System for neuronavigation registration and robotic trajectory guidance, robotic surgery, and related methods and devices

A system for robotic surgery makes use of an end-effector which has been configured so that any selected one of a group of surgical tools may be selectively connected to such end-effector. The end-effector makes use of a tool-insert locking mechanism which secures a selected one of the surgical tools at not only a respective, predetermined height and angle of orientation, but also at a rotational position relative to an anatomical feature of the patient. The tool-insert locking mechanism may include interchangeable inserts to interconnect multiple tools to the same end-effector. In this way, different robotic operations may be accomplished with less reconfiguration of the end-effector. The end-effector may also include a tool stop which has a sensor associated with a moveable stop mechanism which may be positioned to selectively inhibit tool insertion or end-effector movement.

FIELD

The present disclosure relates to medical devices and systems, and more particularly, systems for neuronavigation registration and robotic trajectory guidance, robotic surgery, and related methods and devices.

BACKGROUND

Position recognition systems for robot assisted surgeries are used to determine the position of and track a particular object in 3-dimensions (3D). In robot assisted surgeries, for example, certain objects, such as surgical instruments, need to be tracked with a high degree of precision as the instrument is being positioned and moved by a robot or by a physician, for example.

Position recognition systems may use passive and/or active sensors or markers for registering and tracking the positions of the objects. Using these sensors, the system may geometrically resolve the 3-dimensional position of the sensors based on information from or with respect to one or more cameras, signals, or sensors, etc. These surgical systems can therefore utilize position feedback to precisely guide movement of robotic arms and tools relative to a patients' surgical site. Thus, there is a need for a system that efficiently and accurately provide neuronavigation registration and robotic trajectory guidance in a surgical environment.

End-effectors used in robotic surgery may be limited to use in only certain procedures, or may suffer from other drawbacks or disadvantages.

SUMMARY

According to some implementations, a surgical robot system is configured for surgery on an anatomical feature of a patient, and includes a surgical robot, a robot arm connected to such surgical robot, and an end-effector connected to the robot arm. The end-effector has a tool-insert locking mechanism connected to it. The tool-insert locking mechanism is configured to secure any one of a plurality of surgical tools at a respective, predetermined height, angle of orientation, and rotational position relative to the anatomical feature of the patient. The surgical robot system may likewise include a tool stop, which is also located on and connected to the end-effector. The tool stop has a component which comprises a stop mechanism and also includes a sensor. The stop mechanism is selectively moveable between two positions—an engaged position to prevent surgical tools from being connected to the end-effector and a disengaged position in which surgical tools may be selectively connected to such end-effector. The sensor is able to detect whether the stop mechanism is in the engaged position or the disengaged position. When the sensor determines that the stop mechanism is in the disengaged position, the processor executes suitable instructions, which instructions prevent movement of the end-effector relative to the anatomical feature.

According to still other implementations, the end-effector includes a cylindrical bore which extends between proximal and distal surfaces of the end-effector, with the tool insert locking mechanism located on the proximal surface and the tool stop located on the distal surface. In this implementation, the tool stop and the tool insert locking mechanism each have circular apertures which are axially aligned with the bore. As such, the apertures on the bore are sized and shaped to receive therethrough any desired one of a set of surgical tools for use with the end-effector.

In still another implementation and related variations, the stop mechanism may include a ring which is also axially aligned with the bore. The ring is mounted so that it may be manually rotated when desired to move the stop mechanism between the aforementioned engaged position and disengaged position.

In still another variation, the above-described stop mechanism may be constructed so that it includes a detent mechanism located on and mounted to the ring. In this way, the detent mechanism can be secured relative to the ring and the stop mechanism so as to lock the ring against rotational movement when the stop mechanism is in the engaged position. Furthermore, the detent mechanism may be released or otherwise manually actuatable to unlock the ring from its previously locked position so that the ring can be manually rotated to move from the engaged position to the disengaged position.

In another implementation, the tool stop of any of the above-described surgical robot systems and variations may include a pivotable lever arm. The lever arm is mounted adjacent to the bore of the end-effector and works or is otherwise operatively connected to the stop mechanism so that when the stop mechanism is brought into the engaged position, the lever arm moves to close the aperture of the stop mechanism. In the closed position, the lever arm prevents attachment of the tools to the end-effector. Conversely, the lever arm is pivotable to open the aperture in response to the stop mechanism being moved to the disengaged position, and a selected one of the surgical tools may be attached to the end-effector.

Any of the foregoing described implementations may likewise include a sensor in the form of a Hall Effect sensor which operates in conjunction with a magnet. For example, the Hall Effect sensor and the magnet may be located and movable relative to each other to generate respective magnetic fields detectable by the sensor and corresponding to the engaged position and the disengaged position of the ring, respectively. When the disengaged position is sensed, the lever arm does not block the aperture, permitting tool attachment, and the sensor signals the system100to prevent movement of end-effector112. When the engaged position is sensed, the lever arm blocks the aperture and end-effector motion is permitted due to the impossibility of tools being inserted down the end-effector bore.

In still further implementations of the present disclosure, the tool insert locking mechanism of any of the systems described above may include a connector configured to mate with and secure a selected one of the plurality of surgical tools at the height, angle of orientation, and rotational position desired or preferably for the connected tools in relation to the anatomical feature of the patient. The connector of the tool insert locking mechanism may include a rotatable flange, which flange has a slot adapted to receive therethrough a corresponding tongue which is associated with a selected one of the plurality of tools.

In other implementations, the mating features of slot and tongue may assume other forms suitable to allow the tool to be connected to the tool insert locking mechanism and in turn to the end-effector. So, for example, the mating portion associated with the tool may be directly connected to such tool or, in other suitable implementations, the mating portion may be connected to an adapter. Such adapter may be configured to interconnect at least one of the plurality of surgical tools and the end-effector by means of selective attachment of the adapter to the tool insert locking mechanism, on the one hand, and selective attachment of one or more surgical tools to the adapter, on the other hand.

The tool insert locking mechanism, in still other implementations, may make use of a rotatable flange in the form of a collar, the collar having a proximally oriented surface and multiple slots radially spaced on such proximally oriented surface. In such implementation, the multiple slots are configured to receive therethrough corresponding tongues which are either directly connected to any one of the plurality of tools or are connected instead to an adapter which is removably received in the rotatable flange. In this way, the slots in the corresponding tongues permit securing of the selected one of the plurality of tools only when such tools are at the predetermined angle of orientation and rotational position relative to the anatomical feature of the patient.

The rotatable flange may be adapted, in still other implementations of the current disclosure, so as to be manually rotatable between open and closed positions. The open position is one in which one or more tongues of the adapter or the tool are received through corresponding one or more slots. The closed position is accomplished by rotating the flange after receipt of the tongues through the slots so as to bring a portion of the rotatable flange into engagement with the corresponding tongue and thereby secure the selected one of the tools, or the adapter in which the tool is received, at the respective, predetermined height, angle of orientation, and rotational position relative to the anatomical feature of the patient.

In those implementations that make use of an adapter, the rotatable flange has an inner perimeter edge while the adapter as an outer perimeter edge, the dimensions of each selected so that the edges oppose each other when the adapter is received in the rotatable flange. The adapter has a tongue, as mentioned for some of the implementations discussed previously, and also further includes a tool receiver adapted to connect a selected one of the tools to such adapter. As such, when the tongue of the adapter is received in the slot of the rotatable flange and locked thereto, and when the selected one of the tools is connected to the tool receiver of the adapter, such selected tool is then secured at the predetermined height, angle of orientation, and rotational position relative to the anatomical feature.

