Patent Description:
During a surgical procedure, and in particular during a spinal interbody fusion, surgical cleaning tools, such as brushes, may be used to prepare a surface of an anatomical element for the procedure or for a particular step thereof. A surgical robot may be used to assist with or autonomously carry out one or more steps of a surgical procedure.

<CIT> discloses a radial deployment surgical tool having an inner shaft, an outer shaft and a function head.

<CIT> discloses a robotic system for performing minimally invasive spinal stabilization, using two screws inserted in oblique trajectories from an inferior vertebra pedicle into the adjacent superior vertebra body.

According to <CIT>, a shaft member is sized and configured for introduction through a percutaneous access path into a cancellous bone volume. The shaft has an elongated axis. A cutting blade is sized and configured to be carried by the shaft member and project radially outward of the elongated axis into contact with cancellous bone. The cutting blade is capable of cutting cancellous bone in a path about the elongated axis in response to rotation of the shaft member within cancellous bone.

In <CIT>, a cleaning brush and method are described for removing occluding material from an implanted stent.

According to <CIT>, a surgical instrument includes an actuator. A member is connected with the actuator and includes a mating part releasably engageable with a tissue engaging element such that the member is interchangeable with a plurality of alternate tissue engaging elements.

The invention provides a surgical tool according claim <NUM>, and a system for cleaning an anatomical space according to claim <NUM>.

It should also be understood that, depending on the example or embodiment, certain acts or events of any of the processes or methods described herein may be performed in a different sequence, may be added, merged, or left out altogether (e.g., all described acts or events may not be necessary to carry out the techniques). In addition, while certain aspects of this disclosure are described as being performed by a single module or unit for purposes of clarity, it should be understood that the methods of this disclosure may be performed by a combination of units or modules associated with, for example, a computing device and/or a medical device (including a medical imaging device).

In one or more examples, one or more steps of the described methods, processes, and techniques may be implemented in hardware, software, firmware, or any combination thereof.

Instructions may be executed by one or more processors, such as one or more digital signal processors (DSPs), general purpose microprocessors (e.g., Intel Core i3, i5, i7, or i9 processors; Intel Celeron processors; Intel Xeon processors; Intel Pentium processors; AMD Ryzen processors; AMD Athlon processors; AMD Phenom processors; Apple A10 or 10X Fusion processors; Apple A11, A12, A12X, A12Z, or A13 Bionic processors; or any other general purpose microprocessors), application specific integrated circuits (ASICs), field programmable logic arrays (FPGAs), or other equivalent integrated or discrete logic circuitry.

Similarly, the term "exemplary" as used herein means "example. " Also, unless explicitly stated otherwise, terms such as "about" and "approximately" when used in connection with a stated value mean within ten percent of the stated value.

Disc removal is a critical step in spinal interbody fusion. Some of the challenges of disc removal include that disc removal currently takes significant time and is often incomplete (e.g., the interbody space is not thoroughly cleaned of all disc remnants), leading to a risk of non-fusion. The nucleus pulposus, or inner core of the vertebral disc, is a sticky material not easily removed. Forceps can be used for some bulk reduction (e.g., removal of larger segments of the disc), but cannot clean the end plates sufficiently. Brushes are often used for end plate preparation, but each can be used only a single time, as cleaning the brushes (e.g., to remove the sticky nucleus pulposus material from the brush's bristles) is impractical. Thus, use of multiple brushes may be required for disc removal. With forceps and/or brushes, the removal and cleaning process is lengthy and incomplete. Moreover, many in-out maneuvers are required, endangering neutral tissue. Attempted mechanical solutions for disc removal have failed, at least in part due to an inability to overcome such problems as the stickiness of the material being removed, clogging suction tubes, and smoothing burring surfaces.

The solution described herein comprises a rotating brush to remove disc material, coupled with an integrated cleaning mechanism. The eccentric brush at its closed configuration is in the form of a tube, so as to allow a clean entry to the disc. The eccentric brush spins and cleans the end plate, then goes through a thin slot in the cleaning tool that wipes the brush and, by doing so, cleans the brush at every single spin. In order to remove solid matter dislodged from the end plate and from the brush, the cleaning tool includes an irrigation and vacuum system.

Embodiments of the present disclosure may be particularly useful, for example, during surface preparation in connection with spinal interbody fusion.

Inclusion of a slot, irrigation system, and vacuum system increases the life of a brush and reduces the need to use multiple brushes for one procedure, while also reducing and/or eliminated time associated with changing brushes and reducing or eliminating multiple entries and exits of cleaning tools to the surgical site, thus better protecting neutral tissue from unnecessary damage. The brush may also be sterilized and is thus reusable.

