Method and apparatus for computer aided surgery

• US 8,560,047 B2
• Filed: 06/18/2007
• Issued: 10/15/2013
• Est. Priority Date: 06/16/2006
• Status: Active Grant

• Current Assignee: Board of Regents of the University of Nebraska
• Original Assignee: Board of Regents of the University of Nebraska
• Inventors: Haider, Hani, Barrera, O. Andres
• Primary Examiner(s): Chen, Tse
• Assistant Examiner(s): REARDON, ROCHELLE D
• Application Number:
  US11/764,505
• Publication Number:
  US 20080009697A1
• Time in Patent Office: 2,311 Days
• Field of Search: 600/407, 600/424, 600/437, 600/471, 606/41, 606/45
• US Class Current: 600/407
• CPC Class Codes: A61B 17/142 with reciprocating saw blades, e.g. with cutting edges at the distal end of the saw blades
• CPC Class Codes: A61B 17/15 Guides therefor arrangements for guiding straight saw blades in general B23D51/025
• CPC Class Codes: A61B 17/154 for preparing bone for knee prosthesis
• CPC Class Codes: A61B 17/1626 Control means; Display units
• CPC Class Codes: A61B 17/1675 for the knee
• CPC Class Codes: A61B 17/1703 using imaging means, e.g. by X-rays
• CPC Class Codes: A61B 17/1764 for the knee
• CPC Class Codes: A61B 2017/00026 Conductivity or impedance, e.g. of tissue
• CPC Class Codes: A61B 2017/00199 with a console, e.g. a control panel with a display
• CPC Class Codes: A61B 2017/00212 using remote controls
• CPC Class Codes: A61B 2017/00221 with wireless transmission of data, e.g. by infrared radiation or radiowaves
• CPC Class Codes: A61B 2017/00725 Calibration or performance testing
• CPC Class Codes: A61B 2017/320052 Guides for cutting instruments by marking A61B2090/395
• CPC Class Codes: A61B 2034/101 Computer-aided simulation of surgical operations
• CPC Class Codes: A61B 2034/102 Modelling of surgical devices, implants or prosthesis
• CPC Class Codes: A61B 2034/104 Modelling the effect of the tool, e.g. the effect of an implanted prosthesis or for predicting the effect of ablation or burring
• CPC Class Codes: A61B 2034/105 Modelling of the patient, e.g. for ligaments or bones
• CPC Class Codes: A61B 2034/107 Visualisation of planned trajectories or target regions
• CPC Class Codes: A61B 2034/108 Computer aided selection or customisation of medical implants or cutting guides
• 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 2034/2072 : Reference field transducer attached to an instrument or patient
• CPC Class Codes: A61B 2034/254 : being adapted depending on the stage of the surgical procedure
• CPC Class Codes: A61B 2034/256 : having a database of accessory information, e.g. including context sensitive help or scientific articles
• CPC Class Codes: A61B 2034/258 : providing specific settings for specific users
• CPC Class Codes: A61B 2090/061 : for measuring dimensions, e.g. length
• CPC Class Codes: A61B 2090/065 : for measuring contact or contact pressure
• CPC Class Codes: A61B 2090/0812 : indicating loosening or shifting of parts of an instrument, signaling maladjustment of parts
• CPC Class Codes: A61B 2090/365 : augmented reality, i.e. correlating a live optical image with another image
• CPC Class Codes: A61B 2090/367 : creating a 3D dataset from 2D images using position information
• CPC Class Codes: A61B 2090/372 : Details of monitor hardware
• CPC Class Codes: A61B 2090/3937 : Visible markers
• CPC Class Codes: A61B 2090/395 : with marking agent for marking skin or other tissue
• 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 34/25 : User interfaces for surgical systems
• CPC Class Codes: A61B 34/30 : Surgical robots
• CPC Class Codes: A61B 90/11 : with guides for needles or instruments, e.g. arcuate slides or ball joints
• CPC Class Codes: A61B 90/36 : Image-producing devices or illumination devices not otherwise provided for
• CPC Class Codes: A61B 90/90 : Identification means for patients or instruments, e.g. tags
• CPC Class Codes: A61F 2002/4632 : using computer-controlled surgery, e.g. robotic surgery
• CPC Class Codes: A61F 2002/4633 : for selection of endoprosthetic joints or for pre-operative planning
• CPC Class Codes: G16H 20/40 : relating to mechanical, radiation or invasive therapies, e.g. surgery, laser therapy, dialysis or acupuncture
• CPC Class Codes: G16H 40/63 : for local operation

Abstract

A number of improvements are provided relating to computer aided surgery. The improvement relates to both the methods used during computer aided surgery and the devices used during such procedures. Some of the improvement relate to controlling the selection of which data to display during a procedure and/or how the data is displayed to aid the surgeon. Other improvements relate to the structure of the tools used during a procedure and how the tools can be controlled automatically to improve the efficiency of the procedure. Still other improvements relate to methods of providing feedback during a procedure to improve either the efficiency or quality, or both, for a procedure.