In still further implementations, the surgical system may include a plurality of the adapters, the adapters being configured so as to be in the form of interchangeable inserts. Such inserts have substantially the same, predetermined outer perimeter which is sized to be receivable within the aforesaid inner perimeter of the rotatable flange. Furthermore, such interchangeable inserts have bores extending therethrough, which bores have different, respective diameters selected to receive corresponding ones of the plurality of tools therein. In this way, inserts may be selectively connected to or removed from the tool insert locking mechanism, depending on the tools associated with such adapters, and the need for such tools to be mounted to the end-effector for given procedures on the anatomical feature of the patient.

The end-effector may likewise be equipped, in still other variations, with at least one illumination element which is mounted on a distal surface of the end-effector. In certain implementations, the illumination element is mounted at a location spaced from the tool stop so that tools received therein do not obstruct illumination when received in the tool insert locking mechanism.

According to some embodiments of inventive concepts, a system includes a processor circuit and a memory coupled to the processor circuit. The memory includes machine-readable instructions configured to cause the processor circuit to determine, based on a first image volume comprising an anatomical feature of a patient, a registration fixture that is fixed with respect to the anatomical feature of the patient, and a first plurality of fiducial markers that are fixed with respect to the registration fixture, determine, for each fiducial marker of the first plurality of fiducial markers, a position of the fiducial marker relative to the image volume. The machine-readable instructions are further configured to cause the processor circuit to determine, based on the determined positions of the first plurality of fiducial markers, a position and orientation of the registration fixture with respect to the anatomical feature. The machine-readable instructions are further configured to cause the processor circuit to, based on a data frame from a tracking system comprising a second plurality of tracking markers that are fixed with respect to the registration fixture, determine, for each tracking marker of the second plurality of tracking markers, a position of the tracking marker. The machine-readable instructions are further configured to cause the processor circuit to determine, based on the determined positions of the second plurality of tracking markers, a position and orientation of the registration fixture with respect to a robot arm of a surgical robot. The machine-readable instructions are further configured to cause the processor circuit to determine, based on the determined position and orientation of the registration fixture with respect to the anatomical feature and the determined position and orientation of the registration fixture with respect to the robot arm, a position and orientation of the anatomical feature with respect to the robot arm. The machine-readable instructions are further configured to cause the processor circuit to control the robot arm based on the determined position and orientation of the anatomical feature with respect to the robot arm.

According to some other embodiments of inventive concepts, a computer-implemented method is disclosed. The computer-implemented method includes, based on a first image volume comprising an anatomical feature of a patient, a registration fixture that is fixed with respect to the anatomical feature of the patient, and a first plurality of fiducial markers that are fixed with respect to the registration fixture, determining, for each fiducial marker of the first plurality of fiducial markers, a position of the fiducial marker. The computer-implemented method further includes determining, based on the determined positions of the first plurality of fiducial markers, a position and orientation of the registration fixture with respect to the anatomical feature. The computer-implemented method further includes, based on a tracking data frame comprising a second plurality of tracking markers that are fixed with respect to the registration fixture, determining, for each tracking marker of the second plurality of tracking markers, a position of the tracking marker. The computer-implemented method further includes determining, based on the determined positions of the second plurality of tracking markers, a position and orientation of the registration fixture with respect to a robot arm of a surgical robot. The computer-implemented method further includes determining, based on the determined position and orientation of the registration fixture with respect to the anatomical feature and the determined position and orientation of the registration fixture with respect to the robot arm, a position and orientation of the anatomical feature with respect to the robot arm. The computer-implemented method further includes controlling the robot arm based on the determined position and orientation of the anatomical feature with respect to the robot arm.

According to some other embodiments of inventive concepts, a surgical system is disclosed. The surgical system includes an intraoperative surgical tracking computer having a processor circuit and a memory. The memory includes machine-readable instructions configured to cause the processor circuit to provide a medical image volume defining an image space. The medical image volume includes an anatomical feature of a patient, a registration fixture that is fixed with respect to the anatomical feature of the patient, and a plurality of fiducial markers that are fixed with respect to the registration fixture. The machine-readable instructions are further configured to cause the processor circuit to, based on the medical image volume, determine, for each fiducial marker of the plurality of fiducial markers, a position of the fiducial marker with respect to the image space. The machine-readable instructions are further configured to cause the processor circuit to determine, based on the determined positions of the plurality of fiducial markers, a position and orientation of the registration fixture with respect to the anatomical feature. The machine-readable instructions are further configured to cause the processor circuit to provide a tracking data frame defining a tracking space, the tracking data frame comprising positions of a first plurality of tracked markers that are fixed with respect to the registration fixture. The machine-readable instructions are further configured to cause the processor circuit to, based on the tracking data frame, determine a position of the anatomical feature with respect to the first plurality of tracked markers in the tracking space. The surgical system further includes a surgical robot having a robot arm configured to position a surgical end-effector. The surgical robot further includes a controller connected to the robot arm. The controller is configured to perform operations including, based on the tracking data frame, determining a position of the robot arm with respect to the tracking space. The controller is configured to perform operations including determining, based on the determined position and orientation of the anatomical feature with respect to the tracking space and the determined position and orientation of the robot arm with respect to the tracking space, a position and orientation of the anatomical feature with respect to the robot arm. The controller is configured to perform operations including controlling movement of the robot arm based on the determined position and orientation of the anatomical feature with respect to the robot arm to position the surgical end-effector relative to a location on the patient to facilitate surgery on the patient.

Other methods and related devices and systems, and corresponding methods and computer program products according to embodiments will be or become apparent to one with skill in the art upon review of the following drawings and detailed description. It is intended that all such devices and systems, and corresponding methods and computer program products be included within this description, be within the scope of the present disclosure, and be protected by the accompanying claims. Moreover, it is intended that all embodiments disclosed herein can be implemented separately or combined in any way and/or combination.

DETAILED DESCRIPTION

It is to be understood that the present disclosure is not limited in its application to the details of construction and the arrangement of components set forth in the description herein or illustrated in the drawings. The teachings of the present disclosure may be used and practiced in other embodiments and practiced or 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. Unless specified or limited otherwise, the terms “mounted,” “connected,” “supported,” and “coupled” and variations thereof are used broadly and encompass both direct and indirect mountings, connections, supports, and couplings. Further, “connected” and “coupled” are not restricted to physical or mechanical connections or couplings.

According to some other embodiments, systems for neuronavigation registration and robotic trajectory guidance, and related methods and devices are disclosed. In some embodiments, a first image having an anatomical feature of a patient, a registration fixture that is fixed with respect to the anatomical feature of the patient, and a first plurality of fiducial markers that are fixed with respect to the registration fixture is analyzed, and a position is determined for each fiducial marker of the first plurality of fiducial markers. Next, based on the determined positions of the first plurality of fiducial markers, a position and orientation of the registration fixture with respect to the anatomical feature is determined. A data frame comprising a second plurality of tracking markers that are fixed with respect to the registration fixture is also analyzed, and a position is determined for each tracking marker of the second plurality of tracking markers. Based on the determined positions of the second plurality of tracking markers, a position and orientation of the registration fixture with respect to a robot arm of a surgical robot is determined. Based on the determined position and orientation of the registration fixture with respect to the anatomical feature and the determined position and orientation of the registration fixture with respect to the robot arm, a position and orientation of the anatomical feature with respect to the robot arm is determined, which allows the robot arm to be controlled based on the determined position and orientation of the anatomical feature with respect to the robot arm.

