U.S. patent application number 17/190289 was filed with the patent office on 2022-09-08 for systems and methods for cutting an anatomical element.
The applicant listed for this patent is Mazor Robotics Ltd.. Invention is credited to Omer Ravid, Avi Turgeman.
Application Number | 20220280168 17/190289 |
Document ID | / |
Family ID | 1000006549538 |
Filed Date | 2022-09-08 |
United States Patent
Application |
20220280168 |
Kind Code |
A1 |
Turgeman; Avi ; et
al. |
September 8, 2022 |
SYSTEMS AND METHODS FOR CUTTING AN ANATOMICAL ELEMENT
Abstract
A system for cutting bone is provided and may comprise a cutting
tool configured to rotate and a shield. The system may also
comprise a first robotic arm configured to hold the cutting tool
and a second robotic arm configured to hold the shield. A processor
and a memory storing instructions for execution by the processor
that, when executed, may cause the processor to cause the second
robotic arm to orient the shield proximate an anatomical element
along a cutting path of the cutting tool.
Inventors: |
Turgeman; Avi; (Beer Yaakov,
IL) ; Ravid; Omer; (Pardes-Hana, IL) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
Mazor Robotics Ltd. |
Caesarea |
|
IL |
|
|
Family ID: |
1000006549538 |
Appl. No.: |
17/190289 |
Filed: |
March 2, 2021 |
Current U.S.
Class: |
1/1 |
Current CPC
Class: |
A61B 17/1633 20130101;
A61B 2017/00991 20130101; A61B 34/30 20160201; A61B 17/1626
20130101; A61B 17/1671 20130101 |
International
Class: |
A61B 17/16 20060101
A61B017/16; A61B 34/30 20060101 A61B034/30 |
Claims
1. A system for cutting bone comprising: a cutting tool configured
to rotate; a shield; a first robotic arm configured to hold the
cutting tool; a second robotic arm configured to hold the shield; a
processor; and a memory storing instructions for execution by the
processor that, when executed, cause the processor to: cause the
second robotic arm to orient the shield proximate an anatomical
element along a cutting path of the cutting tool.
2. The system of claim 1, wherein the cutting tool is configured to
extend in a first direction, wherein the shield comprises a first
body configured to extend in a second direction and a second body
coupled to the first body by a joint, the second direction distinct
from the first direction, the second body configured to selectively
rotate about the joint.
3. The system of claim 1, wherein the cutting tool comprises a
first tube nested inside of a second tube, the first tube having a
distal end comprising a set of cutting teeth.
4. The system of claim 3, further comprising: a vacuum source
configured to apply a suction force to the cutting tool to suction
anatomical particles through the first tube.
5. The system of claim 3, wherein the first tube is configured to
extend axially.
6. The system of claim 1, wherein the shield has a width at least
as wide as a diameter of the cutting tool.
7. The system of claim 1, wherein a diameter of the cutting tool is
about 10 mm.
8. A system for cutting bone comprising: a cutting tool supported
by a robotic arm; a shield supported by the robotic arm; a
processor; and a memory storing instructions for execution by the
processor that, when executed, cause the processor to: cause the
robotic arm to orient the shield proximate an anatomical element at
a planned exit point of the cutting tool, and to control the
cutting tool to cut through the anatomical element toward the
planned exit point.
9. The system of claim 8, wherein at least one of a cutting tool
and the shield is configured to extend telescopically.
10. The system of claim 8, wherein the cutting tool comprises a
first tube nested inside of a second tube, the first tube
configured to extend from the second tube, the first tube having a
distal end comprising a set of cutting teeth.
11. The system of claim 10, wherein causing the robotic arm to
orient the cutting tool includes extending the second tube to
orient the cutting tool at the side of the anatomical element,
wherein the first tube does not extend past the second tube.
12. The system of claim 8, wherein the shield comprises a first
segment and a second segment disposed at an angle to the first
segment.
13. The system of claim 12, wherein the second segment is
perpendicular to the first segment.
14. The system of claim 12, wherein the first segment and the
second segment are fixed.
15. A system for cutting bone comprising: a cutting tool; and a
shield positionable independently of the cutting tool and
comprising: a first segment; and a second segment coupled to the
first segment by a joint, the second segment having a selectively
adjustable angle relative to the first segment.
16. The system of claim 15, wherein the cutting tool comprises: a
first tube having a distal end comprising a plurality of teeth; and
a second tube, the first tube nested inside of the second tube, the
first tube and the second tube configured to extend in an axial
direction.
17. The system of claim 16, wherein the first tube is configured to
move from a first orientation in which the cutting teeth are nested
within the second tube to a second orientation in which the cutting
teeth extend beyond the second tube.
18. The system of claim 15, wherein the cutting tool is configured
to move in a first direction, wherein the shield further comprises
a base, and wherein the first segment is selectively extendable
from the base in a second direction distinct from the first
direction.
19. The system of claim 15, wherein the cutting tool is configured
to rotate, vibrate, or oscillate.
20. The system of claim 18, wherein the shield is configured to
prevent further movement of the cutting tool in the first direction
upon contact of the cutting tool with the shield.
Description
FIELD
[0001] The present technology generally relates to cutting an
anatomical element, and relates more particularly to preventing
collateral damage when cutting an anatomical element.
BACKGROUND
[0002] Surgical procedures may require removal of a portion of an
anatomical element such as a bone. One or more tools may be used to
remove the portion of the anatomical element. Surgical robots may
assist a surgeon or other medical provider in using the one or more
tools to carry out the surgical procedure, or may complete one or
more surgical procedures autonomously.
SUMMARY
[0003] Example aspects of the present disclosure include:
[0004] A system for cutting bone according to at least one
embodiment of the present disclosure comprises a cutting tool
configured to rotate; a shield; a first robotic arm configured to
hold the cutting tool; a second robotic arm configured to hold the
shield; a processor; and a memory storing instructions for
execution by the processor that, when executed, cause the processor
to: cause the second robotic arm to orient the shield proximate an
anatomical element along a cutting path of the cutting tool.
[0005] Any of the aspects herein, wherein the cutting tool is
configured to extend in a first direction, wherein the shield
comprises a first body configured to extend in a second direction
and a second body coupled to the first body by a joint, the second
direction distinct from the first direction, the second body
configured to selectively rotate about the joint.
[0006] Any of the aspects herein, wherein the cutting tool
comprises a first tube nested inside of a second tube, the first
tube having a distal end comprising a set of cutting teeth.
[0007] Any of the aspects herein, further comprising: a vacuum
source configured to apply a suction force to the cutting tool to
suction anatomical particles through the first tube. Any of the
aspects herein, wherein the first tube is configured to extend
axially.
[0008] Any of the aspects herein, wherein the shield has a width at
least as wide as a diameter of the cutting tool.
[0009] Any of the aspects herein, wherein a diameter of the cutting
tool is about 10 mm.
[0010] A system for cutting bone according to at least one
embodiment of the present disclosure comprises a cutting tool
supported by a robotic arm; a shield supported by the robotic arm;
a processor; and a memory storing instructions for execution by the
processor that, when executed, cause the processor to: cause the
robotic arm to orient the shield proximate an anatomical element at
a planned exit point of the cutting tool, and to control the
cutting tool to cut through the anatomical element toward the
planned exit point.
[0011] Any of the aspects herein, wherein at least one of a cutting
tool and the shield is configured to extend telescopically.
[0012] Any of the aspects herein, wherein the cutting tool
comprises a first tube nested inside of a second tube, the first
tube configured to extend from the second tube, the first tube
having a distal end comprising a set of cutting teeth.
[0013] Any of the aspects herein, wherein causing the robotic arm
to orient the cutting tool includes extending the second tube to
orient the cutting tool at the side of the anatomical element,
wherein the first tube does not extend past the second tube.
[0014] Any of the aspects herein, wherein the shield comprises a
first segment and a second segment disposed at an angle to the
first segment.
[0015] Any of the aspects herein, wherein the second segment is
perpendicular to the first segment.
[0016] Any of the aspects herein, wherein the first segment and the
second segment are fixed.
[0017] A system for cutting bone according to at least one
embodiment of the present disclosure comprises a cutting tool; and
a shield positionable independently of the cutting tool and
comprising: a first segment; and a second segment coupled to the
first segment by a joint, the second segment having a selectively
adjustable angle relative to the first segment.
