WO2018219881A1 - Système d'assistance d'une chirurgie - Google Patents

Système d'assistance d'une chirurgie Download PDF

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Publication number
WO2018219881A1
WO2018219881A1 PCT/EP2018/063964 EP2018063964W WO2018219881A1 WO 2018219881 A1 WO2018219881 A1 WO 2018219881A1 EP 2018063964 W EP2018063964 W EP 2018063964W WO 2018219881 A1 WO2018219881 A1 WO 2018219881A1
Authority
WO
WIPO (PCT)
Prior art keywords
alignment system
assisting
surgical
alignment
support means
Prior art date
Application number
PCT/EP2018/063964
Other languages
English (en)
Inventor
Andy GIJBELS
Jonas SMITS
Original Assignee
Katholieke Universiteit Leuven
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 Katholieke Universiteit Leuven filed Critical Katholieke Universiteit Leuven
Publication of WO2018219881A1 publication Critical patent/WO2018219881A1/fr

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/30—Surgical robots
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/70—Manipulators specially adapted for use in surgery
    • A61B34/72—Micromanipulators
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/50—Supports for surgical instruments, e.g. articulated arms
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/50—Supports for surgical instruments, e.g. articulated arms
    • A61B2090/508—Supports for surgical instruments, e.g. articulated arms with releasable brake mechanisms
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/50—Supports for surgical instruments, e.g. articulated arms
    • A61B90/57—Accessory clamps
    • A61B2090/571—Accessory clamps for clamping a support arm to a bed or other supports