Embodiments of the present disclosure also provide a brush housed in a tube during positioning of the brush for cleaning, thereby protecting the brush (as well as neutral tissue along the insertion path) from damage. Tools according to embodiments of the present disclosure are also advantageously small and non-intrusive, and may be suitable for minimally invasive procedures.

As described more fully below, a cleaning tool according to at least some embodiments of the present disclosure may be designed to clean an anatomical element with a brush that moves between a cleaning position and a closed position, a fluid supply that supplies fluid to the brush to clean the brush, and an evacuation conduit for evacuating the fluid and loose anatomical particles from the anatomical element and/or the volume in proximity thereto.

With reference first to <FIG>, a cleaning tool <NUM> according to at least one embodiment of the present disclosure comprises a tube <NUM>, a brush set <NUM>, a brush motor <NUM>, an elevation motor <NUM>, a fluid source <NUM> (shown in <FIG>), and a vacuum source <NUM> (shown in <FIG>). In some embodiments, the tool <NUM> may have fewer components or more components. For example, the tool <NUM> may not include the elevation motor <NUM>, the fluid source <NUM>, and/or the vacuum source <NUM> (shown in <FIG>). The tool <NUM> may be used to prepare a surface of an anatomical element (which may be, for example, a vertebral endplate) using a single, reusable brush or brush set. The tool <NUM> includes a proximal portion <NUM> opposite a distal portion <NUM>. The tool <NUM> may be held by a robot <NUM>, as described with respect to <FIG>, by a passive tool holder, or by a surgeon or other human, and may automatically (e.g., under control of the robot <NUM>) or manually (e.g., under control of a surgeon) perform each step described herein.

In the illustrated embodiment, the tool <NUM> includes the tube <NUM>. The tube <NUM> includes a first conduit <NUM> with a first axis parallel to a second axis of a second conduit <NUM>, and also includes a first end <NUM> opposite a second end <NUM>. The first conduit <NUM> may have a diameter less than, greater than, or equal to a diameter of the second conduit <NUM>. The tube <NUM> may be any solid material including, but not limited to, metal, steel, plastic, or the like, or any combination thereof, and may be biocompatible. In some embodiments the tube <NUM> may have a diameter shaped for minimally invasive procedures for insertion into small incisions. For example, the diameter of the tube <NUM> may be <NUM>, though in other examples the tube <NUM> may have a diameter less than or greater than <NUM>. In other embodiments, the tube <NUM> may have a larger diameter.

The brush set <NUM> can include one brush, two brushes, or more than two brushes. The tube <NUM> may include a brush slot set <NUM>. The brush slot set <NUM> may include one slot, two slots, or more than two slots, with the number of slots corresponding to the number of brushes in the brush set <NUM>. In the illustrated embodiment, the brush slot set <NUM> comprises three slots positioned near the first end <NUM>. In other embodiments, the brush slot set <NUM> may be positioned anywhere on the tube <NUM>, for example, at or near the second end <NUM> or near a midportion <NUM> of the tube <NUM>, depending on the particular anatomy being cleaned and from which anatomical particles are being evacuated. In the illustrated embodiment, each slot of the brush slot set <NUM> has a height substantially similar to or slightly larger than a height of each brush of the brush set <NUM> such that loose anatomical particles that may be stuck on each brush of the brush set <NUM> are dislodged by contact with the edges of the corresponding slot of the brush slot set <NUM>. In other embodiments, each slot of the brush slot set <NUM> may have a height larger than the corresponding brush of the brush set <NUM>.

The tube <NUM> may also include one or more evacuation slots <NUM>. In the illustrated example, the tube <NUM> includes a first evacuation slot disposed above the brush slot set <NUM> and a second evacuation slot disposed below the brush slot set <NUM>. In other embodiments, the tube <NUM> may include one evacuation slot or more than two evacuation slots. In further embodiments, the one or more evacuation slots may be disposed anywhere on the tube <NUM>, for example, at or near the second end <NUM> or near the midportion <NUM> of the tube <NUM>, depending on the particular anatomy being cleaned and from which anatomical particles are being evacuated. In the illustrated embodiment, the one or more evacuation slots <NUM> extend partially around a circumference of the tube <NUM> and have a height greater than the height of a slot of the brush slot set <NUM>. In other examples, the one or more evacuation slots <NUM> may fully extend around the circumference of the tube and/or may have a height greater than or less than the height of a slot of the brush slot set <NUM>. The one or more evacuation slots <NUM> may be sized to facilitate entry therethrough of anatomical particles dislodged by the brush set <NUM> during operation of the cleaning tool <NUM>, and may further be sized to reduce a likelihood of being clogged by a plurality of anatomical particles being pulled into the second conduit <NUM> at once.