Advantages of this and other embodiments include the ability to combine neuronavigation and robotic trajectory alignment into one system, with support for a wide variety of different registration hardware and methods. For example, as will be described in detail below, embodiments may support both computerized tomography (CT) and fluoroscopy (fluoro) registration techniques, and may utilize frame-based and/or frameless surgical arrangements. Moreover, in many embodiments, if an initial (e.g. preoperative) registration is compromised due to movement of a registration fixture, registration of the registration fixture (and of the anatomical feature by extension) can be re-established intraoperatively without suspending surgery and re-capturing preoperative images.

Referring now to the drawings,FIG. 1Aillustrates a surgical robot system100in accordance with an embodiment. Surgical robot system100may include, for example, a surgical robot102, one or more robot arms104, a base106, a display110, an end-effector112, for example, including a guide tube114, and one or more tracking markers118. The robot arm104may be movable along and/or about an axis relative to the base106, responsive to input from a user, commands received from a processing device, or other methods. The surgical robot system100may include a patient tracking device116also including one or more tracking markers118, which is adapted to be secured directly to the patient210(e.g., to a bone of the patient210). As will be discussed in greater detail below, the tracking markers118may be secured to or may be part of a stereotactic frame that is fixed with respect to an anatomical feature of the patient210. The stereotactic frame may also be secured to a fixture to prevent movement of the patient210during surgery.

According to an alternative embodiment,FIG. 1Bis an overhead view of an alternate arrangement for locations of a robotic system100, patient210, surgeon120, and other medical personnel during a cranial surgical procedure. During a cranial procedure, for example, the robot102may be positioned behind the head128of the patient210. The robot arm104of the robot102has an end-effector112that may hold a surgical instrument108during the procedure. In this example, a stereotactic frame134is fixed with respect to the patient's head128, and the patient210and/or stereotactic frame134may also be secured to a patient base211to prevent movement of the patient's head128with respect to the patient base211. In addition, the patient210, the stereotactic frame134and/or or the patient base211may be secured to the robot base106, such as via an auxiliary arm107, to prevent relative movement of the patient210with respect to components of the robot102during surgery. Different devices may be positioned with respect to the patient's head128and/or patient base211as desired to facilitate the procedure, such as an intra-operative CT device130, an anesthesiology station132, a scrub station136, a neuro-modulation station138, and/or one or more remote pendants140for controlling the robot102and/or other devices or systems during the procedure.

The surgical robot system100in the examples ofFIGS. 1A and/or 1Bmay also use a sensor, such as a camera200, for example, positioned on a camera stand202. The camera stand202can have any suitable configuration to move, orient, and support the camera200in a desired position. The camera200may include any suitable camera or cameras, such as one or more cameras (e.g., bifocal or stereophotogrammetric cameras), able to identify, for example, active or passive tracking markers118(shown as part of patient tracking device116inFIG. 2) in a given measurement volume viewable from the perspective of the camera200. In this example, the camera200may scan the given measurement volume and detect the light that comes from the tracking markers118in order to identify and determine the position of the tracking markers118in three-dimensions. For example, active tracking markers118may include infrared-emitting markers that are activated by an electrical signal (e.g., infrared light emitting diodes (LEDs)), and/or passive tracking markers118may include retro-reflective markers that reflect infrared or other light (e.g., they reflect incoming IR radiation into the direction of the incoming light), for example, emitted by illuminators on the camera200or other suitable sensor or other device.

In many surgical procedures, one or more targets of surgical interest, such as targets within the brain for example, are localized to an external reference frame. For example, stereotactic neurosurgery may use an externally mounted stereotactic frame that facilitates patient localization and implant insertion via a frame mounted arc. Neuronavigation is used to register, e.g., map, targets within the brain based on pre-operative or intraoperative imaging. Using this pre-operative or intraoperative imaging, links and associations can be made between the imaging and the actual anatomical structures in a surgical environment, and these links and associations can be utilized by robotic trajectory systems during surgery.

According to some embodiments, various software and hardware elements may be combined to create a system that can be used to plan, register, place and verify the location of an instrument or implant in the brain. These systems may integrate a surgical robot, such as the surgical robot102ofFIGS. 1A and/or 1B, and may employ a surgical navigation system and planning software to program and control the surgical robot. In addition or alternatively, the surgical robot102may be remotely controlled, such as by nonsterile personnel.

The robot102may be positioned near or next to patient210, and it will be appreciated that the robot102can be positioned at any suitable location near the patient210depending on the area of the patient210undergoing the operation. The camera200may be separated from the surgical robot system100and positioned near or next to patient210as well, in any suitable position that allows the camera200to have a direct visual line of sight to the surgical field208. In the configuration shown, the surgeon120may be positioned across from the robot102, but is still able to manipulate the end-effector112and the display110. A surgical assistant126may be positioned across from the surgeon120again with access to both the end-effector112and the display110. If desired, the locations of the surgeon120and the assistant126may be reversed. The traditional areas for the anesthesiologist122and the nurse or scrub tech124may remain unimpeded by the locations of the robot102and camera200.

With respect to the other components of the robot102, the display110can be attached to the surgical robot102and in other embodiments, the display110can be detached from surgical robot102, either within a surgical room with the surgical robot102, or in a remote location. The end-effector112may be coupled to the robot arm104and controlled by at least one motor. In some embodiments, end-effector112can comprise a guide tube114, which is able to receive and orient a surgical instrument108used to perform surgery on the patient210. As used herein, the term “end-effector” is used interchangeably with the terms “end-effectuator” and “effectuator element.” Although generally shown with a guide tube114, it will be appreciated that the end-effector112may be replaced with any suitable instrumentation suitable for use in surgery. In some embodiments, end-effector112can comprise any known structure for effecting the movement of the surgical instrument108in a desired manner.

The surgical robot102is able to control the translation and orientation of the end-effector112. The robot102is able to move end-effector112along x-, y-, and z-axes, for example. The end-effector112can be configured for selective rotation about one or more of the x-, y-, and z-axis such that one or more of the Euler Angles (e.g., roll, pitch, and/or yaw) associated with end-effector112can be selectively controlled. In some embodiments, selective control of the translation and orientation of end-effector112can permit performance of medical procedures with significantly improved accuracy compared to conventional robots that use, for example, a six degree of freedom robot arm comprising only rotational axes. For example, the surgical robot system100may be used to operate on patient210, and robot arm104can be positioned above the body of patient210, with end-effector112selectively angled relative to the z-axis toward the body of patient210.

In some embodiments, the position of the surgical instrument108can be dynamically updated so that surgical robot102can be aware of the location of the surgical instrument108at all times during the procedure. Consequently, in some embodiments, surgical robot102can move the surgical instrument108to the desired position quickly without any further assistance from a physician (unless the physician so desires). In some further embodiments, surgical robot102can be configured to correct the path of the surgical instrument108if the surgical instrument108strays from the selected, preplanned trajectory. In some embodiments, surgical robot102can be configured to permit stoppage, modification, and/or manual control of the movement of end-effector112and/or the surgical instrument108. Thus, in use, in some embodiments, a physician or other user can operate the system100, and has the option to stop, modify, or manually control the autonomous movement of end-effector112and/or the surgical instrument108. Further details of surgical robot system100including the control and movement of a surgical instrument108by surgical robot102can be found in co-pending U.S. Patent Publication No. 2013/0345718, which is incorporated herein by reference in its entirety.

