Patent Publication Number: US-2023133876-A1

Title: Robot-mounted retractor system

Description:
CROSS REFERENCE TO RELATED APPLICATIONS 
     The present application is a continuation of U.S. patent application Ser. No. 17/326,788, filed May 21, 2021, which is a continuation of U.S. patent application Ser. No. 16/416,323 filed on a May 20, 2019, all of which are incorporated in their entirety herein. 
    
    
     FIELD 
     This disclosure generally relates to devices and methods that improve surgical procedures by, for example, providing a working space for the procedure and improving the surgical conditions for the practitioner of a procedure. 
     BACKGROUND 
     In surgical procedures generally, surgeons try to keep incisions as small as possible to minimize or reduce trauma to the patient and damage to tissue. However, it is usually necessary that the surgeon have a clear view of the operating field. Also, an opening may need to be enlarged to accommodate the passing of medical implants therethrough. 
     In the field of spine surgery, there is an increasing interest in developing minimally invasive methods, as opposed to conventional “open” spine surgery. The goals of these less invasive alternatives are to avoid the surgical exposure, dissection, and retraction of muscles and tissues that is necessary with “open” surgery. In general, a minimally invasive spine surgery system should be able to perform the same procedure as the traditional open technique, but through smaller incisions. As a result, some physicians feel that using a minimally invasive spine surgery system generally causes less soft tissue damage, reduces blood loss and reduces recovery time. In addition, patients generally prefer the smaller scars that are left using a minimally invasive approach. 
     A variety of retractors are available for use in surgical operations to reposition muscular tissue, vessels, nerves, and other tissue with the aid of retractor blades, thereby providing access to the site of the operation. U.S. Pat. Nos. 9,993,239 and 10,039,539 describe exemplary retractors, each of which is incorporated herein by reference. Surgical retractors are particularly important in performing surgical procedures that involve the spinal column, where access to the surgical site can be obtained through a posterior, anterior, lateral, or combined approach. 
     Referring to  FIG.  1   , a prior art retractor system  10  according to the invention is shown. The retractor system  10  includes a retractor  11  having a frame  12  that is attachable to an arm  14 . Arm  14  may be attached to a supporting structure  15  which typically includes the patient table. Relative motion between the retractor or port and anatomy is minimized as the patient is also typically immobilized relative to the table. A rigid setup protects the patient from potentially harmful damage caused by shifted retractor blades and a misaligned working corridor. 
     Several issues commonly arise when fixing the retractor or port with a traditional table-mounted articulating arm. The sterile arm must be mounted to the table frame, which is located beneath the sterile field. Currently, surgical staff must reach below the sterile field to install the arm then return to the sterile field to fix the arm to the retractor or port. The sterile field may also be compromised if the table-arm connection requires intraoperative adjustment. This often occurs because the arm is not properly installed or is rigidly fixed to a non-stiff or loose component of the bed frame. In summary, this method is time consuming which reduces surgical efficiency and patient safety. 
     SUMMARY 
     In at least one embodiment, the present disclosure provides a retractor mounting assembly including an end-effector having a body extending between first and second faces. The first face is configured for attachment to an interface plate on the robotic arm of a surgical robot. The second face defines an arm mount. An arm extending between first and second ends with the first end configured for attachment to the end-effector arm mount and the second end providing a retractor mount configured for supportive attachment of a retractor. 
     In at least one embodiment, the present disclosure provides a retractor mounting system including a surgical robot having a robotic arm defining an interface plate and a retractor mounting assembly. The retractor mounting assembly includes an end-effector having a body extending between first and second faces. The first face is configured for attachment to an interface plate on the robotic arm of a surgical robot. The second face defines an arm mount. An arm extending between first and second ends with the first end configured for attachment to the end-effector arm mount and the second end providing a retractor mount configured for supportive attachment of a retractor. 
     In at least one embodiment, the present disclosure provides a method of implanting an implant utilizing a retractor mounting system including a surgical robot having a robotic arm defining an interface plate; and a retractor mounting assembly including: an end-effector having a body extending between first and second faces, the first face configured for attachment to the interface plate, and the second face defining an arm mount; and an arm extending between first and second ends, the first end configured for attachment to the end-effector arm mount and the second end providing a retractor mount, the method includes: attaching a retractor to the retractor mount; moving the robot arm and the arm to position and support the retractor at a desired location; actuating the retractor to create a surgical port; and implanting the implant through the surgical port utilizing a surgical tool. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The accompanying drawings, which are incorporated herein and constitute part of this specification, illustrate the presently preferred embodiments of the invention, and, together with the general description given above and the detailed description given below, serve to explain the features of the invention. In the drawings: 
         FIG.  1    is a perspective view of a prior art retractor system positioned adjacent a bone model by a surgical arm. 
