Robotic systems and methods

• US 9,155,544 B2
• Filed: 03/20/2002
• Issued: 10/13/2015
• Est. Priority Date: 03/20/2002
• Status: Active Grant

• Current Assignee: P TECH, LLC
• Original Assignee: P TECH, LLC
• Inventors: Bonutti, Peter M.
• Primary Examiner(s): WEISBERG, AMY REGINA
• Application Number:
  US10/102,413
• Publication Number:
  US 20030181800A1
• Time in Patent Office: 4,955 Days
• Field of Search: 606/1, 606215-218, 606/130, 606139-148, 606/104, 606232-233, 600/104, 128/898, 227/19, 173 1- 4
• US Class Current: 1/1
• CPC Class Codes: A61B 17/025 Joint distractors
• CPC Class Codes: A61B 17/0401 Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors A61B17/0642 takes precedence; fixation devices for tendons or ligaments A61F2/0811
• CPC Class Codes: A61B 17/0644 penetrating the tissue, deformable to closed position
• CPC Class Codes: A61B 17/14 Surgical saws A61B17/1637 takes precedence; tooth saws A61C3/12 ; Accessories therefor
• 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 17/88 Osteosynthesis instruments; Methods or means for implanting or extracting internal or external fixation devices A61B17/7074 takes precedence
• CPC Class Codes: A61B 17/8802 Equipment for handling bone cement or other fluid fillers
• CPC Class Codes: A61B 17/8805 for introducing fluid filler into bone or extracting it A61B17/7097, A61B17/8833 take precedence
• CPC Class Codes: A61B 17/885 Tools for expanding or compacting bones or discs or cavities therein A61B17/8805, A61B17/7097 take precedence
• CPC Class Codes: A61B 17/8852 capable of being assembled or enlarged, or changing shape, inside the bone or disc
• CPC Class Codes: A61B 17/8855 inflatable, e.g. kyphoplasty balloons
• CPC Class Codes: A61B 17/8858 laterally or radially expansible inflatable A61B17/8855
• CPC Class Codes: A61B 17/8875 Screwdrivers, spanners or wrenches
• CPC Class Codes: A61B 2017/00557 inflatable A61B2017/22051 takes precedence
• CPC Class Codes: A61B 2017/0256 for the spine
• CPC Class Codes: A61B 2017/0648 threaded, e.g. tacks with a screw thread
• CPC Class Codes: A61B 2034/303 specifically adapted for manipulations within body lumens, e.g. within lumen of gut, spine, or blood vessels
• CPC Class Codes: A61B 2090/034 abutting on parts of the device itself
• CPC Class Codes: A61B 2090/065 for measuring contact or contact pressure
• CPC Class Codes: A61B 2090/3916 : Bone tissue
• CPC Class Codes: A61B 34/10 : Computer-aided planning, simulation or modelling of surgical operations
• CPC Class Codes: A61B 34/30 : Surgical robots
• CPC Class Codes: A61B 34/32 : operating autonomously
• CPC Class Codes: A61B 34/77 : Manipulators with motion or force scaling
• CPC Class Codes: A61B 5/0071 : by measuring fluorescence emission
• CPC Class Codes: A61B 6/032 : Transmission computed tomography [CT]
• CPC Class Codes: A61B 90/03 : Automatic limiting or abutting means, e.g. for safety
• CPC Class Codes: A61B 90/37 : Surgical systems with images on a monitor during operation
• CPC Class Codes: A61B 90/39 : Markers, e.g. radio-opaque or breast lesions markers
• CPC Class Codes: A61F 2/0063 : Implantable repair or support meshes, e.g. hernia meshes
• CPC Class Codes: A61F 2/389 : Tibial components A61F2/3868 takes precedence
• CPC Class Codes: A61F 2002/30133 : kidney-shaped or bean-shaped

Abstract

An improved method of securing body tissue may be performed with a robotic mechanism. The robotic mechanism may be utilized to tension a suture with a predetermined force and urge a suture retainer toward body tissue with a predetermined force. Ultrasonic vibratory energy may be transmitted to the suture retainer to effect a gripping of the suture by the suture retainer. The body tissue may be secured with a staple. Legs of the staple may be bonded together to secure the staple. The legs of the staple may be bonded together by transmitting ultrasonic vibratory energy to the legs of the staple. A tissue positioning assembly may be used to hold the body tissue in a desired position. Images of the body tissue being secured may be obtained using various known devices including one or more endoscopes, a fluoroscope, a magnetic resonance imaging device, and/or other known imaging devices.

