Laser-guidance robot for visually projecting a guide to a surgery plan, projection method, and laser-guidance robot system

Abstract

The present invention relates to a laser-guidance robot (1) for visually projecting a surgical guide onto a surgery region of a patient (100). The laser-guidance robot comprises: a guidance robot (1) having a robot arm (2) and a robot head (4); a tracking system (6), which can detect a position and / or an orientation of the robot head (4) and of the patient (100); a projection laser (8) on the robot head (4), so that position and orientation of the projection laser (8) can be adjusted via the robot head (4); and a control unit (12), which is adapted to determine a target position and target orientation of the projection laser (8) in relation to the surgery region of the patient (100) and to control the robot arm (2) such that the projection laser (8) is moved into the target position and target orientation and, by means of the projection laser projecting the laser radiation (12) in the target orientation, at least one guide axis (16) is visually displayed. The invention also relates to a laser-guidance robot system and to a projection method.

Description

[0001] Laser guidance robot for visual projection of a surgical plan, projection method and laser guidance robot system

[0002] Description

[0003] The present disclosure relates to a laser guidance robot for visually projecting a surgical plan onto a patient's surgical site. The disclosure also relates to a projection method for visually projecting guidance and a laser guidance robot system comprising the laser guidance robot and a medical instrument or product according to the preambles of the independent claims.

[0004] Technical background

[0005] Computer-assisted surgery involves the use of navigation systems and / or surgical robots. Navigation systems are used to detect and track surgical instruments. In particular, the position and orientation of the surgical instruments in space are recorded. The recorded information is correlated and combined with preoperative images acquired before the operation. These preoperative images are, in particular, a model of a patient or a patient’s body. This digital model is created, for example, using a computed tomography (CT) scan and / or a magnetic resonance imaging (MRI) scan. When surgical robots are used, surgical instruments are moved to a target position by one or more robotic arms, with the target position being determined based on the preoperative images.

[0006] Both the use of navigation systems and surgical robots have certain disadvantages. The use of navigation systems imposes restrictions on freedom of movement due to the attachment of navigation trackers to surgical instruments. The use of surgical robots, on the other hand, reduces the working space or work area due to the necessary end effector and is also more complex from a system perspective.

[0007] Therefore, solutions have been developed in which the operation is performed conventionally by a surgeon, but the surgeon is supported by a projection of a preoperatively calculated surgical plan.

[0008] State of the art

[0009] DE 10 2017 127 791 A1 discloses a medical control system. A projector, e.g., in the form of a laser, projects surgical instructions onto a patient. The surgical instructions can depict a surgical site on the patient as well as the position of vulnerable tissue or organs on the patient. The projected surgical instructions support the attending surgeon, as they can orient themselves using the projection. The surgical instructions were determined prior to the operation by scanning the patient.

[0010] EP 3 733 111 A1 discloses a laser-based system for surgical guidance. The system has a semicircular arm (C-X-ray device) with a laser projector. The (X-ray) arm scans a patient's body and displays the scan on a screen. A user can edit surgical information directly on the screen. For example, the user can enter surgical information via a touchscreen. A control unit converts the surgical information, and the laser projector projects the surgical information onto the patient's body. However, the system has a voluminous and cumbersome C-shaped arm, which negatively impacts handling during the operation. Furthermore, the C-shaped arm cannot be moved arbitrarily during the operation and requires strategic repositioning.

[0011] There are also known (robotic) systems that use high-energy lasers to cut bone. A surgical plan is created based on preoperative data. An effector is guided by an optical navigation system and cuts bone with the laser according to the surgical plan. This is advantageous because the robot creates a very clean cutting edge, and laser cutting does not produce any chips. However, laser cutting cannot be used for biopsies or other surgical procedures such as screw insertion or similar.

[0012] Furthermore, Liao et al. - Precision-guided surgical navigation systems using laser guidance and 3D autostereoscopic image overlay describes a system with multiple stationary lasers. At least two lasers are mounted at a distance. Both lasers project a laser beam onto a surgical surface. The intersection of the two lasers represents a surgical line. This can be used, for example, to display the line of intervention during a surgery. However, the stationary system lacks the flexibility for multiple operations.

