Tool guide for a surgical tool

• US 6,377,839 B1
• Filed: 05/29/1998
• Issued: 04/23/2002
• Est. Priority Date: 11/30/1992
• Status: Expired due to Fees

• Current Assignee: Cleveland Clinic Foundation
• Original Assignee: Cleveland Clinic Foundation
• Inventors: Kalfas, Iain H., Steiner, Charles P., Kormos, Donald W., Barnett, Gene H., Piraino, David W.
• Primary Examiner(s): Smith, Ruth S.
• Application Number:
  US09/087,370
• Time in Patent Office: 1,425 Days
• Field of Search: 600/411, 600/414, 600/417, 600/426, 600/427, 600/429, 600/461, 600/421, 600/415, 600/117, 606/130, 128/897
• US Class Current: 600/426
• CPC Class Codes: A61B 10/02 Instruments for taking cell samples or for biopsy A61B10/0038 and A61B10/0045 take precedence; needle locating or guiding means A61B17/3403; samplers for enzymology or microbiology C12M1/26; sampling or preparing biological specimens G01N33/48
• CPC Class Codes: A61B 17/00234 for minimally invasive surgery A61B17/0218, A61B17/0469, A61B17/12013, A61B17/1285, A61B17/29, A61B17/320016 take precedence
• CPC Class Codes: A61B 17/3403 Needle locating or guiding means guides for suture needles A61B17/0482; guiding or tracking by nuclear magnetic resonance G01R33/285
• CPC Class Codes: A61B 2017/00473 Distal part, e.g. tip or head A61B2017/00464 takes precedence
• CPC Class Codes: A61B 2017/00477 Coupling A61B2017/0046 takes precedence
• 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 2034/2068 using pointers, e.g. pointers having reference marks for determining coordinates of body points
• CPC Class Codes: A61B 2090/363 Use of fiducial points
• CPC Class Codes: A61B 2090/3954 magnetic, e.g. NMR or MRI
• CPC Class Codes: A61B 2090/3983 Reference marker arrangements for use with image guided surgery
• CPC Class Codes: A61B 34/10 Computer-aided planning, simulation or modelling of surgical operations
• 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 90/06 Measuring instruments not otherwise provided for
• CPC Class Codes: A61B 90/10 for stereotaxic surgery, e.g. frame-based stereotaxis
• CPC Class Codes: A61B 90/39 Markers, e.g. radio-opaque or breast lesions markers

Abstract

A patient is secured to a subject support (10). A stereotaxic wand (40) is inserted into a tool guide (60). The wand has a tip portion (44), a portion extending along a pointing axis (46) of the wand, an offset portion (42) which is offset from the pointing axis of the wand, and at least two wand emitters (48, 50), mounted in alignment with the pointing axis of the wand. The two emitters selectively emit wand signals which are received by three receivers (14) mounted to a frame assembly (12). The tool guide includes a bore (66) extending along a guide axis. The bore is configured for selectively receiving a tool and the tip portion of the wand. An entry point and a trajectory are identified by the surgeon with the wand in the guide. More specifically, a trajectory and location of the wand are superimposed on a diagnostic image on a monitor (30). If the surgeon is satisfied with the entry point and trajectory shown on the monitor, a surgical tool is inserted into the bore while the tool guide is held along the designated trajectory and at the designated entry point.

Claims

1. An apparatus for guiding a surgical tool in relation to a patient, the apparatus comprising:

a guide member defining a guide axis, the guide member being configured to support a tool along the defined guide axis; and

a plurality of discrete sources, which are located on the guide member, of one of sonic, infrared, light, and radio frequency signals indicative of an orientation of the guide axis.

2. The apparatus for guiding a surgical tool according to claim 1, wherein the guide member includes a bore extending along the guide axis, the bore being adapted to receive the surgical tool.

3. An apparatus for guiding a surgical tool in relation to a patient, the apparatus comprising;

a guide member defining a guide axis, the guide member being configured to support a tool along the defined guide axis; and

a means for generating signals indicative of an orientation of the guide axis, the signal generating means including;

a wand which is configured for receipt in the guide member; and

at least two emitters affixed to the wand for emitting the orientation signals.

4. An apparatus for guiding a surgical tool in relation to a patient, the apparatus comprising:

a guide member defining a guide axis, the guide member being configured to support a tool alone the defined guide axis and including a groove extending parallel to the guide axis to receive the surgical tool; and

a means for radiating one of sonic, infrared, light, and radio frequency signals indicative of an orientation of the guide axis.

5. An apparatus for guiding a surgical tool in relation to a patient, the apparatus comprising:

a guide member defining a guide axis, the guide member being configured to support a tool along the defined guide axis; and

a means for generating signals indicative of an orientation of the guide axis, the signal generating means including at least two emitters mounted in a fixed relationship to the guide member.

6. An apparatus for guiding a surgical tool in relation to a patient, the apparatus comprising:

a guide member defining a guide axis, the guide member being configured to support a tool along the defined guide axis;

a means for generating signals indicative of an orientation of the guide axis;

a means for receiving the generated signals;

a means connected to the means for receiving for determining an orientation of the guide axis;

a means for storing a diagnostic image of the patient, the image having an image coordinate system; and

a means for correlating the guide axis with the image coordinate system.