Claims

1. A method for performing a navigated freehand computer assisted surgical procedure on a knee of a patient, comprising the steps of:

creating a three dimensional representation of a knee portion of a patient to which the procedure is to be performed;

identifying a portion of the three dimensional representation corresponding to a bony portion of knee to be resected;

identifying the orientation of a cutting plane for resecting the identified bony portion;

displaying the three dimensional representation during the surgical procedure,

wherein the step of displaying comprises;

displaying the portion to be resected in a first color;

displaying a boundary adjacent the portion to be resected in a second color that is different from the first color; and

;

displaying a portion of tissue adjacent the boundary, which is not to be resected, in a third color, which is different from the first and second colors;

performing the navigated freehand surgical procedure using a navigated freehand surgical tool to resect the bony portion of the knee;

tracking the real time position and orientation of the freehand surgical tool relative to the cutting plane; and

displaying an indicator of the variation between the cutting plane and the real time position of the navigated freehand surgical tool, wherein the indicator is based upon the identified orientation of the cutting plane and the real time position of the navigated freehand surgical tool.

2. The method of claim 1 comprising the step of deleting a portion of the three dimensional representation corresponding to tissue being removed during the surgical procedure.

3. The method of claim 2 wherein the step of deleting a portion of the three dimensional representation is repeatedly updated in real time.

8. The method of claim 1 wherein the indicator is a graphical display indicative of the variation between the cutting plane and the plane to be cut.

9. The method of claim 8 wherein the indicator provides a representation of the cutting plane wherein the shape of the representation of the cutting plane varies according to the deviation between the cutting plane and the real time position and orientation of the navigated freehand surgical tool.

10. The method of claim 1 comprising the steps of providing a graphical display of the plane to be cut and a graphical display of the cutting plane.

11. The method of claim 10 wherein the step of providing a graphical display of the cutting plane comprises providing a real-time graphical display indicative of the orientation of the cutting plane relative to the plane to be cut.

31. The method of claim 1 further comprising:

displaying a portion of a pre-operative plan on a virtual model of a patient overlaid with the real-time navigated freehand procedure.

4. A method for controlling a navigated freehand surgical tool during a surgical procedure, comprising the steps of:

creating a three dimensional representation of a portion of a patient to which a procedure is to be performed;

identifying a portion of the three dimensional representation corresponding to a portion of tissue onto which a surgical procedure is to be performed;

identifying the position and orientation of a desired cut plane for resecting the identified portion;

cutting the portion of the patient by performing a navigated freehand surgical procedure;

tracking the position and orientation of the surgical tool during the cutting step; and

providing an indicator of the variation between the tracked position, orientation and path of the freehand surgical instrument from the tracking step relative to the desired cut plane;

automatically controlling in real time the operation of the surgical tool in response to the proper position and alignment of the surgical tool relative to the patient.

5. The method of claim 4 wherein the surgical tool is a motorized cutting tool and the step of controlling the operation comprises the step of turning off the surgical tool.

6. The method of claim 4 wherein the surgical tool is a motorized cutting tool and the step of controlling the operation comprises the step of slowing the speed of the surgical tool.

7. The method of claim 4 comprising the step of manually overriding the automatic control of the surgical tool.

12. A method for planning and performing a navigated freehand computer assisted surgical procedure on a joint of a patient, comprising the steps of:

creating a three dimensional representation of a portion of a joint to which the procedure is to be performed;

identifying a portion of the three dimensional representation corresponding to a bony portion of the joint to be resected;

identifying a position and an orientation of a plane to be cut for resecting the identified portion;

displaying on a view screen a pre-operative three dimensional representation of the bony portion of the patient based on the creating, identifying a portion and the identifying a position and an orientation steps;

performing a navigated freehand surgical procedure using a surgical tool to resect the identified portion of the joint;

tracking the position and orientation of the surgical tool relative to the portion of the joint;

providing an indicator on the view screen of the alignment between the position and orientation of the surgical tool to the identified plane to be cut, wherein the position and orientation of the surgical tool is determined based on the step of tracking; and

updating the indicator in real time during the performing step.

