U.S. patent application number 14/568691 was filed with the patent office on 2015-05-21 for surgical procedures using instrument to boundary spacing information extracted from real-time diagnostic scan data.
This patent application is currently assigned to VANTAGE SURGICAL SYSTEMS, INC.. The applicant listed for this patent is VANTAGE SURGICAL SYSTEMS, INC.. Invention is credited to James S. Gibson, Hubschman P. Jean, Steven Schwartz, Tsu-Chin Tsao, Jason Wilson.
Application Number | 20150141801 14/568691 |
Document ID | / |
Family ID | 45494218 |
Filed Date | 2015-05-21 |
United States Patent
Application |
20150141801 |
Kind Code |
A1 |
Jean; Hubschman P. ; et
al. |
May 21, 2015 |
SURGICAL PROCEDURES USING INSTRUMENT TO BOUNDARY SPACING
INFORMATION EXTRACTED FROM REAL-TIME DIAGNOSTIC SCAN DATA
Abstract
Specific embodiments of the invention are directed to improved
surgical procedures involving the use of processed non-visual
three-dimensional data (i.e. diagnostic scan data) to provide a
surgeon with additional guidance (i.e. more than that generally
obtained from visual observation of the working area) concerning
the distance separating a working end of a surgical instrument and
the posterior portion of a target tissue. Separation information
may be used to aid the surgeon in minimizing the risk of unintended
penetration of adjacent tissue with the working end of the
instrument. Some embodiments provide for the visual and/or auditory
conveyance of distance information to the surgeon. Additional
embodiments provide for overlaying visual representations of
selected three-dimensional structure information (e.g. depths of
troughs cut into the lens) with the real surface feature images
viewed by the surgeon.
Inventors: |
Jean; Hubschman P.; (Beverly
Hills, CA) ; Schwartz; Steven; (Los Angeles, CA)
; Wilson; Jason; (Alisa Viejo, CA) ; Tsao;
Tsu-Chin; (Manhattan Beach, CA) ; Gibson; James
S.; (Manhattan Beach, CA) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
VANTAGE SURGICAL SYSTEMS, INC. |
Irvine |
CA |
US |
|
|
Assignee: |
VANTAGE SURGICAL SYSTEMS,
INC.
Irvine
CA
|
Family ID: |
45494218 |
Appl. No.: |
14/568691 |
Filed: |
December 12, 2014 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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13169076 |
Jun 27, 2011 |
8945140 |
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14568691 |
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13164671 |
Jun 20, 2011 |
8836723 |
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13169076 |
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61358793 |
Jun 25, 2010 |
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61356150 |
Jun 18, 2010 |
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Current U.S.
Class: |
600/411 ;
600/427; 600/439; 606/107 |
Current CPC
Class: |
A61B 34/30 20160201;
A61F 9/00754 20130101; A61B 5/0066 20130101; A61B 5/4836 20130101;
A61B 34/20 20160201; A61B 2090/3735 20160201; A61B 5/7415 20130101;
A61F 9/00745 20130101; A61B 2090/365 20160201; A61B 8/5223
20130101; A61B 5/055 20130101; A61F 9/00736 20130101; A61B 8/10
20130101; A61B 2090/374 20160201; A61B 2090/3612 20160201; A61B
2090/378 20160201; A61B 5/0036 20180801 |
Class at
Publication: |
600/411 ;
606/107; 600/427; 600/439 |
International
Class: |
A61F 9/007 20060101
A61F009/007; A61B 8/08 20060101 A61B008/08; A61B 8/10 20060101
A61B008/10; A61B 5/00 20060101 A61B005/00; A61B 5/055 20060101
A61B005/055 |
Claims
1. A method for an improved phacoemulsification procedure,
comprising: providing a phacoemulsification instrument including a
distal working end configured to be inserted through an opening in
the anterior region of an eye's lens capsule; processing diagnostic
scan data for at least a portion of the lens capsule and the
working end of the phacoemulsification instrument; providing a
signal corresponding to a calculated separation distance
information from an analysis of the diagnostic scan data and the
distal working end of the phacoemulsification instrument during the
course of the phacoemulsification procedure, wherein during the
course of the phacoemulsification procedure, the diagnostic scan
data is undated to provide the calculated separation signal in real
time.
2. The method of claim 1, wherein the portion of the capsule from
which at least some of the diagnostic scan data is obtained has a
relatively planar central region which defines an XY plane from
which a Z-axis extends toward the anterior portions of the eye, and
wherein the separation distance is measured as a distance between
the working end and the capsule along a line that is substantially
parallel to the Z-axis.
3. The method of claim 2, additionally comprising: analyzing the
diagnostic scan data to provide thickness information between an
anterior surface of the lens capsule and the portion of the capsule
along lines substantially parallel to Z-axis for a plurality of XY
locations.
4. The method of claim 3, wherein the thickness information is
provided as a visual representation overlaid with the visual image
being viewed.
5. The method of claim 1, additionally comprising: overlaying a
visual representation of selected diagnostic scan information with
visual images being viewed by the surgeon.
6. The method of claim 5, additionally comprising: updating the
overlayed visual representation a plurality of times per
second.
7. The method of claim 6, wherein the updating is done at a rate of
about at least 20 times per second.
8. The method of claim 5, wherein the overlaying is updated with
each update of captured visual image data that is displayed to the
surgeon.
9. The method of claim 5, additionally comprising: aligning the
overlaid visual representation and a visual image with one another
using markerless tracking methods.
10. The method of claim 1, wherein the diagnostic scan data
comprises one or more of data from an OCT, an MRI, an UBM, and an
ultrasound.
11. The method of claim 1, wherein the separation distance
information is an auditory signal comprising one or more of: a
series of discrete pulse-like signals that can vary in temporal
duration based on a predetermined set of distance ranges, a series
of discrete pulse-like signals that can vary in temporal separation
based on a predetermined set of distance ranges, a signal whose
pitch varies in frequency based on a predetermined set of distance
ranges, and a signal that enunciates different sounds, selected
from the group consisting of numbers, letters, words, or phrases
based on a predetermined set of distance ranges.
12. A medical procedure for penetrating, or removing target tissue,
to a desired thickness from a posterior or distal boundary of the
target tissue without penetrating the boundary with a working end
of a surgical instrument, the procedure comprising: forming at
least one opening in a covering tissue in proximity to the anterior
surface of the target tissue to provide access to said anterior
surface of the target tissue; inserting a working end of surgical
instrument through the opening in the cover tissue to contact the
target tissue; obtaining diagnostic scan data for the target
tissue, the posterior boundary, and the working end of the surgical
instrument; analyzing the diagnostic scan data to obtain a
separation distance between the working end of the surgical
instrument and the posterior boundary region; and operating the
surgical instrument while viewing the target tissue, the working
end of the surgical instrument and while receiving separation
distance information from the analysis of the diagnostic scan data,
wherein during the course of the procedure, the diagnostic scan
data, the analysis of the data, and the receiving of the separation
distance information are updated a plurality of times.