[0013] In summary, the known state-of-the-art systems can indicate to the surgeon where to perform an intervention and can also mark relevant anatomical landmarks, such as organs that the surgeon must not damage during the operation. However, the information is only projected onto the patient from above. This only displays a two-dimensional image without providing any spatial information.

[0014] Summary of Revelation

[0015] The objects of the present disclosure are therefore to overcome or at least mitigate the disadvantages of the prior art and, in particular, to provide an effective, flexible laser guidance robot, projection method, and laser guidance robot system that provides a user, in particular a treating surgeon, with additional spatial information for guidance and navigation and, in particular, enables a display function indicating where and, in particular, at what angle a procedure can be performed. A further sub-objective can be seen in providing a cost-effective and movable laser guidance robot and guidance robot system that is, in particular, mobile and has a minimal impact on an operating room in terms of required volume. In particular, an intervention area should continue to be freely accessible to the surgeon.

[0016] The objects of the present disclosure are achieved with respect to a generic laser guidance robot by the features of claim 1, with respect to a generic laser guidance robot system by the features of claim 12, with respect to a generic projection method by the features of claim 13, with respect to a computer-readable storage medium by the features of claim 14, and with respect to a computer program by the features of claim 15.

[0017] The core idea of ​​the present disclosure is therefore to be able to not only display a location through a combination of a robot as a positioning system and a laser as a display system with laser radiation having a longitudinal axis, but also to visually display an axis in space pointing to this location for the surgeon, so that the surgeon can use the axis information to align medical products or instruments accordingly. The crucial point here is that the robot can control and thus move the laser into a predeterminable position and orientation relative to the patient and thus to the surgical site, that the laser, in this position, targets a target point in the surgical area, and aligns a laser beam with a longitudinal axis and thus a guide axis to this target point and visually displays it.This enables the surgeon to not only place medical devices, such as a biopsy needle, or instruments, such as a screwdriver, in a displayed position, but also to align a longitudinal axis according to the displayed guide axis.

[0018] In other words, the present disclosure relates to a laser guidance robot for the visual projection of (operative) guidance, in particular a preoperatively calculated surgical plan, onto a patient's surgical area. The laser guidance robot comprises a (guiding) robot with a robot arm movably articulated or connected to a robot base and a terminal / distal robot head / end section connected to the robot arm, as well as a tracking system, in particular an optical navigation system or a robot kinematics-based tracking system (here, the kinematics of the (guiding) robot are used to preferably determine the position and orientation of the laser, in particular relative to the patient), which is adapted to detect a position and / or orientation of the robot head and / or a position and / or orientation of the patient and thus of the surgical area.The laser guidance robot further comprises a projection laser whose emitted laser radiation is preferably within a range visible to the human eye, and which is arranged, in particular attached, to the robot head so that the position and orientation of the projection laser can be both detected and adjusted indirectly via the robot head. The laser guidance robot also comprises a control unit adapted to determine a target position and target orientation of the projection laser in relation to the patient's surgical area and to control the robot arm with the robot head and the projection laser such that the projection laser is moved / travels to the target position and target orientation and, via its (visual) projection of the laser radiation in the target orientation, visually represents at least one guidance axis onto the surgical area.

[0019] In particular, the control unit calculates the surgical plan and thus at least one predefined intervention site for the procedure, with an associated target position and target orientation of the projection laser, from preoperative images. Furthermore, the control unit can be particularly adapted to calculate an intervention axis that lies at the intervention site at a calculated intervention angle. The robot arm is movable and has a number of degrees of freedom. The projection laser is attached / attached to a distal end section of the robot arm or the robot head and is thus movable with the robot arm and controllable by the robot. The tracking system detects the position and orientation of the robot head and thus (in particular via a static, known or predeterminable transformation from the coordinate system of the robot head to the projection laser) the position and orientation of the projection laser in space.In this way, the projection laser's target position and orientation can be both controlled and detected. The robot arm's degrees of freedom allow the projection laser to be arranged / positioned and aligned such that the laser radiation emitted by the projection laser (i.e., the longitudinal axis of the laser radiation) corresponds to the calculated axis of engagement with the calculated angle of engagement. The laser radiation emitted by the projection laser, which is directly visible because it emits wavelengths in the visible range, or in a non-visible range but causes fluorescence in instruments, thus forms the guiding axis for the operation or procedure.

