WO2014049598A1 - Orientation et manipulation d'un outil articulé de chirurgie laparoscopique - Google Patents

Orientation et manipulation d'un outil articulé de chirurgie laparoscopique Download PDF

Info

Publication number
WO2014049598A1
WO2014049598A1 PCT/IL2013/050806 IL2013050806W WO2014049598A1 WO 2014049598 A1 WO2014049598 A1 WO 2014049598A1 IL 2013050806 W IL2013050806 W IL 2013050806W WO 2014049598 A1 WO2014049598 A1 WO 2014049598A1
Authority
WO
WIPO (PCT)
Prior art keywords
tool
surgical
rule
movements
movement
Prior art date
Application number
PCT/IL2013/050806
Other languages
English (en)
Inventor
Gal ATAROT
Yaron LEVINSON
Original Assignee
M.S.T. Medical Surgery Technologies Ltd.
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 M.S.T. Medical Surgery Technologies Ltd. filed Critical M.S.T. Medical Surgery Technologies Ltd.
Priority to EP13841164.0A priority Critical patent/EP2900130A4/fr
Publication of WO2014049598A1 publication Critical patent/WO2014049598A1/fr
Priority to US14/671,128 priority patent/US20150238276A1/en
Priority to US17/711,023 priority patent/US20220395159A1/en

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/06—Devices, other than using radiation, for detecting or locating foreign bodies ; determining position of probes within or on the body of the patient
    • A61B5/065—Determining position of the probe employing exclusively positioning means located on or in the probe, e.g. using position sensors arranged on the probe
    • A61B5/066—Superposing sensor position on an image of the patient, e.g. obtained by ultrasound or x-ray imaging
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive 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
    • A61B34/20—Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis

Definitions

  • the present invention generally pertains to a system and method for directing and maneuvering an articulating tool such as an endoscope during laparoscopic surgery.
  • Laparoscopic surgery is becoming increasingly popular with patients because the scars are smaller and their period of recovery is shorter. Laparoscopic surgery requires special training for the surgeon and the theatre nursing staff. The equipment is often expensive and is not available in all hospitals.
  • the system comprises an endoscope or other surgical tool that can change shape, size or angulation so as to simplify maneuvering of the system.
  • said route rule comprises a communicable database storing predefined route in which said at least one surgical tool is adapted to move within said surgical environment; said predefined route comprises n 3D spatial positions of said at least one surgical tool; n is an integer greater than or equal to 2; said ALLOWED movements are movements in which said at least one surgical tool is located substantially in at least one of said n 3D spatial positions of said predefined route, and said RESTRICTED movements are movements in which said location of said at least one surgical tool is substantially different from said n 3D spatial positions of said predefined route.
  • said environmental rule comprises a comprises a communicable database; said communicable database adapted to receive at least one real-time image of said surgical environment and is adapted to perform real-time image processing of the same and to determine the 3D spatial position of hazards or obstacles in said surgical environment; said environmental rule is adapted to determine said ALLOWED and RESTRICTED movements according to said hazards or obstacles in said surgical environment, such that said RESTRICTED movements are movements in which said at least one surgical tool is located substantially in at least one of said 3D spatial positions, and said ALLOWED movements are movements in which the location of said at least one surgical tool is substantially different from said 3D spatial positions.
  • said tagged tool rule comprises means adapted to tag at least one surgical tool within said surgical environment and to determine said ALLOWED movement of said endoscope to constantly track the movement of said tagged surgical tool.
  • said field of view rule comprises a communicable database comprising n 3D spatial positions; n is an integer greater than or equal to 2; the combination of all of said n 3D spatial positions provides a predetermined field of view; said field of view rule is adapted to determine said ALLOWED movement of said endoscope within said n 3D spatial positions so as to maintain a constant field of view, such that said ALLOWED movements are movements in which said endoscope is located substantially in at least one of said n 3D spatial positions, and said RESTRICTED movements are movements in which the location of said endoscope is substantially different from said n 3D spatial positions.
  • said preferred volume zone rule comprises a communicable database comprising n 3D spatial positions; n is an integer greater than or equal to 2; said n 3D spatial positions provides said preferred volume zone; said preferred volume zone rule is adapted to determine said ALLOWED movement of said endoscope within said n 3D spatial positions and RESTRICTED movement of said endoscope outside said n 3D spatial positions, such that said ALLOWED movements are movements in which said endoscope is located substantially in at least one of said n 3D spatial positions, and said RESTRICTED movements are movements in which the location of said endoscope is substantially different from said n 3D spatial positions.
  • said no fly zone rule comprises a communicable database comprising n 3D spatial positions; n is an integer greater than or equal to 2; said n 3D spatial positions define a predetermined volume within said surgical environment; said no fly zone rule is adapted to determine said RESTRICTED movement if said movement is within said no fly zone and ALLOWED movement if said movement is outside said no fly zone, such that said RESTRICTED movements are movements in which said at least one of said surgical tool is located substantially in at least one of said n 3D spatial positions, and said ALLOWED movements are movements in which the location of said at least one endoscope is substantially different from said n 3D spatial positions.
  • said history-based rule comprises a communicable database storing each 3D spatial position of each said surgical tool, such that each movement of each surgical tool is stored; said history-based rule is adapted to determine said ALLOWED and RESTRICTED movements according to historical movements of said at least one surgical tool, such that said ALLOWED movements are movements in which said at least one surgical tool is located substantially in at least one of said 3D spatial positions, and said RESTRICTED movements are movements in which the location of said at least one surgical tool is substantially different from said n 3D spatial positions.
  • said tool-dependent ALLOWED and RESTRICTED movements rule comprises a communicable database; said communicable database is adapted to store predetermined characteristics of at least one of said surgical tool; said tool-dependent ALLOWED and RESTRICTED movements rule is adapted to determine said ALLOWED and RESTRICTED movements according to said predetermined characteristics of said surgical tool; such that ALLOWED movements are movements of said endoscope which track said surgical tool having said predetermined characteristics.
  • said predetermined characteristics of said surgical tool are selected from a group consisting of: physical dimensions, structure, weight, sharpness, and any combination thereof.
  • said movement detection rule comprises a communicable database comprising the real-time 3D spatial positions of each said surgical tool; said movement detection rule is adapted to detect movement of said at least one surgical tool when a change in said 3D spatial positions is received, such that said ALLOWED movements are movements in which said endoscope is re-directed to focus on said moving surgical tool.
  • said at least one location estimating means comprises at least one endoscope adapted to acquire realtime images of said surgical environment within said human body; and at least one surgical instrument spatial location software adapted to receive said real-time images of said surgical environment and to estimate said 3D spatial position of said at least one surgical tool.
  • said at least one location estimating means comprises (a) at least one element selected from a group consisting of optical imaging means, radio frequency transmitting and receiving means, at least one mark on said at least one surgical tool and any combination thereof; and, (b) at least one surgical instrument spatial location software adapted to estimate said 3D spatial position of said at least one surgical tool by means of said element.
  • said at least one location estimating means is an interface subsystem between a surgeon and said at least one surgical tool, the interface subsystem comprising: a. at least one array comprising N regular or pattern light sources, where N is a positive integer; b. at least one array comprising M cameras, each of the M cameras, where M is a positive integer; c. optional optical markers and means for attaching the optical marker to the at least one surgical tool; and; d. a computerized algorithm operable via the controller, the computerized algorithm adapted to record images received by each camera of each of the M cameras and to calculate therefrom the position of each of the tools, and further adapted to provide automatically the results of the calculation to the human operator of the interface.
  • said route rule comprises steps of: providing a communicable database; storing a predefined route in which said at least one surgical tool is adapted to move within said surgical environment; comprising said predefined route of n 3D spatial positions of said at least one surgical tool, n is an integer greater than or equal to 2; said ALLOWED movements are movements in which said at least one surgical tool is located substantially in at least one of said n 3D spatial positions of said predefined route, and said RESTRICTED movements are movements in which said location of said at least one surgical tool is substantially different from said n 3D spatial positions of said predefined route.
  • said environmental rule comprises steps of: providing a communicable database; receiving at least one real-time image of said surgical environment in said communicable database; performing real-time image processing of the same and determining the 3D spatial position of hazards or obstacles in said surgical environment; determining said ALLOWED and RESTRICTED movements according to said hazards or obstacles in said surgical environment, such that said RESTRICTED movements are movements in which said at least one surgical tool is located substantially in at least one of said 3D spatial positions, and said ALLOWED movements are movements in which the location of said at least one surgical tool is substantially different from said 3D spatial positions.
  • said operator input rule comprises steps of: providing a communicable database; and receiving input from an operator of said system regarding said ALLOWED and RESTRICTED movements of said at least one surgical tool.
  • said proximity rule comprises steps of: defining a predetermined distance between at least two surgical tools; said ALLOWED movements are movements which are within the range or out of the range of said predetermined distance, and said RESTRICTED movements are movements which are out of the range or within the range of said predetermined distance.
  • said proximity rule comprises steps of: defining a predetermined angle between at least three surgical tools; said ALLOWED movements are movements which are within the range or out of the range of said predetermined angle, and said RESTRICTED movements are movements which are out of the range or within the range of said predetermined angle.
  • said collision prevention rule comprises steps of: defining a predetermined distance between said at least one surgical tool and an anatomical element within said surgical environment; said ALLOWED movements are movements which are in a range that is larger than said predetermined distance, and said RESTRICTED movements are movements which is in a range that is smaller than said predetermined distance.
  • said right tool rule comprises steps of: determining said ALLOWED movement of said endoscope according to the movement of the surgical tool positioned to right of said endoscope; further wherein said left tool rule comprises steps of: determining said ALLOWED movement of said endoscope according to the movement of the surgical tool positioned to left of said endoscope.
  • said tagged tool rule comprises steps of: tagging at least one surgical tool within said surgical environment and determining said ALLOWED movements of said endoscope to be movements that constantly track the movement of said tagged surgical tool.
  • said field of view rule comprises steps of: providing a communicable database comprising n 3D spatial positions; n is an integer greater than or equal to 2; generating a field of view from the combination of all of said n 3D spatial positions; maintaining a constant field of view by determining said ALLOWED movement of said endoscope to be within said n 3D spatial positions, such that said ALLOWED movements are movements in which said endoscope is located substantially in at least one of said n 3D spatial positions, and said RESTRICTED movements are movements in which the location of said endoscope is substantially different from said n 3D spatial positions.
  • said preferred volume zone rule comprises steps of: providing a communicable database comprising n 3D spatial positions; n is an integer greater than or equal to 2; generating said preferred volume zone from said n 3D spatial positions; determining said ALLOWED movement of said endoscope to be within said n 3D spatial positions and said RESTRICTED movement of said endoscope to be outside said n 3D spatial positions, such that said ALLOWED movements are movements in which said endoscope is located substantially in at least one of said n 3D spatial positions, and said RESTRICTED movements are movements in which the location of said endoscope is substantially different from said n 3D spatial positions.
  • said preferred tool rule comprises steps of: providing a communicable database, storing a preferred tool in said database; determining said ALLOWED movement of said endoscope so as to constantly track the movement of said preferred tool.
  • said no fly zone rule comprises steps of: providing a communicable database comprising n 3D spatial positions, n is an integer greater than or equal to 2; defining a predetermined volume within said surgical environment from said n 3D spatial positions; determining said RESTRICTED movement to be said movement within said no fly zone; determining said ALLOWED movement to be said movement outside said no fly zone, such that said RESTRICTED movements are movements in which said at least one of said surgical tool is located substantially in at least one of said n 3D spatial positions, and said ALLOWED movements are movements in which the location of said at least one endoscope is substantially different from said n 3D spatial positions.
  • said most used tool rule comprises steps of: providing a communicable database; counting the amount of movement of each said surgical tool; constantly positioning said endoscope to track movement of the most moved surgical tool.
  • said history-based rule comprises steps of: providing a communicable database storing each 3D spatial position of each said surgical tool, such that each movement of each surgical tool is stored; determining said ALLOWED and RESTRICTED movements according to historical movements of said at least one surgical tool, such that said ALLOWED movements are movements in which said at least one surgical tool is located substantially in at least one of said 3D spatial positions, and said RESTRICTED movements are movements in which the location of said at least one surgical tool is substantially different from said n 3D spatial positions.
  • said tool-dependent ALLOWED and RESTRICTED movements rule comprises steps of: providing a communicable database; storing predetermined characteristics of at least one said surgical tool; determining said ALLOWED and RESTRICTED movements according to said predetermined characteristics of said surgical tool; such that ALLOWED movements are movements of said endoscope which track said surgical tool having said predetermined characteristics.
  • said movement detection rule comprises steps of: providing a communicable database comprising the real-time 3D spatial positions of each said surgical tool; detecting movement of said at least one surgical tool when a change in said 3D spatial positions is received, such that said ALLOWED movements are movements in which said endoscope is re-directed to focus on said moving surgical tool.
  • Fig. 1 depicts a direction indicator
  • Fig. 2A-B presents a means to control the articulation of an articulating endoscope
  • Fig. 3 illustrates the use of the endoscope articulation control
  • Fig. 4 illustrates articulation of the endoscope
  • Fig. 5 illustrates one embodiment of the present invention
  • Fig. 6A-D schematically illustrates operation of an embodiment of a tracking system with collision avoidance system
  • Fig. 7A-D schematically illustrates operation of an embodiment of a tracking system with no fly zone rule/function
  • Fig. 8A-D schematically illustrates operation of an embodiment of a tracking system with preferred volume zone rule/function
  • Fig. 9 schematically illustrates operation of an embodiment of the organ detection function/rule
  • Fig. 10 schematically illustrates operation of an embodiment of the tool detection function/rule
  • Fig. 11A-B schematically illustrates operation of an embodiment of the movement detection function/rule
  • Fig. 12A-D schematically illustrates operation of an embodiment of the prediction function/rule
  • Fig. 13 schematically illustrates operation of an embodiment of the right tool function/rule
  • Fig. 14A-B schematically illustrates operation of an embodiment of the field of view function/rule
  • Fig. 15 schematically illustrates operation of an embodiment of the tagged tool function/rule
  • Fig. 16A-C schematically illustrates operation of an embodiment of the proximity function/rule
  • Fig. 17A-B schematically illustrates operation of an embodiment of the operator input function/rule
  • Figs. 18A-D schematically illustrate an embodiment of a tracking system with a constant field of view rule/function
  • Fig. 19 schematically illustrates an embodiment of a tracking system with a change of speed rule/function
  • Fig. 20A-B schematically illustrates movement of an articulated tool
  • Fig. 21 schematically illustrates movement of an articulated tool.
  • 'articulation' refers hereinafter to any device which has more than 1 degree of freedom.
  • said tool can bend either in the tip thereof or any location in the body of the same.
  • 'toggle' refers hereinafter to switching between one tagged surgical tool to another.
  • the term 'surgical environment' refers hereinafter to any anatomical part within the human body which may be in surrounding a surgical instrument.
  • the environment may comprise: organs, body parts, walls of organs, arteries, veins, nerves, a region of interest, or any other anatomical part of the human body.
  • 'endoscope' refers hereinafter to any means adapted for looking inside the body for medical reasons. This may be any instrument used to examine the interior of a hollow organ or cavity of the body.
  • the endoscope may also refer to any kind of a laparascope. It should be pointed that the following description may refer to an endoscope as a surgical tool.
  • region of interest refers hereinafter to any region within the human body which may be of interest to the operator of the system of the present invention.