[0018] Any of the aspects herein, wherein the cutting tool
comprises: a first tube having a distal end comprising a plurality
of teeth; and a second tube, the first tube nested inside of the
second tube, the first tube and the second tube configured to
extend in an axial direction.
[0019] Any of the aspects herein, wherein the first tube is
configured to move from a first orientation in which the cutting
teeth are nested within the second tube to a second orientation in
which the cutting teeth extend beyond the second tube.
[0020] Any of the aspects herein, wherein the cutting tool is
configured to move in a first direction, wherein the shield further
comprises a base, and wherein the first segment is selectively
extendable from the base in a second direction distinct from the
first direction.
[0021] Any of the aspects herein, wherein the cutting tool is
configured to rotate, vibrate, or oscillate.
[0022] Any of the aspects herein, wherein the shield is configured
to prevent further movement of the cutting tool in the first
direction upon contact of the cutting tool with the shield.
[0023] Any aspect in combination with any one or more other
aspects.
[0024] Any one or more of the features disclosed herein.
[0025] Any one or more of the features as substantially disclosed
herein.
[0026] Any one or more of the features as substantially disclosed
herein in combination with any one or more other features as
substantially disclosed herein.
[0027] Any one of the aspects/features/embodiments in combination
with any one or more other aspects/features/embodiments.
[0028] Use of any one or more of the aspects or features as
disclosed herein.
[0029] It is to be appreciated that any feature described herein
can be claimed in combination with any other feature(s) as
described herein, regardless of whether the features come from the
same described embodiment.
[0030] The details of one or more aspects of the disclosure are set
forth in the accompanying drawings and the description below. Other
features, objects, and advantages of the techniques described in
this disclosure will be apparent from the description and drawings,
and from the claims.
[0031] The phrases "at least one", "one or more", and "and/or" are
open-ended expressions that are both conjunctive and disjunctive in
operation. For example, each of the expressions "at least one of A,
B and C", "at least one of A, B, or C", "one or more of A, B, and
C", "one or more of A, B, or C" and "A, B, and/or C" means A alone,
B alone, C alone, A and B together, A and C together, B and C
together, or A, B and C together. When each one of A, B, and C in
the above expressions refers to an element, such as X, Y, and Z, or
class of elements, such as X.sub.1-X.sub.n, Y.sub.1-Y.sub.m, and
Z.sub.1-Z.sub.o, the phrase is intended to refer to a single
element selected from X, Y, and Z, a combination of elements
selected from the same class (e.g., X.sub.1 and X.sub.2) as well as
a combination of elements selected from two or more classes (e.g.,
Y.sub.1 and Z.sub.o).
[0032] The term "a" or "an" entity refers to one or more of that
entity. As such, the terms "a" (or "an"), "one or more" and "at
least one" can be used interchangeably herein. It is also to be
noted that the terms "comprising", "including", and "having" can be
used interchangeably.
[0033] The preceding is a simplified summary of the disclosure to
provide an understanding of some aspects of the disclosure. This
summary is neither an extensive nor exhaustive overview of the
disclosure and its various aspects, embodiments, and
configurations. It is intended neither to identify key or critical
elements of the disclosure nor to delineate the scope of the
disclosure but to present selected concepts of the disclosure in a
simplified form as an introduction to the more detailed description
presented below. As will be appreciated, other aspects,
embodiments, and configurations of the disclosure are possible
utilizing, alone or in combination, one or more of the features set
forth above or described in detail below.
[0034] Numerous additional features and advantages of the present
invention will become apparent to those skilled in the art upon
consideration of the embodiment descriptions provided
hereinbelow.
BRIEF DESCRIPTION OF THE DRAWINGS
[0035] The accompanying drawings are incorporated into and form a
part of the specification to illustrate several examples of the
present disclosure. These drawings, together with the description,
explain the principles of the disclosure. The drawings simply
illustrate preferred and alternative examples of how the disclosure
can be made and used and are not to be construed as limiting the
disclosure to only the illustrated and described examples. Further
features and advantages will become apparent from the following,
more detailed, description of the various aspects, embodiments, and
configurations of the disclosure, as illustrated by the drawings
referenced below.
[0036] FIG. 1 is a block diagram of a system according to at least
one embodiment of the present disclosure;
[0037] FIG. 2 is a schematic perspective view of a partial
anatomical element cutting system according to at least one
embodiment of the present disclosure;
[0038] FIG. 3 is a schematic perspective view of a partial
anatomical element cutting system according to at least one
embodiment of the present disclosure;
[0039] FIG. 4A is a schematic perspective view of the partial
anatomical element cutting system of FIG. 3 in a first
configuration;
[0040] FIG. 4B is a schematic perspective view of the partial
anatomical element cutting system of FIG. 3 in a second
configuration;
[0041] FIG. 4C is a schematic perspective view of the partial
anatomical element cutting system of FIG. 3 in a third
configuration;
[0042] FIG. 5 is a schematic perspective view of a partial
anatomical element cutting system according to at least one
embodiment;
[0043] FIG. 6A is a schematic perspective view of a partial
anatomical element cutting system according to at least one
embodiment in a first orientation;
[0044] FIG. 6B is a schematic perspective view of the partial
anatomical element cutting system of FIG. 6A in a second
orientation; and
[0045] FIG. 7 is a flowchart according to at least one embodiment
of the present disclosure.
DETAILED DESCRIPTION
[0046] It should be understood that various aspects disclosed
herein may be combined in different combinations than the
combinations specifically presented in the description and
accompanying drawings. It should also be understood that, depending
on the example or embodiment, certain acts or events of any of the
processes or methods described herein may be performed in a
different sequence, and/or may be added, merged, or left out
altogether (e.g., all described acts or events may not be necessary
to carry out the disclosed techniques according to different
embodiments of the present disclosure). In addition, while certain
aspects of this disclosure are described as being performed by a
single module or unit for purposes of clarity, it should be
understood that the techniques of this disclosure may be performed
by a combination of units or modules associated with, for example,
a computing device and/or a medical device.
[0047] In one or more examples, the described methods, processes,
and techniques may be implemented in hardware, software, firmware,
or any combination thereof. If implemented in software, the
functions may be stored as one or more instructions or code on a
computer-readable medium and executed by a hardware-based
processing unit. Computer-readable media may include non-transitory
computer-readable media, which corresponds to a tangible medium
such as data storage media (e.g., RAM, ROM, EEPROM, flash memory,
or any other medium that can be used to store desired program code
in the form of instructions or data structures and that can be
accessed by a computer).
[0048] Instructions may be executed by one or more processors, such
as one or more digital signal processors (DSPs), general purpose
microprocessors (e.g., Intel Core i3, i5, i7, or i9 processors;
Intel Celeron processors; Intel Xeon processors; Intel Pentium
processors; AMD Ryzen processors; AMD Athlon processors; AMD Phenom
processors; Apple A10 or 10.times. Fusion processors; Apple A11,
A12, A12X, A12Z, or A13 Bionic processors; or any other general
purpose microprocessors), graphics processing units (e.g., Nvidia
GeForce RTX 2000-series processors, Nvidia GeForce RTX 3000-series
processors, AMD Radeon RX 5000-series processors, AMD Radeon RX
6000-series processors, or any other graphics processing units),
application specific integrated circuits (ASICs), field
programmable logic arrays (FPGAs), or other equivalent integrated
or discrete logic circuitry. Accordingly, the term "processor" as
used herein may refer to any of the foregoing structure or any
other physical structure suitable for implementation of the
described techniques. Also, the techniques could be fully
implemented in one or more circuits or logic elements.
[0049] Before any embodiments of the disclosure are explained in
detail, it is to be understood that the disclosure is not limited
in its application to the details of construction and the
arrangement of components set forth in the following description or
illustrated in the drawings. The disclosure is capable of other
embodiments and of being practiced or of being carried out in
various ways. Also, it is to be understood that the phraseology and
terminology used herein is for the purpose of description and
should not be regarded as limiting. The use of "including,"
"comprising," or "having" and variations thereof herein is meant to
encompass the items listed thereafter and equivalents thereof as
well as additional items. Further, the present disclosure may use
examples to illustrate one or more aspects thereof. Unless
explicitly stated otherwise, the use or listing of one or more
examples (which may be denoted by "for example," "by way of
example," "e.g.," "such as," or similar language) is not intended
to and does not limit the scope of the present disclosure.