The brush motor <NUM> is disposed near the proximal portion <NUM> and is operable to rotate a shaft <NUM> to cause the brush set <NUM> to rotate from a closed position to a cleaning position and back to the closed position. The closed position is the position in which the greatest portion of the brush set <NUM> is enclosed within a perimeter of the tube <NUM>, while the cleaning position is any rotational position of the brush set <NUM> other than in the closed position. In other words, the cleaning position encompasses any angular offset of the brush set <NUM> from the closed position (e.g., between <NUM> and <NUM> degrees offset from the closed position). In embodiments where where the brush set <NUM> is entirely contained within a perimeter of the tube <NUM> when the brush set <NUM> is in the closed position, the cleaning position encompasses any position of the brush set <NUM> in which any portion of the brush set <NUM> extends beyond a perimeter of the tube <NUM>.

The brush motor <NUM> in the illustrated embodiment is positioned on a motor bracket <NUM> and coupled to the shaft <NUM>. The elevation motor <NUM> is also disposed near the proximal portion <NUM> and is configured to vertically move the tool <NUM> before, during, or after operation of the tool <NUM>. In the illustrated embodiment, an elevation cam <NUM> extends through a cam slot <NUM> in the motor bracket <NUM> and slides along the cam slot <NUM> when the elevation motor <NUM> rotates. The cam <NUM> and the cam slot <NUM> translate the rotational movement of the elevation motor <NUM> to a translational movement (e.g., vertical) of the tool <NUM>. Operation of the elevation motor <NUM> during operation of the cleaning tool <NUM> beneficially enables the brush set <NUM> to clean an entirety (or at least a significant portion) of an interbody disc space, despite having a substantially planar profile.

The brush motor <NUM> and the elevation motor <NUM> may be of the same or a different motor type than each other. In some embodiments, one or more gears, gear boxes, clutches, transmissions, and/or other mechanical elements may be utilized to enable a single motor to be used both to spin the shaft <NUM> and thus the brush set <NUM>, and to adjust the elevation of the tool <NUM>. The brush motor <NUM> and/or the elevation motor <NUM> may be an electric motor, a pneumatic motor, a hydraulic motor, or another type of motor. In some embodiments, the brush motor <NUM> and the elevation motor <NUM> each comprise a gear motor. In other embodiments, each of the brush motor <NUM> and the elevation motor <NUM> comprise any type of motor including, but not limited to, an AC brushless motor, a DC brushed motor, a DC brushless motor, a servo motor, or the like.

<FIG> illustrate the brush set <NUM> in detail. The brush set <NUM> is positioned on the shaft <NUM> near the distal portion <NUM>. The shaft <NUM> extends through the first conduit <NUM> of the tube <NUM> and has a shaft axis S parallel to (and, in some embodiments, coaxial with) the first conduit axis. The brush set <NUM> has a brush axis B at a center of the brush set <NUM> that is parallel to and offset from the shaft axis S and the first conduit axis, as shown in <FIG>. The brush axis B is parallel to the second conduit axis of the second conduit <NUM>. Rotation of the shaft <NUM> causes the at least one brush axis B to orbit around the shaft axis S, thereby causing eccentric rotation of the brush set <NUM>.

The brush set <NUM> and the shaft <NUM> may be a single piece (e.g., may be integrally formed), or separate pieces. In embodiments where the brush set <NUM> is separate from the shaft <NUM>, the brush set <NUM> as a whole or the individual brushes thereof may be removable from the shaft <NUM> for replacement and/or cleaning. In other embodiments, the brush set <NUM> is fixed to the shaft <NUM> and the shaft <NUM> is removable from the tool <NUM> for cleaning and/or replacement. In further embodiments, the brush set <NUM> may be fixed to a portion of the shaft <NUM>, and the portion may be removeable from the shaft <NUM> for cleaning and/or replacement.

In the illustrated example, the brush set <NUM> comprises three brushes spaced apart from each other. In other examples, the brush set <NUM> comprises one brush, two brushes, or more than three brushes. In examples where the brush set <NUM> comprises two or more brushes, each brush may be spaced from or adjacent to another brush. The brush set <NUM> may have a height substantially similar to a height of a spinal disc, though the brush set <NUM> may have a height less than or greater than a height of a spinal disc.

In some embodiments, the brush set <NUM> comprises a plurality of steel bristles of varying length. In other embodiments, the brush set <NUM> may comprise bristles of any type of material including, but not limited to plastic, metal, synthetic fibers, natural fibers, or the like. As shown in <FIG>, the brush set <NUM> defines a substantially circular shape when viewed from the top or bottom. More specifically, the plurality of bristles form a circle. In other embodiments, the brush set <NUM> may define any shape including, but not limited to, a square, a triangle, an oval, a rectangle, a star, or the like. In such embodiments, the tube <NUM> may be provided with the same or a similar shape, so that the brush set <NUM> may rotate into a closed position in which the brush set <NUM> fits within an outer perimeter of the tube <NUM>.