         FIG.  2    is a perspective view of one embodiment of a retractor mounting assembly according to the present disclosure mounted on a robot arm and supporting a retractor adjacent a patient. 
         FIG.  3    is a front perspective view of a retractor mounting assembly in accordance with an embodiment of the disclosure. 
         FIG.  4    is a rear perspective view of the retractor mounting assembly of  FIG.  3   . 
         FIG.  5    illustrates the retractor mounting assembly of  FIG.  3    mounted on a robot arm with the robot components covered in a sterile drape; and  FIG.  5 A  illustrates the robot arm prior to mounting of the retractor mounting assembly thereon. 
         FIGS.  6  and  7    are front and rear perspective view, respectively, of an end-effector in accordance with another embodiment of the disclosure. 
         FIG.  8    is an exploded perspective view of the end-effector of  FIGS.  6  and  7   . 
         FIG.  9    is a front perspective view of another end-effector in accordance with another embodiment of the disclosure. 
     
    
    
     DETAILED DESCRIPTION 
     In the drawings, like numerals indicate like elements throughout. Certain terminology is used herein for convenience only and is not to be taken as a limitation on the present invention. The following describes preferred embodiments of the present invention. However, it should be understood, based on this disclosure, that the invention is not limited by the preferred embodiments described herein. 
     Referring to  FIGS.  2 - 5   , an exemplary embodiment of a retractor mounting assembly  100  in accordance with an embodiment of the disclosure will be described. The retractor mounting assembly  100  is configured to rigidly attach to a robotic arm  58  at one end and to a retractor  11  or port on the other end. The retractor  11  generally includes a plurality of blades  14  supported by a frame  12 . An attachment member  16  extends from the frame  12  and is configured for attachment with the retractor mounting assembly  100 , as will be described in more detail hereinafter. U.S. Pat. Nos. 9,993,239 and 10,039,539 each describe exemplary retractors which may be utilized with the retractor mounting assembly, however, the disclosure is not limited to such designs and various other retractor designs may be utilized. 
     An exemplary robot  50  with which the retractor mounting assembly  100  may be utilized will be described with reference to  FIGS.  2  and  5   . The robot  50  includes a robotic base station  52  which is the main control center for the robotic computer system. The robotic base station  52  supports a vertical column  54  which in turn supports an upper arm  56  connected to a lower arm  58 . The lower arm  58  includes an extending portion  60  with a pivot portion  62  pivotally supported relative thereto. The free end of the pivot portion  62  may have a bracelet  64  thereon configured to facilitate manual movement of the arm. The bracelet and/or pivot portion define an interface plate  65  for an end effector  110  of the retractor mounting assembly  100 . The robot is configured to facilitate motion about at least 5 axes, namely, vertical  51 , shoulder  53 , elbow  55 , roll  57  and pitch  59 . The robot  50  may include other components, for example, a monitor a tablet compartment, a control panel, a connector panel, stabilizers and rolling casters. The operation and function of exemplary robots are described in more detail in US Appln. Pub. Nos. 2017/0258535 and 2019/0021795, which are incorporated herein by reference. The invention is not limited to the specific robot systems described therein and robot systems having various configurations may be utilized. 
     Referring to  FIGS.  3  and  4   , a retractor mounting assembly  100  in accordance with the disclosure will be described. The retractor mounting assembly  100  generally includes an end-effector  110  configured for mounting to the robot arm  58  and an articulating arm  140 . The end-effector  110  includes a body  112  with a rear face  115  and a front face  116 . In the illustrated embodiment, the rear face  115  includes a series of detents  111  and projections  113  configured to align with and engage corresponding features on the interface plate  65  of the robot arm  58 . The body  112  and/or the interface plate  65  may include magnets such that a magnetic assist helps to position and self-align the end-effector  110  on the robot arm  58 . The end-effector  110  is equipped with a drape-friendly clamp  114  that allows it to be clamped over the drape  70  covering the robot arm  58  (see  FIG.  5 A ) without damaging the drape  70 . The end-effector body  112  is positioned against the interface plate  65  and the clamp  114  is pressed down to lock into place. With this configuration, the end-effector  110 , and thereby the retractor mounting assembly  100 , may be mounted onto the sterile draped robot  50  (see  FIG.  5   ) without disturbing the sterile field. 
