Performing cardiac surgery without cardioplegia

• US 20030055410A1
• Filed: 08/06/2002
• Published: 03/20/2003
• Est. Priority Date: 11/20/1998
• Status: Active Grant

• Current Assignee: Intuitive Surgical Operations, Inc. (Intuitive Surgical Holdings, LLC)
• Original Assignee: Intuitive Surgical Incorporated (Intuitive Surgical Holdings, LLC)
• Inventors: Rosa, David J., Guthart, Gary S., Ramans, Andris D., Falk, Volkmar, Nowlin, William C., Moll, Frederic H., Younge, Robert G., Wilson, Christopher P., Pendleton, Rand P., Evans, Philip C.
• Granted Patent: US 6,858,003 B2
• Time in Patent Office: Days
• US Class Current: 606/1
• CPC Class Codes: A61B 17/04 for suturing wounds; Holders or packages for needles or suture materials suture materials A61L17/00
• CPC Class Codes: A61B 17/0469 Suturing instruments for use in minimally invasive surgery, e.g. endoscopic surgery
• CPC Class Codes: A61B 2017/00243 cardiac
• CPC Class Codes: A61B 2017/00703 correcting for movement of heart, e.g. ECG-triggered
• CPC Class Codes: A61B 2034/2065 Tracking using image or pattern recognition
• CPC Class Codes: A61B 2034/305 Details of wrist mechanisms at distal ends of robotic arms
• CPC Class Codes: A61B 2034/742 Joysticks
• CPC Class Codes: A61B 2090/064 for measuring force, pressure or mechanical tension
• 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 34/32 operating autonomously
• CPC Class Codes: A61B 34/35 for telesurgery
• CPC Class Codes: A61B 34/37 Master-slave robots A61B34/35 takes precedence
• CPC Class Codes: A61B 34/70 Manipulators specially adapted for use in surgery
• CPC Class Codes: A61B 34/71 Manipulators operated by drive cable mechanisms
• CPC Class Codes: A61B 34/77 Manipulators with motion or force scaling
• CPC Class Codes: A61B 90/361 Image-producing devices, e.g. surgical cameras

Abstract

A surgical system or assembly for performing cardiac surgery includes a surgical instrument; a servo-mechanical system engaged to the surgical instrument for operating the surgical instrument; and an attachment assembly for removing at least one degree of movement from a moving surgical cardiac worksite to produce a resultant surgical cardiac worksite. The surgical system or assembly also includes a motion tracking system for gathering movement information on a resultant surgical cardiac worksite. A control computer is engaged to the attachment assembly and to the motion tracking system and to the servo-mechanical system for controlling movement of the attachment assembly and for feeding gathered information to the servo-mechanical system for moving the surgical instrument in unison with the resultant surgical cardiac worksite such that a relative position of the moving surgical instrument with respect to the resultant surgical cardiac worksite is generally constant. A video monitor is coupled to the control computer; and an input system is coupled to the servo-mechanical system and to the control computer for providing a movement of the surgical instrument. The video monitor displays movement of the surgical instrument while the resultant surgical cardiac worksite appears substantially stationary, and while a relative position of the surgical instrument moving in unison with the resultant surgical cardiac worksite, as a result from the movement information gathered by the motion tracking system, remains generally constant. A method of performing cardiac surgery without cardioplegia comprising removing at least one degree of movement freedom from a moving surgical cardiac worksite to produce at least a partially stationary surgical cardiac worksite while allowing a residual heart section, generally separate from the at least partially stationary surgical cardiac worksite, to move as a residual moving heart part. Cardiac surgery is performed on the at least partially stationary cardiac worksite with a surgical instrument such as needle drivers, forceps, blades and scissors.

Claims

1. A method of performing a surgical procedure on a beating heart of a patient, the method including:

positioning an end effector in close proximity to a surgical site on the heart, at which site a surgical procedure is to be performed, the end effector being mounted on a robotically controlled arm;

monitoring motion of the surgical site;

computing end effector tracking command signals in response to monitored motion of the surgical site;

forwarding the tracking command signals to actuators operatively associated with the robotically controlled arm to cause the arm to move the end effector generally to track motion of the surgical site;

inputting an end effector movement command signal; and

forwarding the end effector movement command signal to the actuators to cause the end effector to move relative to the surgical site so as to perform at least part of the surgical procedure at the surgical site.