  • the region of interest may be, for example, an organ to be operated on, a RESTRICTED area to which approach of a surgical instrument is RESTRICTED, a surgical instrument, or any other region within the human body.
  • 'spatial position' refers hereinafter to a predetermined spatial location and/or orientation of an object (e.g., the spatial location of the endoscope, the angular orientation of the endoscope, and any combination thereof).
  • 'prohibited area' refers hereinafter to a predetermined area to which a surgical tool (e.g., an endoscope) is prohibited to be spatially positioned in.
  • a surgical tool e.g., an endoscope
  • 'preferred area' refers hereinafter to predetermined area to which a surgical tool (e.g., an endoscope) is allowed and/or preferred to be spatially positioned in.
  • a surgical tool e.g., an endoscope
  • automated assistant' refers hereinafter to any mechanical device (including but not limited to a robotic device) that can maneuver and control the position of a surgical or endoscopic instrument, and that can in addition be adapted to receive commands from a remote source.
  • 'tool' or 'surgical instrument' refers hereinafter to any instrument or device introducible into the human body.
  • the term may refer to any location on the tool. For example it can refer to the tip of the same, the body of the same and any combination thereof. It should be further pointed that the following description may refer to a surgical tool/instrument as an endoscope.
  • the term 'provide' refers hereinafter to any process (visual, tactile, or auditory) by which an instrument, computer, controller, or any other mechanical or electronic device can report the results of a calculation or other operation to a human operator.
  • 'automatic' or 'automatically' refers to any process that proceeds without the necessity of direct intervention or action on the part of a human being.
  • 'ALLOWED movement' refers hereinafter to any movement of a surgical tool which is permitted according to a predetermined set of rules.
  • 'RESTRICTED movement refers hereinafter to any movement of a surgical tool which is forbidden according to a predetermined set of rules.
  • one rule provides a preferred volume zone rule which defines a favored zone within the surgical environment.
  • an ALLOWED movement of a surgical tool or the endoscope is a movement which maintains the surgical tool within the favored zone; and
  • a RESTRICTED movement of a surgical tool is a movement which extracts (or moves) the surgical tool outside the favored zone.
  • time step' refers hereinafter to the working time of the system.
  • the system receives data from sensors and commands from operators and processes the data and commands and executes actions.
  • the time step size is the elapsed time between time steps.
  • 'proximity sensor' refers to a sensor able to detect the presence of nearby objects without physical contact.
  • Proximity sensors are sometimes referred to as 'force sensors'.
  • a proximity sensor often emits an electromagnetic field or a beam of electromagnetic radiation (infrared, for instance), and looks for changes in the field or return signal.
  • the object being sensed is often referred to as the proximity sensor's target.
  • Different proximity sensor targets demand different sensors. For example, a capacitive photoelectric sensor might be suitable for a plastic target; an inductive proximity sensor always requires a metal target.
  • Proximity sensors can be introduced into the body and used for detecting metal fragments during surgery.
  • Laparoscopic surgery also called minimally invasive surgery (MIS) is a modern surgical technique in which operations in the abdomen are performed through small incisions (usually 0.5-1.5cm) as compared to larger incisions needed in traditional surgical procedures.
  • MIS minimally invasive surgery
  • the key element in laparoscopic surgery is the use of a laparoscope, which is a device adapted for viewing the scene within the body, at the distal end of the laparoscope. Either an imaging device is placed at the end of the laparoscope, or a rod lens system or fiber optic bundle is used to direct this image to the proximal end of the laparoscope.
  • a light source to illuminate the operative field, inserted through a 5 mm or 10 mm cannula or trocar to view the operative field.
  • the abdomen is usually injected with carbon dioxide gas to create a working and viewing space.
  • the abdomen is essentially blown up like a balloon (insufflated), elevating the abdominal wall above the internal organs like a dome.
  • various medical procedures can be carried out.
  • the laparoscope cannot view the entire working space within the body, so the laparoscope is repositioned to allow the surgeon to view regions of interest within the space. In some laparoscopic system, this requires the surgeon to instruct an assistant to manually move the laparoscope. In other systems, the surgeon himself instructs the laparoscope to move, by a manual control system such as a button, joystick or slider attached to the surgeon or to a surgical tool, by contact with a touchscreen, or by voice commands.
  • a manual control system such as a button, joystick or slider attached to the surgeon or to a surgical tool, by contact with a touchscreen, or by voice commands.
  • the controller in directing and maneuvering the surgical controlling system, the controller needs to avoid obstacles such as body organs and tools or other surgical equipment in the body cavity. Its speed should be controlled so that, on the one hand, the speed is low enough to make avoidance routine and to ensure that the instrument accurately reaches the desired location and, on the other hand, the speed needs to be great enough that maneuvers are accomplished in a reasonable time.
  • the endoscope In order to avoid the obstacles, in a conventional system, the endoscope must be routed around them, increasing the complexity of maneuvering and the time taken for maneuvering.
  • the system comprises at least one articulating section, typically an articulating tool such as an articulating endoscope.
  • the articulating tool can have an articulating tip, where the articulations are near the tip, it can have an articulating body, where the articulations are in the body or shaft of the tool, or both.
  • the articulations allow bending in at least two degrees of freedom (DOF), preferably in four DOF, and possibly in all six DOF (bending in all three directions and rotating in all three directions).
  • DOF degrees of freedom
  • an articulating toll can use more direct routes, as the articulating section enables removal of the tip of an articulating tool from the region of an obstacle.
  • the endoscope instead of routing an endoscope around a body organ, the endoscope can articulate such that its tip is withdrawn to a sufficient height that the route of the endoscope can be directly across the organ.
  • the system has more flexibility in positioning.
  • the angle of the field of view can be changed by changing the articulation of the endoscope, with only minimal change of the position of the main part of the endoscope.
  • the device of the present invention additionally comprises a touchscreen used as the display screen on which the image of the field of view of the laparoscope is displayed.
  • the surgeon touches the portion of the image toward which he wants the laparoscope to move and automatic control software controls the motion of the laparoscope towards the goal.
  • the surgeon need not concern himself with the mechanics of repositioning; a brief touch on the display screen and he can return his hand to the instrument while the laparoscope automatically repositions itself.
  • the surgeon directs the instrument to the desired location by touching the portion of the screen showing the image of the desired location. For example, to direct the laparoscope to put the tip of the appendix in the center of the screen, the surgeon would touch the image of the tip of appendix on the screen. In these embodiments, the surgeon touches the screen only briefly; continued pressure is not needed to direct the laparoscope to the desired position.
  • the screen contains at least one graphical direction indicator, which can be at least one arrow, line or pointer or, preferably, a direction rose with 4, 8 or 16 indicators.
  • the surgeon touches the appropriate indicator, for non-limiting example, the one pointing at 45° clockwise from the vertical, and the laparoscope moves so that the center of its field of view moves towards the upper right portion of the image. In these embodiments, the surgeon needs to keep his hand on the touchscreen until the maneuver is complete.
  • the indicator comprises a direction rose (100)
  • the surgeon touches a position anywhere on the graphical indicator and the laparoscope moves so that the center of its field of view moves towards the direction indicated by the position of the touch.
  • the uppermost point (110) indicates movement towards the top of the screen
  • the rightmost point (120) indicates movement towards the right
  • the lowest point (130) movement towards the bottom of the screen
  • the leftmost point (140) movement towards the left.
  • the laparoscope will move so that the center of its field of view moves towards the upper right portion of the image, at an angle 55° clockwise from the vertical.
  • the surgeon needs to keep his hand on the touchscreen until the maneuver is complete.
  • the location of the touch on the indicator defines the speed at which the center of the field of view moves. For non- limiting example, the further from the center of the direction rose, the faster the motion.
  • the direction of motion is indicated by words appearing on the screen such as, but not limited to, left, right, up, down, forward, back, zoom, zoom in, zoom out, and any combination thereof.
  • voice commands are used to direct the endoscope.
  • the direction of motion can be indicated by words spoken by the surgeon such as, but not limited to, left, right, up, down, forward, back, zoom, zoom in, zoom out, and any combination thereof.
  • the surgeon can provide an angular designation, such as, but not limited to, a numerical value or a compass rose designation.
  • numerical values include 60°, 75° clockwise, 30° west of north.
  • Other examples will be obvious to one skilled in the art.
  • Non-limiting examples of compass rose designations are north-northwest, NNW, and southeast by south.
  • eye movements are used to direct the endoscope.
  • the endoscope moves in the direction in which the surgeon moves his eyes. For non-limiting example, if the surgeon looks to the right, the endoscope moves to the right of the field of view, if the surgeon looks up, the endoscope moves towards the top of the field of view, and similarly for eye movements to the left or downward.
  • the surgical controlling system comprises the following components: a. at least one surgical tool adapted to be inserted into a surgical environment of a human body for assisting a surgical procedure, at least one said tool being an articulating tool; b. at least one location estimating means adapted to real-time estimate/locate the location (i.e., the 3D spatial position) of the at least one surgical tool at any given time t; c.
  • At least one movement detection means communicable with a movement-database and with said location estimating means; said movement-database is adapted to store said 3D spatial position of said at least one surgical tool at time tf and at time to , - where tf > to,' said movement detection means is adapted to detect movement of said at least one surgical tool if the 3D spatial position of said at least one surgical tool at time tf is different than said 3D spatial position of said at least one surgical tool at time to , - and, d.
  • a controller having a processing means communicable with a database, the controller adapted to control the spatial position of the at least one surgical tool.
  • the initial time to can be the beginning of the surgical procedure, it can be the time at which the tool entered the body, it can be the time at the beginning of the current movement, or it can be the previous timestep in the current maneuver.
  • the processor will reset to as necessary during the surgical procedure.
  • the difference in position between the location of the tool at the previous timestep and its location at the current timestep can be used to calculate the tool's current velocity while the difference in position between its current position and its position at the start of the current maneuver can be used to calculate the tool's overall direction of motion.
  • the location of the tool can be the location of the tool's tip, the location of a predetermined point on the tool's body, or the location of a predetermined point on the tool's handle.
  • the position defining the location of the tool can be changed as needed, e.g., from the location of the body to the location of the tip.
  • the surgical controlling system additionally comprises a touchscreen adapted to accept input of a location within the body, that location indicated by pressure on the portion of the touchscreen showing the image of the location.
  • the database is adapted to store a predetermined set of rules according to which ALLOWED and RESTRICTED movements of the at least one surgical tool are determined, such that the spatial position of the at least one surgical tool is controlled by the controller according to the ALLOWED and RESTRICTED movements.
  • each detected movement by said movement detection means of said at least one surgical tool is determined as either an ALLOWED movement or as a RESTRICTED movement according to said predetermined set of rules.
  • the present invention stores the 3D spatial position of each surgical tool at a current at time tf and at time to; where tf > to . If the 3D spatial position of said at least one surgical tool at time tf is different than said 3D spatial position of said at least one surgical tool at time to movement of the tool is detected. Next the system analyses said movement according to said set of rule and process whether said movement is ALLOWED movement or RESTRICTED movement.
  • the system prevents said movement, if said movement is a RESTRICTED movement.
  • Said movement prevention is obtained by controlling a maneuvering system which prevents the movement of said surgical tool.
  • the system does not prevent said movement, (if said movement is a RESTRICTED movement), but merely signals/alerts the user (i.e., the physician) of said RESTRICTED movement.
  • said surgical tool is an endoscope.
  • the controller may provide a suggestion to the operator as to which direction the surgical tool has to move to or may be moved to.
  • the present invention provides a predetermined set of rules which define what is an "ALLOWED movement" of any surgical tool within the surgical environment and what is a “RESTRICTED movement” of any surgical tool within the surgical environment.
  • the system of the present invention comprises a maneuvering subsystem communicable with the controller, the maneuvering subsystem is adapted to spatially reposition the at least one surgical tool during surgery according to the predetermined set of rules.
  • the controller may provide instructions to a maneuvering subsystem for spatially repositioning the location of the surgical tool. According to these instructions, only ALLOWED movements of the surgical tool will be performed. Preventing RESTRICTED movements is performed by: detecting the location of the surgical tool; processing all current rules; analyzing the movement of the surgical tool and preventing the movement if the tool's movement is a RESTRICTED movement.
  • system merely alerts the physician of a RESTRICTED movement of at least one surgical tool (instead of preventing said RESTRICTED movement).
  • Alerting the physician of RESTRICTED movements is performed by: detecting the location of the surgical tool; processing all current rules; analyzing the movement of the surgical tool and informing the surgeon (the user of the system) if the tool's movement is an ALLOWED movement or a RESTRICTED movement.
  • the same process (of detecting the location of the surgical tool; processing all current rules and analyzing the movement of the surgical tool) is followed except for the last movement, where the movement is prevented if the tool's movement is a RESTRICTED movement.
  • the surgeon can also be informed that the movement is being prevented.
  • the above is performed by detecting the location of the surgical tool and analyzing the surgical environment of the surgical tool. Following analysis of the surgical environment and detection of the location of the surgical tool, the system may assess all the risks which may follow a movement of the surgical tool in the predetermined direction. Therefore, each location in the surgical environment has to be analyzed so that any possible movement of the surgical tool will be classified as an ALLOWED movement or a RESTRICTED movement.
  • the location of each tool is determined using image processing means and determining in real-time what is the 3D spatial location of each tool.
  • tool may refer to the any location on the tool. For example, it can refer to the tip of the same, the body of the same and any combination thereof.
  • avoidance of body organs is facilitated by means of a proximity sensor on the circumference of at least one tool.
  • the proximity sensor activates, thereby notifying the control system that at least one tool is too close to another object in the surgical environment.
  • the proximity sensor not only determined whether an object is within a predetermined distance of the sensor, it also determines, for objects within the predetermined distance, the distance between the sensor and the object.
  • determination of the 3D location of each tool includes determination by means of a proximity sensor as well as determination by means of image processing.
  • the predetermined set of rules which are the essence of the present invention are adapted to take into consideration all the possible factors which may be important during the surgical procedure.
