Notched apparatus for guidance of an insertable instrument along an axis during spinal surgery

• US 10,548,620 B2
• Filed: 08/08/2017
• Issued: 02/04/2020
• Est. Priority Date: 01/15/2014
• Status: Active Grant

• Current Assignee: KB Medical SA (Globus Medical, Inc.)
• Original Assignee: Globus Medical, Inc.
• Inventors: Kostrzewski, Szymon, Nussbaumer, Billy, Berthelin, Roderik, Patel, Chetan K.
• Primary Examiner(s): Yang, Andrew
• Application Number:
  US15/671,274
• Publication Number:
  US 20170333057A1
• Time in Patent Office: 910 Days
• CPC Class Codes: A61B 17/17 Guides or aligning means for drills , mills, pins or wires
• CPC Class Codes: A61B 17/1703 using imaging means, e.g. by X-rays
• CPC Class Codes: A61B 17/3417 Details of tips or shafts, e.g. grooves, expandable, bendable; Multiple coaxial sliding cannulas, e.g. for dilating syringe needles A61M5/32; dilators A61M29/00
• CPC Class Codes: A61B 2034/2055 Optical tracking systems
• CPC Class Codes: A61B 2034/305 Details of wrist mechanisms at distal ends of robotic arms
• CPC Class Codes: A61B 2090/061 for measuring dimensions, e.g. length
• CPC Class Codes: A61B 2090/062 penetration depth
• CPC Class Codes: A61B 2090/065 for measuring contact or contact pressure
• CPC Class Codes: A61B 2090/066 for measuring torque
• CPC Class Codes: A61B 2090/365 augmented reality, i.e. correlating a live optical image with another image
• CPC Class Codes: A61B 2090/368 changing the image on a display according to the operator's position
• CPC Class Codes: A61B 2090/3937 Visible markers
• CPC Class Codes: A61B 34/20 Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
• CPC Class Codes: A61B 34/30 Surgical robots
• CPC Class Codes: A61B 34/37 Master-slave robots A61B34/35 takes precedence
• CPC Class Codes: A61B 90/11 with guides for needles or instruments, e.g. arcuate slides or ball joints
• CPC Class Codes: A61B 90/39 Markers, e.g. radio-opaque or breast lesions markers

Abstract

Described herein is a surgical instrument guide for use with a robotic surgical system, for example, during spinal surgery. In certain embodiments, the guide is attached to or is part of an end effector of a robotic arm, and provides a rigid structure that allows for precise preparation of patient tissue (e.g., preparation of a pedicle) by drilling, tapping, or other manipulation, as well as precise placement of a screw in a drilled hole or affixation of a prosthetic or implant in a prepared patient situation.

Claims

1. A method of performing surgery with a robotic surgical system, the method comprising:

moving a mobile cart transporting a robotic surgical system comprising a robotic arm in proximity to an operating table, wherein the robotic arm has an end effector comprising a surgical instrument guide attached thereto, the surgical instrument guide configured to hold and/or restrict movement of a surgical instrument therethrough;

stabilizing the mobile cart;

maneuvering the robotic arm to a desired position to align an axis defined by the instrument guide at a desired trajectory in relation to a patient situation, wherein the surgical instrument guide comprises a rigid hollow tubular structure having a first open end and a second open end, said structure defining the axis along which movement of a surgical instrument sliding through the structure is restricted;

fixing the position of the robotic arm; and

maneuvering the surgical instrument in a manner that is constrained by the surgical instrument guide, wherein;

the surgical instrument is fitted with a tool support shaped and sized to slide through the surgical instrument guide along the axis defined by the guide,

the tubular structure of the surgical instrument guide has an interior surface shaped and sized to accommodate the tool support sliding through the guide such that movement of the tool support is constrained in all directions except along the axis defined by the guide, and

the tubular structure comprises a longitudinal notch along its length, wherein the longitudinal notch is sized to (i) permit a marker attached to the tool support to be viewable by a navigation camera along an entire range of movement of the tool support through the guide, (ii) constrain movement of the navigation marker in a fixed orientation along the axis defined by the guide, and (ii) permit the tool support to slide along the axis defined by the guide while the guide is held in a fixed position by the robotic surgical system.

2. The method of claim 1, wherein the surgical instrument is a member selected from the group consisting of:

a drill bit, tap, screw driver, and awl.

3. The method of claim 2, wherein the surgical instrument is a drill bit and the surgical instrument guide is a drill bit guide.

