connection of the fastening device 6 to stereotactic frame 1, shown always in figures 4 and 5, comprises a dovetailed coupling 22, which is steady and easily releasable.
  • guide apparatus 5 can be rotated about pivot 6a of fastening device 6 in order to be arranged in a position of minimum encumbrance.
  • a release lever 30 (figures 4 and 5) locks or unlocks pivot 6a of fastening device 6.
  • the embodiment of figure 5 may be equipped with means of known type for keeping the apparatus 5 integral to the skull 2 of the patient, comprising pins 23 which extend from stereotactic frame 1.
  • Support 9 comprises an electromagnetic element 24, linked to the distal portion 9b of the support 9 by means of a spring 24a having high torsional stiffness and high flexibility in the direction of axis 9a. Moreover, it comprises a locking element 25, integral to the proximal portion 9c of support 9. Electromagnetic element 24, in normal conditions, is a permanent magnet and is very close to locking element 25 thus contacting disk clutch 26, and locking support 9, proximal portion 9c is prevented from rotating with respect to distal portion 9b.
  • instrument 4 can slidingly engage with flange 3, freely moving in the direction of arrow 15a of figure 4.
  • an encoder (not shown) may be provided for measuring the relative position of the proximal end of the instrument 4 with respect to point B, or another reference point.
  • Instrument 4 moreover, can either be kept locked with respect to flange 3, or it can be freed.
  • the surgeon uses the apparatus according to the invention only as unidirectional guide for the instrument, but not as a support for it.
  • instrument 4 by putting instrument 4 in the flange 3 of apparatus 5 when unlocked, it is possible to control the exact position of instrument 4 which is totally handled by the surgeon, which does not lose its control, thanks to the light movement of the supports 7,8,9,10.
  • the surgeon checks the direction of the instrument on the monitor 20, until it exactly coincides with the operation area. Then, after having locked the guide apparatus 5 , the surgeon has only to control the movement of the instrument 4 according to arrow 15a of figure 4, viewing on the monitor its position within the operation area.
  • stereotactic frame 1 can be conformed to other parts of the body .

Landscapes

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

Abstract

L'invention a pour objet un appareil pour guider un instrument chirurgical (4), en particulier, pour la neurochirurgie crânienne, couplé d'une part à un cadre stéréotaxique (1); solidiare d'un patient (2) lors de son utilisation, et d'autre part à un support (3) prévu pour cet instrument (4). Ce support (3) ou rebord est raccordé au cadre stéréotaxique (1) au moyen de plusieurs supports rotatifs (7, 8, 9, 10) reliés, à leur tour, par des bras rigides (11, 12, 13). Chaque support assure un degré de liberté à l'appareil de guidage (5) autour d'un axe de rotation (7a, 8a, 9a, 10a). En particulier, le premier et le deuxième supports (7, 8) permettant à l'instrument de se déplacer, de manière sensiblement sphérique, par rapport au cadre stéréotaxique (1) et les troisième et quatrième supports permettant à l'instrument (4) de se déplacer selon un mouvement de rotation dans plusieurs directions par rapport aux premier et deuxième supports (7, 8). L'appareil peut servir de lecteur de la position de l'instrument en association avec une carte morphologique sur un écran (21) d'ordinateur et de support pour cet instrument, tout en assurant son déplacement près d'une position choisie. L'instrument et les supports rotatifs peuvent être verrouillés dans une position prédéterminée.
PCT/EP1997/006932 1996-12-11 1997-12-11 Appareil de guidage et de guidage d'un instrument tel qu'un instrument chirurgical ou une sonde WO1998025535A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
IT96PI000061A IT1289303B1 (it) 1996-12-11 1996-12-11 Apparecchiatura per l'orientamento ed il supporto di strumenti ad uso chirurgico
ITPI96A000061 1996-12-11

Publications (1)

Publication Number Publication Date
WO1998025535A1 true WO1998025535A1 (fr) 1998-06-18