As will be described in greater detail below, the surgical robot system100can comprise one or more tracking markers configured to track the movement of robot arm104, end-effector112, patient210, and/or the surgical instrument108in three dimensions. In some embodiments, a plurality of tracking markers can be mounted (or otherwise secured) thereon to an outer surface of the robot102, such as, for example and without limitation, on base106of robot102, on robot arm104, and/or on the end-effector112. In some embodiments, such as the embodiment of FIG.3below, for example, one or more tracking markers can be mounted or otherwise secured to the end-effector112. One or more tracking markers can further be mounted (or otherwise secured) to the patient210. In some embodiments, the plurality of tracking markers can be positioned on the patient210spaced apart from the surgical field208to reduce the likelihood of being obscured by the surgeon, surgical tools, or other parts of the robot102. Further, one or more tracking markers can be further mounted (or otherwise secured) to the surgical instruments108(e.g., a screw driver, dilator, implant inserter, or the like). Thus, the tracking markers enable each of the marked objects (e.g., the end-effector112, the patient210, and the surgical instruments108) to be tracked by the surgical robot system100. In some embodiments, system100can use tracking information collected from each of the marked objects to calculate the orientation and location, for example, of the end-effector112, the surgical instrument108(e.g., positioned in the tube114of the end-effector112), and the relative position of the patient210. Further details of surgical robot system100including the control, movement and tracking of surgical robot102and of a surgical instrument108can be found in U.S. Patent Publication No. 2016/0242849, which is incorporated herein by reference in its entirety.

In some embodiments, pre-operative imaging may be used to identify the anatomy to be targeted in the procedure. If desired by the surgeon the planning package will allow for the definition of a reformatted coordinate system. This reformatted coordinate system will have coordinate axes anchored to specific anatomical landmarks, such as the anterior commissure (AC) and posterior commissure (PC) for neurosurgery procedures. In some embodiments, multiple pre-operative exam images (e.g., CT or magnetic resonance (MR) images) may be co-registered such that it is possible to transform coordinates of any given point on the anatomy to the corresponding point on all other pre-operative exam images.

As used herein, registration is the process of determining the coordinate transformations from one coordinate system to another. For example, in the co-registration of preoperative images, co-registering a CT scan to an MR scan means that it is possible to transform the coordinates of an anatomical point from the CT scan to the corresponding anatomical location in the MR scan. It may also be advantageous to register at least one exam image coordinate system to the coordinate system of a common registration fixture, such as a dynamic reference base (DRB), which may allow the camera200to keep track of the position of the patient in the camera space in real-time so that any intraoperative movement of an anatomical point on the patient in the room can be detected by the robot system100and accounted for by compensatory movement of the surgical robot102.

FIG. 3is a flowchart diagram illustrating computer-implemented operations300for determining a position and orientation of an anatomical feature of a patient with respect to a robot arm of a surgical robot, according to some embodiments. The operations300may include receiving a first image volume, such as a CT scan, from a preoperative image capture device at a first time (Block302). The first image volume includes an anatomical feature of a patient and at least a portion of a registration fixture that is fixed with respect to the anatomical feature of the patient. The registration fixture includes a first plurality of fiducial markers that are fixed with respect to the registration fixture. The operations300further include determining, for each fiducial marker of the first plurality of fiducial markers, a position of the fiducial marker relative to the first image volume (Block304). The operations300further include, determining, based on the determined positions of the first plurality of fiducial markers, positions of an array of tracking markers on the registration fixture (fiducial registration array or FRA) with respect to the anatomical feature (Block306).

The operations300may further include receiving a tracking data frame from an intraoperative tracking device comprising a plurality of tracking cameras at a second time that is later than the first time (Block308). The tracking frame includes positions of a plurality of tracking markers that are fixed with respect to the registration fixture (FRA) and a plurality of tracking markers that are fixed with respect to the robot. The operations300further include determining, for based on the positions of tracking markers of the registration fixture, a position and orientation of the anatomical feature with respect to the tracking cameras (Block310). The operations300further include determining, based on the determined positions of the plurality of tracking markers on the robot, a position and orientation of the robot arm of a surgical robot with respect to the tracking cameras (Block312).

The operations300further include determining, based on the determined position and orientation of the anatomical feature with respect to the tracking cameras and the determined position and orientation of the robot arm with respect to the tracking cameras, a position and orientation of the anatomical feature with respect to the robot arm (Block314). The operations300further include controlling movement of the robot arm with respect to the anatomical feature, e.g., along and/or rotationally about one or more defined axis, based on the determined position and orientation of the anatomical feature with respect to the robot arm (Block316).

FIG. 4is a diagram illustrating a data flow400for a multiple coordinate transformation system, to enable determining a position and orientation of an anatomical feature of a patient with respect to a robot arm of a surgical robot, according to some embodiments. In this example, data from a plurality of exam image spaces402, based on a plurality of exam images, may be transformed and combined into a common exam image space404. The data from the common exam image space404and data from a verification image space406, based on a verification image, may be transformed and combined into a registration image space408. Data from the registration image space408may be transformed into patient fiducial coordinates410, which is transformed into coordinates for a DRB412. A tracking camera414may detect movement of the DRB412(represented by DRB412′) and may also detect a location of a probe tracker416to track coordinates of the DRB412over time. A robotic arm tracker418determines coordinates for the robot arm based on transformation data from a Robotics Planning System (RPS) space420or similar modeling system, and/or transformation data from the tracking camera414.

It should be understood that these and other features may be used and combined in different ways to achieve registration of image space, i.e., coordinates from image volume, into tracking space, i.e., coordinates for use by the surgical robot in real-time. As will be discussed in detail below, these features may include fiducial-based registration such as stereotactic frames with CT localizer, preoperative CT or Mill registered using intraoperative fluoroscopy, calibrated scanner registration where any acquired scan's coordinates are pre-calibrated relative to the tracking space, and/or surface registration using a tracked probe, for example.

In one example,FIGS. 5A-5Cillustrate a system500for registering an anatomical feature of a patient. In this example, the stereotactic frame base530is fixed to an anatomical feature528of patient, e.g., the patient's head. As shown byFIG. 5A, the stereotactic frame base530may be affixed to the patient's head528prior to registration using pins clamping the skull or other method. The stereotactic frame base530may act as both a fixation platform, for holding the patient's head528in a fixed position, and registration and tracking platform, for alternatingly holding the CT localizer536or the FRA fixture534. The CT localizer536includes a plurality of fiducial markers532(e.g., N-pattern radio-opaque rods or other fiducials), which are automatically detected in the image space using image processing. Due to the precise attachment mechanism of the CT localizer536to the base530, these fiducial markers532are in known space relative to the stereotactic frame base530. A 3D CT scan of the patient with CT localizer536attached is taken, with an image volume that includes both the patient's head528and the fiducial markers532of the CT localizer536. This registration image can be taken intraoperatively or preoperatively, either in the operating room or in radiology, for example. The captured 3D image dataset is stored to computer memory.

As shown byFIG. 5B, after the registration image is captured, the CT localizer536is removed from the stereotactic frame base530and the frame reference array fixture534is attached to the stereotactic frame base530. The stereotactic frame base530remains fixed to the patient's head528, however, and is used to secure the patient during surgery, and serves as the attachment point of a frame reference array fixture534. The frame reference array fixture534includes a frame reference array (FRA), which is a rigid array of three or more tracked markers539, which may be the primary reference for optical tracking. By positioning the tracked markers539of the FRA in a fixed, known location and orientation relative to the stereotactic frame base530, the position and orientation of the patient's head528may be tracked in real time. Mount points on the FRA fixture534and stereotactic frame base530may be designed such that the FRA fixture534attaches reproducibly to the stereotactic frame base530with minimal (i.e., submillimetric) variability. These mount points on the stereotactic frame base530can be the same mount points used by the CT localizer536, which is removed after the scan has been taken. An auxiliary arm (such as auxiliary arm107ofFIG. 1B, for example) or other attachment mechanism can also be used to securely affix the patient to the robot base to ensure that the robot base is not allowed to move relative to the patient.

