U.S. patent application number 10/738359 was filed with the patent office on 2004-12-02 for surgical robot and robotic controller.
Invention is credited to Lipow, Kenneth I..
Application Number | 20040243147 10/738359 |
Document ID | / |
Family ID | 33456248 |
Filed Date | 2004-12-02 |
United States Patent
Application |
20040243147 |
Kind Code |
A1 |
Lipow, Kenneth I. |
December 2, 2004 |
Surgical robot and robotic controller
Abstract
The present invention was developed by a neurosurgeon and seeks
to mimic the results of primate neurological research which is
indicative of a human's actual neurological control structures and
logic. Specifically, the motor proprioceptive and tactile
neurophysiology functioning of the surgeon's hands and internal
hand control system from the muscular level through the intrafusal
fiber system of the neural network is considered in creating the
robot and method of operation of the present invention. Therefore,
the surgery is not slowed down as in the art, because the surgeon
is in conscious and subconscious natural agreement and
harmonization with the robotically actuated surgical instruments
based on neurological mimicking of the surgeon's behavior with the
functioning of the robot. Therefore, the robot can enhance the
surgeon's humanly limited senses while not introducing disruptive
variables to the surgeon's naturally occurring operation of his
neurophysiology. This is therefore also a new field,
neurophysiological symbiotic robotics.
Inventors: |
Lipow, Kenneth I.;
(Bridgeport, CT) |
Correspondence
Address: |
Michael I. Wolfson
Reed Smith LLP
599 Lexington Avenue
New York
NY
10022-7650
US
|
Family ID: |
33456248 |
Appl. No.: |
10/738359 |
Filed: |
December 17, 2003 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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10738359 |
Dec 17, 2003 |
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09898871 |
Jul 3, 2001 |
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10738359 |
Dec 17, 2003 |
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10321171 |
Dec 17, 2002 |
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Current U.S.
Class: |
606/130 |
Current CPC
Class: |
A61B 90/14 20160201;
A61B 2090/061 20160201; A61B 90/361 20160201; A61B 34/35 20160201;
A61B 34/72 20160201; A61B 90/30 20160201; A61B 90/37 20160201; G09B
23/28 20130101; A61B 34/70 20160201; A61B 2090/064 20160201; A61B
34/25 20160201; A61B 2017/00464 20130101; A61B 90/10 20160201; A61B
2017/0046 20130101; A61B 2090/065 20160201; A61B 2034/305 20160201;
A61B 34/76 20160201; A61B 34/77 20160201; A61B 90/36 20160201; A61B
2034/742 20160201; A61B 34/75 20160201; A61B 90/20 20160201; A61B
1/05 20130101; A61B 2090/372 20160201; A61B 34/20 20160201; A61B
2017/00207 20130101; A61B 34/37 20160201; A61B 34/30 20160201; A61B
34/74 20160201 |
Class at
Publication: |
606/130 |
International
Class: |
A61B 019/00 |
Claims
What is claimed is:
1. A method of controlling a robotically driven surgical instrument
for a surgeon comprising the steps of: locating a controller robot
between a handle and the surgical instrument; sensing incident
tremor force components applied by a surgeon to the handle;
modulating the incident tremor force components to generate
modulated tremor force commands; and applying through the
controller robot the modulated tremor force command onto the
surgical instrument.
2. The method of claim 1 further comprising the step of displaying
a signal representing the modulated tremor force on a display.
3. The method of claim 1 further comprising the step of controlling
and adjusting the modulated tremor force via a modulation parameter
provided by a surgeon.
4. The method of claim 3 wherein the modulation parameter is
dependant upon historical data associated with a surgeon.
5. The method of claim 3 wherein the modulation parameter is
dependant upon input provided by a surgeon during a procedure.
6. The method of claim 1 wherein at the step of applying the
modulated tremor force commands, the modulated tremor force
commands are applied in all degrees of freedom of the surgical
instrument.
7. The method of claim 1 wherein at the step of modulating the
incident tremor force compounds, the moduated tremor force commands
are scaled dependent on a scaling paramenter.
8. The method of claim 1 wherein at the step of outputting through
the controller robot a modulated tremor force on the surgical
instrument the output is smoothed
9. The method of claim 1 wherein at the step of modulating the
incident force, force components, the modulated tremor force
commands, or smoothed to eliminate anomolies.
10. A method of controlling a surgical instrument connected to a
surgical robot comprising the steps of: locating a controller robot
between a handle and a surgical instrument; sensing incident
reflectance force from a sensor when the surgical instrument is
placed against body tissue; modulating the reflectance force
components in the controller robot; and outputting through the
controller robot a modulated reflectance force on the handle,
wherein the modulation scaling step includes modulating the
reflectance force in all degrees of freedom of the handle.
11. The method of claim 10 wherein the output is outputted in all
degrees of freedom of the handle.
12. A method of controlling a surgical instrument comprising the
steps of: locating a controller robot between a handle and a
surgical instrument; sensing incident force components present on
the handle generated by a surgeon's hand; modulating the incident
force components in the controller robot; and outputting through
the controller robot a modulated force on the surgical instrument,
wherein the output step includes the further step of outputting the
modulated force in all degrees of freedom of the surgical
instrument.
13. The method of claim 12 comprising the further step of scaling
the modulated force to a scaled output level for outputting through
the controller robot.
14. A surgical robot comprising: a controller robot located between
a handle and a surgical instrument; a sensor for sensing an
incident reflectance force from the sensor when the surgical
instrument is contact with body tissue; a modulator for modulating
the reflectance force components in the controller robot; and a
motor for outputting through the controller robot a modulated
reflectance force on the handle.
15. A method of controlling a surgical instrument connected to a
surgical robot for a surgeon comprising the steps of: receiving
from a surgeon operator input from an input device indicating
desired forces and deflections of a robotically controlled surgical
instrument; transforming the input into control signals for
directing the motion of and application of force by a robotically
controlled surgical instrument; applying the control signals to a
robotically controlled surgical instrument; monitoring forces
applied to the robotically controlled surgical instrument by a
patient's tissue in response to motion of the robotically
controlled surgical instrument; and applying resistive forces
correlating to the monitored forces to the surgeon operator's input
device in response to input provided by a surgeon operator; wherein
said resistive forces vary sufficiently rapidly to emulate forces
resultant from tremor motions of a surgical instrument against a
patient's tissue.
16. A method of controlling a surgical instrument according to
claim 15, further comprising the step of scaling the operator input
to reduce the magnitude of forces and deflections applied by the
robotically controlled surgical instrument.
17. A method of controlling a surgical instrument according to
claim 16, further comprising the step of scaling resistive forces
applied to the input device to increase indicated forces to a level
detectable by a surgeon operator.
18. A controller robot for performing surgical procedures, the
controller robot comprising: a robotics portion, the robotics
portion comprising at least one surgical instrument unit; an
workstation portion, said workstation portion comprising a display
and an input device; a controller portion, the controller portion
comprising hardware and software for transforming input provided by
a surgeon operator via the interface portion into motion of the at
least one surgical instrument; wherein the robotics portion further
comprises force detection sensors for determining force reflectance
from tissue in contact with the at least one surgical
instrument.
19. A controller robot according to claim 18, wherein said robotics
portion comprises a left robotic arm and a right robotic arm, and
wherein the interface portion comprises a left input device and a
right input device.
20. A controller robot according to claim 19, wherein the right
input device is able to control motion of the left robotic arm.
21. A controller robot according to claim 18, wherein the input
device is engageable to a handle emulating the handle of a surgical
instrument, and further is capable of receiving input from the
handle in six degrees of freedom.
22. A controller robot according to claim 21, wherein said input
device is further capable of receiving input from a seventh degree
of freedom, said seventh degree of freedom associated with the
opening or closing of a levered handle.
23. A controller robot according to claim 21, wherein said input
device is further adapted for alternately receiving varying handles
emulating handles of surgical instruments in use.
24. A controller robot according to claim 18, wherein the robotics
portion further comprises at least one robotics arm, the robotics
arm adapted to alternately engage varying surgical instrument
units.
25. A controller robot according to claim 24, where said robotics
portion further comprises a supply of varying surgical instrument
units, the surgical instrument units adapted to alternately engage
the robotics arm.
26. A controller robot according to claim 25, wherein the
controller portion further comprises capability to direct the
robotics arm to select specific surgical instrument units for
engagement to the robotics arm.