As previously described, the brush set <NUM> is movable from a closed position to a cleaning position. When the brush set <NUM> is in the closed position, the brush set <NUM> is positioned entirely inside of the tube <NUM>, as shown in <FIG>. When the brush set <NUM> is in the cleaning position (or in any position other than the closed position), the brush set <NUM> is at least partially outside of the tube <NUM>. During use, when each brush of the brush set <NUM> passes through the corresponding brush slot of the brush slot set <NUM> while rotating into or through the closed position, the fluid (from the fluid source <NUM>, if used) and the corresponding brush slot of the brush slot set <NUM> facilitate dislodgment and evacuation of loose anatomical particles and/or fluid from each brush of the brush set <NUM> as well as the interbody space into which the distal portion <NUM> extends.

The fluid is supplied from the fluid source <NUM> through a conduit of the shaft <NUM>. As shown in <FIG>, the fluid enters the shaft <NUM> through one or more first fluid apertures <NUM> proximate the proximate portion <NUM> and exits the shaft <NUM> through one or more second fluid apertures <NUM> proximate the distal portion <NUM>. In the illustrated embodiment, the one or more first fluid apertures <NUM> comprise a plurality of first fluid apertures positioned at or proximate a top end or top end portion of the shaft <NUM>. In other embodiments, the one or more first fluid apertures <NUM> comprise a single aperture. The one or more first fluid apertures may be positioned anywhere on the shaft <NUM>, although positioning the one or more first fluid apertures closer to the proximate portion <NUM> may facilitate the provision of fluid thereto from a fluid source <NUM>.

The one or more second fluid apertures <NUM>, as shown in the illustrated example, comprise a plurality of second fluid apertures positioned at a bottom end or bottom end portion of the shaft <NUM> and adjacent to the brush set <NUM>. In the illustrated embodiment, the shaft <NUM> comprises a first set of second fluid apertures <NUM> positioned on a proximate side of each brush of the brush set <NUM>, and a second set of a second fluid apertures <NUM> positioned on a distal side of each brush of the brush set <NUM>. Such positioning of the second fluid apertures <NUM> beneficially enables fluid to be sprayed or otherwise discharged onto both sides of each brush of the brush set <NUM>. In other embodiments, however, the second fluid apertures <NUM> may be positioned only on a proximate side of each brush, or only on a distal side of each brush, or at the same elevation as each brush. In other embodiments, the one or more second fluid apertures <NUM> may be positioned anywhere on the shaft <NUM>.

<FIG> illustrate further details of the tool <NUM> for supplying fluid to the brush set <NUM>. Fluid is supplied to the one or more first fluid apertures <NUM> via a fluid tube <NUM> and a fluid ring <NUM>. The ring <NUM> advantageously supplies fluid to the shaft <NUM> while also allowing the shaft <NUM> to rotate within the ring <NUM>. As illustrated and described above, the second fluid apertures <NUM> are positioned on a proximate side and a distal side of each brush of the brush set <NUM> to enable fluid to be sprayed or otherwise discharged onto both side of each brush of the brush set <NUM>. In some embodiments, the tube <NUM> may include one or more first fluid tube apertures corresponding to the one or more first fluid apertures <NUM> (e.g., in embodiments in which the tube <NUM> extends along a greater portion of the shaft <NUM>, or where the fluid tube <NUM> and fluid ring <NUM> are positioned closer to the distal portion <NUM> of the tool <NUM>) and one or more second fluid tube apertures corresponding to the one or more second fluid apertures <NUM>.

Turning to <FIG>, the brush set <NUM> is shown moving from a closed position to a cleaning position during use. The brush set <NUM> may be continuously rotated (e.g., by continuous rotation of the shaft <NUM>) between the cleaning position and the closed position to clean an anatomical element by alternately brushing the anatomical element (when in the cleaning position) and being cleaned of anatomical particles through a combination of fluid spray and suction (when in the closed position). As previously described, the brush set <NUM> is positioned inside of the tube <NUM> when in the closed position, as shown in <FIG>. In other words, the brush set <NUM> is positioned entirely within a perimeter of the tube <NUM> when in the closed position, in which position the brush set <NUM> can advantageously be cleaned by discharge of fluid from the second fluid apertures <NUM> thereon and by suction within the second or suction conduit <NUM>. As the brush set <NUM> moves towards the cleaning position, as shown in <FIG> (the cleaning position is shown, for example, in <FIG>), the brush set <NUM> rotates through the brush slot set <NUM> and out of the tube <NUM>. As the brush set <NUM> rotates out of the tube <NUM> and through a complete rotation, the brush set <NUM> scrapes or brushes anatomical particles from the anatomical element to clean the surface of the anatomical element from anatomical particles (e.g., from a disc being removed).