As shown byFIG. 5C, a dynamic reference base (DRB)540may also be attached to the stereotactic frame base530. The DRB540in this example includes a rigid array of three or more tracked markers542. In this example, the DRB540and/or other tracked markers may be attached to the stereotactic frame base530and/or to directly to the patient's head528using auxiliary mounting arms541, pins, or other attachment mechanisms. Unlike the FRA fixture534, which mounts in only one way for unambiguous localization of the stereotactic frame base530, the DRB540in general may be attached as needed for allowing unhindered surgical and equipment access. Once the DRB540and FRA fixture534are attached, registration, which was initially related to the tracking markers539of the FRA, can be optionally transferred or related to the tracking markers542of the DRB540. For example, if any part of the FRA fixture534blocks surgical access, the surgeon may remove the FRA fixture534and navigate using only the DRB540. However, if the FRA fixture534is not in the way of the surgery, the surgeon could opt to navigate from the FRA markers539, without using a DRB540, or may navigate using both the FRA markers539and the DRB540. In this example, the FRA fixture534and/or DRB540uses optical markers, the tracked positions of which are in known locations relative to the stereotactic frame base530, similar to the CT localizer536, but it should be understood that many other additional and/or alternative techniques may be used.

FIGS. 6A and 6Billustrate a system600for registering an anatomical feature of a patient using fluoroscopy (fluoro) imaging, according to some embodiments. In this embodiment, image space is registered to tracking space using multiple intraoperative fluoroscopy (fluoro) images taken using a tracked registration fixture644. The anatomical feature of the patient (e.g., the patient's head628) is positioned and rigidly affixed in a clamping apparatus643in a static position for the remainder of the procedure. The clamping apparatus643for rigid patient fixation can be a three-pin fixation system such as a Mayfield clamp, a stereotactic frame base attached to the surgical table, or another fixation method, as desired. The clamping apparatus643may also function as a support structure for a patient tracking array or DRB640as well. The DRB may be attached to the clamping apparatus using auxiliary mounting arms641or other means.

Once the patient is positioned, the fluoro fixture644is attached the fluoro unit's x-ray collecting image intensifier (not shown) and secured by tightening clamping feet632. The fluoro fixture644contains fiducial markers (e.g., metal spheres laid out across two planes in this example, not shown) that are visible on 2D fluoro images captured by the fluoro image capture device and can be used to calculate the location of the x-ray source relative to the image intensifier, which is typically about 1 meter away contralateral to the patient, using a standard pinhole camera model. Detection of the metal spheres in the fluoro image captured by the fluoro image capture device also enables the software to de-warp the fluoro image (i.e., to remove pincushion and s-distortion). Additionally, the fluoro fixture644contains 3 or more tracking markers646for determining the location and orientation of the fluoro fixture644in tracking space. In some embodiments, software can project vectors through a CT image volume, based on a previously captured CT image, to generate synthetic images based on contrast levels in the CT image that appear similar to the actual fluoro images (i.e., digitally reconstructed radiographs (DRRs)). By iterating through theoretical positions of the fluoro beam until the DRRs match the actual fluoro shots, a match can be found between fluoro image and DRR in two or more perspectives, and based on this match, the location of the patient's head628relative to the x-ray source and detector is calculated. Because the tracking markers646on the fluoro fixture644track the position of the image intensifier and the position of the x-ray source relative to the image intensifier is calculated from metal fiducials on the fluoro fixture644projected on 2D images, the position of the x-ray source and detector in tracking space are known and the system is able to achieve image-to-tracking registration.

As shown byFIGS. 6A and 6B, two or more shots are taken of the head628of the patient by the fluoro image capture device from two different perspectives while tracking the array markers642of the DRB640, which is fixed to the registration fixture630via a mounting arm641, and tracking markers646on the fluoro fixture644. Based on the tracking data and fluoro data, an algorithm computes the location of the head628or other anatomical feature relative to the tracking space for the procedure. Through image-to-tracking registration, the location of any tracked tool in the image volume space can be calculated.

For example, in one embodiment, a first fluoro image taken from a first fluoro perspective can be compared to a first DRR constructed from a first perspective through a CT image volume, and a second fluoro image taken from a second fluoro perspective can be compared to a second DRR constructed from a second perspective through the same CT image volume. Based on the comparisons, it may be determined that the first DRR is substantially equivalent to the first fluoro image with respect to the projected view of the anatomical feature, and that the second DRR is substantially equivalent to the second fluoro image with respect to the projected view of the anatomical feature. Equivalency confirms that the position and orientation of the x-ray path from emitter to collector on the actual fluoro machine as tracked in camera space matches the position and orientation of the x-ray path from emitter to collector as specified when generating the DRRs in CT space, and therefore registration of tracking space to CT space is achieved.

FIG. 7illustrates a system700for registering an anatomical feature of a patient using an intraoperative CT fixture (ICT) and a DRB, according to some embodiments. As shown inFIG. 7, in one application, a fiducial-based image-to-tracking registration can be utilized that uses an intraoperative CT fixture (ICT)750having a plurality of tracking markers751and radio-opaque fiducial reference markers732to register the CT space to the tracking space. After stabilizing the anatomical feature728(e.g., the patient's head) using clamping apparatus730such as a three-pin Mayfield frame and/or stereotactic frame, the surgeon will affix the ICT750to the anatomical feature728, DRB740, or clamping apparatus730, so that it is in a static position relative to the tracking markers742of the DRB740, which may be held in place by mounting arm741or other rigid means. A CT scan is captured that encompasses the fiducial reference markers732of the ICT750while also capturing relevant anatomy of the anatomical feature728. Once the CT scan is loaded in the software, the system auto-identifies (through image processing) locations of the fiducial reference markers732of the ICT within the CT volume, which are in a fixed position relative to the tracking markers of the ICT750, providing image-to-tracking registration. This registration, which was initially based on the tracking markers751of the ICT750, is then related to or transferred to the tracking markers742of the DRB740, and the ICT750may then be removed.

FIG. 8Aillustrates a system800for registering an anatomical feature of a patient using a DRB and an X-ray cone beam imaging device, according to some embodiments. An intraoperative scanner852, such as an X-ray machine or other scanning device, may have a tracking array854with tracking markers855, mounted thereon for registration. Based on the fixed, known position of the tracking array854on the scanning device, the system may be calibrated to directly map (register) the tracking space to the image space of any scan acquired by the system. Once registration is achieved, the registration, which is initially based on the tracking markers855(e.g. gantry markers) of the scanner's array854, is related or transferred to the tracking markers842of a DRB840, which may be fixed to a clamping fixture830holding the patient's head828by a mounting arm841or other rigid means. After transferring registration, the markers on the scanner are no longer used and can be removed, deactivated or covered if desired. Registering the tracking space to any image acquired by a scanner in this way may avoid the need for fiducials or other reference markers in the image space in some embodiments.

FIG. 8Billustrates an alternative system800′ that uses a portable intraoperative scanner, referred to herein as a C-arm scanner853. In this example, the C-arm scanner853includes a c-shaped arm856coupled to a movable base858to allow the C-arm scanner853to be moved into place and removed as needed, without interfering with other aspects of the surgery. The arm856is positioned around the patient's head828intraoperatively, and the arm856is rotated and/or translated with respect to the patient's head828to capture the X-ray or other type of scan that to achieve registration, at which point the C-arm scanner853may be removed from the patient.