27. A controller robot according to claim 26, wherein said
interface portion further comprises a microphone for receiving
spoken input from a surgeon operator, and wherein said controller
portion selects a surgical instrument unit for engagement to the
robotics arm dependant on input received via the microphone.
28. A controller robot according to claim 18, wherein the robotics
portion further comprises a left robotics arm and a right robotics
arm, the robotics arms adapted to alternately engage varying
surgical instrument units.
29. A controller robot according to claim 28, where said robotics
portion further comprises a left supply of varying surgical
instrument units and a right supply of varying surgical instrument
units, the surgical instrument units adapted to alternately engage
the robotics arms.
30. A controller robot according to claim 29, wherein the
controller portion further comprises capability to direct the
robotics arms to select specific surgical instrument units for
engagement to the robotics arms.
31. A controller robot according to claim 30, wherein the varying
surgical instrument units are selected dependant on a procedure to
be performed.
32. A controller robot according to claim 31, wherein the varying
surgical instrument units making up the left supply are not
identical to the varying surgical instrument units making up the
right supply.
33. A controller robot according to claim 32, wherein the left
supply further comprises at least one instrument magazine
engageable to the robotics arm.
34. A controller robot according to claim 32, wherein the right
supply further comprises at least one instrument magazine
engageable to the robotics arm.
35. A controller robot according to claim 18, further comprising a
table adapter, the table adapter for receiving the robotics portion
and indexing the robotics portion to a known location on the
table.
36. A controller robot according to claim 35, wherein the robotics
portion is selectively detachable from the mobile base when the
robotics portion is engaged to the table adapter.
37. A controller robot according to claim 18, wherein the
workstation portion is engageable to the mobile base.
38. A controller robot according to claim 18, wherein the
controller portion is engageable to the mobile base.
39. A controller robot according to claim 18, further comprising an
auxiliary interface connected to the controller portion.
40. A controller robot according to claim 39, wherein the
controller portions connected to a communications network.
41. A controller robot according to claim 40, further comprising a
database connected to said network, said database storing
parameters associated with surgeons.
42. A controller robot according to claim 40, further comprising a
database connected to said network, said database storing
parameters associated with tissues.
43. A controller robot according to claim 40, further comprising a
database connected to said network, said database storing
historical information associated with performance of a medical
procedure using the controller robot.
44. A controller robot according to claim 40, further comprising
continuous frameless navigation equipment connected to said
network.
45. A controller robot according to claim 40, further comprising
computer aided tomography equipment connected to said network.
46. A controller robot according to claim 40, further comprising
magnetic resonance imaging equipment connected to said network.
47. A controller robot according to claim 18, wherein said at least
one surgical instrument unit further comprises an imager, said
imager viewing an area associated with a surgical instrument.
48. A controller robot according to claim 18, wherein said at least
one surgical instrument comprises distance cueing capabilities.
49. A controller robot according to claim 48, wherein said distance
cueing capability comprises distance measuring equipment.
50. A controller robot according to claim 48, wherein said distance
cueing capability comprises a plurality of light beams, the light
beams aimed to converge at a location immediately in front of a
surgical instrument associated with the surgical instrument
unit.
51. A controller robot according to claim 18, wherein said
workstation portion signals instrument contact with tissue to a
surgeon operator when forces are first detected against the at
least one instrument unit by the force detection sensors.
52. A controller robot according to claim 18, wherein the
controller portion is able to modulate control signals to the
robotics arm dependant on a instrument lag parameter.
53. A controller robot according to claim 18, wherein the
controller portion is able to modulate control signals to the
robotics arm dependant on a instrument motion damping
parameter.
54. A controller robot according to claim 18, wherein the
controller portion is able to modulate control signals to the
robotics arm dependant on a instrument speed parameter.
55. A controller robot according to claim 18, wherein the
controller portion is able to modulate control signals to the
robotics arm dependant on an instrument force parameter.
56. A controller robot according to claim 18, wherein the
controller portion is able to receive definition of a boundary past
which a surgical instrument should not travel, said controller
further being able to limit motion of the robotics arm to prevent
interference between the surgical instrument and the boundary.
57. A controller robot according to claim 56, wherein the
controller portion predicts a future position of a surgical
instrument dependant on the present motion of the robotics arm, and
further signals a surgeon operator when such prediction indicates a
likely interference between the surgical instrument and the
boundary.
Description
[0001] The present application is a continuation in part of U.S.
patent application Ser. No. 10/321,171, filed on Dec. 17, 2002, the
contents of which are hereby expressly incorporated by reference
thereto into the present application.
BACKGROUND
[0002] The present invention relates to the field of robotic and
computer assisted surgery, and more specifically to equipments and
methods for robotic and computer assisted microsurgery.
[0003] As shown in U.S. Pat. No. 5,943,914 to Morimoto et al.,
"Master/slave" robots are known in which a surgeon's hand input is
converted to a robotic movement. This is particularly useful for
motion scaling wherein a larger motion in millimeters or
centimeters by the surgeon's input is scaled into a smaller micron
movement. Motion scaling has also been applied in cardiac
endoscopy, and neurosurgical target acquisition brain biopsy (with
a needle) but only in one degree of freedom, for example only for
insertion, not for a full range of natural hand movement
directions, .e., not for all possible degrees of natural motion,
Cartesian, spherical or polar coordinate systems or other
coordinate systems.
[0004] Further, in the prior art, surgical robots have been
purposefully designed to eliminate the natural hand tremor motions
of a surgeon's hand which is about a 50 micron tremor which
oscillates with some regularity. The common presumption is that
tremor motion creates inaccuracies in surgery. Therefore, robots
have been tested which entirely eliminate the surgeon's natural
hand tremor. See "A Steady-Hand Robotic System for Microsurgical
Augmentation" Taylor et al., International Journal Of Robotics
Research, 18(12):1201-1210 December 199, and also see
"Robotic-assisted Microsurgery: A Feasibility Study in the Rat"
LeRoux et al., Neurosurgery, March 2001, Volume 48, Number 3, page
584
[0005] The way the primate body handles proprioceptive perception
is via sensory feedback scaling (up and down) at the muscular level
through the intrafusal fiber system of the Gamma efferent neural
circuit. This system responds dynamically to changes in the
anticipated muscle performance requirement at any instance by
adjusting muscle tone with increased discharging for arousal and
attention focusing states, and decrease output for resting and low
attention states. The muscle spindle apparatus that does this is
located in the muscle body, therefore feedback sensory scaling for
muscle positioning, force, length and acceleration is partly
programmed at the effector level in "hardware" of the body, i.e.,
the muscle itself. The evidence indicates a 10 cycle per second
refresh rate for the human neurophysiological system in
general.
[0006] Joint position and fine motor function of the fingers occurs
through unidirectional (50% of fibers) and bi-directional (50% of
fibers) sensing at the joint structure. This coding is for rotation
about an axis, but not for force and no clear speed of rotation
feedback.
[0007] Cutaneous receptors in the skin code for motion, by
modulating higher centers in the thalamus and cerebral cortex. This
can be timed to about 75 ms delays before motion occurs, three
neuronal synaptic transmission delays. These sensors are primarily
distal to the joint of rotation and distal in the moving effector
limb. Finally, the sense of contact is totally discrete from the
above motion feedback sensory systems and the neural pathways and
integration centers in the deep hemispheres and cerebral cortices
function independent of motion to a large degree.
[0008] Force reflectance sensing is also known in order to provide
tactile or haptic feedback to a surgeon via an interface. See
"Connecting Haptic Interface with a Robot" Bardofer et al., Melecon
200--10.sup.th Mediterranean Electrotechnical Conference, May 29-31
2000, Cyprus.
[0009] However, in testing, all of these techniques ultimately slow
down the actual surgery especially when performed in conjunction
with a microscope for viewing the operation. The procedure time is
typically increased by two to three times. See Robotic-assisted
Microsurgery: A Feasibility Study in the Rat" cited above. It is
believed that this affect is related to dissonance between a
surgeons expectations and the feedback and motions of a surgical
robot in use.
[0010] Another major design issue regards the choice between
locating the surgeon in his normal operating position adjacent to
the surgical field or locating the surgeon more remotely from the
normal operating position at a terminal with a joystick and viewing
screen for example. The prior art elects to locate the surgeon
remotely from the traditional operational position about the head
and to use monitors to display the operation to the surgeon.