  • the predetermined set of rules may comprise the following rules or any combination thereof: a. a route rule; b. an environment rule; c. an operator input rule; d. a proximity rule; e. a collision prevention rule; f. a history based rule; g- a tool-dependent ALLOWED and RESTRICTED movements rule. h. a most used tool rule; i. a right tool rule; j- a left tool rule; k. a field of view rule;
  • a no fly zone rule 1. a no fly zone rule; m. an operator input rule; n. a preferred volume zone rule; o. a preferred tool rule;
  • the collision prevention rule defines a minimum distance below which two or more tools should not be brought together (i.e., there is minimum distance between two or more tools that should be maintained). If the movement of one tool will cause it to come dangerously close to another tool (i.e., the distance between them, after the movement, is smaller than the minimum distance defined by the collision prevention rule), the controller either alerts the user that the movement is a RESTRICTED movement or does not permit the movement.
  • the identification is provided by conventional means known to any skilled in the art (e.g., image processing, optical means etc.).
  • the route rule comprises a predefined route in which the at least one surgical tool is adapted to move within the surgical environment;
  • the ALLOWED movements are movements in which the at least one surgical tool is located within the borders of the predefined route, and the RESTRICTED movements are movements in which the at least one surgical tool is located out of the borders of the predefined route.
  • the route rule comprises a communicable database storing at least one predefined route in which the at least one surgical tool is adapted to move within the surgical environment; the predefined route comprises n 3D spatial positions of the at least one surgical tool in the route; n is an integer greater than or equal to 2; ALLOWED movements are movements in which the at least one surgical tool is located substantially in at least one of the n 3D spatial positions of the predefined route, and RESTRICTED movements are movements in which the location of the at least one surgical tool is substantially different from the n 3D spatial positions of the predefined route.
  • each of the surgical tool's courses (and path in any surgical procedure) is stored in a communicable database.
  • ALLOWED movements are defined as movements in which the at least one surgical tool is located substantially in at least one of the stored routes; and RESTRICTED movements are movements in which the at least one surgical tool is in a substantially different location than any location in any stored route.
  • the environmental rule is adapted to determine ALLOWED and RESTRICTED movements according to hazards or obstacles in the surgical environment as received from an endoscope or other sensing means.
  • the environmental rule comprises a comprises a communicable database; the communicable database is adapted to received real-time images of the surgical environment and is adapted to perform realtime image processing of the same and to determine the 3D spatial position of hazards or obstacles in the surgical environment; the environmental rule is adapted to determine ALLOWED and RESTRICTED movements according to hazards or obstacles in the surgical environment, such that RESTRICTED movements are movements in which at least one surgical tool is located substantially in at least one of the 3D spatial positions, and ALLOWED movements are movements in which the location of at least one surgical tool is substantially different from the 3D spatial positions.
  • each element in the surgical environment is identified so as to establish which is a hazard or obstacle (and a path in any surgical procedure) and each hazard and obstacle (and path) is stored in a communicable database.
  • RESTRICTED movements are defined as movements in which the at least one surgical tool is located substantially in the same location as that of the hazards or obstacles; and the ALLOWED movements are movements in which the location of the at least one surgical tool is substantially different from that of all of the hazards or obstacles.
  • hazards and obstacles in the surgical environment are selected from a group consisting of tissues, surgical tools, organs, endoscopes and any combination thereof.
  • the operator input rule is adapted to receive an input from the operator of the system regarding the ALLOWED and RESTRICTED movements of the at least one surgical tool.
  • the operator input rule comprises a communicable database; the communicable database is adapted to receive an input from the operator of the system regarding ALLOWED and RESTRICTED movements of the at least one surgical tool.
  • the input comprises n 3D spatial positions; n is an integer greater than or equal to 2; wherein at least one of which is defined as an ALLOWED location and at least one of which is defined as a RESTRICTED location, such that the ALLOWED movements are movements in which the at least one surgical tool is located substantially in at least one of the n 3D ALLOWED spatial positions, and the RESTRICTED movements are movements in which the location of the at least one surgical tool is substantially different from the n 3D ALLOWED spatial positions.
  • the input comprises at least one rule according to which ALLOWED and RESTRICTED movements of the at least one surgical tool are determined, such that the spatial position of the at least one surgical tool is controlled by the controller according to the ALLOWED and RESTRICTED movements.
  • the operator input rule can convert an ALLOWED movement to a RESTRICTED movement and a RESTRICTED movement to an ALLOWED movement.
  • the proximity rule is adapted to define a predetermined distance between the at least one surgical tool and at least one another surgical tool; the ALLOWED movements are movements which are within the range or out of the range of the predetermined distance, and the RESTRICTED movements which are out of the range or within the range of the predetermined distance; the ALLOWED movements and the RESTRICTED movements are defined according to different ranges.
  • the proximity rule is adapted to define a predetermined distance between at least two surgical tools.
  • the ALLOWED movements are movements which are within the range of the predetermined distance, while the RESTRICTED movements which are out of the range of the predetermined distance.
  • the ALLOWED movements are movements which are out of the range of the predetermined distance, while the RESTRICTED movements are within the range of the predetermined distance
  • the proximity rule is adapted to define a predetermined angle between at least three surgical tools; ALLOWED movements are movements which are within the range or out of the range of the predetermined angle, and RESTRICTED movements are movements which are out of the range or within the range of the predetermined angle.
  • the collision prevention rule is adapted to define a predetermined distance between the at least one surgical tool and an anatomical element within the surgical environment (e.g. tissue, organ, another surgical tool or any combination thereof); the ALLOWED movements are movements which are in a range that is larger than the predetermined distance, and the RESTRICTED movements are movements which is in a range that is smaller than the predetermined distance.
  • an anatomical element within the surgical environment (e.g. tissue, organ, another surgical tool or any combination thereof)
  • the ALLOWED movements are movements which are in a range that is larger than the predetermined distance
  • the RESTRICTED movements are movements which is in a range that is smaller than the predetermined distance.
  • the anatomical element is selected from a group consisting of tissue, organ, another surgical tool or any combination thereof.
  • the surgical tool is an endoscope.
  • the endoscope is adapted to provide real-time images of the surgical environment.
  • the right tool rule is adapted to determine the ALLOWED movement of the endoscope according to the movement of a surgical tool in a specified position in relation to the endoscope, preferably positioned to right of the same.
  • the tool which is defined as the right tool is constantly tracked by the endoscope.
  • the right tool is defined as the tool positioned to the right of the endoscope; according to other embodiments, any tool can be defined as the right tool.
  • An ALLOWED movement, according to the right tool rule is a movement in which the endoscope field of view is moved to a location substantially the same as the location of the right tool, thereby tracking the right tool.
  • a RESTRICTED movement, according to the right tool rule is a movement in which the endoscope field of view is moved to a location substantially different from the location of the right tool.
  • the left tool rule is adapted to determine the ALLOWED movement of the endoscope according to the movement of a surgical tool in a specified position in relation to the endoscope, preferably positioned to left of the same.
  • the tool which is defined as the left tool is constantly tracked by the endoscope.
  • the left tool is defined as the tool positioned to the left of the endoscope; according to other embodiments, any tool can be defined as the left tool.
  • An ALLOWED movement, according to the left tool rule is a movement in which the endoscope field of view is moved to a location substantially the same as the location of the left tool.
  • a RESTRICTED movement, according to the left tool rule is a movement in which the endoscope field of view is moved to a location substantially different from the location of the left tool.
  • the field of view rule is adapted to define a field of view and maintain that field of view.
  • the field of view rule is defined such that if the endoscope is adapted to track a predetermined set of tools in a desired field of view, when one of those tools is no longer in the field of view, the rule instructs the endoscope to zoom out so as to reintroduce the tool into the field of view.
  • the field of view rule comprises a communicable database comprising n 3D spatial positions; n is an integer greater than or equal to 2; the combination of all of the n 3D spatial positions provides a predetermined field of view; the field of view rule is adapted to determine the ALLOWED movement of the endoscope within the n 3D spatial positions so as to maintain a constant field of view, such that the ALLOWED movements are movements in which the endoscope is located substantially in at least one of the n 3D spatial positions, and the RESTRICTED movements are movements in which the location of the endoscope is substantially different from the n 3D spatial positions.
  • the field of view rule comprises a communicable database comprising n 3D spatial positions; n is an integer greater than or equal to 2; the combination of all of the n 3D spatial positions provides a predetermined field of view.
  • the field of view rule further comprises a communicable database of m tools and the 3D spacial locations of the same, where m is an integer greater than or equal to 1 and where a tool can be a surgical tool, an anatomical element and any combination thereof.
  • the combination of all of the n 3D spatial positions provides a predetermined field of view.
  • the field of view rule is adapted to determine ALLOWED movement of the endoscope such that the m 3D spatial positions of the tools comprise at least one of the n 3D spatial positions of the field of view, and RESTRICTED movements are movements in which the 3D spatial position of at least one tool is substantially different from the n 3D spatial positions of the field of view.
  • the preferred volume zone rule comprises a communicable database comprising n 3D spatial positions; n is an integer greater than or equal to 2; the n 3D spatial positions provides the preferred volume zone; the preferred volume zone rule is adapted to determine the ALLOWED movement of the endoscope within the n 3D spatial positions and RESTRICTED movement of the endoscope outside the n 3D spatial positions, such that the ALLOWED movements are movements in which the endoscope is located substantially in at least one of the n 3D spatial positions, and the RESTRICTED movements are movements in which the location of the endoscope is substantially different from the n 3D spatial positions.
  • the preferred volume zone rule defines a volume of interest (a desired volume of interest), such that an ALLOWED movement, according to the preferred volume zone rule, is a movement in which the endoscope (or any surgical tool) is moved to a location within the defined preferred volume.
  • a RESTRICTED movement, according to the preferred volume zone rule, is a movement in which the endoscope (or any surgical tool) is moved to a location outside the defined preferred volume.
  • the preferred tool rule comprises a communicable database, the database stores a preferred tool; the preferred tool rule is adapted to determine the ALLOWED movement of the endoscope according to the movement of the preferred tool.
  • the preferred tool rule defines a preferred tool (i.e., a tool of interest) that the user of the system wishes to track.
  • An ALLOWED movement is a movement in which the endoscope is moved to a location substantially the same as the location of the preferred tool.
  • a RESTRICTED movement is a movement in which the endoscope is moved to a location substantially different from the location of the preferred tool.
  • the endoscope constantly tracks the preferred tool, such that the field of view, as seen from the endoscope, is constantly the preferred tool.
  • the user may define in said preferred tool rule to constantly track the tip of said preferred tool or alternatively, the user may define in said preferred tool rule to constantly track the body or any location on the preferred tool.
  • the no fly zone rule is adapted to define a RESTRICTED zone into which no tool (or alternatively no predefined tool) is permitted to enter.
  • the no fly zone rule comprises a communicable database comprising n 3D spatial positions; n is an integer greater than or equal to 2; the n 3D spatial positions define a predetermined volume within the surgical environment; the no fly zone rule is adapted to determine a RESTRICTED movement if the movement is within the no fly zone and an ALLOWED movement if the movement is outside the no fly zone, such that RESTRICTED movements are movements in which the at least one surgical tool is located substantially in at least one of the n 3D spatial positions, and the ALLOWED movements are movements in which the location of the at least one surgical tool is substantially different from the n 3D spatial positions.
  • the most used tool rule is adapted to define (either real-time, during the procedure or prior to the procedure) which tool is the most used tool (i.e., the tool which is moved the most during the procedure) and to instruct the maneuvering subsystem to constantly position the endoscope to track the movement of this tool.
  • the most used tool rule comprises a communicable database counting the number of movements of each of the surgical tools; the most used tool rule is adapted to constantly position the endoscope to track the movement of the surgical tool with the largest number of movements.
  • the communicable database measures the amount of movement of each of the surgical tools; the most used tool rule is adapted to constantly position the endoscope to track the movement of the surgical tool with the largest amount of movement.
  • the system is adapted to alert the physician of a RESTRICTED movement of at least one surgical tool.
  • the alert can be audio signaling, voice signaling, light signaling, flashing signaling and any combination thereof.
  • an ALLOWED movement is one permitted by the controller and a RESTRICTED movement is one denied by the controller.
  • the operator input rule is adapted to receive an input from the operator of the system regarding ALLOWED and RESTRICTED movements of the at least one surgical tool.
  • the operator input rule receives instructions from the physician as to what can be regarded as ALLOWED movements and what are RESTRICTED movements.
  • the operator input rule is adapted to convert an ALLOWED movement to a RESTRICTED movement and a RESTRICTED movement to an ALLOWED movement.
  • the history-based rule is adapted to determine the ALLOWED and RESTRICTED movements according to historical movements of the at least one surgical tool in at least one previous surgery.
  • the history-based rule comprises a communicable database storing each 3D spatial position of each of the surgical tools, such that each movement of each surgical tool is stored; the history-based rule is adapted to determine ALLOWED and RESTRICTED movements according to historical movements of the at least one surgical tool, such that the ALLOWED movements are movements in which the at least one surgical tool is located substantially in at least one of the 3 ⁇ spatial positions, and the RESTRICTED movements are movements in which the location of the at least one surgical tool is substantially different from the n 3D spatial positions.
  • the tool-dependent ALLOWED and RESTRICTED movements rule is adapted to determine ALLOWED and RESTRICTED movements according to predetermined characteristics of the surgical tool, where the predetermined characteristics of the surgical tool are selected from a group consisting of: physical dimensions, structure, weight, sharpness, and any combination thereof.
  • the tool-dependent ALLOWED and RESTRICTED movements rule comprises a communicable database; the communicable database is adapted to store predetermined characteristics of at least one of the surgical tools; the tool-dependent ALLOWED and RESTRICTED movements rule is adapted to determine ALLOWED and RESTRICTED movements according to the predetermined characteristics of the surgical tool.
  • the predetermined characteristics of the surgical tool are selected from a group consisting of: physical dimensions, structure, weight, sharpness, and any combination thereof.
  • the user can define, e.g., the structure of the surgical tool he wishes the endoscope to track.