Family

ID=11394057

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/EP1997/006932 WO1998025535A1 (fr) 1996-12-11 1997-12-11 Appareil de guidage et de guidage d'un instrument tel qu'un instrument chirurgical ou une sonde

Country Status (2)

Country Link
IT (1) IT1289303B1 (fr)
WO (1) WO1998025535A1 (fr)

Cited By (7)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2001076490A1 (fr) * 2000-04-10 2001-10-18 Karl Storz Gmbh & Co. Kg Dispositif medical de positionnement d'objets
WO2001076500A1 (fr) * 2000-04-07 2001-10-18 Image-Guided Neurologics, Inc. Guide de trajectoire robotise
US8845656B2 (en) 2000-04-07 2014-09-30 Medtronic, Inc. Device for immobilizing a primary instrument and method therefor
US9901713B2 (en) 2002-09-17 2018-02-27 Medtronic, Inc. Low profile instrument immobilizer
US10086193B2 (en) 2004-02-13 2018-10-02 Medtronic, Inc. Apparatus for securing a therapy delivery device within a burr hole and method for making same
US11298043B2 (en) 2016-08-30 2022-04-12 The Regents Of The University Of California Methods for biomedical targeting and delivery and devices and systems for practicing the same
US11497576B2 (en) 2017-07-17 2022-11-15 Voyager Therapeutics, Inc. Trajectory array guide system

Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4548373A (en) * 1983-03-22 1985-10-22 Tokyo Kogaku Kikai Kabushiki Kaisha Medical equipment supporting device
US5050608A (en) * 1988-07-12 1991-09-24 Medirand, Inc. System for indicating a position to be operated in a patient's body
US5230623A (en) * 1991-12-10 1993-07-27 Radionics, Inc. Operating pointer with interactive computergraphics
WO1995013758A1 (fr) * 1993-11-15 1995-05-26 Urso Paul Steven D Procedures chirurgicales
US5494034A (en) * 1987-05-27 1996-02-27 Georg Schlondorff Process and device for the reproducible optical representation of a surgical operation
WO1996010368A2 (fr) * 1994-09-30 1996-04-11 Ohio Medical Instrument Company, Inc. Appareil et procede pour des interventions neurochirurgicales stereotactiques

Patent Citations (6)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US4548373A (en) * 1983-03-22 1985-10-22 Tokyo Kogaku Kikai Kabushiki Kaisha Medical equipment supporting device
US5494034A (en) * 1987-05-27 1996-02-27 Georg Schlondorff Process and device for the reproducible optical representation of a surgical operation
US5050608A (en) * 1988-07-12 1991-09-24 Medirand, Inc. System for indicating a position to be operated in a patient's body
US5230623A (en) * 1991-12-10 1993-07-27 Radionics, Inc. Operating pointer with interactive computergraphics
WO1995013758A1 (fr) * 1993-11-15 1995-05-26 Urso Paul Steven D Procedures chirurgicales
WO1996010368A2 (fr) * 1994-09-30 1996-04-11 Ohio Medical Instrument Company, Inc. Appareil et procede pour des interventions neurochirurgicales stereotactiques