SUMMARY OF THE INVENTION
[0011] The present invention was developed by a neurosurgeon and
seeks to utilize the results of primate neurological research which
is indicative of a human's actual neurological control structures
and logic. Specifically, the proprioceptive and tactile
neurophysiology functioning of the surgeon's hands and internal
hand control system from the muscular level through the intrafusal
fiber system of the neural network is considered in creating the
robot and method of operation of the present invention. Therefore,
the surgery is not slowed down as in the prior art devices, because
the surgeon is in better conscious and subconscious natural
agreement and more accurate harmonization with the robotically
actuated surgical instruments based on neurological mimicking of
the surgeon's behavior through the functioning of the robot.
Therefore, the robot can enhance the surgeon's humanly limited
senses while not introducing disruptive variables to the surgeon's
naturally occurring operation of his neurophysiology. This is
therefore also a new field, neurophysiological symbiotic
robotics.
[0012] One result of the present invention, and associated
discoveries, was that preservation of the hand tremor motion was
unexpectedly found to help to maintain a natural and efficient
synergy between the human surgeon and the robotics, and thus not
disrupt the normal pace of surgery. This is believed to be because
the present invention recognizes that the surgeon's own
neurophysiology beneficially uses tremor motion, and moreover the
neurophysicology of the surgeon expects and anticipates the tremor
to exist for calibration purposes. For example, at the muscular
level, tremor is used neurologically for automated feedback sensory
scaling and also as part of probing, positioning, and training
process of the muscle spindle and muscle. Therefore, human muscle
actually performs some calibration and "thinking" itself including
anticipating forces to come based on historically learned data or
instinct. Thus, preservation of hand tremor may be
counter-intuitive, and the opposite of what is taught and suggested
in the art.
[0013] Additionally, the present invention locates the operator
interface of the controller robot to work in basically the same
orientation and location as in a standard manual operation. In
neurosurgery for example, the controller robot may be included in a
halo structure fixed to the patient's head in much the same way as
a standard retractor system is affixed. Alternatively, the
controller robot may be located on a stand, the body, the surgical
table or on a rolling or portable platform. In this manner, the
surgeon is not immediately forced to operate in an unnatural,
detached and isolated environment which is foreign to traditional
procedures to which his own body and neurological responses are
accustomed.
[0014] Therefore, in summary, the present invention in its various
controller robot embodiments may include the following features
which may be adjustable by the surgeon to his or her individual
requirements:
[0015] Hand tremor sensing, management, modulation and smoothing
with scaling capability;
[0016] Motion sensing and scaling;
[0017] Force sensing and scaling including squeeze force scaling,
and force reflectance feedback scaling;
[0018] Contact sensing and indicating;
[0019] Contact reflectance sensing, i.e., reflectance force sensing
on the tip of an instrument;
[0020] Endoscopic "tip vision" sensors located to look down the tip
of the surgical instrument;
[0021] External source interface capabilities, including but not
limited to, magnetic resonance imaging, computer aided tomograph,
and continuous frameless navigation;
[0022] Microscope interface capabilities; and
[0023] Instrument selection interface capabilities to allow
automated picking of surgical instruments.
[0024] The present invention may be embodied in a controller robot
for performing surgical procedures. The controller robot may have a
robotics portion. The robotics portion may have at least one
surgical instrument. The controller robot may also have an
interface portion having a display and an input device. The
controller robot may also have a controller portion having hardware
and software for transforming input provided by a surgeon operator
via the interface portion into motion of the surgical instrument of
the robotics portion. The robotics portion may also have force
detection sensors for determining force reflectance from tissue in
contact with the surgical instrument.
[0025] Alternately, the present invention may be embodied in a
method of controlling a surgical instrument connected to a surgical
robot wherein the first step may be locating a controller robot
between a handle and a surgical instrument. Next, incident tremor
force components (TF) present on the handle generated by the
surgeon's hand may be sensed. Then, an incident motion force (MF)
component present on the handle generated by the surgeon's hand
natural motion (NM) as the surgeon moves the handle may be sensed.
Then, the incident tremor force (MTF) components in the controller
robot may be modulated and scaled. Then incident motion force (MMF)
components in the controller robot may also be modulated and
scaled. Then, a modulated and scaled output movement (MSOM)
including the modulated and scaled incident motion force (MMF) and
the modulated and scaled incident tremor force (MTF) in the
controller robot for moving the surgical instrument via the
controller robot, in all degrees of instrument freedom, in response
to the natural movement (NM) inputted by the surgeon on the handle,
may be created. A modulated and scaled movement (MSOM) to move the
surgical instrument with all anatomically possible degrees of human
hand motion freedom, in response to a respective natural movement
(NM) inputted by the surgeon on the handle may then be outputted to
the surgical instrument. Incident reflectance force (RF) components
from the surgical instrument in the controller robot when the
surgical instrument is near body tissue may then be sensed. The
reflectance force (RFMS) components in the controller robot may be
modulated and scaled. The modulated and scaled reflectance force
(RFMS) may then be imposed on the handle. Furthermore, a
contact/non-contact condition may be sensed at the surgical
instrument, and provided to the surgeon via a display to the
surgeon.
BRIEF DESCRIPTION OF THE DRAWINGS
[0026] FIG. 1 is a side view of a patient on an operating table
with a controller robot engaged to a patient.
[0027] FIG. 1a is a top view of the controller robot engaged to a
patient.
[0028] FIG. 1b is a top view of the controller robot engaged to a
patient.
[0029] FIG. 2 is top view of a second embodiment of the controller
robot in which the controller robot is affixed to a stand.
[0030] FIG. 3 is a representation of a controller robot in
operation with associated data displays to.
[0031] FIG. 4 shows a conceptual representation of an instrumented
test.
[0032] FIG. 5 shows a prior art mount for surgery from U.S. Pat.
No. 6,463,319.
[0033] FIG. 6 shows an embodiment of the present invention wherein
the controller robot is embodied in controller, robotics,
interface, and mobile base portions.
[0034] FIG. 7 shows an embodiment of an augmented microsurgical
interface.
[0035] FIG. 8 shows a controller robot in an operating room
environment.
[0036] FIG. 9 shows an interface between a robotic arm for a
controller robot with a surgical instrument unit.
[0037] FIG. 10 shows a robotics portion according to present
invention over which a sheath has been draped to provide a sterile
barrier between the robotics portion and a patient.
[0038] FIG. 11 shows a notional instrument unit as may be used in a
controller robot.
[0039] FIG. 12 shows a notional instrument unit as may be used in a
controller robot, incorporating distance sensing equipment to
provide distance feedback to a surgeon operator.
[0040] FIG. 13 shows a notional instrument unit as may be used in a
controller robot, incorporating dual light pointers to allow the
distance between illuminated points to provide distance cueing to a
surgeon operator.
[0041] FIG. 14 shows distance differences based on instrument
distance for an instrument unit such as that shown in FIG. 13.
[0042] FIG. 15 shows a notional single instrument unit embodying an
interface compatible with the interface as shown in FIG. 9.
[0043] FIG. 16 shows a notional augmented microsurgical interface
(hereafter "AMI") for a controller robot.
[0044] FIG. 17 shows a notional rotary magazine for instruments for
a controller robot.
[0045] FIG. 18 shows a notional input device for a controller
robot.
DETAILED DESCRIPTION OF THE INVENTION
[0046] FIG. 4 shows conceptually how the present invention creates
a virtual surgical instrument by placing controller robot 10
between the surgical instrument 30 and the handle 32 of the
instrument. In this way, the surgeon is not isolated or made remote
from the operation, but instead remains in an environment to which
he is accustomed. Although the conceptual drawing illustrates a
structural connection between the instrument or instrument and the
handle, the controller robot may be indirectly linked between the
instrument and the handle.
[0047] Extrapolating new surgical concepts from known primate
research have been critical to method of the present invention, as
described generally below.
[0048] Therefore, as shown in FIGS. 1-3, in the controller robot 10
of the present invention, the creation of the perception of
"contact" per se in a surgical robot controller robot 10 should not
be based on acceleration/motion reflectance, but rather should be
based purely on a binary sense of touch (see "contact indicator"
display in FIG. 3) in order to move properly be consistent with the
human neurological system; which is different from motion
sense.