[0050] Bone cutting or removal is a complex procedure with
significant risk of harm to the spinal canal or other essential
tissues of a patient, depending on the location of the bone being
cut. Cutting or removal of a part of a vertebra is performed, for
example, to relieve pressure on a nerve or ease a pain in the
spine. It is desirable to avoid harm of surrounding dura matter or
nerves during such cutting or removal of a portion of the vertebra.
Thus, a safe cutting procedure using, for example, two robotic arms
is provided.
[0051] In at least one embodiment, one robotic arm holds a cutting
tool and another robotic arm holds a safety protection device or a
shield. The robotic arms may move synchronously in a
leader-follower (e.g., master-slave) manner. The leader robotic
arm, which holds the cutting tool, may move along a planned
trajectory for cutting the bone (e.g., the vertebra), while the
follower robotic arm tracks the leader robotic arm with a maximum
error of, for example, less than 1.5 mm. As such, the bone or a
portion of the bone is removed under safe boundaries (and secured
by the shield attached to the follower robotic arm). In such
embodiments, an external navigation system or additional markers
may not be used during the procedure.
[0052] The cutting tool may be a rotated, ring-shaped saw, located
inside an external protection tube. While approaching an entry
point at the anatomical element, the cutting edge may be covered in
order to protect soft tissues. The cutting edge may then be exposed
on the bone surface. The protection tool edge of the external
protection tube may be a telescopic expandable tube, which may
retract or extend according to the patient anatomy. The cutting
tool may also be a drill bit or other cutting tool that is
configured to remain in a retracted position during insertion
toward a surgical site, and to then extend from the retracted
position during use.
[0053] Embodiments of the present disclosure provide technical
solutions to one or more of the problems of (1) cutting and/or
removing bone or another anatomical element safely (e.g., without
harming anatomical elements adjacent or otherwise proximate to the
bone or other anatomical element), (2) safe bone or other
anatomical element cutting using two robotic arms synchronously,
(3) providing protection for a cutting mechanism during insertion
of a cutting tool into patient anatomy, (4) preventing a cutting
mechanism from causing damage to a patient's anatomy during
insertion toward a surgical site; (5) inserting a shield or other
protective barrier in a cutting path of a cutting mechanism to
prevent the cutting mechanism from traveling too far along the
path, and doing so in a minimally invasive surgical context; and/or
(6) increasing patient safety during surgical operations.
[0054] Turning first to FIG. 1, a block diagram of a system 100
according to at least one embodiment of the present disclosure is
shown. The system 100 may be used to cut or otherwise remove at
least a portion of an anatomical element such as, for example, a
vertebra, and/or carry out one or more other aspects of one or more
of the methods disclosed herein. The system 100 comprises a bone
cutting or partial anatomical element cutting system 200, 300, 500,
600 (described in detail with respect to FIGS. 2-6B below), a
computing device 102, a robot 114, a navigation system 118, a
database 130, and/or a cloud or other network 134. Systems
according to other embodiments of the present disclosure may
comprise more or fewer components than the system 100. For example,
the system 100 may not include the robot 114, the navigation system
118, one or more components of the computing device 102, the
database 130, and/or the cloud 134. Although referred to as a
"bone" cutting system 200, 300, 500, 600 herein, embodiments of the
present disclosure may also be used for cutting non-bone anatomical
elements, including soft tissue anatomical elements.
[0055] The computing device 102 comprises a processor 104, a memory
106, a communication interface 108, and a user interface 110.
Computing devices according to other embodiments of the present
disclosure may comprise more or fewer components than the computing
device 102.
[0056] The processor 104 of the computing device 102 may be any
processor described herein or any similar processor. The processor
104 may be configured to execute instructions stored in the memory
106, which instructions may cause the processor 104 to carry out
one or more computing steps utilizing or based on data received
from the robot 114, the navigation system 118, the database 130,
and/or the cloud 134.
[0057] The memory 106 may be or comprise RAM, DRAM, SDRAM, other
solid-state memory, any memory described herein, or any other
tangible, non-transitory memory for storing computer-readable data
and/or instructions. The memory 106 may store information or data
useful for completing, for example, any step of the method 700
described herein, or of any other methods. The memory 106 may
store, for example, one or more surgical plans 120 and/or one or
more sets of instructions 122. Such instructions 122 may, in some
embodiments, be organized into one or more applications, modules,
packages, layers, or engines. The instructions 122 may cause the
processor 104 to manipulate data stored in the memory 106 and/or
received from or via the robot 114, the database 130, and/or the
cloud 134.
[0058] The computing device 102 may also comprise a communication
interface 108. The communication interface 108 may be used for
receiving image data or other information from an external source
(such as the robot 114, the navigation system 118, the database
130, the cloud 134, the bone cutting system 200, 300, 500, 600,
and/or any other system or component not part of the system 100),
and/or for transmitting instructions, images, or other information
to an external system or device (e.g., another computing device
102, the robot 114, the navigation system 118, the database 130,
the cloud 134, the bone cutting system 200, 300, 500, 600, and/or
any other system or component not part of the system 100). The
communication interface 108 may comprise one or more wired
interfaces (e.g., a USB port, an ethernet port, a Firewire port)
and/or one or more wireless transceivers or interfaces (configured,
for example, to transmit and/or receive information via one or more
wireless communication protocols such as 802.11a/b/g/n, Bluetooth,
NFC, ZigBee, and so forth). In some embodiments, the communication
interface 108 may be useful for enabling the device 102 to
communicate with one or more other processors 104 or computing
devices 102, whether to reduce the time needed to accomplish a
computing-intensive task or for any other reason.
[0059] The computing device 102 may also comprise one or more user
interfaces 110. The user interface 110 may be or comprise a
keyboard, mouse, trackball, monitor, television, screen,
touchscreen, and/or any other device for receiving information from
a user and/or for providing information to a user. The user
interface 110 may be used, for example, to receive a user selection
or other user input regarding any step of any method described
herein. Notwithstanding the foregoing, any required input for any
step of any method described herein may be generated automatically
by the system 100 (e.g., by the processor 104 or another component
of the system 100) or received by the system 100 from a source
external to the system 100. In some embodiments, the user interface
110 may be useful to allow a surgeon or other user to modify
instructions to be executed by the processor 104 according to one
or more embodiments of the present disclosure, and/or to modify or
adjust a setting of other information displayed on the user
interface 110 or corresponding thereto.
[0060] Although the user interface 110 is shown as part of the
computing device 102, in some embodiments, the computing device 102
may utilize a user interface 110 that is housed separately from one
or more remaining components of the computing device 102. In some
embodiments, the user interface 110 may be located proximate one or
more other components of the computing device 102, while in other
embodiments, the user interface 110 may be located remotely from
one or more other components of the computer device 102.
[0061] The robot 114 may be any surgical robot or surgical robotic
system. The robot 114 may be or comprise, for example, the Mazor
X.TM. Stealth Edition robotic guidance system. The robot 114 may be
configured to position any component such as the cutting tool 202,
602, and/or the shield 204, 304, 504 at one or more precise
position(s) and orientation(s), and/or to return the component(s)
to the same position(s) and orientation(s) at a later point in
time. The robot 114 may additionally or alternatively be configured
to manipulate a surgical tool (whether based on guidance from the
navigation system 118 or not) to accomplish or to assist with a
surgical task. In some embodiments, the robot 114 may be configured
to hold and/or manipulate an anatomical element during or in
connection with a surgical procedure. The robot 114 may comprise
one or more robotic arms 116. In some embodiments, the robotic arm
116 may comprise a first robotic arm and a second robotic arm,
though the robot 114 may comprise more than two robotic arms. In
some embodiments, one or more of the robotic arms 116 may be used
to hold and/or maneuver the bone cutting system 200, 300, 500, 600.
In embodiments where the cutting tool 202, 602 and the shield 204,
304, 504 operate independently of each other, one robotic arm 116
may hold one such component, and another robotic arm 116 may hold
another such component. Each robotic arm 116 may be positionable
independently of the other robotic arm. The robotic arms may be
controlled in a single, shared coordinate space, or in separate
coordinate spaces.