Cited By (13)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2001076500A1 (fr) * 2000-04-07 2001-10-18 Image-Guided Neurologics, Inc. Guide de trajectoire robotise
US8845656B2 (en) 2000-04-07 2014-09-30 Medtronic, Inc. Device for immobilizing a primary instrument and method therefor
US8911452B2 (en) 2000-04-07 2014-12-16 Medtronic, Inc. Device for immobilizing a primary instrument and method therefor
US10300268B2 (en) 2000-04-07 2019-05-28 Medtronic, Inc. Device for immobilizing a primary instrument and method therefor
WO2001076490A1 (fr) * 2000-04-10 2001-10-18 Karl Storz Gmbh & Co. Kg Dispositif medical de positionnement d'objets
US10974029B2 (en) 2002-09-17 2021-04-13 Medtronic, Inc. Low profile instrument immobilizer
US9901713B2 (en) 2002-09-17 2018-02-27 Medtronic, Inc. Low profile instrument immobilizer
US10058681B2 (en) 2002-09-17 2018-08-28 Medtronic, Inc. Low profile instrument immobilizer
US10086193B2 (en) 2004-02-13 2018-10-02 Medtronic, Inc. Apparatus for securing a therapy delivery device within a burr hole and method for making same
US11938312B2 (en) 2004-02-13 2024-03-26 Medtronic, Inc. Apparatus for securing a therapy delivery device within a burr hole and method for making same
US11298043B2 (en) 2016-08-30 2022-04-12 The Regents Of The University Of California Methods for biomedical targeting and delivery and devices and systems for practicing the same
US11298041B2 (en) 2016-08-30 2022-04-12 The Regents Of The University Of California Methods for biomedical targeting and delivery and devices and systems for practicing the same
US11497576B2 (en) 2017-07-17 2022-11-15 Voyager Therapeutics, Inc. Trajectory array guide system

Also Published As

Publication number Publication date
ITPI960061A1 (it) 1998-06-11
IT1289303B1 (it) 1998-10-02

Similar Documents

Publication Publication Date Title
US9867549B2 (en) Motion tracking system for real time adaptive imaging and spectroscopy
US6035228A (en) Frameless stereotactic arm apparatus and method of using same
EP0904733B1 (fr) Procédé et appareil pour l'enregistrement d'une image tridimensionnelle d'une partie du corps
EP0782413B1 (fr) Systeme de recherche de position a l'aide d'une unite de reference fixee sur la tete d'un patient, destine a des applications medicales
US5999837A (en) Localizing and orienting probe for view devices
US6687531B1 (en) Position tracking and imaging system for use in medical applications
US6351661B1 (en) Optically coupled frameless stereotactic space probe
EP1380266B1 (fr) Système d'imagerie et de recherche de position destiné à des applications médicales
US5755725A (en) Computer-assisted microsurgery methods and equipment
US6013087A (en) Image-guided surgery system
EP1323120B1 (fr) Artefact de calage d'images par fluorescence a marqueurs optiques et/ou magnetiques
US20020002330A1 (en) Referencing or registering a patient or a patient body part in a medical navigation system by means of irradiation of light points
JPH11276502A (ja) フレームレス定位手術装置
JP2002186603A (ja) 対象物の案内のための座標変換法
CA3005705A1 (fr) Systeme de navigation, de localisation et de guidage destine au positionnement d'instruments operatoires a l'interieur du corps d'un patient
WO1998025535A1 (fr) Appareil de guidage et de guidage d'un instrument tel qu'un instrument chirurgical ou une sonde
AU2011214864A1 (en) MR gamma hybrid imaging system
Giorgi et al. Preliminary clinical experience with intraoperative stereotactic ultrasound imaging
GB2288249A (en) Operating microscope unit with data interface
WO2008138962A1 (fr) Appareil miniaturisé
JPH0332644A (ja) 磁気共鳴イメージング装置
Koivukangas et al. Neuronavigator-guided cerebral biopsy
JP2023516086A (ja) 画像誘導外科手術を容易にするための固定カメラ装置、システム、および方法
BE1007726A7 (fr) Instrument stereotaxique.
CN219814117U (zh) 镜装置和成像设备

Legal Events

Date Code Title Description
AK Designated states

Kind code of ref document: A1

Designated state(s): CA US

AL Designated countries for regional patents

Kind code of ref document: A1

Designated state(s): AT BE CH DE DK ES FI FR GB GR IE IT LU MC NL PT SE

DFPE Request for preliminary examination filed prior to expiration of 19th month from priority date (pct application filed before 20040101)
121 Ep: the epo has been informed by wipo that ep was designated in this application
122 Ep: pct application non-entry in european phase