[0049] In a human, the motion sense takes over after contact
information has been initiated with a fairly fixed delay measured
in milliseconds. In the present invention, limitation of contact
information may be transferred through the controller robot 10 to
the handle 32 to the surgeon's hand through a physical feedback
such as a jerk or vibration, or optically or audibly through a
display verifying the contact with the target or proximate tissue
in the surgical field.
[0050] True force reflectance perception has to have high refresh
rates measured in milliseconds. This is consistent with numbers
described in the prior art literature which give tactile bandwidths
on the order of 500-1000 Hz. For instrument contact with soft
surfaces, 100-200 Hz may be more than adequate.
[0051] Muscle sensing seeks information regarding amplitude and
time with suitable rise and fall curves to allow to synthesize the
discrete motor performance function in question virtually in the
controller robot.
[0052] Also, the fact that the entire human sensory/motor
neurophysiologic system works in an "anticipatory mode" with
modulation by internal experience and external sensory data
indicated above may be utilized in the control function between the
operation and the instrument. The human anticipatory mode defines
the need for suitable anticipatory delays between contact, muscle
loading and neural transmissions times. All of these parameters may
be scrutinized subconsciously by the operator via optical feedback
(microscope direct vision or endoscopic instrument tip tracking)
during the surgery.
[0053] In light of the above, a first embodiment for a controller
robot 10 is discussed below. FIGS. 1a and 1b show the parts of a
controller robot 10 located about a head during surgery. A pinned
head holder 12 may be attached via cranial screws 16 to a patient
P. The pinned head holder 12 may provide a base for mounting a
right robotic arm 14 and a left robotic arm 24 via robotic arm
mounts 18. Robotic arm mounts 18 are shown as motorized and may
provide for controlled motion including motion on the micron scale
or smaller, and may be moveable and stabilized in radial tracks 20.
The robotic arms may include sub-arms such as those shown in 14a,
14b, 24a, and 24b. Alternatively, the robot arm may be mounted on a
portable tray system which would be fixed to the table which is
turn fixed to the patient or other combination for fixation.
Surgical instruments may be located at the end of the robotic arms
as shown and may be interchangeable. An automated instrument
changer such as a carousel is contemplated as well. Handles 32 may
mimic actual handles from manual surgical instruments. i.e., they
may be the same size and shape, and can be squeezeable or fixed, in
order to provide realism to the surgeon.
[0054] FIG. 3 shows a number of the data displays which are
envisioned as part of controller robot 10.
[0055] Typically, a microscope display 40 is used to view a
neurosurgical surgical field, such as, for example, a procedure
where surgical movements of the surgical instrument tips can be on
the order of 100 micrometers. When viewing the visual operation
through the microscope the surgeon may be viewing a magnified image
so that visual motions of an instrument are magnified. Therefore,
motion scaling wherein a controller robot scales down the surgeon's
movement of for example to 1 cm to 100 micrometers may be
useful.
[0056] Therefore, a settings display 50, which may include a motion
scaling feature, may be included as part of controller robot 10.
The display 50 may include hardware which runs software to control
the motorized robotic arms. The display 50 may include a touch
screen or other interface, however the software, and hardware may
be of any suitable design and this invention is not limited to any
particular hardware, software or robotics per se. The present
invention prefers to use robust hardware and software platforms for
control electronics as required for space based applications where
failure prevention is paramount. Applicable ISO and/or IEEE
standards may provide further information regarding applicable
format tolerances. Each surgeon who uses the robot controller 10
may store his or her personal settings so that his or her personal
settings can be restored at a later time, and thus the machine may
not have to be retrained.
[0057] Returning to FIG. 3, other adjustable settings are shown. An
unexpected result of the present invention in concept is the
significance of tremor regulation and management including both
scaling and smoothing of the tremor oscillation. Hand tremor is a
spurious motions which may be present in surgery. Neurological
tremor is usually a 50 micrometer (or micron) range excursion and
is an oscillation with some regularity that increases with stress.
A trained neurosurgeon's hand tremor is usually in the range of 50
to 100 microns, i.e., under a millimeter. The present concept
implements the results of primate research which suggests that hand
tremor is not an unwanted artifact of evolution, but rather a
useful and necessary product of human evolution used for natural
calibration. Typically, a hand tremor frequency can be at about 8
cycles per second and this regularity may be used by the surgeon's
nervous system to calibrate his movements. The human nervous system
uses tremor to calibrate its movements almost automatically or
subconsciously, and particularly in conjunction with coordination
with optical recognition, i.e., hand/eye coordination, such as when
a surgeon moves his hands his eyes register and acknowledge the
tremor which is used to calibrate his movements neurologically.
This neurological fact is ignored by systems which seek to entirely
filter and eliminate neurological tremor. This neurological
operation may be utilized by the present invention to provide
consistent feedback to a surgeon utilizing the controlled robot.
Thus, such utilization may create tremor motion at the tip of the
surgical instrument, such that a surgeon looking through a
microscope at the tip of his hand held instrument will see tremor
motion and his own neurological system within his body will use
tremor to neurologically and automatically calibrate his eye
motions with his hand motion. Therefore, such tremor management may
be important to surgeons and other human mimicking robotics.
[0058] In practice, due to magnification under a microscope during
microsurgical procedures, the surgeon's own optical system is not
in 1:1 natural correspondence with the optical image. Therefore,
"tremor scaling," i.e., modification and adjustment of the force of
the tremor outputted to the surgical instrument to be harmonized at
a natural level with the optical magnification selected, may be a
very important concept of the present invention which can be
provided via the controller robot 10. Such tremor scaling may help
avoid impeding the pace of the operation. The tremor scaling
feature is preferably also implemented in conjunction and harmony
with motion scaling. For example, reducing natural tremor to half
speed may improve the surgeon's movement. This is because the
controller robot 10 in toto has enhanced the surgeon's
movements.
[0059] For example, a typical surgeon's real hand motion or
excursion of 5 centimeters with the surgical instrument may contain
a 50 micron tremor excursion oscillation, and the motion at the
surgical instrument tip (at the actual surgical site) may be scaled
down by the controller robot 10 to become a 5 millimeter motion
(motion scaling) but may also includes a scaled down tremor motion
of 2 microns (or any value the surgeon is personally comfortable
with given settings based on trial and error wherein such settings
may be stored in the controller robot 10 from one surgery to the
next). Thus, the controller robot may effectively maintain in a
relative fashion, the effect of the surgeon's hand excursion even
under magnification under a surgical microscope, through scaling.
Therefore, when a surgeon looks at the surgical instrument through
a microscope, what he of she may see is a robotically controlled
but natural looking 2 micron tremor excursion (minified from 50
microns) over his 5 millimeter motion (minified from 5
centimeters). This may enhance the surgeon's actual useable natural
range and allow him to have enhanced capabilities by first allowing
him make his hand motions on a human scale of 5 centimeters and
then scaling his motion down to 5 millimeters. Therefore, he or she
may move his or her hand accurately in the micron range. Such
scaling may be performed by the controller robot 10 in all degrees
of freedom associated with a surgical instrument in use, or only
with regard to selected degrees of freedom. Second, by
incorporating and scaling a tremor motion, the natural calibration
of the surgeon's neurological system may be maintained when the
surgeon looks through the microscope.
[0060] Additionally, given that calibration based on tremor is an
important feature for proper motion of the surgeon's hand, the ?
may assist a surgeon by eliminating or processing anomalies from
the tremor oscillation to allow the surgeon's neurological system
to better self-calibrate itself, referred to hereafter as "tremor
smoothing" or "tremor shaping." Therefore, if a surgeon is looking
at the tip of an instrument, his or her optical feedback which is
used for controlling his or her hand can be influenced if anomalies
and great irregular deviations in his tremor signal are smoothed to
be an oscillation with cyclical regularity. Thus, "tremor
smoothing" can actually assist the natural neurological
calibration, rather than slowing it down by eliminating tremor as
taught in the prior art.