[0020] The target position and the target orientation of the projection laser are the position and orientation of the projection laser in which the guide axis projected by the laser radiation corresponds to the calculated intervention axis and is in particular aligned with a target point to be aimed at in an intervention area.

[0021] The preoperative images are taken before the operation, preferably using computed tomography (CT) and / or magnetic resonance imaging (MRI).

[0022] The term “tracking system” describes a technical system that enables spatial localization and enables the detection of the position and / or orientation of a target object.

[0023] The term "position" refers to a geometric position in three-dimensional space, which is specified in particular using coordinates of a Cartesian coordinate system. In particular, the position can be specified by the three coordinates X, Y, and Z.

[0024] The term "orientation," in turn, indicates an alignment (e.g., position) in space. One can also say that orientation indicates an orientation with a direction or rotation specification in three-dimensional space. In particular, orientation can be specified using three angles. The term "position" encompasses both position and orientation. In particular, position can be specified using six coordinates: three position coordinates X, Y, and Z, and three angular coordinates for orientation.

[0025] In other words, the core of the present disclosure can be seen in the fact that a projection laser is positioned and aligned by a robotic arm such that the laser radiation emitted by the projection laser corresponds to an intervention axis to be approached, in particular a preoperatively calculated intervention axis for a surgery. The surgeon is given the opportunity to visually display not only the position in the intervention area, but also an axis (with a corresponding intervention angle).

[0026] The laser guidance robot according to the disclosure enables a user or medical professional, in particular a surgeon, to track the calculated surgical axis as precisely as possible. This allows the advantages of a surgical robot—namely, the precise tracking of a preoperatively calculated surgical trajectory—to be combined with the high flexibility and ease of use of a (conventional) manual operation. In particular, the treating surgeon is shown the angle at which to perform a procedure. The projected guidance axis can, for example, indicate how a biopsy needle should be inserted into the patient's body or the angle at which a pedicle screw should be screwed into the patient's spine. By supporting the surgeon through the display / projection of the guidance axis, a procedure can be performed precisely and patient safety is increased.Surgical-related trauma is reduced.

[0027] The object of the present disclosure is further achieved by a projection method according to the disclosure for projecting a guide (with a guide axis), in particular a (preoperatively calculated) surgical plan, using the projection laser attached to the robot head. The projection method comprises the following steps. A tracking system detects a position and / or an orientation of the robot head and thus (via a determinable transformation between the robot head and the projection laser) the position of the projection laser in space. The control unit calculates a guide axis, in particular based on preoperative images. The control unit further calculates the target position and the target orientation of the projection laser based on the calculated intervention axis, in particular from the preoperative images.The robot arm then uses the projection laser to move the robot head to the calculated and predetermined target position and target orientation. The projection laser projects the laser beam in the target orientation such that at least one guide axis is visually represented on the intervention area. In particular, the projected guide axis corresponds to the calculated intervention axis.

[0028] The surgical plan is preferably calculated by the control unit based on the preoperatively acquired images. The calculated surgical plan includes at least one surgical site (target point) as well as the surgical axis and / or the surgical angle. In particular, the surgical plan has a straight-line trajectory.

[0029] Using the projection method disclosed, the calculated interventional axis of the planned surgery can be represented as the projected guide axis. This allows the surgeon to operate with high precision by following the guide axis and thus the interventional axis.

[0030] Advantageous further developments of the present disclosure are the subject of the dependent claims and are explained in particular below.