13. The procedure of claim 12, wherein the target tissue from which
at least some of the diagnostic scan data is obtained has a
relatively planar central region which defines an XY plane from
which a Z-axis extends toward the anterior surface, and wherein the
separation distance is measured as a distance between the working
end and the target tissue along a line that is substantially
parallel to the Z-axis.
14. The procedure of claim 13, additionally comprising: analyzing
foe diagnostic scan data to provide thickness information between
the anterior surface of the target tissue and the posterior
boundary along lines substantially parallel to Z-axis for a
plurality of XY locations.
15. The procedure of claim 12, wherein the thickness information is
provided as a visual representation overlaid with the visual image
being viewed by a surgeon.
16. The procedure of claim 12, additionally comprising: overlaying
a visual representation of selected diagnostic scan information
with visual images being viewed by a surgeon.
17. The procedure of claim 16, additionally comprising: aligning
the overlaid visual representation and a visual image with one
another using markerless tracking methods.
18. The procedure of claim 12, wherein the diagnostic scan data
comprises one or more of data from an OCT, an MRI an UBM, and an
ultrasound.
19. The procedure of claim 12, wherein surgical instrument
comprises an instrument selected from the group consisting of (1) a
needle, (2) a probe, (3) forceps, (4) a clamp, (5) scissors, (6) a
knife, (7) a spreader, (8) a retractor, (9) tweezers, (10) an
delivery cannula, (11) an aspirating cannula, (12) a cystotome,
(13) a hydrodissector, (14) a hook, (15) a phaco chopper (16) a
polisher, (17) a scrapper, (18) a tissue extraction tool, and (19)
a deposition tool.
20. The procedure of claim 12, wherein the removed tissue includes
one or more of a tumor, a crystalized lens, and a path blockage.
Description
RELATED APPLICATIONS
[0001] This is a divisional application of U.S. patent
non-provisional application Ser. No. 13/169,076 which claims the
benefit of U.S. Provisional Patent Application No. 61/358,793,
filed Jun. 25, 2010 and is a continuation in part of U.S. patent
application Ser. No. 13/164,671 filed Jun. 20, 2011 which to turn
claims benefit of U.S. Provisional Patent Application No.
61/356/150 filed Jun. 18, 2010. These referenced applications which
are hereby incorporated by reference as if set forth in full
herein.
FIELD OF THE INVENTION
[0002] The present invention relates generally to the field of
surgical procedures and more particularly to surgical procedures
involving nearby boundary regions where surgical instrument
penetration is to be minimized or eliminated (i.e. non-fly zones)
and wherein computer generated feedback concerning separation
distance between a surgical instrument and such boundaries is
automatically calculated and optical or auditory feedback is
presided to the surgeon to aid in the performance of the surgery.
Specific embodiments of the invention relate to the field of
ophthalmic surgery and more particularly to the field of
phacoemulsification procedures (e.g. cataract removal procedures)
wherein diagnostic scan data is processed to supply useful and
timely surgical information beyond that which is normally available
to a surgeon via visual observation.
BACKGROUND OF THE INVENTION
[0003] Surgical procedures: (1) involve certain risks to the
patient, (2) take a certain time to perform, (3) take a certain
experience or skill level by a surgeon, (4) result in the
collateral damage of healthy issue, (5) result in the excess
removal of healthy tissue, (6) result in the inadequate removal of
unhealthy tissue, (7) result in the failure to fulfill the surgical
goal, (8) require prolonged recovery times, (9) result in extended
periods of disability, and/or (10) result in the need for extended
therapy. If a surgeon could be provided with more information
during the performance of a procedure be provided with that
information in a more timely manner, and/or be provided with that
information in a more accessible manner, many such procedures
could: (1) be performed with less risk to the patient, (2) be
performed more quickly, (3) be performed by a surgeon with less
experience or skill, (4) result in reduced collateral damage, (5)
result in removal of less healthy tissue, (6) result in more
complete removal of unhealthy tissue, (7) result in higher
probability of fulfilling the surgical goal (8) result in less
recovery time, (9) result in less disability or shortened periods
of disability, and/or (10) result in less need for physical
therapy. A need exists in the surgical arts for a method of
providing more information, proving this additional information in
a timely manner, and/or providing this information in a more
accessible manner.
[0004] Surgical procedures often involve tissue penetration,
manipulation, and/or removal of tissue near a boundary region that
is preferably not crossed or damaged by the surgical instrument
during the procedure. To avoid inadvertently penetrating such
boundaries while still completing the procedure with optimal
results may require the procedure to be slowed down while working
in these critical areas, require that not all tissue on the working
side of the boundary be optimally accessed, or require other
procedural complexities to exist. A need exists in the surgical
arts for improved procedures and systems for addressing these
issues.
[0005] In cataract removal procedures, visual observations and
surgical experience are used to determine when scoring or cutting
the crystalline lens has proceeded to a sufficient depth such that
cracking or chopping can be used to break the lens into smaller
pieces. Unfortunately, inadequate information can lead to
undercutting or overcutting (e.g. including penetration beyond the
posterior portion of capsule). A need exists for an improved
surgical procedure and system that reduces the risk for posterior
capsule damage.
SUMMARY OF THE INVENTION
[0006] is an object of some embodiments of the invention to provide
an improved surgical procedure wherein the provision of more
information to the surgeon, the more timely provision of the
information, and/or the more accessible provision of the
information results in the procedure being performed with less risk
to the patient.
[0007] It is an object of some embodiments of the invention to
provide an improved surgical procedure wherein the provision of
more information to the surgeon, the more timely provision of the
information, and/or the more accessible provision of the
information results in the procedure being performed more
quickly
[0008] It is an object of some embodiments of the invention to
provide an improved surgical procedure wherein the provision of
more information to the surgeon, the more timely provision of the
information, and/or the more accessible provision of the
information results in the procedure being successfully performable
by a surgeon with less experience or skill.
[0009] It is an object of some embodiments of the invention to
provide an improved surgical procedure wherein the provision of
more information to the surgeon, the more timely provision of the
information, and/or the more accessible provision of the
information results in reduced collateral damage.
[0010] It is an object of some embodiments of the invention to
provide an improved surgical procedure wherein the provision of
more information to the surgeon, the more timely provision of the
information, and/or the more accessible provision of the
information results in the removal of less healthy tissue.
[0011] It is an object of some embodiments of the invention to
provide an improved surgical procedure wherein the provision of
more information to the surgeon, the more timely provision of the
information and/or the more accessible provision of the information
results the more complete removal of unhealthy tissue.