[0061] It is envisioned that in the present invention the
controller robot 10 when first used may have to be trained, i.e.,
optimal settings determined on animal tissue, in order for the
surgeon's initial settings to be derived. Thereafter, the surgeon,
while actually using the controller robot 10 on humans, may also
store his or her settings which can be analyzed in real time. A
surgeon can store multiple modes, and may "shift gears" during a
procedure depending on stored settings. Therefore, enabling
personalized surgical robotic symbiosis is another new feature of
the present invention, such symbiosis may be enhanced by providing
the controller with an ability to predictively apply stored
settings which gives the controller robot a layer of artificial
intelligence which is designed to mimic the artificial intelligence
or natural responses naturally present in the neurological system
and for example in the muscle tissue.
[0062] Force scaling may be incorporated in the robotic controller
in all degrees of motion. For example, a neurosurgeon may be
capable of applying 0.01 Newtons of force as his or her minimum
force. However, delicate tissue may require a smaller force to be
applied to avoid damaging the tissue. Therefore, force scaling may
allow a surgeon to scale or minify the actual force presented to
the surgical instrument 30. This may be accomplished though the
controller robot 10. Conversely, feedback forces may be scaled up
or magnified. Significantly, this may enhance the surgeon's natural
perception of the tissue's resistance, density, and elasticity.
[0063] The present invention may enable force scaling in all
instrument degrees of freedom, i.e., the scaling is not limited to
one direction as in some prior art cardiac endoscopy robots for
example. Therefore, all degrees of freedom of movement may be
enabled. For example, the controller robot may move a surgical
instrument in seven degrees of freedom, and such forces and
displacement magnitudes may be sealed or modulated in each of the
seven degrees of freedom.
[0064] Force feedback or force reflectance may enable the tip of
the surgical instrument to relay through the controller robot 10
the feedback forces to the handle 32. Feedback on the handle 32 may
be thought of as a virtual reality representation of the
microsurgery environment and the tip. Such force feedback may also
be capable of being scaled in a continuous real time fashion.
Continuous resistance, elasticity, kickback movements, jerks or
other movements may be presented at the handle 32 as they occur at
the surgical instrument 30 tip. Significantly, some of these forces
may be so small that they need to be scaled up in level to be felt
by the surgeon. Therefore, force reflectance may enable the surgeon
to actually feel feedback via the handle which he is not naturally
capable of feeling, thus enhancing his or her sensing of instrument
feedback during a procedure.
[0065] Contact sensing may also be enabled in the controller robot.
Contact is a binary logic circuit in human neurology, i.e., either
there is contact with tissue or not. It is not a time varying
function of force as in force reflectance above. Therefore, the
controller robot 10 may harmonize the body's natural "binary"
contact sensing circuit by implementing a binary contact sensor and
display (see FIG. 3, Contact "Yes," "No"). Alternately, a scaled
jerk motion may also be presented to the handle 32 to represent
contact. Such scaling may enable the surgeon to feel small contacts
(i.e., delicate tissue) which would not be naturally felt.
[0066] Mini-endoscopic tip-vision capability is also taught and
suggested by the present invention to enable a view down the tip of
the instrument. Such a tip display or "instrument eye view" may
enable vision from angles which are impossible to see through a
traditional microscope view finder. Displays for such endoscopes
are shown as right endoscopic tip display 60 and left endoscopic
tip display 70 in FIG. 3. The displays may be capable of showing
many views and magnifications, current position and history display
of the course the instrument has traveled during the operation.
Playback of actual images, "instant re-play of the operation moves"
may also be part of the history capability.
[0067] It is also contemplated that the handle 32 may be
interchangeable and exchangeable to mimic actual standard surgical
handles depending on field specific, surgeon specific, or operation
specific conditions. For example, some handles may be squeezable,
while some may be different shapes. Such handles may be
instrumented accordingly to receive relevant impute from a
surgeon.
[0068] In a second embodiment, the controller robot 10 of the
present invention may take the form shown in FIG. 6. The components
of the controller robot may include a robotics portion 602, a
surgeon workstation portion 604 (not illustrated in FIG. 6), a
controller portion 606, and a mobile base 608. The controller
portion 606 may be integrated with the robotics portion 602, the
workstation portion 604, or the mobile portion 608. The robotics
portion 602 may include left and right robotic arms 610, 612
(discussed further below) for carrying out commanded actions. The
robotics portion 602 may be adapted to be engaged to an adapter 614
attached to a surgical table 616 (not illustrated in FIG. 6), such
that the positioning of the robotics portion 602 relative to the
surgical table 616 may be adapted for various types of procedures
on varying portions of a patients anatomy simple by adjusting the
position of the adapter 614.
[0069] The ability to locate the robotics portion 602 at various
locations relative to the surgical table 616 may allow different
types of surgery to be accomplished with the same controller robot
10. Furthermore, since an adapter 614 may be moved between surgical
tables, use of a controller robot 10 may not be limited to a single
operating room. Accordingly, the utility of the controller robot
may be maximized, as the need to procure multiple controller robots
for multiple operating rooms can be avoided. Finally, an additional
efficiency may be gained through the reduction in cross training
required by a surgeon where a single piece of equipment is able to
replace several different pieces.
[0070] The mobile base 608 may allow the components of the
controller robot 10 to be portably located within the operating
environment as desired. As preparation of a patient may require the
fullest access possible to the patient, it may be desirable to
minimize the equipment immediately adjacent to the patient during a
preparatory phase, while retaining the ability to utilize robotics
during the actual procedure. Accordingly, the ability to move at
least the robotics portion 602 of the controller robot 10 into and
out of the surgical field may provide benefits during the complete
surgical procedure.
[0071] As shown in FIG. 6, the robotics portion 602 may be provided
with features for alternately engaging the robotics portion 602 to
a mobile base 608 or to table adapter 614. The engagement between
the robotics portion 602 and the mobile base 608 may be
accomplished by a tongue in groove joint 616, utilizing a rail
feature 618 on the robotics portion 602 and a channel 620 on the
mobile base, to form a self aligning and supporting engagement
between the robotics portion 602 and the mobile base 608 when the
robotics portion 602 is engaged to the mobile base 608.
Additionally, retention features 622 such as a threaded retaining
pin 624 may be provided to ensure retention of the robotics portion
602 to the mobile base 608 when the robotics portion 602 is engaged
to the mobile base 608.
[0072] Similar engagement and retention features may be provided
between the robotics portion 602 and the table adapter 614. The use
of the rail in channel structure assists in orienting and
positioning the robotics portion relative to the table adapter 614,
such that indexing the position of the adapter 614 to the surgical
table may allow correct indexing of the robotics portion 602 to the
table 616. With regard to some neurosurgical procedures (as well as
other procedures), the patient may be fixed relative to the table
616, such as through the use of positioning screws (such
positioning screws are known and used in the neurosurgical art),
such that the position of the patient may be indexed to the table
616. Thus, the position of the patient relative to the robotics
portion 602 of the controller robot 10 may be established by the
indexing of the patient and the robotics portion 602 of the
controller robot to the surgical table 616.
[0073] Dis-engagement of the workstation portion 604 shown in FIG.
7 during procedure, through which a user controls the robotics
portion 602, from the robotics portion isolates any potential
spurious motions of the surgeon operator from the robotics portion
602, such that such motions are not inadvertently transferred to a
patient through an instrument or effector. Such isolation reduces
the likelihood of harm as a result of any such spurious motion.
Such isolation further may prevent spurious motions of a patient
from being transmitted to a surgeon operator during a procedure,
thus further reducing the likelihood of harm resultant from
spurious motions.
[0074] The mobile base 608 may be provided with features for
allowing the mobile base 608 to be alternately rolled around within
a surgical environment, or fixed relative to a specific position
within the operating environment. Such alternating function may be
accomplished by providing the mobile base 608 with both rollers 802
(shown in FIG. 8) or casters, as well as jack screws 804 (shown in
FIG. 8) to support the mobile base 608 off of the rollers 802 or
casters when it is desired that the mobile base 608 not move.
Additionally, the robotics portion dock 626 on the mobile base 608
may be height adjustable relative to a floor on which the mobile
base 608 is resting, such that the position of the robotics portion
dock 626 may be adjusted relative to the robotics portion 602 to
allow alignment of the robotics portion 602 relative to the dock
626 to allow engagement of the robotics portion 602 to the dock
626.