When the brush set <NUM> moves from the cleaning position back to the closed position to complete a full rotation, as shown in <FIG>, the brush set <NUM> moves through the brush slot set <NUM>. Whether throughout the rotation or only as the brush set <NUM> rotates through the closed position, fluid may also be supplied to the brush set <NUM> (e.g., via the second fluid apertures <NUM>) to loosen and/or dislodge anatomical particles that may be stuck to the brush set <NUM> and/or prevent loose anatomical particles from becoming lodged in or stuck to the brush set <NUM>. In some embodiments, the tube <NUM> blocks the second fluid apertures <NUM> when the brush set <NUM> is not in or close to the closed position, thus beneficially preventing fluid from being sprayed or discharged into the interbody space being cleaned. Further, as the brush set <NUM> moves through the brush slot set <NUM>, the loose anatomical particles that may be stuck to each brush of the brush set <NUM> may be pushed off each brush when the loose anatomical particles contact an edge of the corresponding brush slot of the brush slot set <NUM> or the tube <NUM>.

As shown and previously described, one or more evacuation slots <NUM> are disposed near the brush slot set <NUM> and in communication with the second conduit <NUM>, also referred to as a suction conduit. The vacuum source <NUM> creates a suction in the second conduit <NUM> or the suction conduit, and as the loose anatomical particles are dislodged, the suction draws the loose anatomical particles (and surrounding fluid) through the evacuation slots <NUM> and through the second conduit <NUM> or suction conduit.

In the illustrated embodiment and as previously described, a first evacuation slot <NUM> may be disposed above the brush slot set <NUM> (e.g., on a proximal side of the brush slot set <NUM>) and a second evacuation slot <NUM> may be disposed below the brush slot set <NUM> (e.g., on a distal side of the brush slot set <NUM>). Inclusion of two evacuation slots <NUM> beneficially facilitates evacuation of loose anatomical particles and fluid from the interbody space. Moreover, when the tool <NUM> is moved upwards or away from the anatomical element, loose anatomical particles (and surrounding fluid) may be evacuated more readily through the second evacuation slot <NUM> and when the tool <NUM> is moved downwards or towards the anatomical element, loose anatomical particles (and surrounding fluid) may be evacuated more readily through the first evacuation slot <NUM>. Also, as shown in the illustrated embodiment, the second conduit <NUM> or suction conduit is connected to a vacuum tube <NUM>, shown in <FIG>, through which the loose anatomical particles are suctioned. Though not shown, the vacuum tube <NUM> may be connected to a receptacle or waste disposal to receive and/or dispose of the loose anatomical particles and/or fluid.

Each of the various components of the tool <NUM> may be made of a metal, a metal alloy, a plastic, a composite, any other suitable material that enables the component to achieve the purpose thereof as described herein, and/or any combination of the foregoing. In some embodiments, one or more components of the tool <NUM> may be made of a radiolucent material, such as polyetheretherketone (PEEK) or thermoplastic resins with carbon-fiber reinforcement. In other embodiments, none of the components of the tool <NUM> are radiolucent. The material(s) from which the various components of the tool <NUM> are made may be selected to enable the tool <NUM> and/or one or more portions thereof to be cleanable, sterilizable (whether by heat, chemical treatment, or otherwise), and/or reusable. Additionally and/or alternatively, the material(s) from which the various components of the tool <NUM> are made may be selected for ease of cleaning, replaceability, or repair.

A tool <NUM>, as described above with respect to <FIG>, may be used in a system <NUM>, as shown in <FIG>, though it will be understood that the tool <NUM> may be used independently of the system <NUM>. The system <NUM> includes a computing device <NUM>, a robot <NUM> (which may include or be holding the tool <NUM>), a fluid source <NUM>, a vacuum source <NUM>, and/or a navigation system <NUM>. In some embodiments of the present disclosure, systems such as the system <NUM> of <FIG> may not include one or more of the illustrated components, may include other components not shown in <FIG>, and/or may include components similar to, but not the same as, one or more components of the system <NUM> shown in <FIG>. For example, in some embodiments, the system <NUM> may not include the navigation system <NUM>. In other embodiments, the system <NUM> may not include the fluid source <NUM> and/or the vacuum source <NUM>.

The computing device <NUM> according to embodiments of the present disclosure may comprise a processor <NUM>, a memory <NUM>, a communication interface <NUM>, and the user interface <NUM>. A computing device such as the computing device <NUM> in some embodiments may have more components or fewer components than the computing device <NUM> shown in <FIG>.

The processor <NUM> of the computing device <NUM> may be any processor described herein or any similar processor. The processor <NUM> may be configured to execute instructions stored in the memory <NUM>, which instructions may cause the processor <NUM> to carry out one or more computing steps utilizing or based on data received from the user interface <NUM>; one or more sensors included in, attached to, or otherwise monitoring operation of the tool <NUM>; the computing device <NUM>, and/or the navigation system <NUM>.