[0012] It is an object of some embodiments of the invention to
provide an improved surgical procedure wherein the provision of
more information to the surgeon, the more timely provision of the
information, and/or the more accessible provision of the
information results in higher probability of fulfilling the
surgical goal.
[0013] It is an object of some embodiments of the invention to
provide an improved surgical procedure wherein the provision of
more information to the surgeon, the more timely provision of the
information, and/or the more accessible provision of the
information results in less recovery time.
[0014] It is an object of some embodiments of the invention to
provide an improved surgical procedure wherein the provision of
more information to the surgeon, the more timely provision of the
information, and/or the more accessible provision of the
information results in less disability or shortened periods of
disability.
[0015] It is an object of some embodiments of the invention to
provide an improved surgical procedure wherein the provision of
more information to the surgeon, the more timely provision of the
information, and/or the more accessible provision of the
information results in less need for physical therapy.
[0016] It is an object of some embodiments of the invention to
provide an improved method for performing a phacoemulsification
procedure.
[0017] It is an object of some embodiments of the invention to
provide an improved cataract removal procedure.
[0018] It is an object of some embodiments of the invention to
provide and improved procedure for placing intraocular lenses.
[0019] Other objects and advantages of various embodiments of the
invention will be apparent to those of skill in the art upon review
of the teachings herein. The various embodiments of the invention,
set forth explicitly herein or otherwise ascertained from the
teachings herein, may address one or more of the above objects
alone or in combination, or alternatively may address some other
object ascertained from the teachings herein. It is not necessarily
intended that all objects be addressed by any single embodiment or
aspect of the invention even though that may be the case with
regard to some embodiments or aspects.
[0020] A first aspect of the inventions provides a
phacoemulsification procedure, including; (a) forming at least one
opening in the eye to provide access to the anterior portion of the
lens capsule; (b) forming an opening in the anterior region of a
lens capsule containing a lens to be removed; (c) inserting a
working end of a phacoemulsification instrument through the opening
in the anterior region of the lens capsule; (d) obtaining
diagnostic scan data for the lens, the posterior portion of the
capsule and the working end of the phacoemulsification instrument;
(e) analyzing the diagnostic scan data to obtain a separation
distance between the working end of the phacoemulsification
instrument and the posterior region of the capsule; (f) operating
the phacoemulsification instrument while viewing the lens and the
working end of the phacoemulsification instrument and while
receiving separation distance information from the analysis of the
diagnostic scan data and using the separation distance information
in the control of the operation of the instrument; wherein during
the course of the procedure, the diagnostic scan data, the analysis
of the data, and the receiving of the separation distance
information are updated a plurality of times.
[0021] Numerous variations of the first aspect of the invention
exist and, for example include: (1) the diagnostic scan data is one
of (a) OCT data; (b) MRI data, (c) UBM data, and (d) ultrasound
data; (2) the viewing of the lens and the working end of the
phacoemulsification instrument occurs directly; (3) the viewing of
the lens and the working end of the phacoemulsification instrument
occurs indirectly (e.g. via an image captured by a camera; (4) the
data associated with an entire diagnostic scan being analyzed to
identify a location of the working end and a surface of the
posterior region of the capsule; (5) only a portion of the data
associated with an entire diagnostic scan is analyzed to identify a
location of the working end and a relevant portion of posterior
region of the capsule; (6) using an image captured by a camera to
produce visual image data that is analyzed to at least partially
identify a tip location of the working end of the
phacoemulsification instrument; (7) identifying the posterior
region of the capsule using an intensity gradient based technique;
(8) identifying the working end of the phacoemulsification
instrument using intensity gradient based techniques; (9)
presenting the separation distance information to the surgeon by
and auditory signal; (10) presenting separation distance
information to the surgeon by a visual signal presented within the
image field containing the surgical field of view; (11) updating of
captured and displayed visual images occur a plurality of times per
second, for example 20 or more times per second or even 100 or more
times per second; (12) updating the diagnostic scan data a
plurality of times per minute, for example, at a rate of at least
once every 10 second, at a rate of at least once per second, or
even at a rate of 5 or more times per second; (13) updating the
diagnostic scan data upon an indication from the operator; (14) in
addition to providing separation distance information, analyzing
diagnostic scan data to provide thickness information between an
anterior surface of the lens and the posterior portion of the
capsule, for example, along lines that are substantially parallel
to Z-axis for a plurality of XY locations and wherein in some
further variations the thickness information may be presented as a
visual representation to the surgeon overlaid with the visual image
being viewed by the surgeon and it may be updated a plurality of
times per second (e.g. 20 or more times per second); and (15) in
addition to providing separation distance information, analyzing
diagnostic scan data and rendering the results of the analysis to
proved a visual representation of selected physical structures
overlaid with the visual image that is presented to the
surgeon.
[0022] Additional variations of the fifth venation of first aspect
of the invention include having the portion of the data that is
analyzed being selected, at least in part, based on a prior known
location of the working end of the phacoemulsification instrument.
In some such variations the prior known location of the working end
of the phacoemulsification instrument includes the location as
determined from an immediately preceding analysis. In some such
variations the prior known location is used as a central location
of a search volume to be analyzed.
[0023] Additional variations of the sixth variation of the first
aspect of the invention include, for example, (1) using the tip
location, at least in part, in defining an analysis region of the
diagnostic scan data and/or (2) using the tip location, at least in
part, in defining locations to undergo diagnosis scanning.
[0024] Additional variations of the first aspect of the invention
are possible. In some such variations separation distance may be
determined in a variety of different ways, including, for example:
(1) identifying the posterior capsule with a plane that is parallel
to the XY plane and defining the plane has having a first Z value,
determining a second Z-value corresponding to the working end of
the instrument, and determining the difference of the first and
second Z-values; (2) defining a geometric solid (e.g. a sphere) of
a desired but small dimension (e.g. radius) that is centered on the
working end of the instrument, and comparing the geometric solid to
the identified posterior capsule position to determine if an
intersection exists, if not, increase the dimension by a desired
incremental resolution step and repeat the intersection comparison,
and continue iterations until an intersection is determined whereby
a separation distance is determined to have a value somewhere
between the immediately preceding dimension and the dimension that
resulted in intersection; and (3) create progressively offset
capsule surface representations, where each offset representation
has an incremental step size, until the working end is intersected
and then use the count of the number of steps and their respective
spacings, with or without taking into consideration the last step,
to determine the separation distance; (4) assuming that the
posterior portion of the capsule has a relatively planar central
region which defines an XY plane form which a Z-axis extends toward
the more anterior portions of the eye, and wherein the gap is
measured as a distance between the working end and the capsule
along a line that is substantially parallel to the Z-axis; (5).