Definitions

  • Embodiments of the present invention relate to an assistive system and method for surgery, which may be cooperative surgery, telesurgery or autonomous surgery. Some embodiments of the present invention provide methods and systems for eye surgery.
  • the present application is generally directed to medical devices, systems, and methods.
  • the invention provides surgical robotic systems and methods that make use of separate and/or independently positionable assemblies for manipulating a plurality of surgical end effectors at a surgical worksite.
  • Minimally invasive medical techniques are aimed at reducing the amount of extraneous tissue that is damaged during diagnostic or surgical procedures, thereby reducing patient recovery time, discomfort, and deleterious side effects.
  • the average length of a hospital stay for a standard surgery may also be shortened significantly using minimally invasive surgical techniques.
  • an increased adoption of minimally invasive techniques could save millions of hospital days, and millions of dollars annually in hospital residency costs alone.
  • Patient recovery times, patient discomfort, surgical side effects, and time away from work may also be reduced with minimally invasive surgery (MIS).
  • MIS minimally invasive surgery
  • a system for assisting in surgery as set out in the appended claims.
  • the system houses a surgical system; support means configured for supporting and positioning a body member when provided on the support means; a first alignment system, said first alignment system configured to support and move/position the surgical system with respect to the support means and configured to couple the support means and surgical system; and a second alignment system, said second alignment system configured to support and move/position the support means, the first alignment system and surgical system.
  • the first alignment system may comprise three translational stages configured for motion along three mutually orthogonal axes of translation ( ⁇ , ⁇ , ⁇ ), wherein each stage advantageously comprises positioning means configured to control the position of the respective stage.
  • the translational stages are advantageously linear motion stages.
  • the first alignment system may further comprise a rotational stage advantageously configured for rotational motion (R) about one of the three axes of translation, the rotational stage advantageously comprising positioning means configured to control the position of the rotational stage (R).
  • the rotational stage (R) may be configured to rotate the surgical system in a plane defined by the axes of translation (X,Y) of two of the three translational stages.
  • the second alignment system advantageously comprises three translational degrees of freedom.
  • the second alignment system may comprise first, second, and third positioning means, each positioning means being configured to control the position of the second alignment system in a respective direction ( ⁇ ', ⁇ ', ⁇ ').
  • the second alignment system may further comprise a rotational stage advantageously configured for rotational motion (R') comprising rotational positioning means configured to control the position of the rotational stage.
  • R' rotational motion
  • At least one of the positioning means may be configured to at least position the support means.
  • the rotational stage of the second alignment system may be configured to tilt or rotate the support means about a first axis substantially parallel to a plane defined by the translational degrees of freedom of the second alignment system.
  • the system may be a portable and/or movable system.
  • the system may be a trolley system.
  • FIG. 1 schematically illustrates an assistive system for surgery in use according to embodiments of the present invention.
  • FIG. 2 schematically illustrates a detailed view of the assistive system for surgery illustrated in FIG. 1.
  • FIG. 3 schematically illustrates the surgical system and the first alignment system, that is, an intra-operative alignment system according to embodiments of the present invention.
  • FIG. 4 schematically illustrates the surgical system and first alignment system and part of the second alignment system according to embodiments of the present invention.
  • FIG. 5 schematically illustrates the second alignment system, that is, a pre-operative alignment system according to embodiments of the present invention.
  • Description of embodiments [000726] The present invention will be described with respect to particular embodiments and with reference to certain drawings but the invention is not limited thereto but only by the claims.
  • the drawings described are only schematic and are non- limiting. In the drawings, the size of some of the elements may be exaggerated and not drawn on scale for illustrative purposes. Where the term “comprising" is used in the present description and claims, it does not exclude other elements or steps. Where an indefinite or definite article is used when referring to a singular noun e.g.
  • the present invention provides an assistive system for surgery which is illustrated in FIG. 1 and FIG. 2.
  • the assistive system 1 which may be for example a telesurgery system, a co-operative surgery system, or an autonomous system, comprises a support means 2, a surgical system 3, a first alignment system or intra-operative alignment system 4, and a second alignment system or pre-operative alignment system 5.
  • the first alignment system 4 is preferably used to position the surgical system 3 in a precise way (e.g. in the mm range), relative to the patient, by the surgeon.
  • the second alignment system 5 is preferably used to position the support and position the support means 2, the first alignment system 4 and surgical system 3 in a more robust way (e.g. in the cm range), for example by the nurse prepping the patient before surgery.
  • the assistive system for surgery 1 may comprise control means, e.g. a control pedal 6 and/or a control unit 7.
  • the patient's body is placed on a surgical bed 9 (table or chair).
  • a surgical microscope 10 is optionally provided for improving visualisation of the body member to be operated on.