[0031] Preferably, the control unit calculates at least a first target position and target orientation of the projection laser based on the surgical plan stored in a memory unit. The control unit can control the robot arm such that the projection laser, in the target position and target orientation, projects its laser radiation onto the calculated surgical site and visually displays the guide axis with the calculated target orientation. Thus, the laser radiation and thus the guide axis indicate the surgical site calculated by the control unit. The memory unit can be implemented as part of the control unit or as part of an external control device.

[0032] It may be advantageous for the control unit to control the projection laser relative to a predefined intervention site via the robot arm, i.e., position and orient it so that the guide axis is at a specified angle to the predefined intervention site (or target point of the intervention site). The laser radiation emitted by the projection laser thus indicates the intervention angle. The intervention angle is, in particular, the angle calculated as the optimal angle for the surgical procedure. The intervention angle can be calculated based on the preoperative data set.

[0033] According to a further optional aspect of the present disclosure, the surgical plan comprises a preferably rectilinear (surgical) trajectory, (intermediate) target points (in particular a target point on the rectilinear surgical trajectory, for example, to indicate an axis and a target position for an instrument), and / or outlines of a (surgical) target. The surgical plan further preferably comprises at least one intervention site, an intervention axis, and / or an intervention angle. The control unit can adjust the target orientation (with associated target position) of the projection laser such that the guide axis corresponds to the intervention axis. The calculated intervention axis is thereby displayed to the user via the projected guide axis. The guide axis can correspond to any (arbitrary) intervention axis because the projection laser can be moved into almost any position and orientation by the (movable) robot arm.During the operation, the surgeon simply needs to follow the projected guide axis to position their (medical) instrument or device at the correct angle. This increases the probability that the surgeon will hit the calculated axis of intervention.

[0034] Preferably, the laser radiation emitted by the projection laser is adjusted to visually indicate or point to a focal point at a predetermined intervention depth. The intervention depth can be part of the calculated surgical plan and can be calculated by the control unit based on the preoperative images. If the projection laser displays the calculated intervention depth during the operation, the likelihood of the surgeon inadvertently intervening at an incorrect depth is minimized. Complications and trauma can thus be avoided. The operation is more gentle for the patient, and postoperative recovery times are shortened.

[0035] It can be advantageous for the laser radiation projected by the projection laser to form a conical structure with a focal point, wherein the focal point indicates the depth of intervention. The focal point at the tip of the conical structure, which faces away from the projection laser, visually represents the depth of intervention, so that in an intervention area above the depth of intervention (i.e. facing the projection laser), rings or oval shapes form which converge on the focal point at the depth of intervention. This means that the emitted laser radiation has a circular cross-section (with a changing diameter) and is not point-shaped. The laser radiation intersects each other at an intersection point, which forms the tip of the cone. The intersection point indicates the optimal (calculated) depth of intervention.If the surgeon has not yet reached the desired intervention depth, the laser radiation is displayed as rings on a projection surface. The size of the rings can indicate how far the surgeon is from the intervention depth. The larger the projected rings, the further the distance is from the desired intervention depth. If the surgeon follows the intervention axis, the laser radiation can be formed as concentric rings. If the surgeon deviates from the intervention axis during the procedure, i.e. the direction of intervention is oblique to the laser radiation and a projection surface onto the patient is not orthogonal to the longitudinal axis, the laser radiation can be displayed as an oval shape. This shows the surgeon that the direction of intervention does not match the calculated intervention axis.

[0036] Preferably, the medical instrument or product can have a predetermined projection area or a device where the user can see the projection of the projection laser. In particular, the laser radiation projected by the projection laser forms a hyperboloid / double cone structure (such as an hourglass) with a focal point for a visual representation of the intervention depth at the common tip of the double cone structure, so that for an intervention area above the intervention depth, rings or oval shapes form, which converge on the focal point at the intervention depth and diverge again as rings or oval shapes below the intervention depth. If the surgeon has penetrated too deeply during the procedure, the laser radiation can appear as rings that expand with increasing distance from the desired intervention depth.