Claims

1. A method of using at least one robotic mechanism in a body, said method comprising:

positioning a fastener in the body from input of a user outside the body by an adaptive arm of the robotic mechanism through a robotic arm interface;

urging at least a portion of the fastener into a body tissue with a force from the robotic mechanism;

determining a tension of a suture in the body by a tensioning assembly of the robotic mechanism, the tensioning assembly having a drive mechanism; and

securing the fastener with respect to the body tissue with the robotic mechanism.

2. The method of claim 1, further comprising controlling the application of the force with a sensor.

3. The method of claim 1, wherein controlling the application of the force includes selectively controlling the application of the force by at least one of a user or computer.

4. The method of claim 1, wherein positioning a fastener includes positioning a fastener that is at least one of a staple, peg, screw, toggling fastener, lockable fastener, and expandable fastener.

5. The method of claim 1, further comprising locking the fastener and the suture together.

6. The method of claim 1, further comprising deforming a second fastener.

7. The method of claim 1, wherein securing the fastener includes applying a second force to the fastener from the robotic mechanism.

8. The method of claim 7, further comprising:

measuring at least one of the first or second force; and

applying at least one of the first or second forces based on a property of at least one of the tissue or fastener.

9. The method of claim 1, wherein securing the fastener includes applying heat to the fastener.

10. The method of claim 1, wherein securing the fastener includes applying energy to the fastener.

11. The method of claim 10, wherein applying energy includes applying ultrasonic energy to the fastener.

12. The method of claim 1, wherein positioning a fastener includes positioning a fastener that is at least one of metallic, polymeric, biodegradable, and hydrophilic.

13. The method of claim 1, further comprising urging the tissue and a second tissue together.

14. The method of claim 1, further comprising sliding the fastener along the suture.

15. The method of claim 1, wherein positioning the fastener includes positioning the fastener that is at least one of an anchor, suture, and retainer.

16. The method of claim 1,further comprising imaging at least one of the tissue and fastener with at least one of computer navigation, magnetic resonance imaging, fiber optic imaging, an endoscope, and a monitor.

17. The method of claim 1, further comprising passing the fastener through a cannula.

18. The method of claim 1, further comprising positioning the fastener with respect to a guide pin.

19. The method of claim 1, further comprising toggling the fastener with respect to the tissue.

20. The method of claim 1, further comprising locking the fastener against the suture to secure at least a portion of the body tissue.

21. The method of claim 1, wherein securing the fastener to the suture with respect to the body tissue includes securing the fastener to the suture with respect to cardiovascular tissue that is at least one of heart tissue and a blood vessel.

22. The method of claim 1, wherein positioning the fastener further comprises positioning the fastener that includes at least one of a growth promoting substance and an antibiotic.

23. The method of claim 1, further comprising expanding the fastener to lock against the body tissue.

24. The method of claim 1, wherein positioning the fastener further comprises at least partially embedding the fastener in the body tissue.

25. A method of using at least one robotic mechanism in a body, said method comprising:

positioning a fastener with respect to a tissue in the body from input of a user outside the body by an adaptive arm of the robotic mechanism through a robotic arm interface;

urging the fastener in at least a portion of the tissue with a first force from the robotic mechanism;

determining a tension of a suture in the body with respect to the fastener with a second force from a tensioning mechanism of the robotic mechanism, the tensioning mechanism having a piezoelectric component.

26. The method of claim 25, further comprising controlling the application of at least one of the first or second forces with a sensor.

27. The method of claim 25, further comprising selectively controlling at least one of the first and second forces by at least one of a user or computer.