[0075] The mobile base 608 may also be adapted to have the elements
which comprise the surgical workstation portion engageable to the
mobile base 608. As shown in FIG. 7, the surgical workstation
portion 604 may include left and right controllers 702 704, as well
as a user interface 706 for displaying operation parameters and
feedback signals to a surgeon using the controller robot 10. The
user interface 706 may be a touch-sensitive display, allowing a
user to select and set parameters, as well as to view graphic
representations of feedback, such as discussed further below. The
controller portion 606, which may include software and hardware for
converting inputs from the workstation portion 604 into motions by
the left and right arms 610, 612, may be integrated into the
workstation portion 604, such that the entire controller robot 10,
including the robotics, workstation and controller portions 602,
604 and 606 may be transportable as a unit when engaged to the
mobile base 608. Alternately, the controller portion may be a
preparation unit, attachable to the mobile base, or be remotely
located away from the operating environment.
[0076] The robotics portion 602 may include two arms 610, 612
having several degrees of freedom to allow correct positioning and
orientation of instruments and/or effectors attached to the ends of
the arms. The arms may include two sections, having at least two
degrees of freedom at each joint, or may have more than two
sections allowing movements to be accomplished by lesser motions at
each joint.
[0077] The ends of the arms 610, 612 may be designed to allow
different instruments or instrument magazines to be interchangeably
attached to the ends of the arms 610, 612. As shown in FIG. 9, the
end 902 of an arm 904 (a non-left/right specification is shown) may
be formed by a interchange block 906 having features for engaging a
instrument unit, such as those discussed further below. The
interchange block 906 may also be provided with instrument
retention features, such as threaded rods 908 extending from a face
910 of the interchange block 906, which are adapted to be received
by a an instrument unit or instrument magazine (shown generically
as 912 or FIG. 9). The threaded rods 908 may be reversibly driven
to allow the rods 908 to be alternately threaded into or withdrawn
from threaded receiver holes 914 on an instrument unit 912. The
interchange block 906 may also be provided with alignment
receptacles 916 for receiving alignment pins 918 on the instrument
unit 912, to assure proper orientation and positioning of the
instrument unit 912 relative to the interchange block 906. A
communications receptacle 920 may also be provided on the face of
the interchange block 906, for receiving a communications connector
922 on an instrument unit 912 to allow communication of electrical
signals between the interchange block 906 and the instrument unit
912.
[0078] The interchange block 906 may have two degrees of freedom
relative to the wrist 924 of the arm. These degrees of freedom may
be a rotational degree of freedom 930 about a finger pin axis 926
extending through a finger pin 928, and a rotational degree of
freedom 932 about an axis 934 perpendicular to the axis 926 through
the interchange block 906 and an engaged instrument unit. The
degree of freedom 930 about the finger pin axis 926 may be provided
by mounting the interchange block 906 to a wrist block 936 through
the finger pin 928. The finger pin may be provided with a
non-circular cross section, such that the interchange block 906 can
not rotate about the pin 928. The pin 928 may extend from a wrist
motor 938 mounted to the wrist block 936, such that rotation of the
pin 928 caused by the wrist motor 938 will cause the interchange
block 906 to rotate about that axis 926. The interchange block 906
may be retained to the finger pin 928 by a fastener 939 threaded
into the end of the finger pin 928 to retain the interchange block
906 to the finger pin 928. Slip rings 940 may be provided between
the interchange block 906 and the wrist block 936 to allow
communication of electrical signals between the interchange block
906 and the wrist block 936 during rotation of the finger pin 928.
Alternately, a flexible wire bundle (not shown) may be provided
between the wrist block 936 and the interchange block 906, although
the use of a flexible cable bundle may require imposition of a
limit on the range of rotation through which the interchange block
906 may be rotated.
[0079] The interchange block 906 may be provided with an annular
channel 942 surrounding the outer surface 944 of the interchange
block 906, to allow a sterile sheath 944 to be retained to the
interchange block 906. As shown in FIG. 10, the sterile sheath may
extend from the interchange block 906 down the arm to which the
interchange block 906 is connected, and may further extend to
encompass all or substantially all of the robotics portion 602 to
provide a sterile barrier between the robotics portion 602 and a
patient on whom the controller robot 10 is being used.
[0080] The use of the interchange block 906 allows varied
instruments to be implemented on the end of the arm 610, 612, such
that the same robotics portion 602 may be used for different
surgical procedures simply by changing the available instruments
for the arm. Furthermore, the instruments available for use during
a procedure may be expanded through provision of instrument units
which carry multiple instruments (hereafter referred to as
instrument magazines), through the use of instrument trays attached
to the robotics portion 602 (such as those shown in FIG. 6 as
reference 628), or through the use of instrument trays containing
instrument magazines. The incorporation of features which allow an
arm 610, 612 to connect to or disconnect from instrument units
allows such instrument units to swapped onto the end of the arm
610, 612 with minimal manual intervention from a surgeon
operator.
[0081] The capability of using multiple instrument units on the
arms 610, 612 of the robotics portion 602 requires the adoption of
a standard interface between the instrument unit and the
interchange block 602. The standard interface should include both
the mechanical interface definition, as well as the electrical
interface definition. The electrical interface definition should be
able to provide available communications paths for each type of
signal which may be needed to be communicated between a an
instrument unit and the controller portion 606.
[0082] An illustrative probe instrument unit is shown in FIG. 11
The probe 1102 shown may be used to press on or move tissue during
a procedure. As shown, the probe 1102 may be connected to its
instrument unit 1104 through a load cell 1106, which may be capable
of measuring forces in one or more directions. The use of the load
cell 1106 allows communication of the amount of force that the
probe 1102 is applying to be communicated to the controller portion
606, which may then use the information for other purposes, such as
for generation of feedback to a surgeon operating the controller
robot. The load cell 1106 will likely require the presence of an
excitation voltage, as well as available paths for communicating
response values from the load cell 1106. These signals may be
communicated to the controller portion 606 in either analog or
digital form. If the signals are communicated in an analog form,
the analog signal would need to be converted to a digital signal in
the controller portion 606. Such analog to digital capture
capabilities are available in programmable form, such that the same
analog to digital unit or units in the controller portion would be
able to receive and transform signals from varying types of sensors
provided in a instrument unit.
[0083] The instrument unit may additionally be provided with
features for assisting a surgeon operator in determining the
distance of an instrument from a piece of tissue. Although the use
of binocular viewing devices can provide depth information, the use
of monocular viewers, or two dimensional displays, reduces the
availability of visual depth perception cues. Accordingly, it may
be desirable to provide cueing for the surgeon operator to assist
the surgeon operator in determining distance from and predicting
contact with tissue.
[0084] One potential visual aid is the addition of a visible light
pointer 1108 to indicate the direction in which the probe 1102 is
pointing. The power of the light source 1110 must be maintained at
a minimum to limit any adverse tissue heating affects. Accordingly,
the size of the light source 1110 may be maintained small enough
such that the source 1110 may be built into the instrument unit
912, slightly off axis from the probe 1102 itself. The inability to
have the light 1112 point directly down the axis 1114 of the
instrument may be offset by aiming the light 1116 at a point of
contact 1118 immediately in front of the position where the probe
1102 would contact tissue 1120, such that that the surgeon would be
able to estimate distance to instrument contact based on the gap
between the probe 1102 and the projected point of light, relative
to the size of the probe 1102 and the viewed motion of the probe
1102.
[0085] A variation on the single light distance cueing is the use
of a proximity sensor. A proximity sensor may use a transmitter and
receiver pair to determine the distance between the transmitter and
a surface. The measured distance may be compared to the known
length of a probe to determine the distance between the end of the
probe and tissue in front of the probe. As shown in FIG. 12, the
transmitter 1202 and receiver 1204 may be off-set on opposite sides
of the probe 1102, such that the distance being measured is the
distance between the end of the probe and the tissue, rather than
the tissue off-set a distance from the probe 1102.
[0086] The distance between the end of the probe 1102 and the
tissue may be represented to the surgeon through a visual or
audible display presented on the workstation portion 604. For
example, an aural indicator, declining in magnitude until zero at
contact, may be provided. Alternately, a graphical read out of the
distance between the tissue and the end of the instrument may be
presented, or the distance may be presented in a graphical format,
such as a vertical bar graph indicating the distance between the
end of the instrument and the tissue.