Another registration method for an anatomical feature of a patient, e.g., a patient's head, may be to use a surface contour map of the anatomical feature, according to some embodiments. A surface contour map may be constructed using a navigated or tracked probe, or other measuring or sensing device, such as a laser pointer, 3D camera, etc. For example, a surgeon may drag or sequentially touch points on the surface of the head with the navigated probe to capture the surface across unique protrusions, such as zygomatic bones, superciliary arches, bridge of nose, eyebrows, etc. The system then compares the resulting surface contours to contours detected from the CT and/or MR images, seeking the location and orientation of contour that provides the closest match. To account for movement of the patient and to ensure that all contour points are taken relative to the same anatomical feature, each contour point is related to tracking markers on a DRB on the patient at the time it is recorded. Since the location of the contour map is known in tracking space from the tracked probe and tracked DRB, tracking-to-image registration is obtained once the corresponding contour is found in image space.

FIG. 9illustrates a system900for registering an anatomical feature of a patient using a navigated or tracked probe and fiducials for point-to-point mapping of the anatomical feature928(e.g., a patient's head), according to some embodiments. Software would instruct the user to point with a tracked probe to a series of anatomical landmark points that can be found in the CT or MR image. When the user points to the landmark indicated by software, the system captures a frame of tracking data with the tracked locations of tracking markers on the probe and on the DRB. From the tracked locations of markers on the probe, the coordinates of the tip of the probe are calculated and related to the locations of markers on the DRB. Once 3 or more points are found in both spaces, tracking-to-image registration is achieved. As an alternative to pointing to natural anatomical landmarks, fiducials954(i.e., fiducial markers), such as sticker fiducials or metal fiducials, may be used. The surgeon will attach the fiducials954to the patient, which are constructed of material that is opaque on imaging, for example containing metal if used with CT or Vitamin E if used with MR. Imaging (CT or MR) will occur after placing the fiducials954. The surgeon or user will then manually find the coordinates of the fiducials in the image volume, or the software will find them automatically with image processing. After attaching a DRB940with tracking markers942to the patient through a mounting arm941connected to a clamping apparatus930or other rigid means, the surgeon or user may also locate the fiducials954in physical space relative to the DRB940by touching the fiducials954with a tracked probe while simultaneously recording tracking markers on the probe (not shown) and on the DRB940. Registration is achieved because the coordinates of the same points are known in the image space and the tracking space.

One use for the embodiments described herein is to plan trajectories and to control a robot to move into a desired trajectory, after which the surgeon will place implants such as electrodes through a guide tube held by the robot. Additional functionalities include exporting coordinates used with existing stereotactic frames, such as a Leksell frame, which uses five coordinates: X, Y, Z, Ring Angle and Arc Angle. These five coordinates are established using the target and trajectory identified in the planning stage relative to the image space and knowing the position and orientation of the ring and arc relative to the stereotactic frame base or other registration fixture.

As shown inFIG. 10, stereotactic frames allow a target location1058of an anatomical feature1028(e.g., a patient's head) to be treated as the center of a sphere and the trajectory can pivot about the target location1058. The trajectory to the target location1058is adjusted by the ring and arc angles of the stereotactic frame (e.g., a Leksell frame). These coordinates may be set manually, and the stereotactic frame may be used as a backup or as a redundant system in case the robot fails or cannot be tracked or registered successfully. The linear x,y,z offsets to the center point (i.e., target location1058) are adjusted via the mechanisms of the frame. A cone1060is centered around the target location1058, and shows the adjustment zone that can be achieved by modifying the ring and arc angles of the Leksell or other type of frame. This figure illustrates that a stereotactic frame with ring and arc adjustments is well suited for reaching a fixed target location from a range of angles while changing the entry point into the skull.

FIG. 11illustrates a two-dimensional visualization of virtual point rotation mechanism, according to some embodiments. In this embodiment, the robotic arm is able to create a different type of point-rotation functionality that enables a new movement mode that is not easily achievable with a 5-axis mechanical frame, but that may be achieved using the embodiments described herein. Through coordinated control of the robot's axes using the registration techniques described herein, this mode allows the user to pivot the robot's guide tube about any fixed point in space. For example, the robot may pivot about the entry point1162into the anatomical feature1128(e.g., a patient's head). This entry point pivoting is advantageous as it allows the user to make a smaller burr hole without limiting their ability to adjust the target location1164intraoperatively. The cone1160represents the range of trajectories that may be reachable through a single entry hole. Additionally, entry point pivoting is advantageous as it allows the user to reach two different target locations1164and1166through the same small entry burr hole. Alternately, the robot may pivot about a target point (e.g., location1058shown inFIG. 10) within the skull to reach the target location from different angles or trajectories, as illustrated inFIG. 10. Such interior pivoting robotically has the same advantages as a stereotactic frame as it allows the user to approach the same target location1058from multiple approaches, such as when irradiating a tumor or when adjusting a path so that critical structures such as blood vessels or nerves will not be crossed when reaching targets beyond them. Unlike a stereotactic frame, which relies on fixed ring and arc articulations to keep a target/pivot point fixed, the robot adjusts the pivot point through controlled activation of axes and the robot can therefore dynamically adjust its pivot point and switch as needed between the modes illustrated inFIGS. 10 and 11.

Following the insertion of implants or instrumentation using the robot or ring and arc fixture, these and other embodiments may allow for implant locations to be verified using intraoperative imaging. Placement accuracy of the instrument or implant relative to the planned trajectory can be qualitatively and/or quantitatively shown to the user. One option for comparing planned to placed position is to merge a postoperative verification CT image to any of the preoperative images. Once pre- and post-operative images are merged and plan is shown overlaid, the shadow of the implant on postop CT can be compared to the plan to assess accuracy of placement. Detection of the shadow artifact on post-op CT can be performed automatically through image processing and the offset displayed numerically in terms of millimeters offset at the tip and entry and angular offset along the path. This option does not require any fiducials to be present in the verification image since image-to-image registration is performed based on bony anatomical contours.

A second option for comparing planned position to the final placement would utilize intraoperative fluoro with or without an attached fluoro fixture. Two out-of-plane fluoro images will be taken and these fluoro images will be matched to DRRs generated from pre-operative CT or MR as described above for registration. Unlike some of the registration methods described above, however, it may be less important for the fluoro images to be tracked because the key information is where the electrode is located relative to the anatomy in the fluoro image. The linear or slightly curved shadow of the electrode would be found on a fluoro image, and once the DRR corresponding to that fluoro shot is found, this shadow can be replicated in the CT image volume as a plane or sheet that is oriented in and out of the ray direction of the fluoro image and DRR. That is, the system may not know how deep in or out of the fluoro image plane the electrode lies on a given shot, but can calculate the plane or sheet of possible locations and represent this plane or sheet on the 3D volume. In a second fluoro view, a different plane or sheet can be determined and overlaid on the 3D image. Where these two planes or sheets intersect on the 3D image is the detected path of the electrode. The system can represent this detected path as a graphic on the 3D image volume and allow the user to reslice the image volume to display this path and the planned path from whatever perspective is desired, also allowing automatic or manual calculation of the deviation from planned to placed position of the electrode. Tracking the fluoro fixture is unnecessary but may be done to help de-warp the fluoro images and calculate the location of the x-ray emitter to improve accuracy of DRR calculation, the rate of convergence when iterating to find matching DRR and fluoro shots, and placement of sheets/planes representing the electrode on the 3D scan.