  • the patient's body member which may be the patient's head 8 in the case of eye surgery, is placed on the support means 2 of the assistive system 1 according to embodiments of the present invention.
  • the first alignment system 4 allows precise positioning of the surgical system 3 with respect to the body member to be operated upon, for example the head in the case of eye surgery.
  • the body member is supported by the support means 2 or support system, and so the first alignment system 4 allows precise positioning of the surgical system 3 with respect to the support system 2.
  • the second alignment system 5 allows positioning of the support means 2, the first alignment system 4 and surgical system 3 with respect to the surgical bed or chair.
  • the attainable surgical precision is higher compared to the case where the patient's body member, e.g. patient's head 8, is placed on the surgical bed and the assistive system 1 could move independently from the patient's head.
  • this layout is compatible with the majority of the commercially available surgical beds as opposed to assistive systems which need to be fixed to the surgical bed with the aid of bed specific mounts.
  • the described assistive system according to embodiments of the present invention in most cases does not require the available surgical bed to be replaced as is the case for assistive systems which are mounted on a custom surgical bed.
  • the surgical system 3 used in an assistive system 1 implements key functionalities of the assistive system as illustrated in FIG. 3.
  • the key functionalities and the means to implement these functionalities may be elucidated as follows for the case of eye surgery: (a) stabilization of the eye with the aid of a remote-centre-of-motion (RCM) mechanism, for example an RCM mechanism as described WO 2014108545 A1 , as described in US5397323 A, or any other suitable RCM mechanism (b) enhancement of the precision of the motion of instrument 12 with aid of actuators (e.g.
  • RCM remote-centre-of-motion
  • damping-like behaviour force opposing the velocity, the force amplitude rises with the speed
  • active damping elements e.g. using back-EMF of electrical motors, eddy current brakes, magnetorheological brakes, electrorheological brakes
  • passive damping e.g. two surfaces moving with respect to one another which are partly or fully immersed in a fluid
  • active braking elements e.g. electrical motors, or an electromagnetic brake
  • passive braking elements e.g. a brake cable system or a pressurized fluid pushing two plates against each other
  • the surgical system 3 comprises at least four degrees of freedom, i.e. it allows for moving a surgical instrument 12 attached to it according to four (or more) degrees of freedom: two rotations A and B about a pivot point P, a rotation C about an axis of the instrument 12 and a (linear) translation T through pivot point P, in particular parallel to the axis of instrument 12.
  • the pivot point P may be a remote centre of motion (RCM).
  • the first alignment system 4 e.g. the intra-operative alignment system, carries the surgical system 3 as illustrated in FIG. 4.
  • the first alignment system 4 is advantageously used by the surgeon during the procedure.
  • the first alignment system 4 is operable for providing one or a combination of the following four motions:
  • the eye when a certain targeted area inside the patient (e.g. inside the eye) cannot be reached, the eye can be moderately tilted intra-operatively by altering the location of the pivot point P with respect to the incision point, and/or
  • the first alignment system 4 can allow for moving the surgical system 3 away from the operating scene in order to switch to manual surgery or to safely remove and/or insert a surgical instrument 12 into a tool holder 13 of the surgical system 3.
  • the first alignment means In orderto implement these functionalities, the first alignment means
  • the intra-operative alignment system is advantageously equipped with at least three, advantageously four degrees of freedom: at least three (orthogonal) translational degrees of freedom X, Y, Z, and optionally at least one rotational degree of freedom R.
  • degrees of freedom can be implemented with the aid of at least three translational (linear motion) stages 41 , 42 and 43 respectively, and optionally at least one rotational stage 44.
  • Each stage is advantageously equipped with an actuator (such as an electrical motor), a combination of a damping and braking element (such as a viscous damper and an electromagnetic brake) and/or a manual positioning element (such as a leadscrew positioner) to control the position of the stage.
  • the stages do not necessarily need to be stacked in the depicted order (R-X-Y-Z).
  • Rotational stage 44 can be omitted, but such design is believed to be suboptimal.
  • the XYZ motion is not implemented by means of translational stages, but other designs are believed to be suboptimal.
  • the second alignment system 5 e.g. pre-operative alignment system
  • the first alignment means 4 e.g. the intra- operative alignment system and the surgical system 3 as illustrated in FIG. 5. It is advantageously used by a member of the clinical team, e.g. a nurse, to correctly position the support means 2 with respect to the surgical bed such that the patient's body member, e.g. head, can be placed on the support means 2 in the desired posture with respect to the patient's body.
  • the reachable workspace of the first alignment system 4, i.e. intra-operative alignment system, and surgical system 3 will cover the regions of interest for the procedure.
  • the second alignment system preferably comprises at least three, preferably at least four degrees of freedom: at least three (orthogonal) translational degrees of freedom X', Y' and Z' and optionally at least one rotational degree of freedom R'.
  • Degrees of freedom X' and Y' may be implemented with the aid of advantageously pivoting wheels 51 placed at the bottom of the assistive system. This allows the operator to correctly position the assistive system 1 with respect to the surgical bed or chair on the floor.
  • the assistive system may also include one or more brakes or motion- preventing elements which allow the wheels 51 , and the assistive system 1 , to be prevented from moving once the correct position of the assistive system 1 is achieved.