[0037] Preferably, the projection laser emits at least two straight laser beams that are at an angle to one another and intersect (or overlap), and the intersection point of the at least two laser beams indicates the calculated depth of cut. As explained above, the laser radiation from the projection laser cannot be emitted parallel or converging. As a result, the multiple emitted laser beams (straight, non-fanning) intersect and form the intersection point. The intersection point indicates the calculated depth of cut. In particular, the two straight laser beams can project two points whose distance decreases towards the focal point and converges into a single superimposed point.

[0038] According to a further optional aspect of the present disclosure, the laser guidance robot has an input and output unit, in particular a (touch) display, for inputting control commands and / or outputting information to a medical professional, in particular a surgeon. The user can, for example, select a desired end position and end orientation of the robot head and / or a target position and target orientation of the projection laser via the input and output unit, and the robot moves the projection laser accordingly. The user, in particular the medical professional or the surgeon, can also enter a trajectory of the operation via the input and output unit. Preferably, the tracking system has an optical navigation system with a navigation camera and one or more optical trackers. The trackers are prepared and designed to be attached to the distal end section orto be attached to the robot head of the robot arm and / or the patient, so that their position and orientation in space are recorded by a navigation camera of the navigation system in order to move the projection laser to the calculated target position and target orientation relative to the recorded position and / or orientation of the patient and thus to the procedure area. In particular, the robot head has a rigid body with reflective markers as robot trackers. For example, one tracker is attached to the patient and one tracker is attached to the robot head. The navigation camera is preferably a stereo camera that can record the position and orientation of the trackers. Thus, the position and orientation of the patient and thus of the procedure area and the position and orientation of the robot head and thus of the projection laser can be recorded. In particular, a registration of the patient can be carried out based on the patient tracker.The control unit must be adapted to perform patient registration using the tracking system. The optical navigation system can, in particular, detect an initial position of the robot head and move the robot head to the target position relative to the patient's intervention area and align it in the target orientation. The optical navigation system detects when the target position and target orientation are reached.

[0039] Preferably, the position and orientation of the robot head can be detected via servomotors of the leading robot (via appropriate robot kinematics). This eliminates the need for an optical tracking or navigation system with a camera and trackers to detect the position and orientation of the robot head. The precisely controllable servomotors are already present in the leading robot.

[0040] Furthermore, the projection laser can preferably be moved relative to the robot head by servo motors to actively adjust the orientation of the projection laser relative to the robot head. Thus, the projection laser also has at least one degree of freedom relative to the robot head. This would make the alignment of the projection of the laser radiation by the projection laser even more flexible.

[0041] According to a further optional aspect of the present disclosure, preoperative images of the patient are stored in a storage unit / data provision unit, in particular in the form of computed tomography and / or magnetic resonance imaging (CT images and / or MRI images). Based on a registered patient, the control unit calculates an intervention axis incorporated into the preoperative images and an optimal associated target position and target orientation, and the projection laser is moved / displaced accordingly so that the guide axis is displayed as optimally as possible and, in particular, corresponds to the intervention axis, i.e., is aligned coaxially with it.

[0042] Preferably, the guidance robot has at least one projection laser, preferably two projection lasers, and the projection laser(s) are adapted to emit at least two different wavelengths to display two different colors and, in particular, to color-mark different targets in the intervention area. The different colors of the laser can be used to display different relevant landmarks, such as organs or different targets such as a biopsy and / or a tumor or a medical device.

[0043] According to a further optional aspect of the present disclosure, the projection laser can also be moved to the calculated final position by manually moving the robot arm, while the (optical) navigation system detects the current position and / or orientation of the projection laser during the manual movement and indicates when the calculated target position and / or target orientation has been reached. This allows the robot arm to be manually positioned by the surgeon, and the surgeon can see, via the display device, approximately how far the surgeon is from his target position and target orientation.

[0044] In particular, the target position can be adjusted and, in particular, displayed along a longitudinal axis of the laser beam. In other words, the guide axis can be aligned in space, but with parallel laser beams, it can be moved along the longitudinal axis while still displaying the guide axis.