[0087] As shown in FIGS. 13 and 14, an alternate distance cueing
capability may be created by providing two light pointers 1302,
1304, such that when aligned, the points are projected onto the
tissue past the instrument. Due to the angle between the light
paths, the distance .DELTA., shown in FIG. 14, between the
projected points will increase when the instrument is farther away
from the tissue, and decrease as the instrument comes closer to the
tissue, until the projected points of light are projected onto the
same point immediately before contact.
[0088] The instrument units themselves may be provided with the
necessary structure for interfacing with the interchange block
directly, such as shown in FIG. 15. The instrument unit 912 shown
in FIG. 15 is also provided with a video camera 1502 to allow a
instrument's eye view to be obtained for the surgeon, such that the
view may be provided to a surgeon operator through instrument view
displays (such as those shown in FIG. 16).
[0089] Instrument units 912 may alternately be designed to allow
several instrument units to be contained in a magazine which can be
engaged to the interchange block. In such a configuration, some
form of ability to extend and retract the individual instrument
units must be provided, to allow the motion of the instrument in
the operation site without increasing the risk of accidental
contact between not-in-use instruments and patient tissue.
[0090] A notional instrument magazine is shown in FIG. 17 showing
two instrument units 1702, 1704 in a magazine 1706, with a probe
instrument unit 1702 shown in an extended position and a forceps
instrument unit 1704 shown in a retracted position. A latch 1708
may be provided to positively engage an extended instrument unit
with a drive 1710 for extending the instrument unit. Additionally,
contacts 1712 for electrical communication between the instrument
unit 1702 and the magazine 1706 may be provided on the outer
surface of the instrument unit 1702, such that different instrument
units may be engaged in the magazine 1706. Where a magazine 1706 is
utilized, a instrument's eye view camera 1714 may be incorporated
into the magazine 1706, allowing the complexity of instrument units
to be kept at a minimum. The magazine 1706 may be provided with
features for engaging the interchange block, including alignment
pins 1716, and an electrical connector 1718 for providing a
communications path between the instrument units and a remotely
located controller portion 606.
[0091] The notional magazine shown may use a rotary pattern, in
which instrument units are rotated about the long axis of the
magazine 1706 until located in a deployment station. In the
deployment station, an extension drive 1720 may move the instrument
unit forward to a deployed position, in which a surgeon can direct
the effector portion of the instrument as required for an on-going
procedure.
[0092] The use of instrument magazines allows quicker instrument
access over requiring a robotic arm to move to a instrument change
station, thus providing a more efficient surgical procedure. The
selection of instruments to incorporate in a magazine, however, is
a trade-off between the allowable size of the magazine, especially
in the surgical site, versus the speed with which instruments must
be accessible. The use of instrument trays to hold spare magazines
with different instrument mixes allows utilization of a magazine
tailored for a specific portion of a procedure, while retaining a
larger selection such as can be made available on a instrument
tray. Thus, the instruments provided in a magazine can be
instruments which will be needed rapidly or frequently, while
instruments kept in magazines on the instrument tray may be
instruments needed at a later point in the procedure, or
instruments for which the change-overtime required to change a
magazine is not as critical. Furthermore, the instrument tray may
be used to hold both instrument magazines and instrument units
adapted to engage the interchange block.
[0093] Furthermore, the instrument trays may be replaced during a
procedure, such that several different mixes of magazines and
individual instrument units may be utilized during a procedure. The
mixes selected may be dependant on the surgeon utilizing the
controller robot, as well as on the procedure being performed.
Individual instrument trays may be marked to allow the controller
robot 10 to identify instrument magazines and instrument units
loaded into a tray, such that the controller portion 606 may
display correct selection parameters to a surgeon during a
procedure, as well as provide feedback when a instrument is not
available in a given mix of instrument units in magazines and
individual instrument units. The marking may be accomplished by
providing an identifier for a tray, and having a stores list for
the tray pre-stored in the controller portion, or may utilize
auto-detection capabilities to query instrument units in the tray
to identify themselves.
[0094] As shown in FIG. 7 the workstation comprises the interface
between the surgeon and the controller portion 606, and accordingly
should be configured to provide necessary information to a surgeon
during a procedure, as well as to receive necessary input from the
surgeon during the procedure. Typically, surgeons use vocal
commands to receive assistance from other personnel in the
operating theater in order to minimize the actions required from
the surgeon apart from the procedure itself. For example, a surgeon
desiring a different instrument than the one presently in hand may
verbally request to be provided with a different instrument. Thus,
the workstation may preferably include speech recognition
capabilities to allow the surgeon to function in a manner
consistent with traditional practices.
[0095] The workstation may include three types of input
capabilities: instrument position, speech recognition, and manual
selection. The instrument position input may be received via left
and right instrument input devices 702, 704, as described above.
The instrument input devices may comprise articulated arms which
allow a surgeon to operate handles 710, 712 in a manner consistent
with the motions that would be required to manually utilize the
instrument in question. As shown in FIG. 18, the handles 710, 712
may be connected to the arms 702, 704 through a load sensing device
1802, able to determine the forces which are being applied to a
handle 710. The load sensing device may be a six-axis load cell,
able to measure forces in three axes and torques in three axes.
[0096] Gross motion of the handle may be allowed through the use of
an intermediate arm section 1804 or sections. The intermediate arm
section 1804 or sections may utilize one or more degree of freedom
motion at each end of the section, similar to the joints of the
robotics portion arms, to allow motion to be imparted through the
controller. Feedback may be provided to the surgeon through
coupling of feedback mechanisms 1808 in each degree of freedom. The
handle 710 may be provided with a rotational degree of freedom
about the long axis of the handle 1806. A feedback mechanism, such
as a stepper motor controlled by the controller portion of the
controller robot (not shown), may be used to both provide
resistance to rotation of the handle by the surgeon, as well as
vary the resistance and reflective force based on feedback being
measured at an instrument.
[0097] The intermediate arm 1808 or arms may be connected to a base
arm 1802 through a joint having one or more degrees of freedom,
with each degree of freedom being coupled with a feedback
mechanism. Finally, the base arm 1802 may be connected to the
workstation structure (not visible in view) through a joint 1812
having one or more degrees of freedom, with each degree of freedom
being coupled with a feedback mechanism. Furthermore, each joint
should be provided with position sensing means, such a variable
resistance potentiometer, to allow the controller portion to
determine the position and orientation of the handle while in
use.
[0098] The mechanism may be designed so as to allow smooth motion
in the six degrees of freedom 1814 of a simple handle. The six
degrees of freedom may correspond to deflections in three axes, as
well as rotation in three axes.
[0099] The handle itself may include an additional degree of
freedom 1816, such that seven degrees of freedom define motions of
the handle. The seventh degree of freedom may be associated with
the clamping of the grip, such as where two grips 1818, 1820 are
levered to allow an operator to emulate the motion of scissors,
forceps, or a hemostat. Since different instruments may require
different motions at the handle, the handle may be rapidly
interchangeable through the use of a connector 1822 between the
handle 710 and the intermediate arm 1808.
[0100] Returning to FIG. 7, the workstation structure may
additionally be provided with adjustable supports 714, 716 to
provide stability to a surgeons arms during a procedure. The
ability to adjust the position of the supports 714, 716 allows the
surgeon to correctly position his or her arms relative to the
handles 710, 712 during a procedure.
[0101] Verbal input may be received into the workstation through
the incorporation of a microphone 718. The microphone 718 may be
external to the structure of the workstation, such as in the form
of a clip on microphone or boom microphone extending from the
workstation, or may be built internally in the workstation. Such a
design choice is dependant on the ability of the microphone 718
selected to adequately detect commends uttered by the surgeon
during a procedure, while remaining in a non-interfering
location.
[0102] Manual entry capabilities may also be provided, such as
through the use of a touch screen display 708. Alternately, other
pointing devices (not shown), such as a mouse, trackball, or force
post may be utilized, however it may be beneficial to minimize the
necessity for a surgeon to remove his or her hands from the handles
during a procedure. Finally, display commands may be received from
a surgeon via the microphone in response to verbal commands.
Alternately, an auxiliary display and input device may be provided
to allow an assistant to the surgeon to be responsible for manual
data entry during a procedure.
[0103] Instrument eye view displays may either be provided adjacent
to the left and right robotic arms, where the surgeon is located
immediately adjacent to the surgical field, or through instrument
eye view displays 1604, 1606 incorporated into a display
presentation on the workstation (such as is shown in FIG. 16). The
use of a graphical user interface allows displays to be generated
by the controller portion based on the needs of the surgeon at that
point in a procedure, or in response to pre-programmed or manually
selected parameters provide by the surgeon.