[0025] Further variations of the ninth variation of the first
aspect of the invention include using an auditory signal or signals
selected from one or more of: (1) a series of discrete pulse-like
signals that can vary in temporal duration based on a predetermined
set of distance ranges; (2) a series of discrete pulse-like signals
that can vary in temporal separation based on a predetermined set
of distance ranges; (3) a signal whose pitch varies in frequency
based on a predetermined set of distance ranges; and (4) a signal
that enunciates different sounds, selected from the group
consisting of numbers, letters, words, or phrases based on a
predetermined set of distance ranges.
[0026] Further variations of the tenth variation of the first
aspect of the invention include using a visual signal or signals
selected from one or more of: (1) color variations overlaid on the
working end of the phacoemulsification instrument based on a
predetermined set of distance ranges; (2) a geometric shape (e.g. a
circular or elliptical image) centered on the working end of the
phacoemulsification instrument based on a predetermined set of
distance ranges; (3) a shape located in proximity to the working
end of me phacoemulsification instrument selected from the group
consisting of numbers, letters, words, phrases, or geometric shapes
based on a predetermined set of distance ranges; (4) a color in
combination with a shape located in proximity to the working end of
the phacoemulsification instrument selected from the group
consisting of numbers, letters, words, phrases, or geometric shapes
based on a predetermined set of distance ranges; (5) a tinting of a
selected portion of the image within the field of view based on a
predetermined set of distance ranges; (6) a shape located within
the field of view selected from the group consisting of numbers,
letters, words, phrases, or geometric shapes based on a
predetermined set of distance ranges; and (7) an intensity
modulation of a portion of the visual signal within a field of view
based on a predetermined set of distance ranges; and (8) the
overlaid visual representation and visual image are aligned with
one another using markerless tracking methods. Other variations
may, for example, present an auditory signal or signals in addition
to the visual signal or signals which may, for example, include one
or more of the further variations of the ninth variation of the
first aspect of the invention as noted above.
[0027] A second aspect of the invention provides a medical
procedure for penetrating, or removing target tissue, to a desired
thickness from a posterior or distal boundary of the target tissue
without penetrating the boundary with a working end of a surgical
instrument, the procedure composing: (a) forming at least one
opening in a covering tissue in proximity to the anterior surface
of the target tissue to provide access to said anterior surface of
the target tissue; (b) inserting a working end of surgical
instrument through the opening in the cover tissue to contact the
target tissue; (d) obtaining diagnostic scan data for the target
tissue, the posterior boundary, and the working end of the surgical
instrument; (e) analyzing the diagnostic scan data to obtain a
separation distance between the working end of the surgical
instrument and the posterior boundary region; (f) operating the
surgical instrument while viewing the target tissue, the working
end of the surgical instrument and while receiving separation
distance information from the analysis of the diagnostic scan data
and using the separation distance information in controlling or
deciding how to control of the surgical instrument; wherein during
the course of the procedure, the diagnostic scan data, the analysis
of the data, and the receiving of the separation distance
information are updated a plurality of times.
[0028] A third aspect of the invention provides a diagnostic or
therapeutic medical procedure involving the penetration or removal
of target tissue from one or more selected target tissue locations
or placement of a material at one or more selected locations
relative to a posterior or distal boundary of the target tissue
without penetrating the boundary with a working end of surgical
instrument, the procedure including: (a) inserting a working end of
an instrument into the target tissue; (b) obtaining diagnostic scan
data for the target tissue, the posterior boundary, and the working
end of the instrument: (c) analyzing the diagnostic scan data to
obtain a separation distance between the working end of the
surgical instrument and the posterior boundary region; and (d)
moving and operating the instrument while viewing the target
tissue, the working end of the instrument, and while receiving
separation distance information from the analysis of the diagnostic
scan data and using the separation distance information in
controlling or deciding how to control of the movement and
operating of the instrument; wherein during the course of the
procedure, the diagnostic scan data, the analysis of the data, and
the receiving of the separation distance information are updated a
plurality of times.
[0029] Numerous variations of the second and third aspects of
invention exist. Some such variations provide surgical instruments
selected from the group consisting of (1) a needle, (2) a probe,
(3) forceps, (4) a clamp, (5) scissors, (6) a knife, (7) a
spreader, (8) a retractor, (9) tweezers, (10) an delivery cannula,
(11) an aspirating cannula, (12) a cystotome, (13) a
hydrodissector, (14) a hook, (15) a phaco chopper (16) a polisher,
(17) a scrapper, (18) a tissue extraction tool, and (19) a
deposition tool. Other variations provide the features noted in
many of the variations of the first aspect of the invention,
mutatis mutandis.
[0030] Other aspects of the invention will be understood by these
of skill in the art upon review of the teachings herein. Other
aspects of the invention may involve combinations of the above
noted aspects of the invention. These other aspects of the
invention may provide various combinations of the aspects presented
above as well as provide other configurations, structures,
functional relationships, and processes that have not been
specifically set forth above.
BRIEF DESCRIPTION OF THE DRAWINGS
[0031] FIG. 1 provides a block diagram representing selected
elements of an improved surgical procedure (e.g. an improved
phacoemulsification procedure) according to a first embodiment of
the invention that focuses on enhancements to using a surgical
instrument (e.g. a phacoemulsification instrument) to penetrate or
remove tissue (e.g. remove the crystalline lens of the eye) from an
anterior surface toward a posterior surface which includes not only
the use of visual images of the surgical field of view that is
available to the surgeon but also of representations of separation
distances of a working end of the surgical instrument (e.g.
phacoemulsification instrument) relative to a posterior boundary
region defining a non-fly zone (no or limited penetration zone) or
posterior portion of tissue to be removed (e.g. relative to an
anterior surface of the back wall of the capsule which borders the
posterior surface of the lens), wherein the separation distance
data is extracted from three-dimensional diagnostic scan data.
[0032] Numerous variations of the first embodiment are possible.
Some of those possibilities are set forth in FIGS. 2A-2C which
provide examples of various alternatives that may form part of the
procedure of the first embodiment, such as alternative diagnostic
scan data types (FIG. 2A), rendering alternatives (FIG. 2B), and
distance calculations including optional uses of previously known
instrument locations (e.g. working end locations that were obtained
from previously analyzed diagnostic data) and/or capsule locations
(FIG. 2C).
[0033] FIG. 3 provides a block diagram representing selected steps
of a second embodiment of the invention that is similar to the
first embodiment of the invention with the exception that rendered
information takes the form of a visual representation that is
overlaid with real visual images (e.g. of a surgical region or
area) are presented to the surgeon.
[0034] FIG. 4 provides a block diagram representing selected steps
of a third embodiment of the invention that is similar to the
second embodiment of the invention with the exception that in
addition to the diagnostic scan data being used to provide
information concerning an instrument to boundary separation
distance of a working end of the instrument and the posterior
boundary or surface or an allowed fly-zone or penetration zone, the
diagnostic scan data is also used to provide information concerning
remaining thickness of material that is located between the working
end of the instrument and the posterior surface, which thickness
may be less than the distance as some of the intervening material
may already have been removed, visual information associated with
the distance and thickness is then combined with the visual image
of the instrument and tissue for presentation to the surgeon.