2. A method as claimed in claim 1, which further includes bracing the beating heart to at least reduce motion of the surgical site.

3. A method as claimed in claim 2, in which bracing the beating heart includes contacting the heart with a brace member connected to a stationary base positioned outside the patient.

4. A method as claimed in claim 3, in which the brace member is arranged to operate under suction, the method including displacing air relative to the brace member to cause the brace member to attach itself to the heart by suction.

5. A method as claimed in claim 3, in which the brace member is connected to the base by means of a robotically controlled arm, the method including forwarding command signals to actuators operatively associated with the robotically controlled arm to cause the arm to move the brace member from a position clear of the heart to a position in contact with the heart.

6. A method as claimed in claim 3, which includes maintaining the brace member in a stationary condition relative to the base when in contact with the beating heart so as to inhibit heart motion by at least one degree of freedom of movement.

7. A method as claimed in claim 3, which includes permitting the brace member to move in sympathy with the heart and whilst in contact therewith, restraining motion of the brace member so as to restrain motion of the surgical site, monitoring motion of the surgical site then including monitoring restrained motion of the brace member.

8. A method as claimed in claim 1, in which monitoring motion of the surgical site includes contacting the surgical site with a motion detector, permitting the motion detector to move in sympathy with the surgical site and monitoring movement of the motion detector so as to monitor motion of the surgical site.

9. A method as claimed in claim 1, in which monitoring motion of the surgical site includes securing at least one target marker on the surgical site and monitoring movement of the target marker so as to monitor motion of the surgical site.

10. A method as claimed in claim 9, which includes securing a plurality of target markers at spaced apart positions on the surgical site and monitoring movement of the target markers so as to monitor motion of the surgical site.

11. A method as claimed in claim 10, in which the movement of the target markers differ, monitoring motion of the surgical site then including monitoring a computed motion derived from the motions of at least some of the target markers.

12. A method as claimed in claim 10, in which the target markers are arranged to cooperate with a sensor, the method further comprising positioning a sensor at an appropriate position to detect motion of the target markers.

13. A method as claimed in claim 12, in which the sensor is arranged to cooperate with the markers so as to monitor their movements electromagnetically.

14. A method as claimed in claim 1, which further includes:

directing an image capture device at the surgical site to capture an image of the surgical site;

displaying the image of the surgical site on an image display operatively connected to the image capture device; and

compensating for motion of the surgical site to cause the image of the surgical site to be displayed on the image display as if the surgical site were generally stationary relative to the image capture device.

15. A method as claimed in claim 14, wherein the image capture device is mounted on a robotically controlled arm, compensating for motion of the surgical site to cause the image of the surgical site to be displayed on the image display as if the surgical site were generally stationary relative to the image capture device comprising:

computing image capture device tracking command signals in response to monitored motion of the surgical site; and

forwarding the image capture device tracking command signals to actuators operatively associated with the robotically controlled arm to cause the arm to move the image capture device generally to track motion of the surgical site.

16. A method as claimed in claim 14, wherein the image capture device is arranged to capture at least two images of the surgical site from two different vantage points, compensating for motion of the surgical site to cause the image of the surgical site to be displayed on the image display as if the surgical site were generally stationary relative to the image capture device comprising processing information related to the two images so as to cause the image of the surgical site displayed on the image display to be displayed as if the surgical site were generally stationary relative to the image capture device.

17. A method as claimed in claim 16, in which processing the information related to the two images comprises transforming optical information related to the two images into digital information and processing the digital information so as to cause the surgical site to be displayed on the image display as if the surgical site were generally stationary relative to the image capture device.

18. A method as claimed in claim 16, in which monitoring motion of the surgical site includes the processing of the information related to the two images.

19. A method as claimed in claim 18, in which computing the tracking command signals in response to the monitored motion of the surgical site includes computing tracking command signals in the form of vectors derived from information corresponding to the two images.

20. A method as claimed in claim 19, in which processing the information related to the two images includes defining a plurality of discrete locations at the surgical site and monitoring the motion of the discrete locations by means of information derived from the two images.

21. A method as claimed in claim 20, which includes securing markers on the surgical site at the discrete locations.

22. A method as claimed in claim 21, in which the markers are distinctively colored, monitoring the motion of the discrete locations then including monitoring motion of the distinctively colored markers.

23. A method as claimed in claim 14, in which the image capture device is in the form of a stereo endoscope, directing the image capture device at the surgical site then including passing a viewing end of the endoscope through a relatively small aperture in a chest region of a patient.