[0045] In particular, the projection laser can be adapted to adjust the laser radiation in the form of intersecting laser beams by changing the distance between the projection laser and the intersecting laser beams to set the focal point. In particular, the control unit can be adapted to maintain the focal point during a translational displacement of the robot head with the projection laser along the longitudinal axis of the laser radiation by correspondingly changing the distance between the projection laser and the intersecting laser beams.

[0046] The object of the present disclosure is further achieved by a laser guidance robot system comprising a laser guidance robot according to the present disclosure, in particular according to one of the aspects explained above, and comprising a medical, in particular surgical, instrument, in particular a screwdriver, and / or a medical product, in particular a biopsy needle or a pedicle screw. The laser guidance robot projects the guidance axis onto an intervention area via the projection laser. The medical instrument or product can be aligned with a longitudinal axis along the guidance axis by a preferably proximal section of the instrument or product (along the longitudinal axis) having a projection surface onto which the projection laser projects the laser radiation when the instrument or product is aligned with its longitudinal axis substantially parallel, in particular coaxial, to the guidance axis.

[0047] Preferably, the medical device has an optical marking at a proximal end that indicates whether the surgical device is aligned along the axis of engagement. The proximal marking can, for example, be concentric circles. If the laser radiation falls on the proximal marking in such a way that the point-like projection is in the center of the marking or a ring-shaped projection is arranged concentrically with the circles of the marking, the surgical product is aligned along the guide axis or the axis of engagement. The other rings can indicate a certain angle, which helps the surgeon decide whether the selected axis of engagement of the instrument or product is still within a tolerance range of the optimal axis of engagement.In particular, a target or target-like rings can be applied to the projection surface so that the surgeon is shown whether he is coaxial with the guide axis when the laser point lights up in the center of the target.

[0048] The laser guidance robot according to the disclosure can be modified in particular according to at least one of the following embodiments: The robot head can have a surgical microscope; The laser guidance robot can be combined with a known navigation system; The laser guidance robot can be combined with a surgical robot system; The projection laser can be integrated into an optics of the surgical microscope; The projection laser can be attached to the robot head or designed to be attachable to the robot head; The laser guidance robot can be used as a robotic laser pointer controlled by an external user; The navigation system can be based on an infrared system with an infrared camera and / or can be based on electromagnetic tracking (EM tracking) and / or can be based on a computer vision system.

[0049] The laser guidance robot and the projection method can be used as follows. The following applications are examples only and are not exhaustive. A planned surgical site / incision site can be projected onto the patient's skin. A path or a (particularly straight-line) trajectory from the surgical site to a tumor can be projected. Critical structures such as vessels can be marked to prevent unintentional damage. The outer boundaries / boundaries of a tumor can be marked. A biopsy trajectory can be marked and displayed via the guidance axis. A (planned) bone screw trajectory can be marked via the guidance axis. The laser can be used as a remote-controlled laser pointer, with which an assisting surgeon can point anatomical landmarks to guide a performing or operating surgeon.

[0050] The objects are achieved with regard to a computer-readable storage medium and with regard to a computer program in that the latter comprises instructions which, when executed by a computer, cause the computer to carry out the steps of the projection method according to the present disclosure.

[0051] Short description of the characters

[0052] The present disclosure is explained in more detail below using preferred embodiments with the aid of figures. They show:

[0053] Fig. 1 shows a laser guidance robot according to a preferred embodiment of the present disclosure;

[0054] Fig. 2 is a schematic diagram of a laser guidance robot according to another embodiment of the present disclosure;

[0055] Fig. 3 shows a partial section of the laser guidance robot with a robot head with a projection laser;

[0056] Fig. 4 is a schematic representation of a display view with an engagement axis in a tissue;

[0057] Fig. 5 shows a system according to a preferred embodiment of the present disclosure with a medical product in the form of an instrument and the robot head;

[0058] Fig. 6a is a schematic view of an overlapping laser beam from the projection laser, creating a double-cone projection; Fig. 6b is a schematic view of a simple, straight laser beam from the projection laser;

[0059] Fig. 6c is a schematic view of a parallel laser beam of the projection laser to create a hollow cylindrical projection; and

[0060] Fig. 7 is a flowchart of a projection method according to a preferred embodiment of the present disclosure.