[0062] The robot 114, together with the robotic arm 116, may have,
for example, one, two, three, four, five, six, seven, or more
degrees of freedom. Further, the robotic arm 116 may be positioned
or positionable in any pose, plane, and/or focal point. The pose
includes a position and an orientation. As a result, a cutting tool
202, 602, a shield 204, 304, 504, a surgical tool, a surgical
instrument, or other object held by the robot 114 (or, more
specifically, by the robotic arm 116) may be precisely positionable
in one or more needed and specific positions and orientations.
[0063] The robotic arm(s) 116 may comprise one or more sensors that
enable the processor 104 (or a processor of the robot 114) to
determine a precise pose in space of the robotic arm 116 (as well
as any object or element held by or secured to the robotic arm
116).
[0064] In some embodiments, reference markers (i.e., navigation
markers) may be placed on the robot 114 (including, e.g., on the
robotic arm 116), the bone cutting system 200, 300, 500, 600,
and/or any component thereof, or any other object in the surgical
space. The reference markers may be tracked by the navigation
system 118, and the results of the tracking may be used by the
robot 114 and/or by an operator of the system 100 or any component
thereof. In some embodiments, the navigation system 118 can be used
to track other components of the system (e.g., the bone cutting
system 200, 300, 500, 600) and the system can operate without the
use of the robot 114 (e.g., with the surgeon manually manipulating
the bone cutting system 200, 300, 500, 600 and/or one or more
surgical tools, based on information and/or instructions generated
by the navigation system 118, for example).
[0065] The navigation system 118 may provide navigation for a
surgeon and/or a surgical robot during an operation. The navigation
system 118 may be any now-known or future-developed navigation
system, including, for example, the Medtronic StealthStation.TM. S8
surgical navigation system or any successor thereof. The navigation
system 118 may include one or more cameras or other sensor(s) for
tracking one or more reference markers, navigated trackers, or
other objects within the operating room or other room in which some
or all of the system 100 is located. The one or more cameras may be
optical cameras, infrared cameras, or other cameras. In some
embodiments, the navigation system may comprise one or more
electromagnetic sensors. In various embodiments, the navigation
system 118 may be used to track a position and orientation (i.e.,
pose) of the bone cutting system 200, 300, 500, 600, the robot 114
and/or robotic arm 116, and/or one or more surgical tools (or, more
particularly, to track a pose of a navigated tracker attached,
directly or indirectly, in fixed relation to the one or more of the
foregoing). The navigation system 118 may include a display for
displaying one or more images from an external source (e.g., the
computing device 102, or other source) or for displaying an image
and/or video stream from the one or more cameras or other sensors
of the navigation system 118. In some instances, such as, for
example, if it is not possible to determine an exact location of a
tool tip with sensor data from the robot 114, then data from the
navigation system 118 may be used to determine the location of the
tool tip. The navigation system 118 may be configured to provide
guidance to a surgeon or other user of the system 100 or a
component thereof, to the robot 114, or to any other element of the
system 100 regarding, for example, a pose of one or more anatomical
elements, whether or not the cutting tool 202, 602, the shield 204,
304, 504, or any other tool is in the proper trajectory, and/or how
to move the cutting tool 202, 602, the shield 204, 304, 504, or any
other tool into the proper trajectory to carry out a surgical task
according to a preoperative or other surgical plan such as the
surgical plan 120. In some embodiments, the system 100 can operate
without the use of the navigation system 118.
[0066] The system 100 or similar systems may be used, for example,
to carry out one or more aspects of the method 700 described
herein. The system 100 or similar systems may also be used for
other purposes.
[0067] Turning to FIG. 2, a schematic perspective view of a bone
cutting system 200 is shown. The bone cutting system 200 may be
used in a minimally invasive surgical procedure or an open surgery.
For example, the system 200 may be used in a minimally invasive
surgical procedure using two ports. Though the system 200 is
referred to as a bone cutting system 200, it will be appreciated
that the system 200 can be used to cut any anatomical element.
[0068] The system 200 includes a cutting tool 202 and a shield 204.
During use, the shield 204 is positioned proximate an anatomical
element 206 at a planned exit point of the cutting tool 202 such
that when the cutting tool 202 exits the anatomical element 206
after cutting the anatomical element 206, the shield 204 protects
the surrounding soft tissue (such as dura matter, a spinal cord,
nerves, etc.) from the cutting tool 202. In other instances, the
shield 204 may be positioned along any portion of a cutting path or
trajectory of the cutting tool 202.
[0069] The shield 204 is separate from and therefore may be
oriented independently of the cutting tool 202. As such, two
incisions may be formed to each receive the cutting tool 202 or the
shield 204, respectively, during a surgical procedure (such as, for
example, a minimally invasive surgical procedure). In some
embodiments, the cutting tool 202 may be oriented by a first
robotic arm and the shield 204 may be oriented by a second robotic
arm. The first robotic arm and the second robotic arm may be the
same as or similar to the robotic arm 116 described above with
reference to FIG. 1. In other embodiments, the cutting tool 202 and
the shield 204 may be oriented by a user such as a surgeon or other
medical provider. In further embodiments, one of the cutting tool
202 or the shield 204 may be oriented by a robotic arm such as the
robotic arm 116 and the other one of the cutting tool 202 or the
shield 204 may be oriented by a user.
[0070] The cutting tool 202 may have a width of about 10 mm in some
embodiments. In other embodiments, the cutting tool 202 may have a
width greater than or less than 10 mm. In the illustrated
embodiment, the cutting tool 202 includes a first tube 208 nested
inside of a second tube 210. The first tube 208 and/or the second
tube 210 may be formed from any solid, biocompatible material such
as metal, aluminum, stainless steel, steel, titanium, plastic
(e.g., PEEK), or the like. In the illustrated embodiment, the first
tube 208 includes a plurality of teeth 228 or serrations at a
distal end of the first tube 208 for cutting the anatomical element
206. The plurality of teeth 228 may constitute serrations similar
to a saw. In other embodiments, the first tube 208 may include any
type and any number of cutters for cutting, scraping, drilling, or
crushing the anatomical element 206. In some embodiments, the first
tube 208 may be configured to rotate (for example, the first tube
208 may rotate as indicated by the arrow 230) to cut or scrape the
anatomical element 206. In other embodiments, the first tube 208
may be configured to oscillate or vibrate (in any direction) to
crush or otherwise cut into the anatomical element 206.
[0071] The first tube 208 and the second tube 210 are configured to
extend telescopically in a first direction as indicated by the
arrow 232. In some embodiments, the first tube 208 may extend a
maximum distance of about 250 mm from the second tube 210. In other
embodiments, the first tube 208 may extend a maximum distance
greater than or less than 250 mm from the second tube 210. The
first tube 208 and the second tube 210 may extend automatically
(e.g., whether by an external or internal motor, a robotic arm such
as the robotic arm 116 causing the first tube 208 and/or the second
tube 210 to extend, and whether in response to a user input or
otherwise) or may be extended manually by, for example, a user
(such as a surgeon or other medical provider). During use, the
first tube 208 may remain nested inside of the second tube 210 in a
first position during insertion and positioning of the cutting tool
202 in a patient anatomy. In the first position, the plurality of
teeth 228 do not extend beyond the second tube 210. In other words,
the plurality of teeth 228 are not exposed. By nesting the first
tube 208 inside of the second tube 210, the benefits are two-fold.
The anatomical elements are protected from accidental damage by the
plurality of teeth 228 and the plurality of teeth 228 are also
protected from accidental damage by anatomical elements (such as
bone). When the cutting tool 202 is in place (by way of positioning
the cutting tool 202 and potentially extending the second tube 210
telescopically in the first direction), the first tube 208 may move
to a second position in which the plurality of teeth 228 extend
beyond the second tube 210. The first tube 208 may move to the
second position by extending in the first direction.
[0072] The first tube 208 and/or the second tube 210 include a
cannula 212 through which debris (such as anatomical particles
resulting from cutting the anatomical element 206) may be removed.