24. A method as claimed in claim 1 or claim 14, which includes analyzing information corresponding to monitored motion history of the surgical site to predict motion of the surgical site.

25. A method as claimed in claim 24, in which computing tracking command signals in response to monitored motion of the surgical site includes computing the tracking command signals from predicted motion of the surgical site.

26. A method as claimed in claim 24, in which predicting motion of the surgical site includes comparing information corresponding to monitored motion of the surgical site with an ECG signal.

27. A method as claimed in claim 1, in which the surgical procedure is to be performed in a minimally invasive manner, positioning the end effector in close proximity to the surgical site on the heart then including passing the end effector through a relatively small aperture in a chest region of the patient. A method as claimed in claim 1, in which the surgical procedure is to be performed in a minimally invasive manner, positioning the end effector in close proximity to the surgical site on the heart then including passing the end effector through a relatively small aperture in a chest region of the patient.

28. A method of performing a surgical procedure on a beating heart of a patient, the method including:

positioning an end effector in close proximity to a surgical site on the heart at which site a surgical procedure is to be performed, the end effector being mounted on a robotically controlled arm;

monitoring motion of the surgical site;

using monitored motion history of the surgical site to compute predictive tracking command signals in response to monitored motion of the surgical site;

forwarding the predictive tracking command signals to actuators operatively associated with the robotically controlled arm to cause the end effector generally to track motion of the surgical site;

inputting an end effector movement command signal; and

forwarding the end effector movement command signal to the actuators to cause the end effector to move relative to the surgical site so as to perform at least part of the surgical procedure at the surgical site.

29. A method as claimed in claim 28, which further includes bracing the beating heart to at least reduce motion of the surgical site.

30. A method as claimed in claim 29, in which bracing the beating heart includes contacting the heart with a brace member connected to a stationary base positioned outside the patient.

31. A method as claimed in claim 30, in which the brace member is arranged to operate under suction, the method including displacing air relative to the brace member to cause the brace member to attach itself to the heart by suction.

32. A method as claimed in claim 30, in which the brace member is mounted on a robotically controlled arm, the method including forwarding command signals to actuators operatively associated with the robotically controlled arm to cause the arm to move the brace member from a position clear of the heart to a position in contact with the heart.

33. A method as claimed in claim 32, which includes maintaining the brace member in a stationary condition relative to the base when in contact with the beating heart so as to inhibit heart motion by at least one degree of freedom of movement.

34. A method as claimed in claim 32, which includes permitting the brace member to move in sympathy with the heart whilst in contact therewith and restraining motion of the brace member so as to restrain motion of the surgical site, monitoring motion of the surgical site then including monitoring restrained motion of the surgical site.

35. A method as claimed in claim 28, in which monitoring motion of the surgical site includes contacting the surgical site with a motion detector, permitting the motion detector to move in sympathy with the surgical site and monitoring movement of the motion detector so as to monitor motion of the surgical site.

36. A method as claimed in claim 28, in which monitoring motion of the surgical site includes securing at least one target marker on the surgical site and monitoring movement of the target marker so as to monitor motion of the surgical site.

37. A method as claimed in claim 36, which includes securing a plurality of target markers at spaced apart positions at the surgical site and monitoring movement of the target markers so as to monitor motion of the surgical site.

38. A method as claimed in claim 37, in which the movement of the target markers differ, monitoring motion of the surgical site then including monitoring a computed motion derived from the monitored motions of at least some of the target markers.

39. A method as claimed in claim 37, in which the target markers are arranged to cooperate with a sensor, the method further including positioning a sensor at an appropriate position to detect motion of the target markers.

40. A method as claimed in claim 39, in which the sensor is arranged to cooperate with the markers so as to sense their movement electromagnetically.

41. A method as claimed in claim 28, which further includes:

directing an image capture device at the surgical site to capture an image of the surgical site;

displaying the image of the surgical site on an image display operatively connected to the image capture device; and

compensating for motion of the surgical site to cause the image of the surgical site to be displayed on the image display as if the surgical site were generally stationary relative to the image capture device.