  • these wheels 51 may be provided in the form of the assistive system 1 being a trolley housing the surgical system 3, the first and second alignment systems 4, 5 and the support means 2.
  • a combination of moving and fixed parts may be provided, fixing the assistive system 1 at one side while enabling two translational movements (in ⁇ ', ⁇ ') at the other side.
  • the (linear) translational degree of freedom Z' is advantageously implemented in a central column 52 of the assistive system with the aid of e.g. an actuated (e.g. electrical motor) or manually movable (e.g. hydraulically, manually driven leadscrew system or other conventional mechanical means) translational joint. It is used to vertically level the support means 2 with the surface of the surgical table or chair within a certain range.
  • Rotational degree of freedom R' is advantageously implemented in correspondence of the support means 2 with the aid of an actuated or manually movable rotational joint. It is used to place the support means 2 in the desired angle relative to the surface of the surgical bed. Axis of rotation of rotational degree of freedom R' is advantageously substantially parallel to a plane defined by translational degrees of freedom X and Y of the intra-operative alignment system 4.
  • the translational movement Z' of the second alignment system 5 is configured to move, e.g. lift, the support means 2, the first alignment system 4, and the surgical system 3 together, whereas the translation movement Z of the first alignment means 4 is configured to only move the surgical system 3. Therefore in preferred embodiments two separate, independent of each other, translational stages are provided.
  • a translational stage Z' may be provided on the second alignment system 5 dedicated to displacing solely the support means 2 and a translational stage Z on the first alignment system 4 for displacing the surgical system 3.
  • the assistive system 1 advantageously comprises a mounting platform 53, on which the support means 2 and the stages 41 -44 of the first alignment system 4 are separately mounted.
  • the mounting platform 53 is advantageously configured to move according to the three translational degrees of freedom X', Y', Z' of the second alignment system 5.
  • mounting platform 53 is mounted on the wheels 51 and the column 52.
  • the three translational stages 41 - 43 and the rotational stage 44 of the first alignment system are advantageously mounted between the mounting platform 53 and the surgical system 3 but advantageously not between the mounting platform and the support means 2.
  • the mounting platform 53 advantageously couples the support means 2 and the surgical system 3.
  • the support means 2 is advantageously mounted on platform 53 through a rotational joint 54 implementing the rotational movement R'.
  • the rotational movement R' of the second alignment system 5 is configured to tilt the support means 2 about a first axis substantially parallel to a plane defined by the translational movements X and Y, and/or a plane defined by the translational movements X' and Y', advantageously without affecting the position and/or orientation of the surgical system 3, nor the first alignment system 4.
  • the rotational movement R of the first alignment system 4 is configured to rotate the surgical system 3 left to right in a plane substantially parallel to plane defined by the translational movements of the first and second alignment systems 4, 5 (X,Y or ⁇ ', ⁇ '), advantageously without affecting the position and/or orientation of the support means 2.
  • the rotational movement R of the first alignment system 4 is in a direction substantially perpendicular to the rotational movement R' of the second alignment system 5.
  • the rotational movements R and R' have rotation axes which are substantially orthogonal to one another.
  • further degrees of freedom can be provided to the support means 2 by adapting the second alignment means 5 (and enabling additional movement besides the rotational movement R').
  • the rotational movements R, R' of the first and second alignment system 4, 5 respectively may be omitted still enabling a functional assistive system according the embodiments of the present invention.
  • the assistive system 1 allows on the one hand to position the support means 2 and the surgical system 3 integrally by way of the second alignment system 5, and on the other hand to move/position the surgical system 3, and hence the surgical instrument 12 relative to the support means 2 by way of the first alignment system 4.
  • control means may be provided.
  • Said control means may comprise a control unit 7 configured to receive information from a control pedal 6, sensors and/or screen and preferably ensures that the assistive system 1 behaves as commanded by the operator.
  • the control unit 7 may be integrated in the central column 52 of the assistive system 1 or provided as an external device.
  • the control unit 7 is optional for the operation of the assistive system 1 according to embodiments of the present invention.
  • the second alignment system 5 i.e. pre-operative alignment system
  • the first alignment system 4 i.e.
  • control means may comprise a control pedal 6 (or a combination of the control pedal 6 and control unit 7).
  • control pedal 6 may comprise a number of input elements (buttons, levers, switches and/or alike) that are used by the operator to control the second alignment system 5, i.e. the pre-operative alignment system, the first alignment system 4, i.e. intra-operative alignment system and/or the surgical system 3.
  • control pedal 6 can be simplified to a pedal where maximum one input element is foreseen for every one of these subsystems.
  • the subsystems are constructed to be partly or fully back-drivable. Passive dampers can be used to increase the positioning precision of the surgeon in the different degrees of freedom. Active or passive brakes can be coupled to one or more of the degrees of freedom of the subsystems.
  • the input element on the control pedal 6 is then used to lock/unlock the related subsystem in part or in full. When the subsystem is unlocked, the surgeon can manually move the subsystem to the desired pose by hand.