     The articulating arm  140  includes a pair of arms  142 ,  152  which are pivotally connected to one another at pivot ends  146 ,  156 , respectively, via an adjustment screw  148 . The adjustment screw  148  may include a handle  147  or the like. The free end  144  of the arm  142  includes a mounting member  144  configured for mounting on the front face  116  of the end-effector  110 . In the illustrated embodiment, a mounting post  118  extends from the front face  116  and the mounting member  144  includes a slot  145  configured to receive and retain the post  118  (see  FIG.  2   ). While a post and slot configuration is illustrated, the disclosure is not limited to such and other connection assemblies may be utilized. The free end  154  of the arm  152  includes a mounting member  154  configured for mounting a retractor mounting component  160 . In the illustrated embodiment, the retractor mounting component  160  includes a ball  161  at one end configured to be received in a slot  155  of the mounting member  154 . The opposite end of the retractor mounting component defines a mounting platform  162  which supports a mounting screw  164 . The mounting platform  162  and mounting screw  164  are configured to engage the attachment member  16  on the retractor  11 . The retractor mounting component  160  is not limited to the illustrated embodiment and may have other configurations which complement the configuration of the attachment member  16  of a given retractor. Relative motion between the robotic arm  58  and retractor  11  or port is rigidly locked by tightening the adjustment screw  148  on the articulating arm  140 . Relative motion may be restored intraoperatively to make minor adjustments by loosening the adjustment screw  148 . The use of the retractor mounting assembly  100  reduces the potential for compromising the sterile field, provides a quick and easy setup, positions the arm in a convenient location, provides a rigid fixation, and increases intraoperative efficiency. 
     Referring to  FIG.  2   , once the retractor  11  is positioned via the retractor mounting assembly  100 , the retractor  11  may be actuated to open a surgical port. The surgeon may then use one or more surgical tools  20  as the procedure may require. In one embodiment, the surgical tool  20  is a dynamic reference base used for registering a patient in an imaging space. In another embodiment, the surgical tool  20  may be utilized to implant an intervertebral implant through the surgical port. Since the robot arm  58  is utilized to mount the retractor  11  via the mounting assembly  100 , the features of the robot  50  may be utilized during the procedure. For example, the surgical tool  20  may have a tracker  22  with a plurality of markers  24  thereon which can be detected by the robot system and thereby guide the surgeon. 
     In some instances, there may be a risk that the robotic arm  58  may inadvertently move intraoperatively and potentially cause adverse effects to the patient. To reduce the likelihood of such inadvertent movement, the system may include a lockout device to prevent movement of the robotic arm  58  once the retractor mounting assembly  100  is positioned. This lockout may occur through various means including mechanical locks, disruption of electrical supply, or signal transfer. Such lockout device may be activated through various mechanisms. As one example, the robot  50  may include a user input that activates the lockout feature whereby the user presses a button on the control panel or the like once the retractor mounting assembly  100  is positioned. Upon receipt of such user input, the robot is configured to actuate the lockout through the mechanical lock, disruption of electrical supply, signal transfer or the like. As an another alternative, the end-effector  110  may include a mechanical actuator. For example, upon mounting of the end-effector  110 , a portion thereof contacts a mechanical actuator on the robot arm, thereby causing actuation of the lockout. 
     As yet another example, a lockout actuator  180  may be embedded in the end-effector  110 , to actuate the lockout device when the articulating arm is attached. An illustrative example of such an actuator  180  within the end-effector  110 ′ will be described with reference to  FIGS.  6 - 8   . The end-effector  110 ′ again includes a body  112 ′ with a rear face  115  and a front face  116 ′. A clamping mechanism  114  is again provided along the body  112 ′ such that the end-effector  110 ′ may be clamped to the robot arm in a manner discussed above. 
     In the present embodiment, the mounting post  118 ′ defines a hollow chamber  119  configured to house the lockout actuator  180 . The lockout actuator  180  is positioned within the chamber  119  such that the surface of an end cap  190  thereof is flush with the end of the post  118 ′. While not illustrated, in the present embodiment, the articulating arm  140  may be temporarily or permanently mounted to the mounting post  118 ′. As such, when the end-effector  110 ′ is mounted to the robot arm  58 , the articulating arm  140  is also mounted to the robot arm  58 . At this time, it would then be desirable to actuate the lockout device via the lockout actuator  180 . 