[0104] In addition to force and motion feedback provided to the
surgeon through the handles, visual feedback can be provided
through the display on the workstation. A notional display is shown
in FIG. 16 showing an illustrative force/response curve resultant
1602 from pressing a probe as discussed above against tissue,
showing both a force deflection curve 1608 resultant from imposing
the probe against the tissue, as well as a hysteresis curve 1610
resultant from a controlled withdrawal of the probe from the
contact with the tissue. Selection of sensor displays may be voice
activated, such that a surgeon can reconfigure the display as
required during a procedure. Alternately, the reconfiguring of the
display can be the responsibility of an assistant in verbal
communication with the surgeon during the procedure, such as
through an auxiliary interface (shown in FIG. 8).
[0105] The controller portion 606 of the controller robot 10 may be
able to cross control instruments when selected. Thus, the operator
could elect to control a instrument on a left robotic arm through a
right handle on the workstation. The controller logic may provide
additional functionality during such cross-control utilization,
such as locking out the non-used control to limit the likelihood of
control confusion resulting from simultaneously cross controlling
multiple instruments. Additionally, display parameters may be
imposed during such cross-controlled utilization, such as enforcing
the selected instrument's instrument-eye view for the primary
display during cross-controlled utilization.
[0106] The controller portion 606 of the controller robot 10 may
include a general purpose computer operating a program for
controlling motion of the robotic arms as a result of input from a
surgeon via the workstation. Accordingly, the controller software
may be designed to enable to controller to assist the surgeon in
varying ways, such as the imposed limitations associated with
cross-controlling discussed above, or the generation of the
force/response and hysteresis display shown in FIG. 16
[0107] The information obtained from a sensor such as the probe
illustrated in FIG. 12 may be used for more than simple feedback to
the surgeon. Analytical methods may be applied to the results to
provide characterizations to a surgeon. For example, tissue
stiffness or hysteresis values obtained from force/position
information obtained from a probe may be compared to cataloged
tissue characteristic inform such as information stored in a remote
database 806 as shown in FIG. 8. The characteristics of the tissue
may be matched with known tissue values, or may be compared with
known values for particular tissue type selected by the surgeon.
Other sensors may be selected as useful during the procedure (while
such sensors are incorporated into a instrument unit or magazine)
to allow a surgeon to obtain a variety of parameters (temperature,
mechanical characteristics of tissue, oxygen saturation of blood
adjacent to a surgical site, etc.), or to allow the surgeon to
select control points in a surgical field. Such control points may
be utilized to identify boundaries for allowable motion of the
instruments or other elements of the robotics portion of the
controller robot. Furthermore, connections to external systems such
as continuous frameless navigation capabilities may allow the
externally obtained data to be superimposed into displays presented
on the workstation, such as a microscope view
[0108] The principal purpose of the controller portion, 606
however, is to translate the inputs of the surgeon as provided
through the handles into motions made by instruments engaged to the
arms of the robotics portion. Parameters may be provided by the
surgeon to affect the motion of the robotic arms and instruments in
response to input commands provided by a surgeon through the
handles. As discussed above, scaling of motions and forces may
assist a surgeon in working in miniature, as may be required during
some procedures. Additionally, damping parameters may be applied to
provide increased controllability of instruments during a
procedure.
[0109] The use of parameters may be implemented to provide a robust
situation for motion of the instruments, such that maximum speed
constraints, maximum motion constraints, motion damping, and
controlled area prohibitions may be implemented as requested by a
surgeon to assist the surgeon during a procedure. Controlled area
prohibitions may be implemented based on control points identified
by the surgeon, such that the controller portion may maintain a
spatial model of the geometry of the patient and surrounding
structures to prevent contact between instruments or any other
portion of the robotics portion and prescribed areas. Offsets may
be provided based on control points, such that the actual geometry
of a prescribed area may be determined based on located reference
points without requiring contact with the actual prescribed area,
or to impose a no-contact safety margin between a prescribed area
and an instrument or other part of the robotics portion.
[0110] The inviolability of the prescribed area may further be
enhanced through the implementation of predictive motion modeling
to generate expected position information, such that interference
determinations between a prescribed area and an instrument position
may be based not only on the position of the instrument, but also
on the existing path of the instrument in motion, such that
potential or predicted contact with a prescribed region may be
signaled to the surgeon prior to such contact occurring, as well as
allowing smoothing of the motion of the instrument adjacent to such
a prescribed area. For example, as the contact potential measured
as a factor of distance, direction of travel, and instrument speed,
increases, the controller portion 606 may automatically increase
motion damping and decrease maximum instrument velocity allowable,
to provide the surgeon with greater control adjacent to the
prescribed portion.
[0111] The ability to impose motion constraints, such as maximum
instrument velocity, maximum instrument acceleration, and maximum
instrument force, may be implemented to limit the likelihood of
unwanted contact or spurious motions by the instrument. Force
limitations may be applied to prevent damage to tissue which could
result from over-application of force to tissue. Accordingly, it
may be beneficial to provide for rapid configuration of the
instrument force limit, to allow a surgeon to vary the instrument
force limit based on an expected tissue type. Such a determination
may further be assisted through the use of a catalog of force
limitations based on tissue type, such that tissue type
determinations obtained through external analysis, such as magnetic
resonance imaging or computer aided tomography, may be applied to
the spatial model of the surgical field to vary force limits based
on tissue types defined by the external analysis.
[0112] The controller portion may be provided with a means for
communicating information obtained during a procedure with external
processors, to allow integration of the information utilized by the
controller portion with information in use by other equipment in
the surgical theater or hospital environment in general. For
example, a network connection may be utilized by the controller
portion to receive data obtained by magnetic resonance imaging or
computer aided tomography to provide information for a spatial
model of the surgical field. Alternately, the positions of each
portion of the robotic arms may be used to determine the position
of an instrument, such that the information could be exported to
continuous frameless navigation equipment to allow the position of
the instrument within the surgical field to be communicated to and
integrated with the spatial information contained within the
continuous frameless navigation equipment, or within the imagery
presented by a enhanced viewing equipment, such as a electronic
microscope. Other information, such as control points, could also
be communicated between the pieces of equipment, such that the
information could be overlayed into the other pieces of equipment.
For example, a pre-defined prescribed area could be shaded in an
electronic presentation of a microscope or instrument eye view, to
inform the surgeon of the presence of and location of the
prescribed area during a procedure, without requiring the surgeon
to change attention from one display to another.
[0113] The exporting of information from the controller portion to
external equipment may also allow remote storage of historical
procedure information, such as the instrument selection and
instrument position at any point during a procedure, such that the
stored information could be later used to replay a procedure for
teaching or review purposes. Furthermore, since the connection
between the surgeon and the robotics portion is electrical, the
stored information could be utilized to generate a replay of the
handle positions and feedbacks, to allow a physician to follow
through the procedures without actually creating motion of a
robotics portion, while viewing the displays presented to the
surgeon during the procedure.
[0114] Stored data may also be utilized to generate predictive
selection of instruments for a surgeon prior to and during a
procedure. For example, a certain surgeon may utilize a specific
group of instruments for a specific type of procedure,
distinguishable from the instruments that a different surgeon would
select. Archived instrument selection information would allow
provisioning of instrument trays based on the surgeons prior
instrument selections, reducing the effort required to determine
instrument provisioning for a procedure. Alternately, expected
instrument information could be presented to an assistant to the
physician to allow the assistant to review and confirm instrument
selection based on the expected instrument selections, such as
through the auxiliary workstation, further improving the efficiency
of instrument provisioning in the surgical theater.
[0115] Finally, archived instrument selection information could be
used administratively, such as to generate billings for instruments
used during a procedure. Such use would reduce the administrative
overhead associated with determining instrument usage for billing
after a procedure.
[0116] Other variations and modifications of the present invention
will be apparent to those of skill in the art, and it is the intent
of the appended claims that such variations and modifications be
covered. The particular values and configurations discussed above
can be varied and are cited merely to illustrate a particular
embodiment of the present invention and are not intended to limit
the scope of the invention. It is contemplated that the use of the
present invention can involve components having different
characteristics as long as the principles of the invention are
followed.
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