The memory <NUM> may be or comprise RAM, DRAM, SDRAM, other solid-state memory, any memory described herein, or any other tangible, non-transitory memory for storing computer-readable data and/or instructions. The memory <NUM> may store information or data useful for completing any step of the method <NUM> described herein. The memory <NUM> may store, for example, one or more instructions <NUM> and/or one or more surgical plans <NUM>. Such instructions <NUM> may, in some embodiments, be organized into one or more applications, modules, packages, layers, or engines. The instructions <NUM> may be configured for execution by the processor <NUM> to carry out any method described herein (including the method <NUM>) or portion thereof, and/or to operate one or more of the robot <NUM>, the navigation system <NUM>, the tool <NUM>, the fluid source <NUM>, and/or the vacuum source <NUM>. The instructions <NUM> may cause the processor <NUM> to manipulate data stored in the memory <NUM> and/or received from the navigation system <NUM>.

The computing device <NUM> may also comprise a communication interface <NUM>. The communication interface <NUM> may be used for receiving information from an external source (such as the tool <NUM>, the robot <NUM>, and/or the navigation system <NUM>), and/or for transmitting instructions, data, or other information to an external system or device (e.g., the tool <NUM>, the robot <NUM>, and/or the navigation system <NUM>). The communication interface <NUM> may comprise one or more wired interfaces (e.g., a USB port, an ethernet port, a Firewire port) and/or one or more wireless interfaces (configured, for example, to transmit information via one or more wireless communication protocols such as <NUM>. 11a/b/g/n, Bluetooth, NFC, ZigBee, and so forth). In some embodiments, the communication interface <NUM> may be useful for enabling the computing device <NUM> to communicate with one or more other processors <NUM> or computing devices <NUM>, whether to reduce the time needed to accomplish a computing-intensive task or for any other reason.

The computing device <NUM> may also comprise one or more user interfaces <NUM>. The user interface <NUM> may be or comprise a keyboard, mouse, trackball, monitor, television, touchscreen, joystick, switch, button, headset and/or any other device for receiving information from a user and/or for providing information to a user. The user interface <NUM> may be used, for example, to receive a user selection or other user input regarding controlling a robot to position the tool <NUM> within an interbody space; a user selection or other user input regarding causing the brush set <NUM> to rotate between a cleaning position and a closed position in an alternating fashion; a user selection or other user input regarding causing a fluid source to supply a fluid to the brush set <NUM>; a user selection or other user input regarding evacuating fluid from the brush set <NUM> through the suction conduit <NUM>; a user selection or other user input regarding adjusting an elevation of the distal portion <NUM> of the tool <NUM>; to receive user input useful in connection with the instructions <NUM> and/or the surgical plan <NUM>, to receive a user selection or other user input regarding operation of the robot <NUM>, manipulation of the robotic arm <NUM>, and/or use of the tool <NUM>; and/or to display the instructions <NUM> and/or the surgical plan <NUM>. In some embodiments, the user interface <NUM> may be useful to allow a surgeon or other user to modify the instructions <NUM>, the plan <NUM>, or other information displayed, though it will be appreciated that each of the preceding inputs may be generated automatically by the system <NUM> (e.g., by the processor <NUM> or another component of the system <NUM>) or received by the system <NUM> from a source external to the system <NUM>. In some embodiments, user input such as that described above may be optional or not needed for operation of the systems, devices, and methods described herein.

Although the user interface <NUM> is shown as part of the computing device <NUM>, in some embodiments, the computing device <NUM> may utilize a user interface <NUM> that is housed separately from one or more remaining components of the computing device <NUM>. In some embodiments, the user interface <NUM> may be located proximate one or more other components of the computing device <NUM>, while in other embodiments, the user interface <NUM> may be located remotely from one or more other components of the computing device <NUM>.

The robot <NUM> may be any surgical robot or surgical robotic system. The robot <NUM> may be or comprise, for example, the Mazor X™ Stealth Edition robotic guidance system. The robot <NUM> may comprise one or more robotic arms <NUM>. In some embodiments, the robotic arm <NUM> may comprise one robotic arm, though in other embodiments, the robotic arm <NUM> may comprise two robotic arms or more than two robotic arms. The tool <NUM> may be disposed on an end of the robotic arm <NUM>. In other examples, the tool <NUM> may be disposed on any portion of the robotic arm <NUM> and/or the robot <NUM>.