     The lockout actuator  180  may have various configurations. In the embodiment illustrated in  FIG.  8   , the lockout actuator  180  includes a pair of printed circuit boards  186  and  188  positioned within opposed end caps  182 ,  190 . The end caps  182 ,  190  are preferably manufactured from a non-conductive material, for example, polyetheretherketone (PEEK). A wireless power transfer coil  184  is also provided within the lockout actuator  180  such that power to the circuit boards  186 ,  188  may be provided wirelessly from the robotic arm  58 . The transfer coil  184  may also be configured to transfer signals between the circuit boards  186 ,  188  and the robotic arm  58  or separate signal transfer elements may be enclosed within the actuator  180 . An elastomeric ring  189  may be provided within the end caps  182 ,  190  to seal the components therein. Such minimizes the likelihood of fluids or any other contaminates entering the actuator  180 , helping to maintain the sterile quality of the end-effector  110 ′. The circuit boards  186 ,  188  are configured to wirelessly instruct the robot  50  to actuate the lockout device once the circuit boards  186 ,  188  receive power. As such, when the end-effector  110 ′ is mounted on the interface plate  65 , the wireless power transfer coil  184  receives power from the robot arm  58 . The circuit boards  186 ,  188  are thereby powered and send the actuation signal to the robot  50  to actuate the lockout device. 
     In some circumstances, it may be desirable to attach the motion-locking end-effector to the robotic arm  58  apart from the articulating arm  140 . This may be due to a change in workflow or to attach an additional accessory that requires total motion lockout. To accommodate these circumstances, another embodiment of an end-effector  110 ′ is shown in FIG.  9 . The end-effector  110 ′ is similar to the previous embodiment and includes a lockout actuator (not shown) positioned within the mounting post  118 ′, however, instead of mounting the articulating arm to the mounting post  118 ′, a secondary mounting post assembly  121  is mounted to the mounting post  118 ′. The secondary mounting post assembly  121  includes a base  123  attached to the mounting post  118 ′. A secondary post  125  extends from the base  123  and is configured to connect with the articulating arm  140  or other accessories. A locking notch  127  may be provided in the post  125 . Since the end-effector  110 ″ includes the lockout actuator, mounting of the end-effector  110 ″, without the articulating arm  140  attached thereto, would still cause actuation of the lockout device. With the robot arm  58  locked in place, the articulating arm  140  or any other accessory may be attached via the secondary post  125 . 
     In another embodiment, the robotic arm may be placed near the surgical site and the motion lock end effector is placed on the robotic arm to lock out motion. The articulating arm is then attached to the motion lock end effector and retractor and tightened to hold the desire position. 
     In another embodiment, the robotic arm may be placed near the surgical site. The motion lock end effector with articulating arm attached is placed on the robotic arm to lock out motion. The articulating arm is then loosened, attached to the retractor and tightened to hold the desired position. 
     In yet another embodiment, the articulating arm is loosened and attached to the retractor. The motion lock end effector is then attached to the articulating arm and the robotic arm is placed in reach of the articulating arm and the motion lock end effector is attached. The articulating arm is then tightened to hold the desired position. 
     It is to be understood that the terminology used herein is for the purpose of describing particular embodiments only and is not intended to be limiting of the invention. Unless otherwise defined, all terms (including technical and scientific terms) used herein have the same meaning as commonly understood by one of ordinary skill in the art to which this disclosure belongs. It will be further understood that terms, such as those defined in commonly used dictionaries, should be interpreted as having a meaning that is consistent with their meaning in the context of this specification and the relevant art and will not be interpreted in an idealized or overly formal sense unless expressly so defined herein. 
     The terminology used herein is for the purpose of describing particular aspects only and is not intended to be limiting of the disclosure. As used herein, the singular forms “a”, “an” and “the” are intended to include the plural forms as well, unless the context clearly indicates otherwise. It will be further understood that the terms “comprises” and/or “comprising,” when used in this specification, specify the presence of stated features, integers, steps, operations, elements, and/or components, but do not preclude the presence or addition of one or more other features, integers, steps, operations, elements, components, and/or groups thereof. As used herein, the term “and/or” includes any and all combinations of one or more of the associated listed items. Like reference numbers signify like elements throughout the description of the figures. 
     The corresponding structures, materials, acts, and equivalents of any means or step plus function elements in the claims below are intended to include any disclosed structure, material, or act for performing the function in combination with other claimed elements as specifically claimed. The description of the present disclosure has been presented for purposes of illustration and description but is not intended to be exhaustive or limited to the disclosure in the form disclosed. Many modifications and variations will be apparent to those of ordinary skill in the art without departing from the scope and spirit of the disclosure. The aspects of the disclosure herein were chosen and described in order to best explain the principles of the disclosure and the practical application, and to enable others of ordinary skill in the art to understand the disclosure with various modifications as are suited to the particular use contemplated.