Ophthalmic orbital surgery apparatus and method and image-guided navigation system

• US 20050054900A1
• Filed: 07/21/2004
• Published: 03/10/2005
• Est. Priority Date: 07/21/2003
• Status: Active Grant

• Current Assignee: Vanderbilt University
• Original Assignee: Vanderbilt University
• Inventors: Mawn, Louise A., Galloway, Robert L. Jr.
• Granted Patent: US 8,403,828 B2
• Time in Patent Office: Days
• US Class Current: 600/156
• CPC Class Codes: A61B 1/012 characterised by internal passages or accessories therefor
• CPC Class Codes: A61B 1/3132 for laparoscopy
• CPC Class Codes: A61B 2034/107 Visualisation of planned trajectories or target regions
• CPC Class Codes: A61B 2034/2051 Electromagnetic tracking systems
• CPC Class Codes: A61B 2034/2055 Optical tracking systems
• CPC Class Codes: A61B 2034/2072 Reference field transducer attached to an instrument or patient
• 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 5/064 using markers A61B5/062 takes precedence
• CPC Class Codes: A61B 5/065 Determining position of the probe employing exclusively positioning means located on or in the probe, e.g. using position sensors arranged on the probe
• CPC Class Codes: A61B 90/361 Image-producing devices, e.g. surgical cameras
• CPC Class Codes: A61F 2009/00851 Optical coherence topography [OCT]
• CPC Class Codes: A61F 2009/00897 Scanning mechanisms or algorithms
• CPC Class Codes: A61F 9/007 Methods or devices for eye surgery
• CPC Class Codes: A61F 9/008 using laser
• CPC Class Codes: A61F 9/00802 for photoablation
• CPC Class Codes: A61F 9/00821 for coagulation

Abstract

A flexible endoscope for ophthalmic orbital surgery includes a flexible probe housing having a proximal end, a distal end and a lumen extending between the proximal end and the distal end. The endoscope also includes an image fiber disposed in the lumen that communicates image information from the distal end of the flexible probe, a purge fluid/gas port disposed at the proximal end of the flexible probe that accepts purge fluid/gas and a purge fluid/gas conduit disposed in the lumen and in fluid communication with the purge fluid/gas port. The fluid/gas conduit delivers purge fluid/gas to the distal end of the endoscope. The endoscope also includes an access conduit disposed in the lumen that receives one of an ablation instrument, a coagulating instrument and a medication delivery instrument.

Claims

1. A flexible endoscope for ophthalmic orbital surgery comprising:

(a) a flexible probe housing having a proximal end, a distal end and a lumen extending between the proximal end and the distal end;

(b) an image fiber disposed in the lumen that communicates image information from the distal end of the flexible probe;

(c) a purge fluid/gas port disposed at the proximal end of the flexible probe that accepts purge fluid/gas;

(d) a purge fluid/gas conduit disposed in the lumen and in fluid communication with the purge fluid/gas port, the conduit delivering purge fluid/gas to the distal end of the endoscope; and

(e) an access conduit disposed in the lumen that receives one of an ablation instrument, a coagulating instrument and a medication delivery instrument.

2. The flexible endoscope of claim 1, wherein the ablation instrument is a laser delivery system including:

(i) a waveguide disposed in the lumen;

(ii) a laser source coupled to a proximal end of the waveguide; and

(iii) a lens mounted to a distal end of the waveguide nearest the distal end of the endoscope.

3. The flexible endoscope of claim 2, wherein the laser source is one of a free electron laser source, an Argon laser source, a Dye laser source, a YAG laser source and a carbon dioxide laser source.

4. The flexible endoscope of claim 1, wherein the ablation instrument uses one of radio-frequency waves, microwaves, ultrasonic waves, infrared waves, heat, cryoablation, and a laser to ablate the particular portion of the tissue.

5. The flexible endoscope of claim 1, wherein the coagulating instrument uses one of radio-frequency waves, microwaves, ultrasonic waves, infrared waves, heat, cryoablation and a laser.

6. The flexible endoscope of claim 1, wherein the medication delivery instrument is configured to apply dissolvable time release medication.

7. The flexible endoscope of claim 1, wherein the medication delivery instrument is configured to apply radioactive seeds.

8. The flexible endoscope of claim 1, wherein the flexible probe housing has an outer diameter of less than about 3.2 mm.

9. An apparatus for collecting and processing physical space data for use while performing image-guided surgery with an instrument, the apparatus comprising:

(a) an endoscope including;

(i) a probe housing having a proximal end, a distal end and a lumen extending between the proximal end and the distal end;

(ii) an image fiber disposed in the lumen that communicates image information from the distal end;

(iii) a purge fluid/gas port disposed at the proximal end of the probe that accepts purge fluid/gas;

(iv) a purge fluid/gas conduit disposed in the lumen and in fluid communication with the purge fluid/gas port, the conduit delivering purge fluid/gas to the distal end of the endoscope; and

(v) an access conduit disposed in the lumen which receives the instrument;

(b) a magnetic tracking system including;

(i) a magnetic tracking tip disposed proximate the distal end of the probe housing; and

(ii) a magnetic scanner configured to detect the magnetic tracking tip in three dimensional (3-D) space and to generate magnetic tracking tip location data; and

(c) an image data processor that receives the magnetic tracking tip location data and determines point-based registrations to indicate surgical position in both image space and physical space based on the magnetic tracking tip location data for display while performing the image-guided surgery.