28. The method of claim 25, wherein positioning the fastener further comprises positioning a fastener that is at least one of a staple, peg, screw, toggling fastener, lockable fastener, and expandable fastener.

29. The method of claim 25, further comprising securing the fastener and the suture.

30. The method of claim 29, wherein securing the fastener and the suture further comprises applying a third force to at least one of the fastener and the suture.

31. The method of claim 29, wherein securing the fastener includes applying heat to the fastener.

32. The method of claim 29, wherein securing the fastener includes applying energy to the fastener.

33. The method of claim 32, wherein applying energy includes applying ultrasonic energy.

34. The method of claim 25, further comprising compressing the tissue.

35. The method of claim 25, further comprising:

measuring at least one of the first or second force; and

applying at least one of the first or second forces based on a property of at least one of the tissue or fastener.

36. The method of claim 25, further comprising sliding the fastener along the suture.

37. The method of claim 25, wherein positioning the fastener includes positioning the fastener that is at least one of an anchor, suture, and retainer.

38. The method of claim 25, further comprising imaging at least one of the tissue and fastener with at least one of computer navigation, magnetic resonance imaging, fiber optic imaging, an endoscope, and a monitor.

39. The method of claim 25, further comprising passing the fastener through a cannula.

40. The method of claim 25, further comprising positioning the fastener with respect to a guide pin.

41. The method of claim 25, further comprising toggling the fastener with respect to the tissue.

42. The method of claim 25, further comprising locking the fastener against the suture to secure at least a portion of the tissue.

43. The method of claim 25, wherein positioning the fastener with respect to the tissue further comprises positioning the fastener with respect to the tissue that is at least one of heart tissue and a blood vessel.

44. The method of claim 25, wherein positioning the fastener further comprises positioning the fastener that includes at least one of a growth promoting substance and an antibiotic.

45. The method of claim 25, further comprising expanding the fastener to lock against the tissue.

46. The method of claim 25, wherein positioning the fastener further comprises at least partially embedding the fastener in the body tissue.

47. A method of using at least one robotic mechanism in a body, said method comprising:

urging a fastener and suture through a first tissue into at least a portion of a second tissue in a body from input of a user outside the body by an adaptive arm of the robotic mechanism through a robotic arm interface with a first force;

determining a tension of the suture in the body with a tensioning mechanism of the robotic mechanism, the tensioning mechanism having a drive mechanism, such that the tension on the suture does not exceed a predetermined threshold;

compressing at least a portion of at least one of the first and second tissues with a second fastener by a second force from the robotic mechanism; and

securing the second fastener to the suture with respect to at least one of the first and second tissues with the robotic mechanism.

48. The method of claim 47, further comprising controlling the application of at least one of the first or second forces with a sensor.

49. The method of claim 47, further comprising selectively controlling at least one of the first or second forces by at least one of a user or computer.

50. The method of claim 47, wherein urging the fastener includes urging the fastener that is at least one of a staple, peg, screw, toggling fastener, lockable fastener, and expandable fastener.

51. The method of claim 47, wherein securing the fastener includes applying a third force.

52. The method of claim 47, wherein securing the fastener includes deforming a second fastener.

53. The method of claim 52, wherein deforming a second fastener includes deforming at least a portion of plastic of the second fastener.

54. The method of claim 47, wherein securing the fastener further comprises applying heat to the fastener.

55. The method of claim 47, wherein securing the fastener further comprises applying energy to the fastener.

56. The method of claim 55, wherein applying energy further comprises applying ultrasonic energy.

57. The method of claim 47, wherein urging the fastener includes urging the fastener that is at least one of metallic, polymeric, biodegradable, and hydrophilic.

58. The method of claim 47, further comprising urging the first and second tissues together.

59. The method of claim 47, further comprising:

measuring at least one of the first or second force; and

applying at least one of the first or second forces based on a property of at least one of the first tissue, second tissue, and fastener.

60. The method of claim 47, further comprising sliding the second fastener along the suture.

61. The method of claim 47,wherein urging the fastener includes urging the fastener that is at least one of an anchor, suture, and retainer.