Abstract

L'invention concerne un système (1) pour assister une chirurgie, comprenant un système chirurgical (3) ; un moyen de support (2) conçu pour soutenir et positionner un élément de corps lorsque ce dernier est disposé sur le moyen de support ; un premier système d'alignement (4), ledit premier système d'alignement étant conçu de manière à soutenir et à positionner le système chirurgical par rapport au moyen de support et étant conçu de manière à accoupler le moyen de support et le système chirurgical ; un second système d'alignement (5), ledit second système d'alignement étant conçu de manière à soutenir et à positionner le moyen de support, le premier système d'alignement et le système chirurgical.
PCT/EP2018/063964 2017-05-29 2018-05-28 Système d'assistance d'une chirurgie WO2018219881A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
US201762512133P 2017-05-29 2017-05-29
US62/512,133 2017-05-29

Publications (1)

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WO2018219881A1 true WO2018219881A1 (fr) 2018-12-06

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PCT/EP2018/063964 WO2018219881A1 (fr) 2017-05-29 2018-05-28 Système d'assistance d'une chirurgie

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Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP3771446A1 (fr) * 2019-07-30 2021-02-03 Katholieke Universiteit Leuven KU Leuven Research & Development Mécanisme de contrainte de mouvement à distance mécanique

Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5397323A (en) 1992-10-30 1995-03-14 International Business Machines Corporation Remote center-of-motion robot for surgery
US20090163928A1 (en) * 2007-12-21 2009-06-25 Bruce Schena Robotic Surgical System with Patient Support
WO2014108545A1 (fr) 2013-01-11 2014-07-17 Katholieke Universiteit Leuven Appareil permettant de générer un mouvement autour d'un centre de rotation déporté
US20160331477A1 (en) * 2015-05-15 2016-11-17 Auris Surgical Robotics, Inc. Surgical robotics system
US20160374771A1 (en) * 2015-11-23 2016-12-29 Sina Robotics and Medical Innovators Co. Ltd Robotic system for tele-surgery

Patent Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5397323A (en) 1992-10-30 1995-03-14 International Business Machines Corporation Remote center-of-motion robot for surgery
US20090163928A1 (en) * 2007-12-21 2009-06-25 Bruce Schena Robotic Surgical System with Patient Support
WO2014108545A1 (fr) 2013-01-11 2014-07-17 Katholieke Universiteit Leuven Appareil permettant de générer un mouvement autour d'un centre de rotation déporté
US20160331477A1 (en) * 2015-05-15 2016-11-17 Auris Surgical Robotics, Inc. Surgical robotics system
US20160374771A1 (en) * 2015-11-23 2016-12-29 Sina Robotics and Medical Innovators Co. Ltd Robotic system for tele-surgery

Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP3771446A1 (fr) * 2019-07-30 2021-02-03 Katholieke Universiteit Leuven KU Leuven Research & Development Mécanisme de contrainte de mouvement à distance mécanique

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