In this and other examples, it is desirable to maintain navigation integrity, i.e., to ensure that the registration and tracking remain accurate throughout the procedure. Two primary methods to establish and maintain navigation integrity include: tracking the position of a surveillance marker relative to the markers on the DRB, and checking landmarks within the images. In the first method, should this position change due to, for example, the DRB being bumped, then the system may alert the user of a possible loss of navigation integrity. In the second method, if a landmark check shows that the anatomy represented in the displayed slices on screen does not match the anatomy at which the tip of the probe points, then the surgeon will also become aware that there is a loss of navigation integrity. In either method, if using the registration method of CT localizer and frame reference array (FRA), the surgeon has the option to re-attach the FRA, which mounts in only one possible way to the frame base, and to restore tracking-to-image registration based on the FRA tracking markers and the stored fiducials from the CT localizer536. This registration can then be transferred or related to tracking markers on a repositioned DRB. Once registration is transferred the FRA can be removed if desired.

Referring now toFIGS. 12-18generally, with reference to the surgical robot system100shown inFIG. 1A, end-effector112may be equipped with components, configured, or otherwise include features so that one end-effector may remain attached to a given one of robot arms104without changing to another end-effector for multiple different surgical procedures, such as, by way of example only, Deep Brain Stimulation (DBS), Stereoelectroencephalography (SEEG), or Endoscopic Navigation and Tumor Biopsy. As discussed previously, end-effector112may be orientable to oppose an anatomical feature of a patient in the manner so as to be in operative proximity thereto, and, to be able to receive one or more surgical tools for operations contemplated on the anatomical feature proximate to the end-effector112. Motion and orientation of end-effector112may be accomplished through any of the navigation, trajectory guidance, or other methodologies discussed herein or as may be otherwise suitable for the particular operation.

End-effector112is suitably configured to permit a plurality of surgical tools129to be selectively connectable to end-effector112. Thus, for example, a stylet113(FIG. 13) may be selectively attached in order to localize an incision point on an anatomical feature of a patient, or an electrode driver115(FIG. 14) may be selectively attached to the same end-effector112.

With reference to the previous discussion of robot surgical system100, a processor circuit, as well as memory accessible by such processor circuit, includes various subroutines and other machine-readable instructions configured to cause, when executed, end-effector112to move, such as by GPS movement, relative to the anatomical feature, at predetermined stages of associated surgical operations, whether pre-operative, intra-operative or post-operative.

End-effector112includes various components and features to either prevent or permit end-effector movement depending on whether and which tools129, if any, are connected to end-effector112. Referring more particularly toFIG. 12, end-effector112includes a tool-insert locking mechanism117located on and connected to proximal surface119. Tool-insert locking mechanism117is configured so as to secure any selected one of a plurality of surgical tools, such as the aforesaid stylet113, electrode driver115, or any other tools for different surgeries mentioned previously or as may be contemplated by other applications of this disclosure. The securement of the tool by tool-insert locking mechanism117is such that, for any of multiple tools capable of being secured to locking mechanism117, each such tool is operatively and suitably secured at the predetermined height, angle of orientation, and rotational position relative to the anatomical feature of the patient, such that multiple tools may be secured to the same end-effector112in respective positions appropriate for the contemplated procedure.

Another feature of the end-effector112is a tool stop121located on distal surface123of end-effector112, that is, the surface generally opposing the patient. Tool stop121has a stop mechanism125and a sensor127operatively associated therewith, as seen with reference toFIGS. 16, 19, and 20. Stop mechanism125is mounted to end-effector112so as to be selectively movable relative thereto between an engaged position to prevent any of the tools from being connected to end-effector112and a disengaged position which permits any of the tools129to be selectively connected to end-effector112. Sensor127may be located on or within the housing of end-effector112at any suitable location (FIGS. 12, 14, 16) so that sensor127detects whether stop mechanism125is in the engaged or disengaged position. Sensor127may assume any form suitable for such detection, such as any type of mechanical switch or any type of magnetic sensor, including Reed switches, Hall Effect sensors, or other magnetic field detecting devices. In one possible implementation, sensor127has two portions, a Hall Effect sensor portion (not shown) and a magnetic portion131, the two portions moving relative to each other so as to generate and detect two magnetic fields corresponding to respective engaged and disengaged position. In the illustrated implementation, the magnetic portion comprises two rare earth magnets131which move relative to the complementary sensing portion (not shown) mounted in the housing of end effector112in operative proximity to magnets131to detect change in the associated magnetic field from movement of stop mechanism125between engaged and disengaged positions. In this implementation the Hall effect sensor is bipolar and can detect whether a North pole or South pole of a magnet opposes the sensor. Magnets131are configured so that the North pole of one magnet faces the path of the sensor and the South pole of the other magnet faces the path of the sensor. In this configuration, the sensor senses an increased signal when it is near one magnet (for example, in disengaged position), a decreased signal when it is near the other magnet (for example, in engaged position), and unchanged signal when it is not in proximity to any magnet. In this implementation, in response to detection of stop mechanism125being in the disengaged position shown inFIGS. 13 and 19, sensor127causes the processor of surgical robot system100to execute suitable instructions to prevent movement of end-effector112relative to the anatomical feature. Such movement prevention may be appropriate for any number of reasons, such as when a tool is connected to end-effector112, such tool potentially interacting with the anatomical feature of the patient.

Another implementation of a sensor127for detecting engaged or disengaged tool stop mechanism125could comprise a single magnet behind the housing (not shown) and two Hall Effect sensors located where magnets131are shown in the preferred embodiment. In such a configuration, monopolar Hall Effect sensors are suitable and would be configured so that Sensor1detects a signal when the magnet is in proximity due to the locking mechanism being disengaged, while Sensor2detects a signal when the same magnet is in proximity due to the locking mechanism being engaged. Neither sensor would detect a signal when the magnet is between positions or out of proximity to either sensor. Although a configuration could be conceived in which a sensor is active for engaged position and inactive for disengaged position, a configuration with three signals indicating engaged, disengaged, or transitional is preferred to ensure correct behavior in case of power failure.

End-effector112, tool stop121, and tool-insert locking mechanism117each have co-axially aligned bores or apertures such that any selected one of the plurality of surgical tools129may be received through such bores and apertures. In this implementation end-effector has a bore133and tool stop121and tool-insert locking mechanism117have respective apertures135and137. Stop mechanism125includes a ring139axially aligned with bore133and aperture135of tool stop121. Ring139is selectively, manually rotatable in the directions indicated by arrow A (FIG. 16) so as to move stop mechanism125between the engaged position and the disengaged position.

In one possible implementation, the selective rotation of ring139includes features which enable ring139to be locked in either the disengaged or engaged position. So, for example, as illustrated, a detent mechanism141is located on and mounted to ring139in any suitable way to lock ring139against certain rotational movement out of a predetermined position, in this case, such position being when stop mechanism125is in the engaged position. Although various forms of detent mechanism are contemplated herein, one suitable arrangement has a manually accessible head extending circumferentially outwardly from ring139and having a male protrusion (not shown) spring-loaded axially inwardly to engage a corresponding female detent portion (not shown). Detent mechanism141, as such, is manually actuatable to unlock ring139from its engaged position to permit ring139to be manually rotated to cause stop mechanism125to move from the engaged position (FIG. 20) to the disengaged position (FIG. 19).

Tool stop121includes a lever arm143pivotally mounted adjacent aperture135of tool stop121so end of lever arm143selectively pivots in the directions indicated by arrow B (FIGS. 16, 19 and 20). Lever arm143is operatively connected to stop mechanism125, meaning it closes aperture135of tool stop121in response to stop mechanism125being in the engaged position, as shown inFIG. 20. Lever arm143is also operatively connected so as to pivot back in direction of arrow B to open aperture135in response to stop mechanism125being in the disengaged position. As such, movement of stop mechanism125between engaged and disengaged positions results in closure or opening of aperture135, respectively, by lever arm143.