  • the endoscope constantly tracks the surgical tool having said predetermined characteristics as defined by the user.
  • the movement detection rule comprises a communicable database comprising the real-time 3D spatial positions of each surgical tool; said movement detection rule is adapted to detect movement of at least one surgical tool.
  • ALLOWED movements are movements in which the endoscope is re-directed to focus on the moving surgical tool.
  • the tagged tool rule comprises means of tagging at least one surgical tool within the surgical environment such that, by maneuvering the endoscope, the endoscope is constantly directed to the tagged surgical tool.
  • the endoscope constantly tracks the preferred (i.e., tagged) tool, such that the field of view, as seen from the endoscope, is constantly maintained on the preferred (tagged) tool.
  • the user can define the tagged tool rule to constantly track the tip of the preferred (tagged) tool, the body of the preferred (tagged) tool, or any other location on the preferred (tagged) tool.
  • the system further comprises a maneuvering subsystem communicable with the controller.
  • the maneuvering subsystem is adapted to spatially reposition the at least one surgical tool during a surgery according to the predetermined set of rules.
  • the at least one location estimating means is at least one endoscope adapted to acquire real-time images of a surgical environment within the human body for the estimation of the location of at least one surgical tool.
  • the location estimating means comprise at least one selected from a group consisting of optical imaging means, radio frequency transmitting and receiving means, at least one mark on at least one surgical tool and any combination thereof.
  • the at least one location estimating means is an interface subsystem between a surgeon and at least one surgical tool, the interface subsystem comprising (a) at least one array comprising N regular light sources or N pattern light sources, where N is a positive integer; (b) at least one array comprising M cameras, where M is a positive integer; (c) optional optical markers and means for attaching the optical markers to at least one surgical tool; and (d) a computerized algorithm operable via the controller, the computerized algorithm adapted to record images received by each camera of each of the M cameras and to calculate therefrom the position of each of the tools, and further adapted to provide automatically the results of the calculation to the human operator of the interface.
  • the present invention can be also utilized to improve the interface between the operators (e.g., the surgeon, the operating medical assistant, the surgeon's colleagues, etc.). Moreover, the present invention can be also utilized to control and/or direct an automated maneuvering subsystem to focus the endoscope on an instrument selected by the surgeon, or to any other region of interest. This may be performed in order to estimate the location of at least one surgical tool during a surgical procedure.
  • operators e.g., the surgeon, the operating medical assistant, the surgeon's colleagues, etc.
  • an automated maneuvering subsystem to focus the endoscope on an instrument selected by the surgeon, or to any other region of interest. This may be performed in order to estimate the location of at least one surgical tool during a surgical procedure.
  • the present invention also discloses a surgical tracking system which is adapted to guide and relocate an endoscope to a predetermined region of interest in an automatic and/or a semi-automatic manner. This operation is assisted by an image processing algorithm(s) which is adapted to analyze the received data from the endoscope in real time, and to assess the surgical environment of the endoscope.
  • the system comprises a "smart" tracking subsystem, which receives instructions from a maneuvering function f(t) (t is the time) as to where to direct the endoscope and which instructs the maneuvering subsystem to relocate the endoscope to the required area.
  • the maneuvering function f(t) receives, as input, output from at least two instructing functions 3 ⁇ 4(t), analyses their output and provides instruction to the "smart" tracking system (which eventually redirects the endoscope).
  • each instructing function g z (t) is also given a weighting function, 3 ⁇ 4(t).
  • the instructing functions g z (t) of the present invention are functions which are configured to assess the environment of the endoscope and the surgery, and to output data which guides the tracking subsystem for controlling the spatial position of the maneuvering subsystem and the endoscope.
  • the instructing functions g z (t) may be selected from a group consisting of: a. a tool detection function g / (t); b. a movement detection function g ⁇ t); c. an organ detection function gi(t); d. a collision detection function g ⁇ (t); e. an operator input function gj(t); f. a prediction function g ⁇ j(t); g- a past statistical analysis function gz(t); h. a most used tool function g$(t); i. a right tool function g ? (t); j- a left tool function g / o(t); k. a field of view function g//(t);
  • the maneuvering function f(t) receives input from two instructing functions: the collision detection function g ⁇ (t) (the function providing information whether the distance between two elements is smaller than a predetermined distance) and from the most used tool function g ⁇ (t) (the function counts the number of times each tool is moved during a surgical procedure and provides information as to whether the most moved or most used tool is currently moving).
  • the output given from the collision detection function g 4 (t) is that a surgical tool is dangerously close to an organ in the surgical environment.
  • the output given from the most used tool function g ⁇ (t) is that the tool identified statistically as the most moved tool is currently moving.
  • the maneuvering function f(t) then assigns each of the instructing functions with weighting functions a z (t). For example, the most used tool function g 8 (t) is assigned with a greater weight than the weight assigned to the collision detection function g ⁇ (t).
  • the same After the maneuvering function f(t) analyses the information received from the instructing functions g / (t) and the weighting functions a z (t) of each, the same outputs instructions to the maneuvering subsystem to re-direct the endoscope (either to focus on the moving tool or on the tool approaching dangerously close to the organ).
  • the identification is provided by conventional means known to any skilled in the art (e.g., image processing, optical means etc.).
  • the surgical tracking subsystem comprises: a. at least one endoscope adapted to acquire real-time images of a surgical environment within the human body; b. a maneuvering subsystem adapted to control the spatial position of the endoscope during the laparoscopic surgery; and, c. a tracking subsystem in communication with the maneuvering subsystem, adapted to control the maneuvering subsystem so as to direct and modify the spatial position of the endoscope to a region of interest.
  • the tracking subsystem comprises a data processor.
  • the data processor is adapted to perform real-time image processing of the surgical environment and to instruct the maneuvering subsystem to modify the spatial position of the endoscope according to input received from a maneuvering function f(t);
  • the maneuvering function f(t) is adapted to (a) receive input from at least two instructing functions g z (t), where z is ⁇ ,. , . , ⁇ and n > 2 and where t is time; i and n are integers; and (b) to output instructions to the maneuvering subsystem based on the input from the at least two instructing functions g z (t), so as to spatially position the endoscope to the region of interest.
  • the tool detection function g (t) is adapted to detect tools in the surgical environment. According to this embodiment, the tool detection function is adapted to detect surgical tools in the surgical environment and to output instructions to the tracking subsystem to instruct the maneuvering subsystem to direct the endoscope to the detected surgical tools.
  • the functions g z (t) may rank the different detected areas in the surgical environment according to a ranking scale (e.g., from 1 to 10) in which prohibited areas (i.e., areas which are defined as area to which the surgical tools are forbidden to 'enter) receive the lowest score (e.g., 1) and preferred areas (i.e., areas which are defined as area in which the surgical tools should be maintained) receive the highest score (e.g., 10).
  • a ranking scale e.g., from 1 to 10
  • prohibited areas i.e., areas which are defined as area to which the surgical tools are forbidden to 'enter
  • preferred areas i.e., areas which are defined as area in which the surgical tools should be maintained
  • one function g (t) is adapted to detect tools in the surgical environment and inform the maneuvering function f(t) if they are in preferred areas or in prohibited areas.
  • the movement detection function g2(t) comprises a communicable database comprising the real-time 3D spatial positions of each of the surgical tools in the surgical environment; means to detect movement of the at least one surgical tool when a change in the 3D spatial positions is received, and means to output instructions to the tracking subsystem to instruct the maneuvering subsystem to direct the endoscope to the moved surgical tool.
  • the organ detection function g ⁇ (t) is adapted to detect physiological organs in the surgical environment and to classify the detected organs as prohibited areas or preferred areas. For example, if the operator instructs the system that the specific surgery is kidney surgery, the organ detection function g ⁇ (t) will classify the kidneys (or one kidney, if the surgery is specified to be on a single kidney) as a preferred area and other organs will be classified as prohibited areas.
  • the organ detection function is adapted to detect organs in the surgical environment and to output instructions to the tracking subsystem to instruct the maneuvering subsystem to direct the endoscope to the detected organs.
  • the right tool function is adapted to detect surgical tool positioned to right of the endoscope and to output instructions to the tracking subsystem to instruct the maneuvering system to constantly direct the endoscope on the right tool and to track the right tool.
  • the left tool function is adapted to detect surgical tool positioned to left of the endoscope and to output instructions to the tracking subsystem to instruct the maneuvering system to constantly direct the endoscope on the left tool and to track the left tool.
  • the collision detection function g 4 (t) is adapted to detect prohibited areas within the surgical environment so as to prevent collisions between the endoscope and the prohibited areas. For example, if the endoscope is located in a narrow area in which a precise movement of the same is preferred, the collision detection function g ⁇ (t) will detect and classify different areas (e.g., nerves, veins, walls of organs) as prohibited areas.
  • areas e.g., nerves, veins, walls of organs
  • the collision prevention function is adapted to define a predetermined distance between the at least one surgical tool and an anatomical element within the surgical environment; and to output instructions to the tracking subsystem to instruct the maneuvering subsystem to direct the endoscope to the surgical tool and the anatomical element within the surgical environment if the distance between the at least one surgical tool and an anatomical element is less than the predetermined distance.
  • the anatomical element is selected from a group consisting of tissue, organ, another surgical tool and any combination thereof.
  • the operator input function gj(t) is adapted to receive an input from the operator.
  • the input can be, for example: an input regarding prohibited areas in the surgical environment, an input regarding allowed areas in the surgical environment, or an input regarding the region of interest and any combination thereof.
  • the operator input function gj(t) can receive instructions from the operator before or during the surgery, and respond accordingly.
  • the operator input function may further comprise a selection algorithm for selection of areas selected from a group consisting of: prohibited areas, allowed areas, regions of interest, and any combination thereof. The selection may be performed via an input device (e.g., a touch screen).
  • the operator input function gj(t) comprises a communicable database; the communicable database is adapted to receive an input from the operator of the system; the input comprising n 3D spatial positions; n is an integer greater than or equal to 2; and to output instructions to the tracking subsystem to instruct the maneuvering subsystem to direct the endoscope to the at least one 3D spatial position received.
  • the prediction function g 6 (t) is adapted to provide data regarding a surgical environment at a time tf > to, wherein to is the present time and tf is a future time.
  • the prediction function g ⁇ j(t) may communicate with a database which stores data regarding the environment of the surgery (e.g., the organs in the environment). This data may be used by the prediction function g ⁇ (t) for the prediction of expected or unexpected events or expected or unexpected objects during the operation.
  • the prediction function g ⁇ j(t) comprises a communicable database storing each 3D spatial position of each of surgical tool within the surgical environment, such that each movement of each surgical tool is stored; the prediction function is adapted to (a) to predict the future 3D spatial position of each of the surgical tools (or each object); and, (b) to output instructions to the tracking subsystem to instruct the maneuvering subsystem to direct the endoscope to the future 3D spatial position.
  • the past statistical analysis function g 7 (t) is adapted to provide data regarding the surgical environment or the laparoscopic surgery based on past statistical data stored in a database.
  • the data regarding the surgical environment may be for example: data regarding prohibited areas, data regarding allowed areas, data regarding the region of interest and any combination thereof.
  • the past statistical analysis function g ⁇ $(t) comprises a communicable database storing each 3D spatial position of each of surgical tool within the surgical environment, such that each movement of each surgical tool is stored; the past statistical analysis function g ⁇ (t) is adapted to (a) perform statistical analysis on the 3D spatial positions of each of the surgical tools in the past; and, (b) to predict the future 3D spatial position of each of the surgical tools; and, (c) to output instructions to the tracking subsystem to instruct the maneuvering subsystem to direct the endoscope to the future 3D spatial position.
  • the past statistical analysis function gz(t) the past movements of each tool are analyzed and, according to this analysis, a prediction of the tool's next move is provided.
  • the most used tool function g ⁇ (t) comprises a communicable database counting the amount of movement of each surgical tool located within the surgical environment; the most used tool function is adapted to output instructions to the tracking subsystem to instruct the maneuvering subsystem to direct the endoscope to constantly position the endoscope to track the movement of the most moved surgical tool.
  • the amount of movement of a tool can be defined as the total number of movements of that tool or the total distance the tool has moved.
  • the right tool function gp(t) is adapted to detect at least one surgical tool in a specified position in relation to the endoscope, preferably positioned to right of the endoscope and to output instructions to the tracking subsystem to instruct the maneuvering subsystem to constantly direct the endoscope to the right tool and to track the same.
  • the right tool is defined as the tool positioned to the right of the endoscope; according to other embodiments, any tool can be defined as the right tool.
  • the left tool function g / o(t) is adapted to detect at least one surgical tool in a specified position in relation to the endoscope, preferably positioned to left of the endoscope and to output instructions to the tracking subsystem to instruct the maneuvering subsystem to constantly direct the endoscope to the left tool and to track the same.
  • the left tool is defined as the tool positioned to the left of the endoscope; according to other embodiments, any tool can be defined as the left tool. .
  • the field of view function g//(t) comprises a communicable database comprising n 3D spatial positions; n is an integer greater than or equal to 2; the combination of all of the n 3D spatial positions provides a predetermined field of view; the field of view function is adapted to output instructions to the tracking subsystem to instruct the maneuvering subsystem to direct the endoscope to at least one 3D spatial position substantially within the n 3D spatial positions so as to maintain a constant field of view.
  • the preferred volume zone function gn( ) comprises a communicable database comprising n 3D spatial positions; n is an integer greater than or equal to 2; the n 3D spatial positions provide the preferred volume zone; the preferred volume zone function g 2(t) is adapted to output instructions to the tracking subsystem to instruct the maneuvering subsystem to direct the endoscope to at least one 3D spatial position substantially within the preferred volume zone.
  • the no fly zone function g / i(t) comprises a communicable database comprising n 3D spatial positions; n is an integer greater than or equal to 2; the n 3D spatial positions define a predetermined volume within the surgical environment; the no fly zone function g/i(t) is adapted to output instructions to the tracking subsystem to instruct the maneuvering subsystem to direct the endoscope to at least one 3D spatial position substantially different from all the n 3D spatial positions.