[0035] FIG. 5 provides a block diagram representing selected steps
of a fourth embodiment of the invention that is similar to the
second embodiment of the invention with the exception that the
selected information about the position (e.g. location and/or
orientation) of the working end of the instrument is tracked and
supplied to the distance analysis block to allow improved (e.g.
more efficient) analysis by allowing the analysis to be focused on
or centered around a known or anticipated position of the working
end of the instrument as determined from analysis of the visual
image or visual image information (e.g. known or estimated X &
Y positioning of the working end may lead to a reduction in the
amount of diagnostic data that must be analyzed).
[0036] FIG. 6 provides a block diagram of selected substeps that
may be involved in the distance analysis process and in particular
provides an example of how instrument tracking data of FIG. 5 may
be supplied to block 432 as a partial prior instrument location
that is used in helping determine a complete current position.
[0037] FIG. 7 provides a block diagram presenting selected steps of
a fifth embodiment of the invention that is similar to the fourth
embodiment of the invention with the exception that the instrument
tracking information is provided as an input to the diagnostic scan
block, as opposed to the distance analysis block so that it may be
used in focusing the diagnostic scan to be made on only the
selected regions that are necessary to derive the required
separation distance information.
[0038] FIG. 8 provides a block diagram representing selected steps
of a sixth embodiment of the invention that combines the
enhancements of the fourth and fifth embodiments such that tracked
position information for the working end is used to both limit the
diagnostic scan region and the portion of the diagnostic scan data
that will be analyzed to yield the desired separation distance
information.
DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS
[0039] In some specific and focused embodiment of the invention, a
phacoemulsification procedure is provided wherein the surgeon not
only uses visual information provided within his/her field of view
but also uses instrument tip (i.e. a working end of a
phacoemulsification instrument) to posterior capsule spacing (i.e.
distance) information that is extracted from three-dimensional
diagnostic scan data to aid in determining whether continued
cutting or scoring in a given location would risk damaging the
capsule. In some embodiments, the distance information is provided
in the form of an auditory signal, in others as a visual signal,
and in still others as a combination of the two. In some
embodiments the visual information is obtained directly (i.e. using
only optical elements such as lenses, mirrors, filters, diffraction
gratings, apertures, and the like between a source object having a
diffuse surface reflection and the eye or eyes of the observer)
while in others it is obtained indirectly (i.e. coming from images
that were captured by a camera or other image capture device and
then displayed).
[0040] In other generalized embodiments of the invention, the
procedures association with a phacoemulsification process may be
applied to other surgical processes, mutatis mutandis. In such
generalized embodiments the posterior portion of the capsule is
analogous to a no fly-zone that the instrument tip should no
penetrate while the crystalline lens is analogous to target tissue
that is to be removed or is at least acceptable tor penetration. In
some such generalized embodiments, the target tissue may be a tumor
that is to be removed while the posterior portion of the capsule
represents healthy tissue or bounding tissue that is not to be
damaged during removal of the tumor.
[0041] A generalized phacoemulsification procedure, includes (a)
forming at least one opening in the eye to provide access to the
anterior portion of the lens capsule; (b) forming an opening in the
anterior region of a lens capsule containing a lens to be removed;
(c) inserting a working end of a phacoemulsification instrument
through the opening in the anterior region of the lens capsule; and
(d) operating the phacoemulsification to remove the crystalline
lens or to make one or more trenches in the lens so that the lens
may be spilt into one or more smaller pieces which may then be
removed.
[0042] As used herein, in generalized embodiments, anterior and
posterior may, respectively, refer to the front (forward portion)
of an organ or body region and the rear (or back) portion of an
organ or body region but they may more generally refer to the front
or back of a structure based on an access direction with the
anterior portion being the portion first accessed while the
posterior portion is that portion which requires more penetration
to access. When confusion is possible, these terms may be replaced
with proximal and distal, respectively.
[0043] According to a first specific embodiment of the invention,
improvements to step (d) of this generalized procedures of a
phacoemulisification process are provided wherein step (d) includes
(1) obtaining diagnostic scan data for the lens, the posterior
portion of the capsule and the working end of the
phacoemulsification instrument; (2) analyzing the diagnostic scan
data to obtain a separation distance between the working end of the
phacoemulsification instrument and the posterior region of the
capsule; and (3) operating the phacoemulsification instrument while
directly or indirectly viewing the lens and the working end of the
phacoemulsification instrument and while receiving separation
distance information resulting from the analysis of the diagnostic
scan data and controlling the operation of the instrument based, at
least in part, on the separation distance information received,
wherein during the course of the operating of the
phacoemulsification instrument, the obtaining of diagnostic scan
data, the analyzing of the data, and the obtaining of separation
distance information occurs a plurality of times.
[0044] FIG. 1 provides a block diagram representing selected
elements of an improved surgical procedure (e.g., an improved
phacoemulsification procedure) according to a first generalized and
specific embodiment of the invention that focuses on enhancements
to using a surgical instrument (e.g. a phacoemulsification
instrument) to remove tissue (e.g. the crystalline lens of the eye)
from an anterior surface toward a posterior surface which includes
not only the use of visual images of the surgical field of view
that is available to the surgeon but also of representations of
separation distances of a working end of the surgical instrument
(e.g. phacoemulsification instrument) relative to a posterior
boundary or portion of the tissue to be removed (e.g. relative to
an anterior surface of the back wall of the capsule which borders
the posterior surface of the lens), wherein the separation distance
data is extracted from three-dimensional diagnostic scan data.
[0045] Element 102 of FIG. 1 calls for (1) a surgical instrument
102 (e.g. phacoemulsification instrument) to be viewed 111, by a
surgeon 181, (2) the surgical instrument to interact with tissue
101 which is also subject to viewing 111, and (3) subjecting a
combination of the surgical instrument 102 and tissue 101 to a
diagnostic scan 121 (e.g. a selected three-dimensional scan). The
diagnostic scan information is then analyzed to provide distance
information 131 (e.g. distance information between a working end of
the instrument and a posterior boundary of the lens tissue, e.g. an
anterior surface of the posterior portion of the capsule bounding
the lens) and the distance information is rendered 141 into a form
appropriate (e.g. visual or auditory) for use by the surgeon. A
combination of the visual image 111 of the instrument and tissue
with the distance information 141 Is then used by the surgeon in
further operating the instrument 151 with the process looping bask
through these information gathering elements/steps to provide
updated visual images and distance, i.e. gap or separation,
information that keeps the surgeon better informed of a current
surgical progress or at least instrument position relative to the
tissue so as to minimize inadvertent excessive penetrations of the
working end of the instrument beyond a desired boundary region
while simultaneously helping ensure that target tissue is at least
penetrated to a sufficient or adequate depth into the target tissue
to provide an intended surgical result.