In the illustrated embodiment, a vacuum source 214 may provide a
suction force to the cannula 212 to suction debris from the
anatomical element 206 or the area surrounding the anatomical
element 206 and through the cannula 212. The debris may be
suctioned to a depository 226. The depository 226 may be directly
attached to the cutting tool 202 or may be connected to the cutting
tool 202 by a hose, tubing, or other connection through which
debris may be delivered. In some embodiments, such as when the
first tube 208 is replaced by a simple drill bit such as a drill
bit 644 (as shown and described with respect to FIG. 6), the system
200 may not include the vacuum source 214 and/or the depository
226. In other embodiments, a fluid may be delivered to a cutting
site to flush debris from the cutting site (whether with or without
the depository 226 and/or the vacuum source 214).
[0073] As further shown in the illustrated embodiment, the first
tube 208 and the second tube 210 extend from a cutting base 234. In
some embodiments, the cutting base 234 may be supported by a
robotic arm, such as the robotic arm 116, or by a user (such as a
surgeon or other medical provider). In other embodiments, the
cutting tool 202 may not include the cutting base 234 and the
robotic arm or the user may support the cutting tool 202 at, for
example, the second tube 210.
[0074] Still referring to FIG. 2, the shield 204 includes a first
body or segment 236 coupled to a second body or segment 238 by a
joint 240. The first segment 236 and/or the second segment 238 may
be formed from any solid, biocompatible material such as metal,
aluminum, stainless steel, steel, titanium, plastic (e.g., PEEK),
or the like. The second segment 238 may have a selectively
adjustable angle relative to the first segment 236. In other words,
the second segment 238 may be selectively rotatable about the joint
240 as indicated by the arrow 242. The second segment 238 may
rotate automatically (e.g., whether by an external or internal
motor, and whether in response to a user input or otherwise) or may
be rotated manually by, for example, a user (such as a surgeon or
other medical provider).
[0075] The second segment 238 may be inserted into an incision
while in a first position where the second segment 238 is
substantially parallel to the first segment 236. In other words,
the second segment 238 may have an angle substantially zero
relative to the first segment 236. The first position provides for
a narrow cross-section of the shield 204, thereby decreasing a
needed diameter of an incision for insertion of the shield 204 and
providing for simple insertion of the shield 204 into the incision.
The second segment 238 may also be placed in the first position for
storage of the shield 204. The second segment 238 may move or be
moved to a second position after insertion of the shield 204 into a
patient anatomy. The second position is defined by the second
segment 238 being at an angle greater than zero relative to the
first segment 236. The second segment 238 may also be locked in the
second position so that the second segment 238 does not move. In
some embodiments the second segment 238 does not move to the second
position until the second segment 238 is oriented at or near the
anatomical element 206. In other embodiments, the second segment
238 may move to the second position prior to being oriented near
the anatomical element 206 and may move to the second position at
any portion of a trajectory of the second segment 238.
[0076] In some embodiments, the first segment 236 may be configured
to extend in a second direction different from the first direction,
as indicated by the arrow 244. The first segment 236 may extend
automatically (e.g., whether by an external or internal motor or a
robotic arm such as the robotic arm 116 causing the first segment
236 to extend, and whether in response to a user input or
otherwise) or may be extended manually by, for example, a user
(such as a surgeon or other medical provider). In at least some
embodiments where the first segment 236 is extendable, the first
segment 236 may be selectively extendable from a shield base 246.
In other embodiments, the first segment 236 may be fixed.
[0077] The second segment 238 may have a width at least as wide as
a diameter of the cutting tool 202. In some embodiments, the width
is about 10 mm. In other embodiments, the width is less than or
greater than 10 mm. In some embodiments, the second segment 238 may
also have a length of about 25 mm. In other embodiments, the length
is greater than or less than 25 mm. The second segment 238 may also
have a depth of about 4 mm. In other embodiments, the depth of the
second segment 238 may be less than or greater than 4 mm.
[0078] The second segment 238 is dimensioned so as to block further
movement of the cutting tool 202 when the first tube 208 contacts
the second segment 238 (after having cut or drilled through the
anatomical element 206). In other words, the shield 204 is sized so
as to block and prevent further movement of the cutting tool 202 in
the first direction (as indicated by the arrow 232) upon contact of
the cutting tool 202 with the shield 204. Such blocking may prevent
damage to surrounding soft tissue (e.g., dura matter, nerves, etc.)
or other anatomical elements when cutting or drilling an anatomical
element such as bone.
[0079] The dimensions of the second segment 238 may be selected,
for example, based on the dimensions of the cutting tool 202, a
flexibility and/or rigidity of the cutting tool 202, and/or a
cutting speed of the cutting tool 202 (e.g., to ensure that the
cutting tool 202 will not cut through the second segment 238 before
being stopped). In some embodiments, the cutting tool 202 may be
configured to only extend as far as the second segment 238, such
that the cutting tool 202 is physically unable to cut through the
shield 304.
[0080] In at least some embodiments where the cutting tool 202 and
the shield 204 are oriented and controlled by a first robotic arm
and a second robotic arm, respectively, the first robotic arm and
the second robotic arm may move synchronously in a leader-follower
manner. In such synchronous manner, the first robotic arm and the
second robotic arm are controlled with a centralized computer such
as, for example, the computing device 102. The computing device 102
may be exposed or in communication with all applicable sensor(s)
and/or robot position(s), which enables the centralized computer to
move the first robotic arm and the second robotic arm in a
synchronous manner with a maximum tracking error, for example, of
about 1 mm. The leader or the first robotic arm may move along a
planned trajectory for cutting the anatomical element 206 while the
follower or the second robotic arm may track the leader trajectory.
In some embodiments, the follower or the second robotic arm may
track the leader trajectory with a maximum error of about less than
1.5 mm. In other embodiments, the maximum trajectory may be about
less than 2.5 mm, less than 2.0 mm, less than 1.0 mm, or less than
0.5 mm. In such embodiments, a navigation system such as the
navigation system 118 may not be used.
[0081] Turning to FIG. 3, a schematic perspective view of a bone
cutting system 300 is shown. The bone cutting system 300 may be
used in a minimally invasive surgical procedure or an open surgery.
Though the system 300 is referred to as a bone cutting system 300,
it will be appreciated that the system 300 can be used to cut any
anatomical element. Many components of the system 300 are the same
as or similar to the components of the system 200, and are
described above in connection with the system 200 such as, for
example, the cutting tool 202, the vacuum source 214, and the
depository 226. The bone cutting system 300 may be used in
single-port minimally invasive surgeries.
[0082] The system 300 includes the cutting tool 202 and a shield
304. In some embodiments, the cutting tool 202 and the shield 304
may be oriented by a robotic arm that may be the same as or similar
to the robotic arm 116 described above with reference to FIG. 1. In
some embodiments, the system 300 may be supported and/or oriented
by a single robotic arm and thus, may only require one patient
incision during a surgical procedure (such as, for example, a
minimally invasive procedure). Also in some embodiments, a pilot
hole may be made to facilitate entrance of the cutting tool 202 and
shield 304 into the patient's anatomy. In at least some
embodiments, for example, the surgical procedure may include
forming a pilot hole such that the tool 202 may enter the pilot
hole with protection (by, for example, positioning the first tube
208 in the first position where the first tube 208 is nested inside
of the second tube 210). In such embodiments, a port may be
inserted into the pilot hole. The incision may be larger than the
pair of incisions formed when using the system 200 as both the
cutting tool 202 and the shield 304 are inserted into the same
incision when using the system 300. In other embodiments, the
cutting tool 202 and the shield 304 may be oriented by a user such
as a surgeon or other medical provider.
[0083] The shield 304 includes a first body or segment 336 and a
second body or segment 338. The first segment 336 and/or the second
segment 338 may be formed from any solid biocompatible material
such as metal, aluminum, stainless steel, steel, titanium, plastic
(e.g., PEEK), or the like. In the illustrated embodiment, the first
segment 336 extends from the base 334 at a fixed distance. In other
embodiments, the first segment 336 may telescopically extend to and
from the base 334, similarly to the first segment 236 described
above with respect to FIG. 2.
[0084] In the illustrated embodiment, the second segment 338 is
substantially perpendicular to the first segment 336. In other
embodiments, the second segment 338 may be disposed at any angle
relative to the first segment 336. Although the second segment 338
is fixed relative to the first segment 336 in the illustrated
embodiment, in further embodiments, the second segment 338 may have
a selectively adjustable angle relative to the first segment 336,
similarly to the second segment 228 described above with respect to
FIG. 2.