10. The apparatus of claim 9, further comprising:

(d) a scanning device for scanning tissue of the patient to acquire, store and process a 3-D reference of tissue prior to the tissue being surgically exposed, wherein the image data processor creates a triangularized mesh based on the scanned tissue, determines the volumetric center of a particular portion of the tissue to be ablated, coagulated or medicated during the surgery, and implements an algorithm using the triangularized mesh and the physical space data collected by the instrument to determine the point-based registrations.

11. The apparatus of claim 10, wherein the scanning device is one of the following scanners:

a computerized tomography (CT) scanner, a magnetic resonance imaging (MRI) scanner and a positron emission tomography (PET) scanner.

12. The apparatus of claim 9, wherein the magnetic tracking tip location data includes <

x, y, z>

positional coordinates and orientation angles and a rotation matrix.

13. The apparatus of claim 9, wherein points from 3-D physical space are mapped to 2-dimensional (2-D) image space.

14. The apparatus of claim 9, wherein points from 3-D physical space are mapped to 2-dimensional (2-D) endoscopic video space using a direct linear transformation (DLT).

15. The apparatus of claim 9, wherein points from 3-D physical space are mapped to 3-D tomographic image space.

16. The apparatus of claim 9, wherein points from 3-D physical space are mapped to 2-dimensional (2-D) endoscopic image space.

17. The apparatus of claim 9, further comprising an optical tracking system including a probe and an optical scanner, the optical tracking system determines triangulated position data of the tip of the endoscope based on emissions from a plurality of infrared emitting diodes (IREDs) distributed over the surface of a handle of the probe, the plurality of IREDs emitting a plurality of intermittent infrared signals used to triangulate the position of the endoscope in 3-D image space;

18. An apparatus comprising:

(a) an endoscope including;

(i) a probe housing having a proximal end, a distal end and a lumen extending between the proximal end and the distal end;

(ii) an image fiber disposed in the lumen that communicates image information from the distal end;

(iii) a purge fluid/gas port disposed at the proximal end of the probe that accepts purge fluid/gas;

(iv) a purge fluid/gas conduit disposed in the lumen and in fluid communication with the purge fluid/gas port, the conduit delivering purge fluid/gas to the distal end of the endoscope; and

(v) an access conduit disposed in the lumen which receives one of an ablation instrument, a coagulating instrument and a medication delivery instrument;

(b) a magnetic tracking system including;

(i) a magnetic tracking tip disposed proximate the distal end of the probe of the endoscope; and

(ii) a magnetic scanner configured to detect the magnetic tracking tip in three dimensional space.

19. A method of performing minimally invasive ophthalmic orbital surgery using an endoscope and an image-guided navigation system, the method comprising:

(a) scanning tissue of the patient using a scanning device to acquire, store and process a 3-D reference of tissue prior to the tissue being surgically exposed, wherein the image data processor creates a triangularized mesh based on the scanned tissue, determines the volumetric center of a particular portion of the tissue to be ablated, coagulated or medicated during the surgery, and implements an algorithm using the triangularized mesh and the physical space data collected by the instrument to determine the point-based registrations;

(b) surgically exposing an area of tissue proximate the ophthalmic orbit of a patient;

(c) inserting a distal end of the endoscope into the exposed area, the endoscope having a magnetic tracking tip disposed proximate the distal end of the endoscope;

(d) detecting the magnetic tracking tip using a magnetic scanner configured to detect the magnetic tracking tip in three dimensional space;

(e) communicating magnetic tracking tip location data to the image-guided navigation system;

(f) determining point-based registrations used to indicate surgical position in both image space and physical space; and

(g) using the registrations determined in step (f) to map into image space, image data describing the physical space of the endoscope used to perform the image-guided surgery and the tissue.

20. The method of claim 19, wherein the endoscope includes at least one of an ablation instrument, a coagulating instrument and a medication delivery instrument.

21. The method of claim 20, wherein the endoscope includes an ablation instrument which uses one of radio-frequency waves, microwaves, ultrasonic waves, infrared waves, heat, cryoablation, and a laser to ablate the particular portion of the tissue.

22. The method of claim 21, wherein the laser is one of a free electron laser source, an Argon laser source, a Dye laser source, a YAG laser source and a carbon dioxide laser source.

23. The method of claim 20, wherein the endoscope includes a coagulating instrument which uses one of radio-frequency waves, microwaves, ultrasonic waves, infrared waves, heat, cryoablation and a laser.

24. The method of claim 20, wherein the endoscope includes a medication delivery instrument configured to apply dissolvable time release medication.

25. The method of claim 20, wherein the endoscope includes a medication delivery instrument configured to apply radioactive seeds.

26. The method of claim 19, wherein a proximal portion of the endoscope emits a plurality of intermittent infrared signals used to triangulate the position of the endoscope in 3-D image space, the signals being emitted from a plurality of infrared emitting diodes (IREDs) distributed over the surface of the handle of the endoscope in a spiraling fashion.

27. The method of claim 19, wherein a housing of the endoscope has an outer diameter of less than 3.2 mm.

28. The method of claim 19, wherein points from 3-D physical space are mapped to 2-dimensional (2-D) image space.

29. The method of claim 19, wherein points from 3-D physical space are mapped to 2-dimensional (2-D) endoscopic video space using a direct linear transformation (DLT).

30. The method of claim 19, wherein points from 3-D physical space are mapped to 3-D tomographic image space.

31. The method of claim 19, wherein points from 3-D physical space are mapped to 2-dimensional (2-D) endoscopic image space.

32. The method of claim 19, wherein step (a) is performed by one of a computerized tomography (CT) scanner, a magnetic resonance imaging (MRI) scanner and a positron emission tomography (PET) scanner.