[0046] Numerous variations of the first embodiment are possible.
Some of those possibilities are set forth in FIGS. 2A-2C which
provide examples of various alternatives that may form part of the
procedure of the first embodiment, such as alternative diagnostic
scan data types (FIG. 2A), rendering alternatives (FIG. 2B), and
distance calculations including optional uses of previously known
instrument locations (e.g. working end locations that were obtained
from previously analyzed diagnostic data) and/or capsule locations
(FIG. 2C).
[0047] Variations of the first embodiment may obtain scan data form
a variety sources and may obtain that data in a variety of forms.
For example FIG. 2A provides several alternative types of
diagnostic scans 121 that may be performed during a given surgery.
In different types of surgeries different types of scans may be
preferred due to different abilities to distinguish different
tissue types, different resolutions available, different scanning
speeds, different scanning logistics that are applicability to
different surgical circumstances, and the like. In particular, FIG.
2A indicates for example scan types that the used: an OCT scan
121-1, an MRI scan 121-2, a UBM scan 121-3, and/or an ultrasonic
scan 121-4. It is understood by those of skill in the art that
other scan types may also be used in some alternative
embodiments.
[0048] Variations of the first embodiment may provide and/or render
distance, information into a variety of forms. FIG. 2B provides two
examples of alternative rendering possibilities 141 for separation
distance information: (1) visual cues 141-1 and (2) audio cues
141-2. In soma embodiments one or the other of these alternatives
may be used while in other embodiments both may be used together.
Each form of cuing may take on a variety of forms. Examples of
visual cues include: (1) a series of discrete pulse-like signals
that can vary in temporal duration based on a predetermined set of
distance ranges; (2) a series of discrete pulse-like signals that
can vary in temporal separation based on a predetermined set of
distance ranges; (3) a signal whose pitch varies in frequency based
on a predetermined set of distance ranges; and/or (4) a signal that
enunciates or provides different sounds, selected from the group
consisting of numbers, letters, words, or phrases based on a
predetermined set of distance ranges.
[0049] Variations of the first embodiment may allow for visual
images of the surgical instrument and tissue being operated on to
be provided to the surgeon in a variety of different ways. For
example visual images may be presented to an eye piece of a
microscope and/or provided via display or projection onto an
enlarged screen.
[0050] Visual cues, associated with the distance information may
also be provided in a variety of different ways as well. For
example, such cues may be provided as color variations overlaid on
the working end of the phacoemulsification instrument based on a
predetermined set of distance ranges; as a geometric shape (e.g. a
circular or elliptical image) centered on the working end of the
phacoemulsification instrument based on a predetermined set of
distance ranges; as a shape located in proximity to the working end
of the phacoemulsification instrument selected from the group
consisting of numbers, letters, words, phrases, or geometric shapes
based on a predetermined set of distance ranges; as a color in
combination with a shape located in proximity to the working end of
the phacoemulsification instrument selected from the group
consisting of numbers, letters, words, phrases, or geometric shapes
based on a predetermined set of distance ranges; as a tinting of a
selected portion of the image within the field of view based on a
predetermined set of distance ranges; as a shape located within the
field of view selected from the group consisting of numbers,
letters, words, phrases, or geometric shapes based on a
predetermined set of distance ranges; as an intensity modulation of
a portion of the visual signal within a field of view based on a
predetermined set of distance ranges; as a flashing signal; and/or
as a flashing icon whose size, color, flash rate, or the like may
be made to vary with distance. In other embodiment variations, the
visual cue may take the form of a separately presented or overlaid
3-D view, 3-D sectional view, a 2-D cut-end view, or 2-D cut side
view showing the actual depth of removed material and/or thickness
of remaining material along with instrument working end position
information, with or without other indications of distance
[0051] In some embodiment variations, augmented reality techniques,
including markerless tracking methods, may be used to display
overlaid or composite images containing both a substantially real
time image of the surgical area along with enhanced images
depicting relevant information extracted from one or more 3-D scans
of the surgical region so that enhanced information may be provided
to a surgeon. Such augmented realty, image overlaying, and
markerless tracking methods are described in a number of the
articles and patent applications referenced herein, which are each
incorporated herein by reference. The creation of composite images
may be done electronically or optically. The creation of composite
images may use feedback of actual composite images to provide
enhanced or improved overlaying of component images.
[0052] Variations of the first embodiment may allow visual image
updates to be provided at different rates. For example they may be
provided at a rate of several times per second or less or at a rate
of 20 times per second or more. Diagnostic scan data may also be
updated at different rates. For example they may be updated once
every ten seconds or less, at a rate of several times per second or
more, or somewhere in between. Alternative diagnostic scan data may
be updated upon triggering by an operator/surgeon. In some
embodiments, visual image (i.e. surgical area visual images) and
diagnostic scan data may be presented at similar refresh rates and
synchronized phases with or without an intentional phase shift. In
still other embodiments image presentation updates of one image
component may be at an integer multiple of the other with or
without the slower frequency component image being presented at the
same rate as the higher frequency component.
[0053] Variations of the first embodiment may allow identification
of the posterior boundary region to be made in a variety of
different ways. The diagnostic scan data, for example, may be
analyzed using intensity gradient based techniques.
[0054] Variations of the first embodiment allow for distance
analysis to be performed in different ways and scan data to be used
in a variety of ways. FIG. 2C provides an example of one such
variation wherein a prior surgical instrument location 132 may be
used in finding (e.g. focusing a search to find) a current surgical
instrument location 133 that may in turn be saved as the prior
instrument location 132 for a next determination and is also used,
in determining a distance 136 that is the output of block 131'
(i.e. a possible variation of block 131 of FIG. 1). Similarly, a
prior location 135 of a posterior boundary (e.g. an anterior
surface of a posterior capsule relative to a lens that is the
target tissue) may be used in locating (e.g. focusing a search to
find) a current position 134 of the posterior boundary, which
current position 135 may be used along with the current position
133 of the surgical instrument to determine the distance 136. In
some variations, prior location of neither of the surgical
instrument location nor the prior location of the boundary will be
used to make the distance termination, only the prior location of
one of the boundary or the instrument location may be used in
finding a current location, or in still other variations both may
be used.
[0055] FIG. 3 provides a block diagram representing selected steps
of a second embodiment of the invention that is similar to the
first embodiment of the invention with the exception that rendered
information takes the form of a visual representation that is
overlaid with real visual images that are presented to the
surgeon.