In some embodiments, the system <NUM> may include a navigation system <NUM>, though in other embodiments, the system <NUM> may not include a navigation system <NUM>. The navigation system <NUM> may provide navigation for a surgeon and/or a surgical robot during an operation. The navigation system <NUM> may be any now-known or future-developed navigation system, including, for example, the Medtronic StealthStation™ S8 surgical navigation system. In various embodiments, the navigation system <NUM> may be used to track a position of the robotic arm <NUM> (or, more particularly, of a navigated tracker attached to the robotic arm <NUM>). The navigation system <NUM> may include a camera or other sensor(s) for tracking one or more reference markers, navigated trackers, or other objects within the operating room. The navigation system <NUM> may include a display for displaying one or more images from an external source (e.g., a camera or other source) or a video stream from the camera or other sensor of the navigation system <NUM>. In some embodiments, the navigation system <NUM> may provide position, movement, and/or other information to the robot <NUM> for use in controlling the tool <NUM> and/or any other aspect of the system <NUM>. In some embodiments, the system <NUM> does not include and can operate without the use of the navigation system <NUM>.

Reference markers (i.e., navigation markers) may be placed on the robot <NUM>, the robotic arm <NUM>, the tool <NUM>, or any other object in the surgical space. The reference markers may be tracked by the navigation system <NUM>, and the results of the tracking may be used by the computing device <NUM> and/or by an operator of the system <NUM> or any component thereof. In some embodiments, the navigation system <NUM> can be used to track other components of the system (e.g., the tool <NUM>) and the system <NUM> can operate without the use of the robot <NUM> (e.g., with the surgeon manually manipulating the tool <NUM>).

The system <NUM> may also include the fluid source <NUM> and/or the vacuum source <NUM>. In some embodiments, the system <NUM> does not include the fluid source <NUM> and/or the vacuum source <NUM>, may include only the fluid source <NUM>, or may include only the vacuum source <NUM>. In other embodiments, the fluid source <NUM> and/or the vacuum source <NUM> may be used with the tool <NUM> independently of the system <NUM>. Each of the fluid source <NUM> and/or the vacuum source <NUM> may be formed as a part of the tool <NUM> or may be separate from the tool <NUM>. A hose (not shown) may extend from each of the fluid source <NUM> and the vacuum source <NUM> to the fluid tube <NUM> and the vacuum tube <NUM>, respectively. The fluid source <NUM> may be configured to provide fluid to the brush set <NUM>. The fluid may be a gas (e.g., oxygen, air, carbon dioxide, heliox) or a liquid (e.g., water, saline, or another irrigant). The fluid may flush loose anatomical particles from the brush set <NUM>, and/or anatomical element. The fluid source <NUM> may be configured with a pressurized fluid storage container or may otherwise comprise a pressurized fluid source so as to enable the fluid to be discharged onto the brush set <NUM> under pressure. In such embodiments, the pressure may be selectable (whether by a surgeon or other human operator of the tool <NUM>, or by the computing device <NUM>, or otherwise). The vacuum source <NUM> may remove the fluid when used with the fluid source <NUM> and/or may remove loose anatomical particles when used with or without the fluid source <NUM>. The fluid may be delivered to the anatomical element via the fluid tube <NUM> and the shaft <NUM>, and/or removed from the anatomical element via the vacuum tube <NUM>. In other embodiments, the fluid may be delivered to or removed from the anatomical element through or via any cannula, annulus, or hose formed on, disposed on, or connected to the tool <NUM>.

Turning now to <FIG>, a method <NUM> for performing a surgical procedure may be executed in whole or in part by a robot (e.g., the robot <NUM> controlled by the computing device <NUM>) and/or a surgeon. The method <NUM> may be performed using, for example, the tool <NUM> described above with respect to <FIG> and/or the system <NUM> described above with respect to <FIG>.

The method <NUM> comprises controlling a robot, such as the robot <NUM>, to position a cleaning tool, such as the tool <NUM>, within an interbody space (step <NUM>). The cleaning tool may be attached to a robotic arm such as the robotic arm <NUM>. The controlling may include sending instructions to the robot for manipulating the robotic arm to insert the cleaning tool into an interbody space, and may be based on, for example, a surgical plan such as a surgical plan <NUM>, one or more images of the anatomy of the patient into which the cleaning tool is being inserted, user input, and/or other information. The instructions may include a predetermined position and orientation of the cleaning tool. The controlling may include providing a trajectory or movement path from the surgical plan to the robot, or determining, with a processor such as the processor <NUM>, a trajectory or movement path for the robot that will result in the cleaning tool being properly positioned within the interbody space, and then providing the determined trajectory or movement path to the robot. In some instances, the tool may be used manually by a surgeon, which surgeon may in some embodiments be assisted by the robot and/or a navigation system (e.g., the navigation system <NUM>).

The method <NUM> also comprises causing a brush set (e.g., the brush set <NUM>) of the tool to rotate between a cleaning position and a closed position in alternating fashion (step <NUM>). As described with respect to <FIG> and <FIG>, the brush set is positioned entirely within a perimeter of a tube (e.g., the tube <NUM>) of the tool when in the closed position. The tube may have a corresponding brush slot of a brush slot set through which each brush passes on each rotation. The brush set may dislodge or remove anatomical particles from an anatomical element to clean a surface of the anatomical element.