62. The method of claim 47, further comprising imaging at least one of the first tissue, second tissue, and fastener with at least one of computer navigation, magnetic resonance imaging, fiber optic imaging, an endoscope, and a monitor.

63. The method of claim 47, further comprising passing the fastener through a cannula.

64. The method of claim 47, further comprising positioning the fastener with respect to a guide pin.

65. The method of claim 47, further comprising toggling the fastener with respect to at least one of the first or second tissue.

66. The method of claim 47, further comprising locking the fastener against the suture to secure at least a portion of at least one of the first or second tissue.

67. The method of claim 47, wherein urging the fastener and suture through the first tissue into at least portion of the second tissue further comprises urging the fastener and suture through the first tissue, that is at least one of heart tissue and a blood vessel, into at least a portion of the second tissue that is at least one of heart tissue and a blood vessel.

68. The method of claim 47, wherein urging the fastener further comprises urging the fastener that includes at least one of a growth promoting substance and an antibiotic.

69. The method of claim 47, further comprising expanding the fastener to lock against at least one of the first or second tissue.

70. The method of claim 47, wherein urging the fastener and suture further comprises at least partially embedding the fastener in the first or second tissue.

71. A method of using at least one robotic mechanism in a body, said method comprising:

positioning a suture in at least a portion of body tissue in the body from input of at least one of a user and a computer by an adaptive arm of the robotic mechanism through a robotic arm interface;

determining a tension of the suture in at least a portion of body tissue with a force from a tensioning assembly of the robotic mechanism, the tensioning assembly having at least one of a piezoelectric component and a spring, such that the tension on the suture does not exceed a predetermined threshold; and

securing the suture with respect to the body tissue with the robotic mechanism.

72. The method of claim 71, further comprising controlling the application of the force with a sensor.

73. The method of claim 71, further comprising selectively controlling the application of the force by at least one of a user or computer.

74. The method of claim 71, further comprising positioning a fastener in at least a portion of body tissue, wherein the fastener is at least one of a staple, peg, screw, toggling fastener, lockable fastener, and expandable fastener.

75. The method of claim 74, wherein securing the fastener includes locking the fastener to a flexible member.

76. The method of claim 75, wherein securing the fastener includes deforming a second fastener.

77. The method of claim 75, wherein securing the fastener further comprises applying a second force to the fastener.

78. The method of claim 77, further comprising:

measuring at least one of the first or second force; and

applying at least one of the first or second forces based on a property of at least one of the body tissue or fastener.

79. The method of claim 75, wherein securing the fastener further comprises applying heat to the fastener.

80. The method of claim 75, wherein securing the fastener further comprises applying energy to the fastener.

81. The method of claim 80, wherein applying energy includes applying ultrasonic energy.

82. The method of claim 74, wherein positioning a fastener includes positioning a fastener that is at least one of metallic, polymeric, biodegradable, and hydrophilic.

83. The method of claim 74, wherein positioning the fastener includes positioning the fastener that is at least one of an anchor, suture, and retainer.

84. The method of claim 74, further comprising imaging at least one of the body tissue and fastener with at least one of computer navigation, magnetic resonance imaging, fiber optic imaging, an endoscope, and a monitor.

85. The method of claim 74, further comprising passing the fastener through a cannula.

86. The method of claim 74, further comprising positioning the fastener with respect to a guide pin.

87. The method of claim 74, further comprising toggling the fastener with respect to the body tissue.

88. The method of claim 74, further comprising locking the fastener against the suture to secure at least a portion of the body tissue.

89. The method of claim 74, wherein positioning the fastener further comprises positioning the fastener that includes at least one of a growth promoting substance and an antibiotic.

90. The method of claim 74, further comprising expanding the fastener to lock against the body tissue.

91. The method of claim 74, wherein positioning the fastener further comprises at least partially embedding the fastener in the body tissue.

92. The method of claim 71, further comprising sliding a fastener along the suture.

93. The method of claim 71, wherein compressing at least the portion of body tissue further comprises compressing at least the portion of body tissue that is at least one of heart tissue or a blood vessel.