[0085] The second segment 338 may have a width at least as wide as
a diameter of the cutting tool 202. In some embodiments, the width
is about 10 mm. In other embodiments, the width is less than or
greater than 10 mm. In some embodiments, the second segment 338 may
also have a length at least as wide as the diameter of the cutting
tool 202. In some embodiments, the length is about 25 mm. In other
embodiments, the length is greater than or less than 25 mm. The
second segment 338 may also have a depth of about 4 mm. In other
embodiments, the depth of the second segment 338 may be less than
or greater than 4 mm.
[0086] The second segment 338 is dimensioned so as to block further
movement of the cutting tool 202 when the first tube 308 contacts
the second segment 338 (after having cut or drilled through the
anatomical element 306). In other words, the shield 304 is sized so
as to block and prevent further movement of the cutting tool 202 in
the first direction (as indicated by the arrow 232) upon contact of
the cutting tool 202 with the shield 304. Such blocking may prevent
damage to surrounding soft tissue (e.g., dura matter, nerves, etc.)
or other anatomical elements when cutting or drilling an anatomical
element such as bone.
[0087] The dimensions of the second segment 338 may be selected,
for example, based on the dimensions of the cutting tool 202, a
flexibility and/or rigidity of the cutting tool 202, and/or a
cutting speed of the cutting tool 202 (e.g., to ensure that the
cutting tool 202 will not cut through the second segment 338 before
being stopped). In some embodiments, the cutting tool 202 may be
configured to only extend as far as the second segment 338, such
that the cutting tool 202 is physically unable to cut through the
shield 304.
[0088] In embodiments of the present disclosure in which the system
300 comprises a fixed shield, the system 300 may be oriented prior
to use so that the anatomical element to be cut is positioned in
between the cutting tool 202 and the shield 304. During use, the
cutting tool 202 advances toward the shield 304, and anatomical
elements on an opposite side of the shield 304 are protected from
harm by the shield 304. Also during use, the second tube 210 may
extend to a side of the anatomical element 306 opposite the shield
304. The first tube 208 may then move from the first position (in
which the plurality of teeth 228 do not extend past the second tube
210) to the second position. The first tube 208 may then engage the
anatomical element 306 and rotate, oscillate, or vibrate to cut,
drill, or otherwise remove a portion of the anatomical element 306.
Once the first tube 208 emerges at the planned exit point (or along
any portion of a cutting path or planned trajectory of the cutting
tool 202), the shield 304 prevents further extension of the cutting
tool 202 and protects the surrounding soft tissue.
[0089] FIGS. 4A-4C illustrate positioning of the cutting tool 202
at the anatomical element 306 and cutting the anatomical element
306 with the cutting tool 202. It will be appreciated that the
positioning of the cutting tool 202 shown in FIGS. 4A-4C is
applicable to the systems 200 and 300 described above with respect
to FIGS. 2 and 3 or to any such systems described herein or
encompassed by the present disclosure.
[0090] FIG. 4A depicts the bone cutting system 300, described above
with respect to FIG. 3 in a first configuration. In the first
configuration, the cutting tool 202 is positioned near the base 334
and is in a non-extended state. In other words, the first tube 208
and the second tube 210 are both spaced from the anatomical element
306. Further, the first tube 208 is shown in the first position, in
which the first tube 208 does not extend past the second tube 210.
In other instances, the first tube 208 may be in the second
position (in which the first tube 208 extends past the second tube
210) when the system 300 is in the first configuration.
[0091] FIG. 4B depicts the bone cutting system 300 in a second
configuration. In the second configuration, the cutting tool 202 is
positioned at the anatomical element 306 such that the second tube
210 contacts the anatomical element 306. To move from the first
configuration to the second configuration, the cutting tool 202 may
be telescopically extended or may telescopically extend from the
first configuration to the second configuration. Such movement may
include telescopically extending both the first tube 208 and the
second tube 210. As illustrated, the second tube 210 is shown in
the first position. In other instances, the second tube 210 may be
in the second position when the system 300 is in the second
configuration and/or any period of time when the cutting tool 202
moves from the first configuration to the second configuration.
[0092] FIG. 4C depicts the bone cutting system 300 in a third
configuration. In the third configuration, the second tube 210 is
contacting the anatomical element 306 and the first tube 210 is
cutting the anatomical element 306. In other words, the first tube
210 is in the second position in which the first tube 208 extends
past the second tube 210, thereby exposing the plurality of teeth
228 for cutting.
[0093] It will be appreciated that the above-described movement of
the cutting tool 202 of system 300 from a first configuration to a
third configuration may describe movement of any cutting tool 202,
602 (described below) of any bone cutting system such as the bone
cutting system 200, 500 or 600 (described below). Further, it will
be appreciated that the bone cutting system 200, 300, 500, or 600
can have more than or fewer than three configurations.
[0094] Turning to FIG. 5, a schematic perspective view of a bone
cutting system 500 is shown. The bone cutting system 500 may be
used in a minimally invasive surgical procedure or an open surgery.
Though the system 500 is referred to as a bone cutting system 500,
it will be appreciated that the system 500 can be used to cut any
anatomical element. Many components of the system 500 are the same
as or similar to the components of the system 200, and are
described above in connection with the system 200 such as, for
example, the cutting tool 202, the vacuum source 214, and the
depository 226.
[0095] The system 500 includes the cutting tool 202 and a shield
504. The shield 504 is separate from and therefore may be oriented
independently of the cutting tool 202. In some embodiments, the
cutting tool 202 may be oriented by a first robotic arm and the
shield 504 may be oriented by a second robotic arm. The first
robotic arm and the second robotic arm may be the same as or
similar to the robotic arm 116 described above with reference to
FIG. 1. In such embodiments, a first incision may be formed to
receive the cutting tool 202 and a second incision may be formed to
receive the shield 504 during a surgical procedure (such as, for
example, a minimally invasive surgical procedure). In other
embodiments, the cutting tool 202 and the shield 504 may be
oriented by a user such as a surgeon or other medical provider. In
further embodiments, one of the cutting tool 202 or the shield 504
may be oriented by a robotic arm such as the robotic arm 116 and
the other one of the cutting tool 202 or the shield 504 may be
oriented by a user.
[0096] The shield 504 may include a base 546 and a platform 538.
Although shown as a rectangular prism, the base 546 (as with every
other base of the present disclosure) may have any suitable shape.
The platform 538 may telescopically extend or slide from a first
position, in which the platform 538 does not extend past the base
546 (as shown in FIG. 6A) to a second position, in which the
platform 538 extends past the base 546 (as shown in FIG. 6B). As
illustrated, the platform 538 comprises a first set of rails 538A,
a second set of rails 538B, and a third set of rails 538C by which
a second platform 537B slides or extends from a first platform
537A. In other embodiments, the platform 538 may include more than
or fewer than three sets of rails and more than or fewer than two
platforms. As shown in the illustrated embodiment, the second
platform 537B is oriented at a side of the anatomical element 506
opposite the cutting tool 202 so that the third platform 538C may
stop or prevent movement of the cutting tool 202 past the second
platform 537B when the cutting tool 202 contacts the second
platform 537B.
[0097] The second platform 537B may have a width at least as wide
as a diameter of the cutting tool 202. In some embodiments, the
width is about 10 mm. In other embodiments, the width is less than
or greater than 10 mm. In some embodiments, the second platform
537B may also have a length at least as wide as the diameter of the
cutting tool 202. In some embodiments, the length is about 25 mm.
In other embodiments, the length is greater than or less than 25
mm. The second platform 537B may also have a depth of about 4 mm.
In other embodiments, the depth of the second platform 537B may be
less than or greater than 4 mm.
[0098] The second platform 537B is dimensioned so as to block
further movement of the cutting tool 202 when the first tube 308
contacts the second platform 537B (after having cut or drilled
through the anatomical element 506). In other words, the shield 504
is sized so as to block and prevent further movement of the cutting
tool 202 in the first direction (as indicated by the arrow 232,
shown in FIG. 2) upon contact of the cutting tool 202 with the
shield 504. Such blocking may prevent damage to surrounding soft
tissue (e.g., dura matter, nerves, etc.) or other anatomical
elements when cutting or drilling an anatomical element such as
bone.