7. The apparatus for guiding a surgical tool according to claim 6 wherein the means for receiving includes one of light sensitive receivers, microphones, and radio frequency receivers.

8. An apparatus for guiding a surgical tool in relation to a patient, the apparatus comprising:

a guide member defining a guide axis, the guide member being configured to support a tool along the defined guide axis; and

three signal emitters, which generate signals indicative of an orientation of the guide axis, on the guide member.

9. A method for guiding a surgical tool in relation to a subject, the method comprising:

generating signals indicative of an orientation of a guide axis defined by a guide member which is configured to support a tool along the defined guide axis;

storing image data indicative of a three dimensional region of a portion of the subject in an image memory;

selecting planar slices of data from the image memory;

converting the selected slices of data into human-readable displays; and

transforming a position of a tip portion of a wand received in the guide member into a coordinate system of the image data stored in the image memory, such that the displayed images have a selected relationship to a position of the wand.

10. A system for positioning a surgical tool comprising:

a surgical tool;

a surgical tool positioner having a bore for receiving and fixing a location and an orientation of the surgical tool; and

a plurality of signal sources each of which radiates one of sonic, infrared, light, and radio frequency signals and is positioned on at least one of the surgical tool and the surgical tool positioner, the signal sources identifying an orientation of the received surgical tool.

11. The system according to claim 10, wherein the bore has a circular cross section such that a positioning axis is defined centrally therealong.

12. The system according to claim 10, wherein the surgical tool is a drill.

13. A system for positioning a surgical tool, comprising:

a surgical tool;

a surgical tool positioner having a bore for receiving and fixing a location and an orientation of the surgical tool; and

a signal generator, including at least two emitters on at least one of the surgical tool and the surgical tool positioner, for generating signals, which identify an orientation of the received surgical tool.

14. A system for positioning a surgical tool comprising:

a surgical tool;

a surgical tool positioner having a bore for receiving and fixing a location and an orientation of the surgical tool; and

three signal emitters for generating signals which identify an orientation of the received surgical tool, the emitters being disposed on at least one of the surgical tool and the surgical tool positioner.

15. The system according to claim 14, wherein the surgical tool positioner includes a stop surface that mates with a surface on the surgical tool to fix a distance that the tool is receivable into the bore.

16. The system according to claim 14, wherein the surgical tool is a biopsy needle.

17. A system for determining a trajectory defined by a tool guide, the system comprising:

a tool guide;

a subject support;

a frame assembly which mounts a plurality of receivers in a fixed relationship to the subject support;

at least one of a pointer and a surgical tool;

at least two emitters mounted on the tool guide, the at least two emitters selectively emitting signals which are received by the plurality of receivers, the tool guide defining a channel which selectively receives at least one of the pointer and the surgical tool such that at least one of the pointer and the tool is aligned with a trajectory defined by the tool guide; and

a position determiner for determining the trajectory defined by the tool guide from the emitted signals traveling between the emitters and the plurality of receivers.

18. The system according to claim 17, further including:

a three-dimensional image memory for storing image data indicative of a three-dimensional region of a portion of a subject which is disposed on the subject support;

a plane selector for selecting planar slices of data from the three-dimensional, image memory;

a display for converting the selected slices of data from the plane selector into human-readable displays;

a transformer for transforming the trajectory defined by the tool guide into a coordinate system of the image data stored in the three-dimensional image memory, the transformer being operatively connected with the plane selector such that the displayed images have a preselected relationship to the defined trajectory.

19. The system according to claim 18 wherein the pointer is received in the tool guide, the system further including:

at least three markers adapted to be disposed on selected portions of a subject, locations of the three markers being identifiable in the three-dimensional image data; and

a transform calculator for calculating a transform between positions of the markers when disposed on the subject denoted by selectively placing the wand pointer on each of the markers with the marker locations in the three-dimensional image data, whereby translational and rotational relationships between a subject space coordinate system and a three-dimensional image data space coordinate system are calculated.

20. An apparatus for guiding an application of a tool to a subject from an entry point along a trajectory, the apparatus comprising:

a guide member defining a guide axis and having a distal end positionable on a selected subject entry point, said guide member being configured to support a tool along the guide axis;

a means for holding, the distal end of the guide member at the selected entry point and for holding the guide axis steady;

a signaling means for sending one of sonic, infrared, light, and radio frequency signals indicative of the guide axis from the guide member to a receiving means;

a receiving means receiving the one of sonic, infrared, light, and radio frequency signals and determining an orientation of the guide axis;

a means for storing a diagnostic image of the subject;

a correlating means for correlating the determined orientation of the guide axis with a coordinate system of the diagnostic data; and

a display means for displaying a selected portion of the diagnostic data with the guide axis superimposed thereon.

21. An apparatus for guiding an application of a tool to a subject from an entry point along a trajectory, the apparatus comprising:

a guide member defining a guide axis and having a distal end positionable on a selected subject entry point, said guide member being configured to support a tool along the guide axis;

a means for holding, the distal end of the guide member at the selected entry point and for holding the guide axis steady;

a signaling means for sending signals indicative of the guide axis;

a means for receiving the signals and determining an orientation of the guide axis;

a means for storing a diagnostic image of the subject;

a correlating means for correlating the determined orientation of the guide axis with a coordinate system of the diagnostic data; and

a display means for displaying a selected portion of the diagnostic data with the guide axis superimposed thereon.