  • the proximity function g / ⁇ (t) is adapted to define a predetermined distance between at least two surgical tools; and to output instructions to the tracking subsystem to instruct the maneuvering subsystem to direct the endoscope to the two surgical tools if the distance between the two surgical tools is less than or if it is greater than the predetermined distance.
  • the proximity function g (t) is adapted to define a predetermined angle between at least three surgical tools; and to output instructions to the tracking subsystem to instruct the maneuvering subsystem to direct the endoscope to the three surgical tools if the angle between the two surgical tools is less than or if it is greater than the predetermined angle.
  • the preferred volume zone function comprises communicable database comprising n 3D spatial positions; n is an integer greater than or equals to 2; the n 3D spatial positions provides the preferred volume zone; the preferred volume zone function is adapted to output instructions to the tracking subsystem to instruct the maneuvering system to direct the endoscope to the preferred volume zone.
  • the field of view function comprises a communicable database comprising n 3D spatial positions; n is an integer greater than or equals to 2; the combination of all of the n 3D spatial positions provides a predetermined field of view; the field of view function is adapted to output instructions to the tracking subsystem to instruct the maneuvering system to direct the endoscope to at least one 3D spatial position substantially within the n 3D spatial positions so as to maintain a constant field of view.
  • the no fly zone function comprises a communicable database comprising n 3D spatial positions; n is an integer greater than or equals to 2; the n 3D spatial positions define a predetermined volume within the surgical environment; the no fly zone function is adapted to output instructions to the tracking subsystem to instruct the maneuvering system to direct the endoscope to at least one 3D spatial position substantially different from all the n 3D spatial positions.
  • the most used tool function comprises a communicable database counting the amount of movement of each surgical tool located within the surgical environment; the most used tool function is adapted to output instructions to the tracking subsystem to instruct the maneuvering system to direct the endoscope to constantly position the endoscope to track the movement of the most moved surgical tool.
  • the prediction function g 6 (t) is adapted to provide data regarding a surgical environment in a time tf > t, wherein t is the present time and tf is the future time.
  • the prediction function g ⁇ j(t) may communicate with a database which stores data regarding the environment of the surgery (e.g., the organs in the environment). This data may be used by the prediction function g ⁇ (t) for the prediction of expected or unexpected events or object during the operation.
  • the prediction function comprises a communicable database storing each 3D spatial position of each of surgical tool within the surgical environment, such that each movement of each surgical tool is stored; the prediction function is adapted to (a) to predict the future 3D spatial position of each of the surgical tools; and, (b) to output instructions to the tracking subsystem to instruct the maneuvering system to direct the endoscope to the future 3D spatial position.
  • the past statistical analysis function g 7 (t) is adapted to provide data regarding the surgical environment or the laparoscopic surgery based on past statistical data stored in a database.
  • the data regarding the surgical environment may be for example: data regarding prohibited areas, data regarding allowed areas, data regarding the region of interest.
  • the past statistical analysis function comprises a communicable database storing each 3D spatial position of each of surgical tool within the surgical environment, such that each movement of each surgical tool is stored; the past statistical analysis function is adapted to (a) statistical analyze the 3D spatial positions of each of the surgical tools in the past; and, (b) to predict the future 3D spatial position of each of the surgical tools; and, (c) to output instructions to the tracking subsystem to instruct the maneuvering system to direct the endoscope to the future 3D spatial position.
  • the past statistical analysis function gz(t) the past movements of each tool are analyzed and according to this analysis a future prediction of the tool's next move is provided.
  • preferred tool function comprises a communicable database, the database stores a preferred tool; the preferred tool function is adapted to output instructions to the tracking subsystem to instruct the maneuvering system to constantly direct the endoscope to the preferred tool, such that said endoscope constantly tracks said preferred tool.
  • the endoscope constantly tracks the preferred tool, such that the field of view, as seen from the endoscope, is constantly maintained on said preferred tool.
  • the user may define in said preferred tool function to constantly track the tip of said preferred tool or alternatively, the user may define in said preferred tool function to constantly track the body or any location on the preferred tool.
  • the tagged tool function g j(t) comprises means adapted to tag at least one surgical tool within the surgical environment and to output instructions to the tracking subsystem to instruct the maneuvering subsystem to constantly direct the endoscope to the tagged surgical tool.
  • the endoscope constantly tracks the preferred (i.e., tagged) tool, such that the field of view, as seen from the endoscope, is constantly maintained on the preferred (tagged) tool.
  • the user can define the tagged tool function to constantly track the tip of the preferred (tagged) tool, the body of the preferred (tagged) tool, or any other location on the preferred (tagged) tool.
  • the means are adapted to constantly tag at least one surgical tool within the surgical environment.
  • the preferred tool function g/ ⁇ j(t) comprises a communicable database.
  • the database stores a preferred tool; and the preferred tool function is adapted to output instructions to the tracking subsystem to instruct the maneuvering subsystem to direct the endoscope to the preferred tool.
  • the system further comprises means adapted to re-tag the at least one of the surgical tools until a desired tool is selected.
  • the system further comprises means adapted to toggle the surgical tools.
  • the toggling is performed manually or automatically.
  • the weighting functions a z (t) are time- varying functions (or constants), the value of which is determined by the operator or the output of the instructing functions g z (t). For example, if a specific function g z (t) detected an important event or object, its weighting functions a z (t) may be adjusted in order to elevate the chances that the maneuvering function f(t) will instruct the maneuvering subsystem to move the endoscope towards this important event or object.
  • the tracking subsystem may implement various image processing algorithms which may also be algorithms that are well known in the art.
  • the image processing algorithms may be for example: image stabilization algorithms, image improvement algorithms, image compilation algorithms, image enhancement algorithms, image detection algorithms, image classification algorithms, image correlations with the cardiac cycle or the respiratory cycle of the human body, smoke reduction algorithms, vapor reduction algorithms, steam reduction algorithms and any combination thereof.
  • Smoke, vapor and steam reduction algorithms may be needed as it is known that, under certain conditions, smoke, vapor or steam may be emitted by or from the endoscope.
  • the image processing algorithm may also be implemented and used to analyze 2D or 3D representations which may be rendered from the realtime images of the surgical environment.
  • the endoscope may comprise an image acquisition device selected from a group consisting of: a camera, a video camera, an electromagnetic sensor, a computer tomography imaging device, a fluoroscopic imaging device, an ultrasound imaging device, and any combination thereof.
  • the system may also comprise a display adapted to provide input or output to the operator regarding the operation of the system.
  • the display may be used to output the acquired real-time images of a surgical environment with augmented reality elements.
  • the display may also be used for the definition of the region of interest by the operator.
  • the endoscope may be controlled be an endoscope controller for performing operations such as: acquiring the real-time images and zooming-in to a predetermined area.
  • the endoscope controller may cause the endoscope to acquire the real-time images in correlation with the cardiac cycle or the respiratory cycle of a human body.
  • the data processor of the present invention may operate a pattern recognition algorithm for assisting the operation of the instructing functions g z (t).
  • the pattern recognition algorithm may be used as part of the image processing algorithm.
  • the identification is provided by conventional means known to any skilled in the art (e.g., image processing, optical means etc.).
  • the identification is provided by conventional means known to any skilled in the art (e.g., image processing, optical means etc.).
  • FIG. 2 is a general schematic view of an embodiment of a surgical tracking system 100.
  • surgical instruments 17b and 17c and an endoscope 21 which may be maneuvered by means of maneuvering subsystem 19 according to the instructions received from a tracking subsystem operable by computer 15.
  • the user may define the field of view function as constantly monitoring at least one of surgical instruments 17b and 17c.
  • the surgical tracking system 100 may also comprise one or more button operated wireless transmitters 12a, which transmit, upon activation, a single code wave 14 through aerial 13 to connected receiver 11 that produces a signal processed by computer 15, thereby directing and modifying the spatial position of endoscope 21 to the region of interest, as defined by the field of view function.
  • the system alerts the user that any movement of either one of the surgical instruments 17b and 17c that will reduce the distance is a RESTRICTED movement.
  • the system comprises all the mechanisms required to control fully the movement of an articulated endoscope so that the position and angle of the tip of the endoscope are fully under control.
  • control is preferably automatic, as described herein, but it can be manual and controlled by a joystick or other control under the command of a surgeon.
  • a standard articulating endoscope such as the StrykerTM articulating endoscope is used.
  • an integral articulating endoscope is used.
  • Figs. 3a-b show an embodiment wherein the fine control means is a control mechanism (1830) which attaches to the endoscope (1810).
  • the fine control mechanism attaches to the manual controls (1820) for the articulating endoscope via a connector (1840).
  • the connector can connect any endoscope control means with any articulating endoscope.
  • Fig. 3a shows the fine control mechanism (1830) before it is attached to the articulating endoscope (1810)
  • Fig. 3b shows the control mechanism (1830) attached to the articulating endoscope (1810), with the endoscope manual control (1840) connected to the fine control mechanism via the connector (1830).
  • Fig. 4 shows an embodiment of the articulating endoscope (1810) in use.
  • the endoscope (1810) is attached to the zoom mechanism of the coarse control system (1960), which is attached to the articulating arm (1970) of the coarse control system.
  • the fine control mechanism (1830) is attached to the articulating endoscope (1810) and also enabled to be controlled (either in a wired manner or wirelessly) either automatically by the control system or manually by the endoscope operator.
  • the fine control mechanism (1840) is also connected to the manual controls (1922, 1924) of the articulating endoscope. In this example, one control (1922) is forward and one (1924) is backward, turning the endoscope tip (1950) toward the right of the figure.
  • Fig. 5a-d shows articulation of an embodiment of the articulating endoscope.
  • Fig. 5a illustrates the flexibility of the articulating tip, showing it in typical positions - bent forwards, out of the plane of the paper (1952), to the right (1954), downward (1956), and to the left and backward, into the plane of the paper (1958).
  • Figs. 5b-d illustrate the articulating tip (1950) in use, following the movements of the tip (2082) of a medical instrument (2080).
  • the endoscope tip (1950) is straight; it is not yet following the tip of the instrument (2082).
  • the instrument tip (2082) has moved to the right and the tip of the endoscope (1950) has turned right to follow the tip (2082) of the instrument. It can be seen from the angle of the endoscope (1950) that the pivoting point of the endoscope has not changed, although the field of view of the endoscope (1950) has changed significantly.
  • the instrument tip (2082) has moved towards the endocope and forward, out of the plane of the paper.
  • Example 1 Tracking system with collision avoidance system
  • Gd2 Organ e.g. Liver
  • Tool movement vector Gd3(t) is calculated from Gdl(t) as the difference between the current location and at least one previous location (probably also taking into account previous movement vectors).
  • the probability of collision - Gd4(t) - is calculated, for example, from the difference between location Gdl and location Gd2 (the smaller the distance, the closer the proximity and the higher the probability of collision), from movement vector Gd3(t) indicating a collision, etc.
  • Gtl Weight function a (t) 1 If Gtl(t) ⁇ a predetermined threshold and 0 otherwise
  • Gt2 Weight function oi2(t) 1 If Gt2(t) > a predetermined threshold and 0 otherwise
  • Tool Instructions ⁇ x / (t) * Gtl + a 2 (t) * Gt2(t);
  • Fig. 6 which shows, in a non-limiting manner, an embodiment of a tracking system and collision avoidance system.
  • the system tracks a tool 310 and the liver 320, in order to determine whether a collision between the tool 310 and the liver 320 is possible within the next time step.
  • Figs. 6a and 6b show how the behavior of the system depends on the distance 330 between the tool 310 and the liver 320
  • Figs. 6c and 6d show how movement of the tool 310 affects the behavior.
  • Fig. 6a and 6b show how the behavior of the system depends on the distance 330 between the tool 310 and the liver 320
  • Figs. 6c and 6d show how movement of the tool 310 affects the behavior.
  • the distance 330 between the tool 310 and the liver 320 is large enough that a collision is not possible in that time step. Since no collision is possible, no movement of the tool is commanded. In Fig. 6b, the distance 330 between the tool 310 and the liver 320 is small enough that a collision is likely.
  • a movement 340 is commanded to move the tool 310 away from the liver 320.
  • the system prevents movement 350, but does not command movement 340; in such embodiments, the tool 310 will remain close to the liver 320.
  • the system warns/signals the operator that the move is RESTRICTED, but does not restrict movement 350 or command movement 340 away from the liver. Such a warning/signaling can be visual or aural, using any of the methods known in the art.
  • Figs. 6c and 6d illustrate schematically the effect of the movement of tool 310 on the collision avoidance system.
  • the tool 310 is close enough to the liver 320 that a collision between the two is possible. If the system tracked only the positions of the tool 310 and the liver 320, then motion of the tool 310 away from the liver 320 would be commanded.
  • Fig. 6c illustrates the effect of a movement 350 that would increase the distance between tool 310 and liver 320. Since the movement 350 is away from liver 320, no collision is possible in this time step and no movement of the tool 310 is commanded.
  • tool 310 is the same distance from liver 320 as in Fig. 6c. However, in Fig. 6d, the movement 350 of the tool 310 is toward the liver 320, making a collision between tool 310 and liver 320 possible.
  • a movement 340 is commanded to move the tool 310 away from the liver 320.
  • the system prevents movement 350, but does not command movement 340; in this embodiment the tool 310 will remain close to the liver 320.
  • the system warns the operator that move is RESTRICTED, but does not restrict movement 350 or command movement 340 away from the liver. Such a warning can be visual or aural, using any of the methods known in the art.
  • the collision detection function can warn the operator that a collision between a tool and the liver is likely but not prevent the collision.
  • the collision detection function can prevent a collision between the tool and the liver, either by preventing the movement or by commanding a movement redirecting the tool away from the liver,
  • Example 2 Tracking system with soft control - fast movement when nothing is nearby, slow movement when something is close
  • Detection (denoted by Gd):
  • Gd-organ2-L - Organ e.g. Liver
  • GdM(t), Gd-tooll-K(t) and Gd-organ2-L(t) are calculated in real time at each time step (from image or location marker).
  • Main Tool Movement Vector Gd3(t) is calculated per GdM (t) as the difference between the current location and at least one previous location (probably also taking into account previous movement vectors)
  • the proximity of the main tool to other tools - Gd4(t) - is calculated, for example, as the smallest of the differences between the main tool location and the other tools' locations.
  • Tool Instructions a (t) * Gtl .
  • Fig. 7a-d which shows, in a non-limiting manner, an embodiment of a tracking system with no-fly rule.
  • the system tracks a tool 310 with respect to a no-fly zone (460), in order to determine whether the tool will enter the no-fly zone (460) within the next time step.
  • the no-fly zone 460 surrounds the liver.