[0099] The dimensions of the second platform 537B may be selected,
for example, based on the dimensions of the cutting tool 202, a
flexibility and/or rigidity of the cutting tool 202, and/or a
cutting speed of the cutting tool 202 (e.g., to ensure that the
cutting tool 202 will not cut through the second platform 537B
before being stopped). In some embodiments, the cutting tool 202
may be configured to only extend as far as the second platform
537B, such that the cutting tool 202 is physically unable to cut
through the shield 504.
[0100] Turning to FIG. 6A, a schematic perspective view of a bone
cutting system 600 is shown in a first orientation. The bone
cutting system 600 may be used in a minimally invasive surgical
procedure or an open surgery. Though the system 600 is referred to
as a bone cutting system 600, it will be appreciated that the
system 600 can be used to cut any anatomical element. Many
components of the system 600 are the same as or similar to the
components of the systems 200 and 500, and are described above in
connection with the systems 200 and 500 such as, for example, the
shield 504, the vacuum source 214, and the depository 226.
[0101] The system 600 includes a cutting tool 602, the shield 504,
and a line 640. The shield 504 is separate from and therefore may
be oriented independently of the cutting tool 602. In some
embodiments, the cutting tool 602 may be oriented by a first
robotic arm and the shield 504 may be oriented by a second robotic
arm. The first robotic arm and the second robotic arm may be the
same as or similar to the robotic arm 116 described above with
reference to FIG. 1. In such embodiments, a first incision may be
formed to receive the cutting tool 602 and a second incision may be
formed to receive the shield 504 during a surgical procedure (such
as, for example, a minimally invasive surgical procedure). In other
embodiments, the cutting tool 602 and the shield 504 may be
oriented by a user such as a surgeon or other medical provider. In
further embodiments, one of the cutting tool 602 or the shield 504
may be oriented by a robotic arm such as the robotic arm 116 and
the other one of the cutting tool 602 or the shield 504 may be
oriented by a user.
[0102] The cutting tool 602 may include a core or base 642 and a
drill bit 644, shown in FIG. 6B. The drill bit 644 may be
configured to telescopically extend from the core or base 642. The
drill bit 644 and/or the base 642 may be made from any solid,
biocompatible material such as metal, aluminum, stainless steel,
steel, titanium, plastic (e.g., PEEK), or the like.
[0103] In some embodiments, the line 640 may be a pneumatic or
hydraulic hose for actuating the telescopic functionality of the
platform 538 (and thereby causing the platform 538 to
telescopically extend or retract). In other embodiments, the line
640 may be a wire for delivering electricity to a motor that causes
the platform 538 to telescopically extend or retract. In further
embodiments, the line 640 may be a wire for mechanically or
electrically actuating a biasing force (for example, a spring) for
telescopically extending the platform 538. For example, a
rigid-flex cable may be attached to an end of the platform 538 (or
in some instances, a spring disposed at, for example, an end of the
platform 538 or at any portion of the shield 504) whereby in
pushing the wire down, the platform 538 is extended and in pulling
the wire up, the platform 538 is retracted.
[0104] In FIG. 6A, the system 600 is shown in the first orientation
in which the drill bit 644 is retracted in the base 642 and the
platform 538 is retracted in the base 546.
[0105] In FIG. 6B, the system 600 is shown in a second orientation
in which the drill bit 644 is telescopically extended from the base
642 and the platform 538 is telescopically extended from the base
546. In the second orientation, the second platform 537B is
oriented at a side of the anatomical element 606 opposite the
cutting tool 602 so that the second platform 537B may stop or
prevent movement of the cutting tool 602 past the second platform
537B when the cutting tool 602 contacts the second platform
537B.
[0106] Though the system 600 is shown in a first orientation and a
second orientation in FIGS. 6A-6B, it will be appreciated that the
system 600 can include one orientation or more than two
orientations.
[0107] It will be appreciated that the systems 200, 300, 500, and
600 may include any combination of any embodiment of the cutting
tool and the shield. For example, the shield may have a fixed
second segment as described with respect to FIG. 3 and may be
oriented independently of the cutting tool as described with
respect to FIG. 2. In another example, the shield may have a second
segment with a selectively adjustable angle relative to the first
segment as described with respect to FIG. 2 and may be oriented by
a robotic arm (instead of two robotic arms) as described with
respect to FIG. 3. In another example, the shield may have a
telescoping second segment as described with respect to FIG. 5 and
may be oriented by one robotic arm as described with respect to
FIG. 3.
[0108] FIG. 7 depicts a method 700 that may be used, for example,
for cutting anatomical elements such as bone. The method 700 may be
used, for example, during a minimally invasive surgical procedure.
The procedure may be, for example, a decompression procedure, a
laminectomy, or a laminotomy. The method 700 may also be used
during an open surgical procedure.
[0109] The method 700 (and/or one or more steps thereof) may be
carried out or otherwise performed, for example, by at least one
processor. The at least one processor may be the same as or similar
to the processor(s) 104 of the computing device 102 described
above. The at least one processor may be part of a robot (such as a
robot 114) or part of a navigation system (such as a navigation
system 118). A processor other than any processor described herein
may also be used to execute the method 700. The at least one
processor may perform the method 700 by executing instructions such
as the instructions 122 stored in a memory such as the memory 106.
The instructions may correspond to one or more steps of the method
700 described below.
[0110] The method 700 comprises orienting a shield proximate an
anatomical element (step 704). The shield may be the same as or
similar to the shield 204, 304, or 504 described above with respect
to FIG. 2, 3, or 5, respectively. The anatomical element may be,
for example, any hard tissue such as bone. The anatomical element
may be, in some embodiments, a vertebra. In some embodiments, the
shield may be oriented by a robotic arm such as the robotic arm 116
as described with respect to FIG. 1 above. In other embodiments,
the shield may be oriented by a user such as a surgeon or other
medical provider. The shield may be oriented proximate the
anatomical element at a planned exit point of a cutting tool. In
other instances, the shield may be positioned along any portion of
a cutting path of the cutting tool. The cutting tool may be the
same as or similar to the cutting tool 202 or 602 described above
with respect to FIG. 2 or 6, respectively. The cutting tool may
include a first tube nested inside of a second tube. The first tube
may include a distal end comprising a set or plurality of cutting
teeth for cutting the anatomical element. At least one of the first
tube and/or the second tube may be configured to extend in a first
direction. The cutting tool may also be or comprise a drill bit
such as the drill bit 644.
[0111] In embodiments where the shield includes a base, orienting
the shield may include positioning a base of the shield.
Positioning the base of the shield may include simply positioning
the base of the shield at an incision. In other instances,
positioning the base of the shield may include maneuvering the base
of the shield along a trajectory into the incision. In instances
where a first segment of the shield may telescope, positioning the
base of the shield may also include maneuvering the base of the
shield in order to insert at least a portion of the first segment
into an incision when the portion needs to be inserted into the
incision prior to telescoping. In these instances, it will be
appreciated that the shield may be any shield described herein,
such as, for example, the shield 204, 304, 504, and that such
shield may telescope in any embodiment. In some embodiments, the
shield may be separate from the cutting tool, as shown and
described in FIGS. 2, 5, and 6A-6B. In other embodiments, the
shield and the cutting tool may be combined, as described with
respect to FIG. 3. Orienting the shield may also include causing a
portion of the shield to extend linearly, whether telescopically
(e.g., a first segment, a second segment, and/or a platform) or
otherwise. For example, when the shield is similar to or the same
as the shield 504, the platform may extend telescopically into
position. Orienting the shield may also include causing one portion
of the shield (e.g., a second segment) to rotate relative to
another portion of the shield (e.g., a first segment). For example,
when the shield is similar to or the same as the shield 204, the
second segment may rotate into position.
[0112] The shield may be oriented at a shield pose (e.g., position
and orientation). In some embodiments, the shield pose may be based
on a surgical plan such as the surgical plan 120. In other
embodiments, the shield pose may be input received from a user such
as a surgeon or other medical provider. The surgical plan and/or
the input may be received from a user interface such as the user
interface 110 and stored in a memory such as the memory 106.