Lever arm143, in this implementation, is not only pivotally mounted adjacent aperture135, but also pivots in parallel with a distal plane defined at a distal-most point of distal surface123of end-effector112. In this manner, any one of the surgical tools129, which is attempted to be inserted through bore133and aperture135, is stopped from being inserted past the distal plane in which lever arm143rotates to close aperture135.

Turning now to tool-insert locking mechanism117(FIG. 13, 17, 18), a connector145is configured to meet with and secure any one of the surgical tools129at their appropriate height, angle of orientation, and rotational position relative to the anatomical feature of the patient. In the illustrated implementation, connector145comprises a rotatable flange147which has at least one slot149formed therein to receive therethrough a corresponding tongue151associated with a selected one of the plurality of tools129. So, for example, inFIG. 14, the particular electrode driver115has multiple tongues, one of which tongue151is shown. Rotatable flange147, in some implementations, may comprise a collar153, which collar, in turn, has multiple ones of slots149radially spaced on a proximally oriented surface155, as best seen inFIG. 12. Multiple slots147arranged around collar153are sized or otherwise configured so as to receive therethrough corresponding ones of multiple tongues151associated with a selected one of the plurality of tools129. Therefore, as seen inFIG. 13, multiple slots149and corresponding tongues151may be arranged to permit securing of a selected one of the plurality of tools129only when selected tool is in the correct, predetermined angle of orientation and rotational position relative to the anatomical feature of the patient. Similarly, with regard to the electrode driver shown inFIG. 14, tongues151(one of which is shown in a cutaway ofFIG. 14) have been received in radially spaced slots149arrayed so that electrode driver115is received at the appropriate angle of orientation and rotational position.

Rotatable flange147has, in this implementation, a grip173to facilitate manual rotation between an open and closed position as shown inFIGS. 17 and 18, respectively. As seen inFIG. 17, multiple sets of mating slots149and tongues151are arranged at different angular locations, in this case, locations which may be symmetric about a single diametric chord of a circle but otherwise radially asymmetric, and at least one of the slots has a different dimension or extends through a different arc length than other slots. In this slot-tongue arrangement, and any number of variations contemplated by this disclosure, there is only one rotational position of the tool129(or adapter155discussed later) to be received in tool-insert locking mechanism117when rotatable flange147is in the open position shown inFIG. 17. In other words, when the user of system100moves a selected tool129(or tool adapter155) to a single appropriate rotational position, corresponding tongues151may be received through slots149. Upon placement of tongues151into slots149, tongues151confront a base surface175within connector145of rotatable flange147. Upon receiving tongues151into slots149and having them rest on underlying base surface175, dimensions of tongues151and slots149, especially with regard to height relative to rotatable flange147, are selected so that when rotatable flange147is rotated to the closed position, flange portions157are radially translated to overlie or engage portions of tongues151, such engagement shown inFIG. 18and affixing tool129(or adapter155) received in connector145at the desired, predetermined height, angle of orientation, and rotational position relative to the anatomical feature of the patient.

Tongues151described as being associated with tools129may either be directly connected to such tools129, and/or tongues151may be located on and mounted to the above-mentioned adapter155, such as that shown inFIGS. 12, 17 and 18, such adapter155configured to interconnect at least one of the plurality of surgical tools129with end-effector112. In the described implementation, adapter155includes two operative portions—a tool receiver157adapted to connect the selected one or more surgical tools129, and the second operative part being one or more tongues151which may, in this implementation, be mounted and connected to the distal end of adapter155.

Adapter155has an outer perimeter159which, in this implementation, is sized to oppose an inner perimeter161of rotatable flange147. Adapter155extends between proximal and distal ends163,165, respectively and has an adapter bore167extending between ends163,165. Adapter bore167is sized to receive at least one of the plurality of surgical tools129, and similarly, the distance between proximal and distal ends163,165is selected so that at least one of tools129is secured to end-effector112at the predetermined, appropriate height for the surgical procedure associated with such tool received in adapter bore167.

In one possible implementation, system100includes multiple ones of adapter155, configured to be interchangeable inserts169having substantially the same, predetermined outer perimeters159to be received within inner perimeter161of rotatable flange147. Still further in such implementation, the interchangeable inserts169have bores of different, respective diameters, which bores may be selected to receive corresponding ones of the tools129therein. Bores167may comprise cylindrical bushings having inner diameters common to multiple surgical tools129. One possible set of diameters for bores167may be 12, 15, and 17 millimeters, suitable for multiple robotic surgery operations, such as those identified in this disclosure.

In the illustrated implementation, inner perimeter161of rotatable flange147and outer perimeter159of adapter155are circular, having central, aligned axes and corresponding radii. Slots149of rotatable flange147extend radially outwardly from the central axis of rotatable flange147in the illustrated implementation, whereas tongues151of adapter155extend radially outwardly from adapter155.

In still other implementations, end-effector112may be equipped with at least one illumination element171(FIGS. 14 and 15) orientable toward the anatomical feature to be operated upon. Illumination element171may be in the form of a ring of LEDs177(FIG. 14) located within adapter167, which adapter is in the form of a bushing secured to tool locking mechanism117. Illumination element171may also be a single LED179mounted on the distal surface123of end-effector112. Whether in the form of LED ring177or a single element LED179mounted on distal surface of end-effector112, or any other variation, the spacing and location of illumination element or elements171may be selected so that tools129received through bore133of end-effector112do not cast shadows or otherwise interfere with illumination from element171of the anatomical feature being operated upon.

The operation and associated features of end-effector112are readily apparent from the foregoing description. Tool stop121is rotatable, selectively lockable, and movable between engaged and disengaged positions, and a sensor prevents movement of end-effector112when in such disengaged position, due to the potential presence of a tool which may not be advisably moved during such disengaged position. Tool-insert locking mechanism117is likewise rotatable between open and closed positions to receive one of a plurality of interchangeable inserts169and tongues151of such inserts, wherein selected tools129may be received in such inserts169; alternately, tongues151may be otherwise associated with tools129, such as by having tongues151directly connected to such tools129, which tongue-equipped tools likewise may be received in corresponding slots149of tool-insert locking mechanism117. Tool-insert locking mechanism117may be rotated from its open position in which tongues151have been received in slots149, to secure associated adapters155and/or tools129so that they are at appropriate, respective heights, angles of orientation, and rotational positions relative to the anatomical feature of the patient.

For those implementations with multiple adapters155, the dimensions of such adapters155, including bore diameters, height, and other suitable dimensions, are selected so that a single or a minimized number of end-effectors112can be used for a multiplicity of surgical tools129. Adapters155, such as those in the form of interchangeable inserts169or cylindrical bushings, may facilitate connecting an expanded set of surgical tools129to the end-effector112, and thus likewise facilitate a corresponding expanded set of associated surgical features using the same end-effector112.

Although several embodiments of inventive concepts have been disclosed in the foregoing specification, it is understood that many modifications and other embodiments of inventive concepts will come to mind to which inventive concepts pertain, having the benefit of teachings presented in the foregoing description and associated drawings. It is thus understood that inventive concepts are not limited to the specific embodiments disclosed hereinabove, and that many modifications and other embodiments are intended to be included within the scope of the appended claims. It is further envisioned that features from one embodiment may be combined or used with the features from a different embodiment(s) described herein. Moreover, although specific terms are employed herein, as well as in the claims which follow, they are used only in a generic and descriptive sense, and not for the purposes of limiting the described inventive concepts, nor the claims which follow. The entire disclosure of each patent and patent publication cited herein is incorporated by reference herein in its entirety, as if each such patent or publication were individually incorporated by reference herein. Various features and/or potential advantages of inventive concepts are set forth in the following claims.