  • Figs. 7a and 7b show how the behavior of the system depends on the location of the tool tip with respect to the no-fly zone, while Figs. 7c and 7d show how movement of the tool affects the behavior.
  • Fig. 7a the tool 310 is outside the no-fly zone rule/function 460 and no movement of the tool is commanded.
  • Fig. 7b the tool 310 is inside the no-fly zone 460.
  • the no-fly zone rule/function performs as follows:
  • a movement 350 is commanded to move the tool 310 away from the no-fly zone 460.
  • the system prevents movement further into the no-fly zone (refers as movement 340, see Fig. 7c), but does not command movement 340; in such embodiments, the tool 310 will remain close to the no-fly zone 460.
  • the system warns/signals the operator that the move is RESTRICTED, but does not restrict movement further into the no-fly zone or command movement 340 away from the no-fly zone 460.
  • a warning/signaling can be visual or aural, using any of the methods known in the art.
  • Figs. 7c and 7d illustrate schematically the effect of the tool's movement on operation of the no-fly zone rule/function.
  • the tool 310 is close enough to the no-fly zone 460 (distance 330 is small enough) that it is possible for the tool to enter the no-fly zone during the next time step.
  • Fig. 7c illustrates the effect of a movement 340 that would increase the distance between tool 310 and no-fly zone 460. Since the movement 340 is away from no-fly zone 460, no collision is possible in this time step and no movement of the tool 310 is commanded.
  • tool 310 is the same distance from no-fly zone 460 as in Fig. 7c.
  • the movement 340 of the tool is toward no-fly zone 460, making it possible for tool 310 to enter no- fly zone 460.
  • a movement 350 is commanded to move the tool 310 away from the no-fly zone 460.
  • the system prevents movement 340, but does not command movement 350; in such embodiments, the tool 310 will remain close to the no- fly zone 460.
  • the system warns/signals the operator that the move is RESTRICTED, but does not restrict movement 340 or command movement 350 away from the no- fly zone rule/function 460.
  • Such a warning/signaling can be visual or aural, using any of the methods known in the art.
  • FIG. 8a-d shows, in a non-limiting manner, an embodiment of a tracking system with a preferred volume zone function/rule.
  • the system tracks a tool 310 with respect to a preferred volume zone (570), in order to determine whether the tool will leave the preferred volume (570) within the next time step.
  • the preferred volume zone 570 extends over the right lobe of the liver.
  • Figs. 8a and 8b show how the behavior of the system depends on the location of the tool tip with respect to the preferred volume zone 570, while Figs. 8c and 8d show how movement of the tool affects the behavior (i.e., the preferred volume zone rule/function).
  • Fig. 8a the tool 310 is inside the preferred volume zone 570 and no movement of the tool is commanded.
  • Fig. 8b the tool 310 is outside the preferred volume zone 570.
  • a movement 340 is commanded to move the tool 310 away from the preferred volume zone 570.
  • the system prevents movement 340; in such embodiments, the tool 310 will remain close to the preferred volume zone 570.
  • the system warns/signals the operator that the move 340 is RESTRICTED. Such a warning/signaling can be visual or aural, using any of the methods known in the art.
  • Figs. 8c and 8d illustrate schematically the effect of the tool's movement on operation of the preferred volume rule/function.
  • the tool 310 is close enough to the edge of preferred volume zone 570 that it is possible for the tool to leave the preferred volume zone during the next time step.
  • Fig. 8c illustrates the effect of a movement 350 that would take the tool 310 deeper into preferred volume zone 570. Since the movement 350 is into preferred volume 570, said movement is an allowed movement.
  • a movement 340 is commanded to move the tool 310 into the preferred volume zone 570.
  • the system prevents movement 350, but does not command movement 340; in such embodiments, the tool 310 will remain close to the preferred volume zone 570.
  • the system warns/signals the operator that the move is RESTRICTED, but does not restrict movement 350 or command movement 340 away from the preferred volume zone 570.
  • Such a warning/signaling can be visual or aural, using any of the methods known in the art.
  • FIG. 9 shows, in a non-limiting manner, an embodiment of an organ detection system (however, it should be noted that the same is provided for detection of tools, instead of organs).
  • the 3D spatial positions of the organs stored in a database.
  • the perimeter of each organ is marked, to indicate the edge of the volume of 3D spatial locations stored in the database.
  • the liver 610 is labeled with a dashed line.
  • the stomach 620 is labeled with a long- dashed line, the intestine 630 with a solid line and the gall bladder 640 is labeled with a dotted line.
  • a label or tag visible to the operator is also presented. Any method of displaying identifying markers known in the art can be used.
  • colored or patterned markers can indicate the locations of the organs, with the marker either indicating the perimeter of the organ or the area of the display in which it appears.
  • FIG. 10 shows, in a non-limiting manner, an embodiment of a tool detection function.
  • the 3 ⁇ spatial positions of the tools stored in a database For each tool, the 3 ⁇ spatial positions of the tools stored in a database.
  • the perimeter of each tool is marked, to indicate the edge of the volume of 3D spatial locations stored in the database.
  • the left tool is labeled with a dashed line while the right tool is labeled with a dotted line.
  • a label or tag visible to the operator is also presented. Any method of displaying identifying markers known in the art can be used.
  • colored or patterned markers can indicate the locations of the tools, with the marker either indicating the perimeter of the tool or the area of the display in which it appears.
  • FIG. 11a schematically illustrates a liver 810, a left tool 820 and a right tool 830 at a time t.
  • Fig. lib schematically illustrates the liver 810, left tool 820 and right tool 830 at a later time t + At, where At is a small time interval.
  • the left tool 820 has moved downward (towards the direction of liver 810) in the time interval At.
  • the system has detected movement of left tool 820 and labels it. This is illustrated schematically in Fig. lib by a dashed line around left tool 820.
  • FIG. 12a-d shows, in a non-limiting manner, an embodiment of the above discussed prediction function.
  • Fig. 12a shows a left tool 920 and a right tool 930 at a time t.
  • Fig. 12b shows the same tools at a later time t + At, where At is a small time interval.
  • Left tool 920 is moving to the right and downward, while right tool 930 is moving to the left and upward. If the motion continues (shown by the dashed line in Fig. 12c), then by the end of the next time interval, in other words, at some time between time t + At and time t + 2At, the tools will collide, as shown by tool tips within the dotted circle 950 in Fig. 12c.
  • the system automatically prevents predicted collisions and, in this example, the system applies a motion 940 to redirect left tool 920 so as to prevent the collision.
  • the system warns/signals the operator that a collision is likely to occur, but does not alter the movement of any tool.
  • a warning/signaling can be visual or aural, using any of the methods known in the art.
  • the prediction function can be enabled to, for non-limiting example, alter the field of view to follow the predicted movement of a tool or of an organ, to warn of (or prevent) predicted motion into a no-fly zone, to warn of (or prevent) predicted motion out of a preferred zone.
  • FIG. 13 shows, in a non-limiting manner, an embodiment of a right tool function.
  • Fig. 13 schematically illustrates a liver 1010, a left tool 1020 and a right tool 1030.
  • the right tool illustrated schematically by the dashed line 1040, is labeled and its 3D spacial location is constantly and real-time stored in a database. Now, according to the right tool function/rule the endoscope constantly tracks the right tool.
  • FIG. 14a-b which shows, in a non-limiting manner, an embodiment of a field of view function/rule.
  • Fig. 14a schematically illustrates a field of view of the abdomen at a time t.
  • the liver 1110 In the field of view are the liver 1110, stomach 1120, intestines 1130 and gall bladder 1140.
  • the gall bladder is nearly completely visible at the left of the field of view.
  • Two tools are also in the field of view, with their tips in proximity with the liver. These are left tool 1150 and right tool 1160.
  • the field of view function/rule tracks left tool 1150.
  • left tool 1150 is moving to the right, as indicated by arrow 1170.
  • Fig. 14b shows the field of view at time t + At.
  • the field of view has moved to the right so that the tip of left tool 1150 is still nearly at the center of the field of view. It can be seen that much less of gall bladder 1140 is visible, while more of right tool 1160 has entered the field of view.
  • the field of view function/rule can be set to follow a selected tool, as in this example or to keep a selected organ in the center of the field of view. It can also be set to keep a particular set of tools in the field of view, zooming in or out as necessary to prevent any of the chosen tools from being outside the field of view.
  • the field of view function/rule defines n 3D spatial positions; n is an integer greater than or equal to 2; the combination of all of said n 3D spatial positions provides a predetermined field of view.
  • Each movement of the endoscope or the surgical tool within said n 3D spatial positions is an allowed movement and any movement of the endoscope or the surgical tool outside said n 3D spatial positions is a restricted movement.
  • said the field of view function/rule defines n 3D spatial positions; n is an integer greater than or equal to 2; the combination of all of said n 3D spatial positions provides a predetermined field of view.
  • the endoscope is relocated if movement has been detected by said detection means, such that said field of view is maintained.
  • Example 11 - Tagged Tool Function/rule (or alternatively the preferred tool rule)
  • Fig. 15 shows, in a non-limiting manner, an embodiment of a tagged tool function/rule.
  • Fig. 15 shows three tools (1220, 1230 and 1240) in proximity to the organ of interest, in this example, the liver 1210.
  • Tool 1240 The tool most of interest to the surgeon, at this point during the operation, is tool 1240.
  • Tool 1240 has been tagged (dotted line 1250); the 3D spacial location of tool 1240 is constantly stored in a database and this spacial location has been labeled as one of interest.
  • the system can use this tagging for many purposes, including, but not limited to, keeping tool 1240 in the center of the field of view, predicting its future motion, keeping it from colliding with other tools or keeping other tools from colliding with it, instructing the endoscope to constantly monitor and track said tagged tool 1250 and so on.
  • the system tags one of the tools and performs as in the tagged tool rule/function.
  • FIG. 16a-c which shows, in a non-limiting manner, an embodiment of a proximity function/rule.
  • Fig. 16a schematically illustrates two tools (1310 and 1320) separated by a distance 1330 which is greater than a predefined proximity distance. Since tool 1310 is not within proximity of tool 1320, the field of view (1380) does not move.
  • Fig. 16b schematically illustrates two tools (1310 and 1320) separated by a distance 1330 which is less than a predefined proximity distance.
  • the system alerts the user of said proximity (which might lead to a collision between the two tools). Alternatively, the system moves one of the tools away from the other one.
  • FIG. 17a-b which shows, in a non-limiting manner, an embodiment of an operator input function/rule. According to this embodiment, input is received from the operator.
  • the input received from the operator is which tool to track.
  • Fig. 17a schematically illustrates an endoscope with field of view 1480 showing a liver 1410 and two tools 1420 and 1430.
  • Operator 1450 first selects the tip of the left tool as the region of interest, preferably by touching the tool tip on the screen, causing the system to tag (1440) the tip of the left tool.
  • the system then directs and modifies the spatial position of the endoscope so that the tagged tool tip 1440 is in the center of the field of view 1480.
  • the system will, according to one embodiment, prevent the movement of the surgical tool.
  • any movement of said tool in the direction is interpreted as input from the operator to continue the movement of said surgical tool in said direction.
  • the operator input function/rule receives input from the operator (i.e., physician) to continue the move of said surgical tool (even though it is "against” the collision prevention rule). Said input is simply in the form of the continued movement of the surgical tool (after the alert of the system or after the movement prevention by the system).
  • FIGs. 18a-d which shows, in a non- limiting manner, an embodiment of a tracking system with a constant field of view rule/function.
  • the tip lens in the camera optics is not at a right angle to the sides of the endoscope.
  • the tip lens angle is described relative to the right angle, so that a tip lens at right angles to the sides of the endoscope is described as having an angle of 0.
  • angled endoscope tip lenses have an angle of 30° or 45°. This tip lens angle affects the image seen during zooming.
  • Fig. 18 illustrates, in an out-of-scale manner, for a conventional system, the effect of zooming in the field of view in an endoscope with tip lens set straight in the end (Fig. 18a and 18b) vs. the effect of zooming in the field of view in an endoscope with angled tip lens (Fig. 18c and 18d).
  • Figs. 18a and 18c illustrate the endoscope (100), the object it is viewing (200) and the image seen by the endoscope camera (130) before the zoom.
  • the solid arrows (160) show the limits of the FOV and the dashed arrow (170), the center of the field of view (FOV); since the object is in the center of the FOV, an image of the object (210) is in the center of the camera image (130).
  • Figs. 18b and 18d illustrate the endoscope (100), the object it is viewing (200) and the image seen by the endoscope camera (130) after the zoom.
  • the solid arrows (160) show the limits of the FOV and the dashed arrow (170), the center of the field of view.
  • the controlling means maintains the center of the field of view (FOV) during zoom independent of the tip lens angle.
  • FOV field of view
  • the endoscope's movement will be adjusted in order to maintain a constant field of view.
  • the system can inform the user of any misalignment of the same system.
  • Misalignment of the system may cause parasitic movement of the endoscope tip, where the endoscope tip does not move exactly in the expected direction.
  • the system comprises sensors (e.g., gyroscopes, accelerometers and any combination thereof) that calculate/estimates the position of the pivot point in real time in order to (a) inform the user of misalignment; or (b) calculate the misalignment so that the system can adjust its movement to prevent parasitic movement.
  • sensors e.g., gyroscopes, accelerometers and any combination thereof
  • FIG. 19 shows, in a non-limiting manner, an embodiment of a tracking system with a change of speed rule/function.
  • the speed of the tip of the endoscope is automatically varied such that, the closer the endoscope tip is to an object, be it a tool, an obstacle, or the object of interest, the more slowly it moves.
  • measurements are made of the distance X (150) from the tip (195) of the endoscope (100) to the pivot point of the endoscope (190), where said pivot point is at or near the surface of the skin (1100) of a patient (1000).
  • Measurements are also made of the distance Y (250) from the tip of the endoscope (195) to the object in the center of the scene of view (200). From a predetermined velocity V p , the actual velocity of the tip of the endoscope at a given time, V act , is calculated from
  • a non-limiting example of movement of an articulating tool (310), here an endoscope, is shown schematically.
  • the endoscope (310) is moved so that, instead of viewing the outer side of the liver (320) from the right, it views the inner side of the liver (320) from the left.
  • Fig. 20a shows the endoscope (310) at the beginning of the movement. It is fully extended and its tip (318) is positioned about halfway up the outer side of the liver.
  • the dashed line shows the movement of the base (312) of the endoscope, which will move in a straight line from its starting position (Fig. 20a) to its final position (Fig. 20b).
  • the dotted line shows the movement of the endoscope tip (318) - the tip (318) moves upward, over the top of the liver (320), and then down the inner side of the liver (320), to allow imaging of the left (inner) side of the liver from between the liver (320) and the lungs (1790).
  • Fig. 20b the movement has been completed.
  • the endoscope tip (318) now points rightward; the articulating section (316) being curved so that the endoscope (310) views the right side of the liver (310), with the endoscope tip (318) being between the liver (320) and the lungs (1790) while its base (312) remains on the right side of the body.
  • a non- limiting example of flexion of an articulating tool (310), here an endoscope, is shown schematically.
  • portions of the small intestine (1795) are shown schematically.
  • the endoscope enters the body from the body's right side (body not shown), and views a portion of the small intestine (1795F) from the left and below.
  • the articulating section of the endoscope (316) bypasses a loop of small intestine (1795A), passes between two portions of small intestine (1795B, 1795C), and over other portions of small intestine (1795D, 1795E) so that the endoscope's tip (318) views the desired portion of the small intestine (1795F) from the desired direction.