Instructions such as the instructions 122 may be generated based on
the surgical plan and/or the input. In some embodiments, the
instructions may be machine readable and transmitted to the robotic
arm to cause the robotic arm to orient the shield at the shield
pose. In other embodiments, the instructions may be human readable
and displayed on the user interface, for example, and include
instructions for a user to orient the shield at the shield
pose.
[0113] The method 700 also comprises orienting the cutting tool at
the anatomical element (step 708). The cutting tool may be
positioned at a side of the anatomical element opposite the shield
as oriented in step 704. In some embodiments, a user such as a
surgeon or other medical provider may orient the cutting tool at
the anatomical element. In other embodiments, a robotic arm such as
the robotic arm 116 may orient the cutting tool at the anatomical
element. In some embodiments, the robotic arm is the same robotic
arm as the robotic arm orienting the shield in step 704. In other
embodiments, the robotic arm is a different robotic arm than the
robotic arm orienting the shield. In such embodiments, the shield
may be oriented independently of the cutting tool.
[0114] The cutting tool may be oriented at a cutting tool pose
(e.g., position and orientation). In some embodiments, the cutting
tool pose may be based on a surgical plan such as the surgical plan
120, and may be based on a trajectory defined in the surgical plan.
In other embodiments, the cutting tool pose may be defined by input
received from a user such as a surgeon or other medical provider.
The surgical plan and/or the input may be received from a user
interface such as the user interface 110 and stored in a memory
such as the memory 106. Instructions such as the instructions 122
may be generated based on the surgical plan and/or the input. In
some embodiments, the instructions may be machine readable and
transmitted to the robotic arm to cause the robotic arm to orient
the cutting tool at the cutting tool pose. In other embodiments,
the instructions may be human readable and displayed on the user
interface, for example, and include instructions for a user to
orient the cutting tool at the cutting tool pose.
[0115] The step 708 may also include extending (whether by a
robotic arm or a user) the second tube of the cutting tool in a
first direction to orient the cutting tool at the cutting tool
pose. During such instances, the first tube may not extend past the
second tube. In other words, the plurality of teeth may not be
exposed and may not extend past the second tube. The step 708 may
also include moving the first tube from a first position, in which
the first tube does not extend past the second tube, to a second
position, in which the first tube (and thus, the plurality of
teeth) extend past the second tube.
[0116] In some embodiments of the present disclosure, the cutting
tool may comprise a sheath or other covering (such as, for example,
the second tube 210, a retractable cap, or a cover through which
the plurality of teeth 228 cut) over one or more cutting portions
thereof (such as, for example, the plurality of teeth 228 disposed
on the first tube 208). In such embodiments, the sheath may be
positioned over the one or more cutting portions during the step
708. In other embodiments, however, the cutting tool may not
comprise a sheath or other covering for the one or more cutting
portions thereof, and which one or more cutting portions may be
exposed during orientation of the cutting tool.
[0117] For the avoidance of doubt, the steps 704 and 708 may occur
in sequence or simultaneously. In some embodiments, the cutting
tool may be oriented prior to orientation of the shield, while in
other embodiments, the shield may be oriented prior to orientation
of the cutting tool. Where the cutting tool is first oriented, the
orientation of the shield may be based on the orientation of the
cutting tool. Where the shield is first oriented, the orientation
of the shield may be based on a planned orientation of the cutting
tool.
[0118] The method 700 also comprises controlling the cutting tool
to cut the anatomical element (step 712). As previously described,
in embodiments where the cutting tool comprises a first tube and a
second tube (as in the systems 200, 300, and 500 described above),
when the first tube is in the second position, the plurality of
teeth are exposed and prepared for engagement with the anatomical
element. The first tube may use rotational movement, vibrational
movement, or oscillations to scrape, crush, drill, or otherwise cut
the anatomical element. In some embodiments, a robotic arm such as
the robotic arm 116 may control the cutting tool to cut through the
anatomical element toward the planned exit point or along a cutting
trajectory. In other embodiments, a user such as a surgeon or other
medical provider may cause the cutting tool to cut the anatomical
element toward the planned exit point or along a cutting
trajectory. The cutting trajectory may include extending the first
tube in the first direction. Once the cutting tool has breached the
anatomical element, the shield prevents further movement of the
cutting tool in the first direction, along the trajectory, and/or
beyond the point of exit of the cutting tool from the anatomical
element, by presenting a physical barrier to further forward
movement and/or cutting of the cutting tool. In some embodiments,
the cutting tool may cease cutting (whether by ceasing a rotational
movement, a vibrational movement, or oscillation) when the cutting
tool contacts the shield. In such embodiments, the robotic arm may
automatically cause the cutting tool to cease cutting. In other
embodiments, the user may cause the cutting tool to cease cutting
(whether by releasing a trigger, pressing a stop button, or
instructing the robotic arm to cause the cutting tool cease
cutting).
[0119] The cutting tool may cut the anatomical element for a
predetermine period of time, to a predetermined depth, and/or based
on any other predetermined cutting parameter. In some embodiments,
one or more predetermined cutting parameters, the planned exit
point, and/or the cutting trajectory may be based on a surgical
plan such as the surgical plan 120. In other embodiments, the one
or more predetermined cutting parameters, the planned exit point,
and/or the cutting trajectory may be defined by input received from
a user such as a surgeon or other medical provider. The surgical
plan and/or the input may be received from a user interface such as
the user interface 110 and stored in a memory such as the memory
106. Instructions such as the instructions 122 may be generated
based on the surgical plan and/or the input. In some embodiments,
the instructions may be machine readable and transmitted to the
robotic arm to cause the robotic arm to cause the cutting tool to
cut the anatomical element along a trajectory toward the planned
exit point or along the cutting trajectory based on one or more
predetermined cutting parameters. In other embodiments, the
instructions may be human readable and displayed on the user
interface, for example, and include instructions for a user to
cause the cutting tool to cut the anatomical element toward the
planned exit point or along the cutting trajectory based on one or
more predetermined cutting parameters.
[0120] The present disclosure encompasses embodiments of the method
700 that comprise more or fewer steps than those described above,
and/or one or more steps that are different than the steps
described above.
[0121] As noted above, the present disclosure encompasses methods
with fewer than all of the steps identified in FIG. 7 (and the
corresponding description of the method 700), as well as methods
that include additional steps beyond those identified in FIG. 7
(and the corresponding description of the method 700). The present
disclosure also encompasses methods that comprise one or more steps
from one method described herein, and one or more steps from
another method described herein.
[0122] Although the present disclosure describes cutting tools
having mechanical cutting implements (e.g., saws or other sharp
and/or serrated edges, drill bits), aspects of the present
disclosure are applicable to energy-based cutting tools as well.
For example, a shield as disclosed herein may be used in connection
with an ablation probe, a laser cutting device, or any other
energy-based cutting tool to protect anatomical elements or tissue
at risk of collateral damage during use of the tool.
[0123] The foregoing is not intended to limit the disclosure to the
form or forms disclosed herein. In the foregoing Detailed
Description, for example, various features of the disclosure are
grouped together in one or more aspects, embodiments, and/or
configurations for the purpose of streamlining the disclosure. The
features of the aspects, embodiments, and/or configurations of the
disclosure may be combined in alternate aspects, embodiments,
and/or configurations other than those discussed above. This method
of disclosure is not to be interpreted as reflecting an intention
that the claims require more features than are expressly recited in
each claim. Rather, as the following claims reflect, inventive
aspects lie in less than all features of a single foregoing
disclosed aspect, embodiment, and/or configuration. Thus, the
following claims are hereby incorporated into this Detailed
Description, with each claim standing on its own as a separate
preferred embodiment of the disclosure.
[0124] Moreover, though the foregoing has included description of
one or more aspects, embodiments, and/or configurations and certain
variations and modifications, other variations, combinations, and
modifications are within the scope of the disclosure, e.g., as may
be within the skill and knowledge of those in the art, after
understanding the present disclosure. It is intended to obtain
rights which include alternative aspects, embodiments, and/or
configurations to the extent permitted, including alternate,
interchangeable and/or equivalent structures, functions, ranges or
steps to those claimed, whether or not such alternate,
interchangeable and/or equivalent structures, functions, ranges or
steps are disclosed herein, and without intending to publicly
dedicate any patentable subject matter.
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