The method <NUM> also comprises causing a fluid source (e.g., the fluid source <NUM>) of the tool to supply a fluid to the brush set (step <NUM>). As previously described with respect to <FIG>, the fluid is supplied to each brush of the brush set as each brush rotates through the closed position. In some embodiments, the fluid is constantly supplied to the brush set. The fluid may prevent loose anatomical particles from sticking to the brush set and/or may loosen anatomical particles lodged in the brush set.

The method <NUM> further comprises causing the fluid (and any anatomical particles entrained therein) to be evacuated from the brush set though a suction conduit (e.g., the second conduit <NUM>) of the tool (step <NUM>). As previously described with respect to <FIG>, the fluid and/or loose anatomical particles may be evacuated from the site through an evacuation slot disposed near the brush slot set. The evacuating may not result in complete removal of all of the fluid provided in the step <NUM>. Further, loose anatomical particles may be dislodged as the brush set passes through the corresponding brush slot set to the closed position and the loose particles may be evacuated through the evacuation slot and the suction conduit. Rotation of the brush set between the cleaning position and the closed position may be continuously repeated until the surface of the anatomical element is sufficiently cleaned.

The method <NUM> further comprises causing an adjustment of an elevation of a distal portion, such as the distal portion <NUM>, of the cleaning tool (step <NUM>). The elevation of the cleaning tool may be adjusted via an elevation motor, such as the elevation motor <NUM>. The elevation may be continuously adjusted or adjusted in discrete increments autonomously or under direction of the surgeon. By continuously adjusting the elevation of the distal portion, an elevation of the brush set is continuously adjusted during use to form a vibration motion, thereby facilitating thorough cleaning of the interbody space.

In some embodiments, the method <NUM> may comprise receiving the surgical plan (e.g., the surgical plan <NUM>). The surgical plan may be received via a user interface such as the user interface <NUM> and/or a communication interface such as the communication interface <NUM> of a computing device such as the computing device <NUM>, and may be stored in a memory such as the memory <NUM> of the computing device. The surgical plan may include information about one or more planned movements of the tool (and/or of the robot holding the tool) during a surgical procedure. The information may also include a timeline or schedule of the one or more planned movements. The one or more planned movements may include one or more of timestamps, a type of movement (e.g., translational and/or rotational), a duration of the movement, and/or positional information (e.g., coordinates).

In some embodiments, the method <NUM> may comprise determining information about one or more needed movements of the tool during a surgical procedure outlined or otherwise described in a surgical plan. In such embodiments, the surgical plan may not include receiving any such information via the computing device, but through the processor executing instructions stored in the memory, which may generate such information based on the surgical plan.

In some embodiments, the method <NUM> may comprise generating instructions such as the instructions <NUM> for causing the tool (e.g., the tool <NUM>) to perform one or more surgical steps such as those described in connection with the steps <NUM> to <NUM>. The instructions may be based on the surgical plan. In some embodiments, however, the tool may be automatically actuated based on instructions stored in a memory thereof that are not based on a surgical plan.

The instructions <NUM> may include one or more instructions that cause an alert or other indication to be given to the surgeon (e.g., via a user interface such as the user interface <NUM>) prior to each movement of the tool, and/or prior to executing one of the one or more planned surgical steps. In some embodiments, such an alert may pause execution of the surgical plan for approval by the surgeon or other operator. In other embodiments, the alert may simply notify the surgeon of the planned movement and/or of the planned volume increase or decrease, and automatically execute the planned movement. The alert and/or notification may be displayed on the user interface and/or may include a sound and/or a visual display.

As may be appreciated based on the foregoing disclosure, the present disclosure encompasses methods with fewer than all of the steps identified in <FIG> (and the corresponding description of method <NUM>), as well as methods that include additional or other steps beyond those identified in <FIG> (and the corresponding description of method <NUM>).

Claim 1:
A surgical tool (<NUM>) comprising:
at least one brush (<NUM>) disposed on a shaft (<NUM>) extending through a tube (<NUM>), the tube (<NUM>) having a corresponding brush slot (<NUM>) for each brush (<NUM>);
a motor (<NUM>) operable to rotate the shaft (<NUM>) to cause the at least one brush (<NUM>) to move from a closed position to a cleaning position, the at least one brush (<NUM>) positioned entirely inside of the tube (<NUM>) when in the closed position and at least partially outside of the tube (<NUM>) when in the cleaning position; and
a fluid source (<NUM>) operable to supply fluid to the at least one brush (<NUM>) as the at least one brush (<NUM>) passes through the brush slot (<NUM>).