Landscapes

  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Animal Behavior & Ethology (AREA)
  • Veterinary Medicine (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Robotics (AREA)
  • Gynecology & Obstetrics (AREA)
  • Radiology & Medical Imaging (AREA)
  • Human Computer Interaction (AREA)
  • Physics & Mathematics (AREA)
  • Biophysics (AREA)
  • Pathology (AREA)
  • Endoscopes (AREA)

Abstract

La présente invention concerne un système de commande chirurgical qui comprend : a. un outil chirurgical adapté à être inséré dans un environnement chirurgical d'un corps humain pour assister une procédure chirurgicale, ledit outil chirurgical étant un outil articulé ; b. un moyen d'estimation de localisation conçu pour localiser en temps réel la position en 3D dans l'espace dudit outil chirurgical à tout temps "t" donné ; c. un moyen de détection de mouvements ; et d. un organe de commande ayant un moyen de traitement pouvant communiquer avec une base de données d'organe de commande, ledit organe de commande étant conçu pour commander la position spatiale dudit outil chirurgical ; ladite base de données d'organe de commande se trouvant en communication avec ledit moyen de détection de mouvements ; ledit organe de commande étant conçu pour fournir des instructions pour déplacer ledit outil chirurgical.
PCT/IL2013/050806 2012-09-30 2013-09-30 Orientation et manipulation d'un outil articulé de chirurgie laparoscopique WO2014049598A1 (fr)

Priority Applications (3)

Application Number Priority Date Filing Date Title
EP13841164.0A EP2900130A4 (fr) 2012-09-30 2013-09-30 Orientation et manipulation d'un outil articulé de chirurgie laparoscopique
US14/671,128 US20150238276A1 (en) 2012-09-30 2015-03-27 Device and method for assisting laparoscopic surgery - directing and maneuvering articulating tool
US17/711,023 US20220395159A1 (en) 2012-09-30 2022-03-31 Device and method for assisting laparoscopic surgery - directing and maneuvering articulating tool

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US201261707976P 2012-09-30 2012-09-30
US61/707,976 2012-09-30

Related Child Applications (1)

Application Number Title Priority Date Filing Date
US14/671,128 Continuation-In-Part US20150238276A1 (en) 2012-09-30 2015-03-27 Device and method for assisting laparoscopic surgery - directing and maneuvering articulating tool

Publications (1)

Publication Number Publication Date
WO2014049598A1 true WO2014049598A1 (fr) 2014-04-03

Family

ID=50387095

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/IL2013/050806 WO2014049598A1 (fr) 2012-09-30 2013-09-30 Orientation et manipulation d'un outil articulé de chirurgie laparoscopique

Country Status (3)

Country Link
EP (1) EP2900130A4 (fr)
DE (1) DE202013012276U1 (fr)
WO (1) WO2014049598A1 (fr)

Cited By (7)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2016005988A1 (fr) * 2014-07-10 2016-01-14 M.S.T. Medical Surgery Technologies Ltd. Interface améliorée pour gestes de mouvement de chirurgies laparoscopiques
WO2017037705A1 (fr) * 2015-08-30 2017-03-09 M.S.T. Medical Surgery Technologies Ltd Système de commande d'outil chirurgical intelligent pour chirurgies laparoscopiques
US9795282B2 (en) 2011-09-20 2017-10-24 M.S.T. Medical Surgery Technologies Ltd Device and method for maneuvering endoscope
US9937013B2 (en) 2011-08-21 2018-04-10 M.S.T. Medical Surgery Technologies Ltd Device and method for assisting laparoscopic surgery—rule based approach
US9943372B2 (en) 2005-04-18 2018-04-17 M.S.T. Medical Surgery Technologies Ltd. Device having a wearable interface for improving laparoscopic surgery and methods for use thereof
US10866783B2 (en) 2011-08-21 2020-12-15 Transenterix Europe S.A.R.L. Vocally activated surgical control system
WO2022171537A1 (fr) * 2021-02-12 2022-08-18 B. Braun New Ventures GmbH Système d'assistance chirurgicale et procédé d'affichage

Families Citing this family (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
DE102016118441A1 (de) 2016-09-29 2018-03-29 Olympus Winter & Ibe Gmbh Verfahren zur Verarbeitung elektronischer Bilddaten eines Endoskops, System bestehend aus einem Endoskop, einer Bildaufnahmeeinrichtung, einer Bildverarbeitungseinheit und einer Bildwiedergabevorrichtung, und Bildverarbeitungseinheit
DE102017101782A1 (de) 2017-01-30 2018-08-02 Aktormed Gmbh Operations-Assistenz-System und Verfahren zur Erzeugung von Steuersignalen zur Sprachsteuerung einer motorisch gesteuert bewegbaren Roboterkinematik eines derartigen Operations-Assistenz-Systems
DE102020131232B4 (de) 2020-11-25 2023-07-06 Aktormed Gmbh Operations-Assistenz-System und Verfahren zur Erzeugung von Steuersignalen zur Sprachsteuerung einer motorisch gesteuert bewegbaren Roboterkinematik eines derartigen Operations-Assistenz-Systems

Citations (8)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20020091301A1 (en) * 1999-05-18 2002-07-11 Levin John M. Retractor with memory
US20030216833A1 (en) * 2002-05-17 2003-11-20 Kazuo Mukai Method and system for controlling drive of a robot
US20050219552A1 (en) * 2002-06-07 2005-10-06 Ackerman Jermy D Methods and systems for laser based real-time structured light depth extraction
US20070013336A1 (en) * 2005-05-19 2007-01-18 Intuitive Surgical Inc. Software center and highly configurable robotic systems for surgery and other uses
US7319897B2 (en) * 2002-12-02 2008-01-15 Aesculap Ag & Co. Kg Localization device display method and apparatus
US20090240259A1 (en) * 2008-03-24 2009-09-24 Carl Nelson System and methods for controlling surgical tool elements
US20100022871A1 (en) * 2008-07-24 2010-01-28 Stefano De Beni Device and method for guiding surgical tools
US20110177469A1 (en) * 2009-12-17 2011-07-21 Straumann Holding Ag Dental tools for guided surgery

Family Cites Families (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US10258285B2 (en) * 2004-05-28 2019-04-16 St. Jude Medical, Atrial Fibrillation Division, Inc. Robotic surgical system and method for automated creation of ablation lesions
WO2011021192A1 (fr) * 2009-08-17 2011-02-24 Mazor Surgical Technologies Ltd. Dispositif permettant d'améliorer la précision d'opérations manuelles
WO2013027200A2 (fr) * 2011-08-21 2013-02-28 M.S.T. Medical Surgery Technologies Ltd. Dispositif et méthode pour assister une approche fondée sur des règles de chirurgie laparoscopique

Patent Citations (8)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20020091301A1 (en) * 1999-05-18 2002-07-11 Levin John M. Retractor with memory
US20030216833A1 (en) * 2002-05-17 2003-11-20 Kazuo Mukai Method and system for controlling drive of a robot
US20050219552A1 (en) * 2002-06-07 2005-10-06 Ackerman Jermy D Methods and systems for laser based real-time structured light depth extraction
US7319897B2 (en) * 2002-12-02 2008-01-15 Aesculap Ag & Co. Kg Localization device display method and apparatus
US20070013336A1 (en) * 2005-05-19 2007-01-18 Intuitive Surgical Inc. Software center and highly configurable robotic systems for surgery and other uses
US20090240259A1 (en) * 2008-03-24 2009-09-24 Carl Nelson System and methods for controlling surgical tool elements
US20100022871A1 (en) * 2008-07-24 2010-01-28 Stefano De Beni Device and method for guiding surgical tools
US20110177469A1 (en) * 2009-12-17 2011-07-21 Straumann Holding Ag Dental tools for guided surgery

Non-Patent Citations (1)

* Cited by examiner, † Cited by third party
Title
See also references of EP2900130A4 *

Cited By (12)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US9943372B2 (en) 2005-04-18 2018-04-17 M.S.T. Medical Surgery Technologies Ltd. Device having a wearable interface for improving laparoscopic surgery and methods for use thereof
US9937013B2 (en) 2011-08-21 2018-04-10 M.S.T. Medical Surgery Technologies Ltd Device and method for assisting laparoscopic surgery—rule based approach
US10866783B2 (en) 2011-08-21 2020-12-15 Transenterix Europe S.A.R.L. Vocally activated surgical control system
US11957301B2 (en) * 2011-08-21 2024-04-16 Asensus Surgical Europe S.à.R.L. Device and method for assisting laparoscopic surgery—rule based approach
US9795282B2 (en) 2011-09-20 2017-10-24 M.S.T. Medical Surgery Technologies Ltd Device and method for maneuvering endoscope
WO2016005988A1 (fr) * 2014-07-10 2016-01-14 M.S.T. Medical Surgery Technologies Ltd. Interface améliorée pour gestes de mouvement de chirurgies laparoscopiques
EP3166468A4 (fr) * 2014-07-10 2018-03-07 M.S.T. Medical Surgery Technologies Ltd. Interface améliorée pour gestes de mouvement de chirurgies laparoscopiques
US10799302B2 (en) 2014-07-10 2020-10-13 Transenterix Europe S.A.R.L. Interface for laparoscopic surgeries—movement gestures
WO2017037705A1 (fr) * 2015-08-30 2017-03-09 M.S.T. Medical Surgery Technologies Ltd Système de commande d'outil chirurgical intelligent pour chirurgies laparoscopiques
US11638615B2 (en) * 2015-08-30 2023-05-02 Asensus Surgical Us, Inc. Intelligent surgical tool control system for laparoscopic surgeries
WO2022171537A1 (fr) * 2021-02-12 2022-08-18 B. Braun New Ventures GmbH Système d'assistance chirurgicale et procédé d'affichage
CN116829091A (zh) * 2021-02-12 2023-09-29 B·布莱恩新风险投资有限责任公司 外科手术辅助系统和表示方法

Also Published As

Publication number Publication date
DE202013012276U1 (de) 2016-01-20
EP2900130A4 (fr) 2016-10-05
EP2900130A1 (fr) 2015-08-05

Similar Documents

Publication Publication Date Title
US20230040952A1 (en) Device and method for assisting laparoscopic surgery utilizing a touch screen
US11957301B2 (en) Device and method for assisting laparoscopic surgery—rule based approach
US11185315B2 (en) Device and method for assisting laparoscopic surgery—rule based approach
US10052157B2 (en) Device and method for assisting laparoscopic surgery—rule based approach
EP2754383B1 (fr) Dispositif et procédé d'aide à la chirurgie laparoscopique - approche basée sur une règle
US9757206B2 (en) Device and method for assisting laparoscopic surgery—rule based approach
EP2744389B1 (fr) Dispositif pour assister une approche fondée sur des règles de chirurgie laparoscopique
US11638615B2 (en) Intelligent surgical tool control system for laparoscopic surgeries
EP2900130A1 (fr) Orientation et manipulation d'un outil articulé de chirurgie laparoscopique

Legal Events

Date Code Title Description
121 Ep: the epo has been informed by wipo that ep was designated in this application

Ref document number: 13841164

Country of ref document: EP

Kind code of ref document: A1

NENP Non-entry into the national phase

Ref country code: DE

WWE Wipo information: entry into national phase

Ref document number: 2013841164

Country of ref document: EP