94. A method of using at least one robotic mechanism in a body, said method comprising:

positioning a fastener and a suture relative to a body tissue in the body from input from at least one of a user and computer by an adaptive arm of the robotic mechanism through a robotic arm interface;

moving the fastener relative to the suture;

determining a tension of the suture in the body with a tensioning assembly of the robotic mechanism, the tensioning assembly having a drive mechanism, such that the tension on the suture does not exceed a tension threshold; and

locking the fastener to the suture with a force from the robotic mechanism.

95. The method of claim 94, further comprising controlling the application of the force with a sensor.

96. The method of claim 94, wherein positioning a fastener includes positioning a fastener that is at least one of a staple, peg, screw, toggling fastener, lockable fastener, and expandable fastener.

97. The method of claim 94, wherein locking the fastener includes deforming the fastener.

98. The method of claim 94, wherein positioning a fastener includes positioning a fastener that is at least one of metallic, polymeric, biodegradable, and hydrophilic.

99. The method of claim 94, further comprising:

measuring the force; and

applying the force based on a property of at least one of the tissue, fastener, and suture.

100. The method of claim 94, wherein positioning a fastener includes positioning a fastener that is at least one of an anchor, suture, and retainer.

101. The method of claim 94, further comprising imaging at least one of the tissue and fastener with at least one of computer navigation, magnetic resonance imaging, fiber optic imaging, an endoscope, and a monitor.

102. The method of claim 94, further comprising passing the fastener through a cannula.

103. The method of claim 94, further comprising positioning the fastener with respect to a guide pin.

104. The method of claim 94, wherein positioning the fastener and the suture relative to the body tissue further comprises positioning the fastener and the suture relative to the body tissue that is at least one of heart tissue or a blood vessel.

105. The method of claim 94, wherein positioning the fastener further comprises positioning the fastener that includes at least one of a growth promoting substance and an antibiotic.

106. The method of claim 94, further comprising expanding the fastener to lock against the body tissue.

107. The method of claim 94, wherein positioning the fastener further comprises at least partially embedding the fastener in the body tissue.

108. A method of using at least one robotic mechanism in a body, said method comprising:

positioning a fastener and a suture relative to tissue in the body from input of a user outside the body by an adaptive arm of the robotic mechanism through a robotic arm interface;

urging the suture into a body tissue;

determining a tension of the suture in the body with a tensioning mechanism of the robotic mechanism, the tensioning mechanism having at least one of a piezoelectric component and a spring, such that the tension on the suture does not exceed a tension threshold;

sliding the fastener relative to the suture; and

locking the fastener to the suture with a force from the robotic mechanism.

109. The method of claim 108, further comprising controlling the application of the force with a sensor.

110. The method of claim 108, wherein positioning a fastener includes positioning a fastener that is at least one of a staple, peg, screw, toggling fastener, lockable fastener, and expandable fastener.

111. The method of claim 108, wherein locking the fastener includes deforming the fastener.

112. The method of claim 108, wherein positioning a fastener includes positioning a fastener that is at least one of metallic, polymeric, biodegradable, and hydrophilic.

113. The method of claim 108, further comprising measuring the force and applying the force based on a property of at least one of the tissue, fastener, and suture.

114. The method of claim 108, wherein positioning a fastener includes positioning a fastener that includes at least one of an anchor, suture, and retainer.

115. The method of claim 108, further comprising imaging at least one of the tissue or fastener with at least one of computer navigation, magnetic resonance imaging, fiber optic imaging, an endoscope, and a monitor.

116. The method of claim 108, further comprising passing the fastener through a cannula.

117. The method of claim 108, further comprising positioning the fastener with respect to a guide pin.

118. The method of claim 108, wherein positioning the fastener and the suture relative to the tissue further comprises positioning the fastener and the suture relative to the tissue that is at least one of heart tissue or a blood vessel.

119. The method of claim 108, wherein positioning the fastener further comprises positioning the fastener that includes at least one of a growth promoting substance and an antibiotic.

120. The method of claim 108, further comprising expanding the fastener to lock against the body tissue.

121. The method of claim 108, wherein positioning the fastener further comprises at least partially embedding the fastener in the body tissue.