13. The method of claim 12 wherein the step of providing an indicator comprises the step of providing a graphical display on the view screen that is indicative of the alignment of the cutting plane relative to the identified plane to be cut.

14. The method of claim 13 wherein the step of providing a graphical display comprises providing a real-time graphical display indicative of the orientation of the cutting plane relative to the plane to be cut.

15. The method of claim 12 wherein the step of providing an indicator comprises the step of illustrating on the view screen a representation of the cutting plane wherein the shape of the representation of the cutting plane varies according to deviation between the cutting plane and the identified plane to be cut.

16. The method of claim 12 comprising the step of automatically changing the angle from which the three dimensional representation is viewed in response to the step of tracking.

17. The method of claim 16 comprising the step of identifying the angle from which the three dimensional representation is viewed based on the orientation of the cutting tool relative to the portion of the patient.

18. A method for performing a computer assisted surgical procedure, comprising the steps of:

creating a three dimensional representation of a portion of a patient to which a prosthetic implant procedure is to be performed;

identifying a portion of the three dimensional representation corresponding to a portion of tissue to be resected to support a portion of a prosthetic implant;

identifying the position and orientation of a target surface for resecting the identified portion according to the prosthetic implant procedure to form a final surface shape;

displaying the three dimensional representation during a surgical procedure, wherein the step of displaying comprises;

displaying the portion to be resected in a first color;

displaying a boundary adjacent the portion to be resected in a second color that is different from the first color; and

;

displaying a portion of tissue adjacent the boundary, which is not to be resected, in a third color, which is different from the first and second colors;

performing a surgical procedure in support of the prosthetic implant procedure using a freehand surgical tool to resect the portion of tissue;

tracking the location and orientation of the freehand surgical tool relative to the location and orientation of the target surface; and

providing an indicator to the user of the variation between the location and orientation of the freehand surgical tool and the location and orientation of the target surface from the tracking step.

19. The method of claim 18 comprising the step of deleting a portion of the three dimensional representation corresponding to tissue being removed during the surgical procedure.

20. The method of claim 19 wherein the step of deleting a portion of the three dimensional representation is repeatedly updated in real time.

21. The method of claim 18 wherein the indicator is a graphical display indicative of the variation between the cutting surface and the surface to be cut.

22. The method of claim 18 wherein the indicator provides a representation of the cutting surface wherein the shape of the representation of the cutting surface varies according to the deviation between the cutting surface and the surface to be cut.

23. The method of claim 18 comprising the steps of providing a graphical display of the surface to be cut and a graphical display of the cutting surface.

24. The method of claim 23 wherein the step of providing a graphical display of the cutting surface comprises providing a real-time graphical display indicative of the orientation of the cutting surface relative to the surface to be cut.

25. A method for performing a computer assisted surgical procedure using a navigated freehand saw, comprising the steps of:

creating a three dimensional representation of a portion of a patient to which a procedure is to be performed;

identifying a portion of the three dimensional representation corresponding to a portion of tissue to be resected;

identifying a position and an orientation of a surface to be cut for resecting the identified portion;

displaying on a view screen on the navigated freehand saw the three dimensional representation of the portion of the patient and a plane based on the identifying the position and the orientation step;

performing the surgical procedure with feedback from the displaying step while using the navigated freehand saw to resect the portion of tissue;

tracking the location and orientation of the navigated freehand saw relative to the patient; and

providing an indicator of the alignment between a cutting surface and the identified surface to be cut, wherein the cutting surface is the surface along which the navigated freehand saw is positioned to cut and is determined based on the step of tracking.

26. The method of claim 25 wherein the step of providing an indicator comprises the step of providing a graphical display on the view screen that is indicative of the alignment of the cutting surface relative to the identified surface to be cut.

27. The method of claim 26 wherein the step of providing a graphical display comprises providing a real-time graphical display indicative of the location and orientation of the cutting surface relative to the surface to be cut.

28. The method of claim 25 wherein the step of providing an indicator comprises the step of illustrating on the view screen a representation of the cutting surface wherein the shape of the representation of the cutting surface varies according to deviation between the cutting surface and the identified surface to be cut.

29. The method of claim 25 comprising the step of automatically changing the angle from which the three dimensional representation is viewed in response to the step of tracking.

30. The method of claim 29 comprising the step of identifying the angle from which the three dimensional representation is viewed based on the location and orientation of the cutting tool relative to the portion of the patient.