42. A method as claimed in claim 41, wherein the image capture device is mounted on a robotically controlled arm, compensating for motion of the surgical site to cause the surgical site to be displayed on the image display as if the surgical site were generally stationary relative to the image capture device including:

computing image capture device tracking command signals in response to monitored motion of the surgical site; and

forwarding the image capture device tracking command signals to actuators operatively associated with the robotically controlled arm to cause the arm to move the image capture device generally to track motion of the surgical site.

43. A method as claimed in claim 41, wherein the image capture device is arranged to capture at least two images of the surgical site from two different vantage points, compensating for motion of the surgical site to cause the surgical site to be displayed on the image display as if the surgical site were generally stationary relative to the image capture device including processing information related to the two images so as to cause the surgical site to be displayed on the image display as if the surgical site were generally stationary relative to the image capture device.

44. A method as claimed in claim 43, in which processing the information related to the two images includes transforming optical information related to the two images into digital information and processing the digital information so as to cause the surgical site to be displayed on the image display as if the surgical site were generally stationary relative to the image capture device.

45. A method as claimed in claim 43, in which monitoring motion of the surgical site includes the processing of the information related to the two images.

46. A method as claimed in claim 45, in which computing tracking command signals in response to monitored motion of the surgical site includes computing tracking command signals in the form of vectors derived from monitored information corresponding to the two images.

47. A method as claimed in claim 45, in which processing the two images includes defining a plurality of discrete locations at the surgical site and monitoring the motion of the discrete locations.

48. A method as claimed in claim 47, which includes securing markers on the surgical site at the discrete locations.

49. A method as claimed in claim 48, in which the markers are distinctively colored, monitoring the motion of the discrete locations then including monitoring motion of the distinctively colored markers.

50. A method as claimed in claim 28, in which the surgical procedure is to be performed in a minimally invasive manner, positioning the end effector in close proximity to the surgical site on the heart then including passing the end effector through a relatively small aperture in the chest region of the patient.

51. A method as claimed in claim 41, in which the image capture device is in the form of a stereo endoscope, directing the image capture device at the surgical site then including passing a viewing end of the endoscope through a relatively small aperture in the chest region of the patient.

52. A method as claimed in claim 28 or claim 41, in which using monitored motion history of the surgical site to compute predictive tracking command signals includes comparing the monitored history with a real-time signal from the patient.

53. A method as claimed in claim 52, in which predicting motion of the surgical site includes comparing the information corresponding to monitored motion history of the surgical site with an ECG signal.

54. A robotically controlled surgical system for performing a surgical procedure on a beating heart of a patient, the system including:

a robotically controlled arm;

an end effector mounted on the arm and arranged to perform the surgical procedure on a surgical site on the heart;

a plurality of actuators operatively associated with the arm so as to move the arm in response to the actuators receiving actuator command signals;

a motion tracking system for monitoring motion of the surgical site;

a master input device through which an operator can selectively input end effector movement commands; and

a control system in which the robotically controlled arm, the motion tracking system and the master input device are operatively connected, the control system being arranged to compute a first set of actuator command signals, in response to information received from the motion tracking system, arranged to cause the actuators to move the end effector generally to track surgical site motion, and a second set of actuator command signals, in response to input from the master input device, arranged to move the end effector relative to the surgical site so as to perform the surgical procedure.

55. A system as claimed in claim 54, which further includes an imaging system having an image capture device for capturing an image of the surgical site, the image capture device being operatively connected to an image display arranged to display a corresponding image of the surgical site, the image display being positioned in close proximity to the master input device so that the operator can view the image of the surgical site displayed on the image display while inputting end effector movement commands through the master input device.

56. A system as claimed in claim 55, wherein the imaging system is arranged to compensate for surgical site motion so as to cause the image of the surgical site displayed on the image display to be displayed as if the actual surgical site were generally stationary relative to the image capture device.

57. A system as claimed in claim 56, in which the image capture device is mounted on a robotically controlled arm.

58. A system as claimed in claim 57, which includes actuators operatively associated with the arm on which the image capture device is mounted, the actuators being arranged to cause the arm to move in response to the actuators receiving actuator command signals.

59. A system as claimed in claim 58, in which the actuators associated with the arm on which the image capture device is mounted are connected in the control system, the control system being arranged to forward actuator command signals to the actuators, the actuator command signals being derived from the motion tracking system and arranged to cause the actuators to move the image capture device generally to track motion of the surgical site.

60. A system as claimed in claim 55, in which the image capture device is in the form of a stereo endoscope.

61. A system as claimed in claim 54, in which the motion tracking system includes an image processor.