4. The method of any of claim 1, wherein the robotic surgical system is for use in spinal surgery.

5. The method of any of claim 1, wherein the rigid hollow tubular structure is a cylindrical structure.

6. The method of any of claim 1, wherein the longitudinal notch is a slot.

7. The method of any of claim 1, wherein the navigation marker is used by navigation camera to track the surgical instrument.

8. The method of claim 1, wherein the longitudinal notch is sized in relation to a peg to permit the surgical instrument to slide along the axis of insertion in reference to the tool support.

9. The method of claim 1, wherein the surgical instrument guide is configured to be used to guide a screw implant and a tissue protector.

10. The method of claim 1, wherein the manipulator is attached to the robotic arm.

11. The method of claim 1, wherein the manipulator is molded into the robotic arm.

12. The method of claim 1, comprising:

prior to maneuvering the robotic arm to a desired position, obtaining or accessing a CT scan, 3D CT scan, fluoroscopy, 3D fluoroscopy, or natural landmark-based image of the patient situation.

13. The method of claim 1, comprising:

maneuvering the surgical instrument through the surgical instrument guide.

14. A method of performing surgery with a robotic surgical system, the method comprising:

obtaining access to one or more vertebrae of a patient;

attaching a patient navigation marker to the patient;

registering the patient;

moving a mobile cart transporting a robotic surgical system comprising a robotic arm in proximity to an operating table, wherein the robotic arm has an end effector comprising a surgical instrument guide attached thereto, the surgical instrument guide configured to hold and/or restrict movement of a surgical instrument therethrough;

stabilizing the mobile cart;

inserting a first surgical instrument into the surgical instrument guide;

maneuvering the robotic arm to a desired position to align an axis defined by the instrument guide at a desired trajectory in relation to a patient situation, wherein the surgical instrument guide comprises a rigid hollow tubular structure having a first open end and a second open end, said structure defining the axis along which movement of a surgical instrument sliding through the structure is restricted;

fixing the position of the robotic arm;

maneuvering the surgical instrument along the desired trajectory, wherein the robotic surgical system assists in said maneuvering;

placing the robotic arm in a hold position mode;

manually preparing a hole for a screw using the first surgical instrument;

removing the first surgical instrument from the surgical instrument guide; and

inserting an implant through the guiding tube and positioning the implant within the patient,

wherein the surgical instrument is fitted with a tool support shaped and sized to slide through the surgical instrument guide along the axis defined by the guide,

the tubular structure of the surgical instrument guide has an interior surface shaped and sized to accommodate the tool support sliding through the guide such that movement of the tool support is constrained in all directions except along the axis defined by the guide, and

the tubular structure comprises a longitudinal notch along its length, wherein the longitudinal notch is sized to (i) permit a marker attached to the tool support to be viewable by a navigation camera along an entire range of movement of the tool support through the guide, (ii) constrain movement of the navigation marker in a fixed orientation along the axis defined by the guide, and (ii) permit the tool support to slide along the axis defined by the guide while the guide is held in a fixed position by the robotic surgical system.

15. The method of claim 14, wherein a lock, when engaged, prevents movement of the surgical instrument beyond a preset position along the axis defined by the guide.

16. The method of claim 15, wherein the lock, when engaged, prevents removal of the surgical instrument from the surgical instrument guide.

17. The method of claim 14, comprising an instrument position sensor configured to detect the position of the surgical instrument in the rigid hollow tubular structure.

18. The method of claim 14, wherein the navigation marker is used by navigation camera to track the surgical instrument.

19. A robotic surgical system comprising:

a robotic arm in proximity to an operating table, wherein the robotic arm has an end effector comprising a surgical instrument guide attached thereto, the surgical instrument guide configured to hold and/or restrict movement of a surgical instrument therethrough;

wherein the surgical instrument guide comprises;

a rigid hollow tubular structure having a first open end and a second open end, said structure defining the axis along which movement of a surgical instrument sliding through the structure is restricted;

a tool support shaped and sized to slide through the surgical instrument guide along the axis defined by the guide,

wherein the tubular structure of the surgical instrument guide has an interior surface shaped and sized to accommodate the tool support sliding through the guide such that movement of the tool support is constrained in all directions except along the axis defined by the guide, and

wherein the tubular structure comprises a longitudinal notch along its length, wherein the longitudinal notch is sized to (i) permit a marker attached to the tool support to be viewable by a navigation camera along an entire range of movement of the tool support through the guide, (ii) constrain movement of the navigation marker in a fixed orientation along the axis defined by the guide.