[0056] Like elements between FIGS. 1 and 3 are labeled with like
reference numerals with the exception that the elements of FIG. 3
use the 200 series while elements in FIG. 1 used the 100 series,
Element 241 calls for the rendering to be in visual form which is
combined with the visual image 211 of the surgical instrument 202
and tissue 201 before presentation to the surgeon. The combining or
overlaying of these visual images may occur optically as described
in incorporated U.S. patent application Ser. No. 13/164,671 or
electronically while the images remain in a data form. The
overlaying may occur using markerless tracking algorithms with or
without electronic or optical feedback allowing optimization of
image registration. The rendered visual image of the distance data
for in a phacoemulsification procedure may take a variety forms
such as by identifying the posterior capsule with a plane that is
parallel to the XY plane and defining the plane as having a first Z
value, determining a second Z-value corresponding to the working
end of the instrument, and determining the difference of the first
and second Z-values; by defining a geometric solid (e.g. a sphere)
of a desired but small dimension (e.g. radius) that is centered on
the working end of the instrument, and comparing the geometric
solid to the identified posterior capsule position to determine if
an intersection exists, if not, increasing the dimension by a
desired incremental resolution step and repeating the intersection
comparison, and continuing iterations until an intersection is
determined whereby a separation distance is determined to have a
value somewhere between the immediately preceding dimension and the
dimension that resulted in intersection; and/or by creating
progressively offset capsule surface representations, where each
offset representation has an incremental step size, until the
working end is intersected and then use the count of the number of
steps and their respective spacings, with or without taking into
consideration the last step, to determine the separation
distance.
[0057] FIG. 4 provides a block diagram representing selected steps
of a third embodiment of the invention that is similar to the
second embodiment of the invention with the exception that in
addition to the diagnostic scan data being used to provide distance
information concerning the separation of a working end of the
instrument and the posterior surface, the diagnostic scan data is
also used to provide information concerning remaining thickness of
material that is located between the working end of the instrument
and the posterior surface, which thickness may be less than the
distance when some of the intervening material has already been
removed, visual information associated with the distance and the
thickness is then combined with the visual image of the instrument
and tissue for presentation to the surgeon.
[0058] As with FIG. 3 like elements between FIGS. 4 and 3 are
identified with like reference numerals with the exception that the
reference numerals of FIG. 4 are presented in the 300 series as
opposed to the 200 series.
[0059] As noted above, in addition to the diagnostic scan data
being used to determine distance information 331, the scan data is
used to determine remaining thickness as set forth in block 371.
This second determination may be made in a variety of different
ways. For example it may be based on the scan having sufficient
ability to detect not only the instrument tip and the boundary
between the target tissue and the anterior surface of an underlying
posterior tissue) but also a boundary between an anterior surface
of the target tissue that is located below and possibly spaced from
the working surface of the instrument. In alternative variations,
the thickness may be set to a previously calculated value based on
a previously attained and determined distance of the instrument tip
from the posterior surface of the target issue (in the same XY
location) that is less than the present distance under the
assumptions that the distance is measured in a Z-direction and that
any previously attained smaller distance necessarily dictates the
previous removal of underlying tissue. The rendered distance
information 341 and rendered thickness information 372 are overlaid
361 with the visual image 311. Blocks 341 and 372 may be providing
either visual images or data representative such visual images. As
noted with regard to FIG. 3 the overlaying may occur optically,
electronically, or via a combination of the two (e.g. two images
overlaid electronically and the combination overlaid optically with
the third or two images overlaid optically, then the combination
captured electronically, and subsequently electronically overlaid
with the third. As noted with the second embodiment, the overlaying
may or may not involve optical or electronic feedback to provide
for improved overlaying of the images with success updating of
component or composite image frames.
[0060] FIG. 5 provides a block diagram representing selected steps
of a fourth embodiment of the invention that is similar to the
second embodiment of the invention with the exception that the
selected information about the position (e.g. location and/or
orientation) of the working end of the instrument is tracked and
supplied to the distance analysis block to allow improved (e.g.
more efficient) analysis by allowing the analysis to be focused on
or centered around a known or anticipated position of the working
end of the instrument as determined from analysis of the visual
image or visual image information (e.g. known or estimated X &
Y positioning of the working end may lead to a reduction in the
amount of diagnostic data that must be analyzed).
[0061] Like elements of FIG. 5 as compared to FIG. 2 are labeled
with like reference numeral as those of FIG. 2 with the exception
that the elements of FIG. 5 use the 400 series of numerals as
opposed to the 200 series. Element 481 is added between element 411
and 431 so that instrument working end information (position and
possibly orientation) can be at least partially determined and
provided, along with the scan information from 421, to the distance
gap analysis block 431 and thereafter the distance information,
like in FIG. 2, is rendered per block 441 and provided to block 461
for overlaying. In some embodiment variations, visual image updates
will occur more often than diagnostic scan up-dates. The instrument
working end information associated with block 481 may be derived
from the most current visual image presented to block 461 or it may
be from visual image information that is relatively current but not
necessarily from the most recent visual image update.
[0062] FIG. 6 provides a block diagram of selected substeps that
may be involved in the distance analysis process and in particular
provides an example of how instrument tracking data of FIG. 5 may
be supplied to block 432 as a partial prior instrument location
that is used in helping determine the complete current
position.
[0063] In the variation of FIG. 6, surgical instrument tracking
information (block 481 of FIG. 5) and diagnostic scan information
(block 421 of FIG. 5) are input to block 431', which is an expanded
variation of block 431 of FIG. 5, with distance information 436
supplied to line information rendering block 441 of FIG. 5, in the
venation of FIG. 6 the instrument tracking information extracted
from the visual image information of block 411 is supplied to block
432 as partial prior instrument location information and then
passed on to block 433 for determination of surgical instrument
location. Diagnostic scan information is provided to block 433 as
well so that both inputs may be used in determining the surgical
instrument location. The input from block 432 may allow less
examination and analysis of the diagnostic scan data to identify
the surgical instrument location. Diagnostic scan data is also
passed onto block 434 for use in locating the posterior boundary of
the target tissue (e.g. anterior surface of the posterior portion
of the capsule). Block 434 may also make use of prior saved
posterior boundary location information in determining new
posterior boundary location and the new posterior boundary location
may be saved to the prior boundary location block for subsequent
use. The use of prior posterior boundary location information, may
allow less examination and analysis of the diagnostic scan data to
identify the current posterior boundary location. The new posterior
target tissue boundary location from block 434 and surgical
instrument location from block 433 are used together to determine a
separation distance by block 436 torn which the output of block
431' is taken.
[0064] FIG. 7 provides a block diagram representing selected steps
of a fifth embodiment of the invention that is similar to the
fourth embodiment of the invention with the exception that the
instrument tracking information is provided as an input to the
diagnostic scan block, as opposed to the distance analysis block so
that it may be used in focusing the next diagnostic scan onto only
the selected regions that are necessary to derive the required
separation distance information.
[0065] Elements of FIG. 7 that are similar to elements of FIG. 5
are identified with like reference numerals with the exception that
reference numerals use the 500 series of numbers. In fact the only
real difference between FIGS. 5 and is that the output of block 581
is feed into one of the inputs for block 521 as opposed to block
531. As with the information associated with block 481, the
information associated with block 581 may be the most recent visual
image information or relatively current information but not the
most recent (e.g. it may take longer to perform the diagnostic scan
than allowed by the refresh rate of the visual images). The
information supplied from block 581 to block 521 may be used to
limit the effective diagnostic scan region and thus might aid in
reducing scan time associated with gathering the scan data.
[0066] FIG. 8 provides a block diagram representing selected steps
of a sixth embodiment of the invention that combines the
enhancements of the fourth and fifth embodiments such that tracked
position information for the working end is used to both limit the
diagnostic scan region and the portion of the diagnostic scan data
that will be analyzed to yield the desired separation distance
information.
[0067] Elements of FIG. 8 that are similar to elements of FIGS. 5
and 7 are identified with like reference numerals with the
exception that reference numerals use the 600 series of numbers. In
fact the only real difference between FIGS. 8 relative to FIGS. 5
and 7 is that the output of block 681 is feed into inputs for both
block 621 and 631 as opposed to one or the other. As with the
information associated with blocks 481 and 581, the information
associated with block 681 may be the most recent visual image
information or relatively current information but not the most
recent (e.g. it may take longer to perform the diagnostic scan than
allowed by the refresh rate of the visual images). The information
supplied from block 681 to block 621 (as in FIG. 7) may be used to
limit the effective diagnostic scan region and thus might aid in
reducing scan time associated with gathering the scan data while
the information supplied from block 681 to block 631 (as in FIG. 5)
may be used to reduce an amount of diagnostic data that must be
analyzed to derive the distance information.
[0068] Numerous variations of the above noted embodiments are
possible. For example, such variations may include modified
embodiments resulting from the combination of selected elements
from two or more of the six presented specific embodiments. Other
modified embodiments can result from combining features of the
presented embodiments with selected variations presented above for
the aspects of the invention.
[0069] Other embodiment may be directed to other medical procedures
where selected tissue is to be penetrated or removed (i.e. other
than the lens in a phacoemulsification procedure) either to a
desired depth below an original anterior or proximal surface or to
a desired thickness above a posterior or distal boundary of the
target tissue (including to a thickness of zero) and it is desired
to determine, know, and make use of current distance information
(i.e. between a working end of an instrument and a more posterior
boundary region during the tissue removal process such that
penetrations of the working end of the instrument beyond the distal
boundary are minimized or more preferably do not occur at all). In
other alternative embodiment the surgical instrument may be a
diagnostic instrument and the procedure may be a diagnostic
procedure (e.g. a biopsy procedure). In still other embodiments,
the surgical instrument may be a therapeutic or diagnostic
instrument that is intended not to necessarily remove significant
tissue but to locate a drug, therapeutic material, or diagnostic
marker at one or more precise positions relative to a boundary of
the target tissue wherein the locating process may involve both
visual image observations and correlated distance information for
precise placement of the drug, material or marker. Features of the
previously presented embodiments and their variations, as well as
features and variations set forth in the aspects of the invention
may be combined with the other embodiments presented herein to
derive further embodiment variations and alternatives.
[0070] In some embodiments, a surgeon may not have direct control
over a surgical instrument but instead the surgical instrument may
be moved under robotic control based on movements or other signals
provided by the surgeon (see blocks 151-651). In such embodiments,
another optical or auditory quing to the Surgeon might indicate
whether or not a movement of the instrument actually occurred when
commanded to make a movement by the surgeon and even whether the
instrument movement was in an anticipated movement range.
[0071] Further Comments and Conclusions
[0072] The methods described herein may be used in combination with
the methods set forth in U.S. patent application Ser. No.
13/169,072, by Jean P. HUBSCHMAN et al., filed concurrently
herewith, having Docket No. VSSP-007US-A, and entitled "Surgical
Procedures Using Visual Images Overlaid with Visual Representations
of Selected Three-Dimensional Data". Further information about
overlaying multiple visual images (whether they be from physical
sources or from computer rendered images) can be found in the
various patents, patent applications, and non-patent publications
referenced herein (e.g. in the '671 application referenced herein
above). These referenced patents, applications, and non-patent
publications are each incorporated herein by reference as if set
forth in full herein.
[0073] In some embodiments, three-dimensional data (i.e. data from
a diagnostic scan) is processed by a programmed computer to
generate a visual representation of the three-dimensional data
thereafter the visual representation is positioned and oriented
with and overlaid on the image data of the eye so that the visual
representation and image data may be viewed simultaneously. In some
such embodiments of the invention, the overlaying of the visual
representation and image data of the eye occurs via the use of
markerless tracking algorithms. Such markerless tracking algorithms
are known in the art and have been described previously. See for
example the section entitled Markerless Tracking" in U.S. Pat. No.
7,428,318; U.S. Patent Pub. No. 2005-1190972; and Comport et al.
IEEE Trans Visual Compo Graph. 12(4); 615-628 (2006). Additional
teachings concerning the overlaying of multiple images can be found
in U.S. patent application Ser. No. 13/164/671, filed Jun. 20, 2011
and entitled "Augmented Reality Methods and Systems Including
Optical Merging of a Plurality of Component Optical Images". Each
of these referenced applications patents and publications is hereby
incorporated herein by reference) as if set forth in full
herein.
[0074] As used herein surgeon may refer to an actual surgeon or
other medical practitioner that is involved in performing a
procedure of interest. Diagnostic scan means medical scans that are
not simply visible light images of the eye taken with one or more
conventional cameras (digital, video, etc). Visual image means one
or more images viewed directly by a surgeon with only optical
element extending from the source (e.g. a object with a diffuse
reflective surface) or indirectly by a surgeon with an intermediate
electronic capture and visual reproduction from electronic data
between the surgeon and the source.
[0075] Though various portions of this specification have been
provided with headers, it is not intended that the headers be used
to limit the application of teachings found in one portion of the
specification from applying to other portions of the specification.
For example, it should be understood that alternatives acknowledged
in association with one embodiment, am intended to apply to all
embodiments to the extent that the features of the different
embodiments make such application functional and do not otherwise
contradict or remove all benefits of the adopted embodiment.
Various other embodiments of the present invention exist. Some of
these embodiments may be based on a combination of the teachings
herein with various teachings incorporated herein by reference.
[0076] In view of the teachings herein, many further embodiments,
alternatives in design and uses of the embodiments of the instant
invention will be apparent to those of skill in the art. As such,
it is not intended that the invention be limited to the particular
illustrative embodiments, alternatives, and uses described above
but instead that it be solely limited by the claims presented
hereafter.
* * * * *