[0061] The figures are merely schematic in nature and are intended only to aid understanding of the disclosure. Like elements are designated by like reference numerals. The features of the various embodiments may be interchanged.

[0062] Detailed description of preferred embodiments

[0063] Fig. 1 shows a laser guidance robot 1 arranged next to a patient 100. The laser guidance robot 1 has a guidance robot with a (movable) robot arm 2 that is movably articulated or attached to a robot base 3. The robot arm 2 has a distal robot head 4 connected to the robot arm 2. The laser guidance robot 1 further has a tracking system 6, a projection laser 8, and, in this embodiment, an input and output unit 10. The tracking system 6 detects a position and orientation of the robot head 4 as well as a position and orientation of the patient 100 and thus of the intervention area. The projection laser 8 is attached to the robot head 4 so that the position and orientation of the projection laser 8 can be adjusted indirectly via the robot head 4.The projection laser 8 emits laser radiation 12, which in this embodiment lies in a range visible to the human eye between 380nm and 750nm.

[0064] The laser guidance robot 1 further comprises a control unit 14 (shown in Fig. 2) adapted to determine a target position and target orientation of the projection laser 8 in relation to the surgical area of ​​the patient 100. The control unit 14 controls the robot arm 2 with the robot head 4 and the projection laser 8 such that the projection laser 8 is moved / travels into the target position and target orientation. A (visual) projection of the laser radiation 12 of the projection laser 8 in the target orientation visually displays at least one guidance axis 16 and also an intervention site (target point) on the surgical area. In this way, in contrast to the known prior art, the surgeon is not only provided with a projection of an intervention point on the patient, but also a guidance axis is visually displayed.

[0065] The robot base 3 of the laser guidance robot 1 is preferably mounted on a rolling or movable cart to provide a mobile laser guidance robot 1 that can be moved to different positions in an operating room. The cart houses the control unit 14 (not shown in Fig. 1, but shown in Fig. 2), a power supply (not shown), and optionally a battery (not shown) for backup power. Furthermore, a storage unit 17 (not shown) is housed in the cart.

[0066] The robot arm 2 has several robot arm segments and joints, allowing the robot arm 2 to move in various translational degrees of freedom and at least one rotational degree of freedom. The robot head 4 is pivotally mounted on a distal end of the robot arm 2 about an axis. Thus, the robot head 4, and thus the projection laser 8, are translationally movable at least in space and can be rotated about a longitudinal axis of the distal end of the robot arm 2 in order to set a target position in space (relative to the patient) and a target orientation with a corresponding guide axis.

[0067] Fig. 2 shows a schematic representation of the laser guidance robot 1 with the robot arm 2 together with the robot head 4, the tracking system 6, the projection laser 8, and the control unit 14. The tracking system 6 has an optical navigation system 18 with a navigation camera 19 with at least two spaced-apart camera lenses 20 and a number of (optical) trackers 22 (markers). The trackers 22 each have three or four arms 24 that extend from a common point in different directions. The respective arms 24 are preferably arranged perpendicularly or at an angle of 120° to one another. A tracker sphere 26 is attached to the outer end of each arm. The tracker spheres 26 are designed such that they can be easily detected by the navigation camera 19 and can also emit light signals. The respective tracker spheres 26 of a tracker 22 lie in a common plane.By orienting the plane in space, the navigation system 8 can calculate how the respective tracker 22 is attached to an object. Such trackers 22 are known.

[0068] A laser tracker 28 is attached to the robot head 4 at the distal end of the robot arm 2. This allows the position and orientation of the robot head 4 in space to be detected. A patient tracker 30 is attached to the patient 100 to detect the position and orientation of the patient 100 in space and to use them for patient registration.

[0069] The input and output unit 10 is a touchscreen display via which information can be output to a user and information can be input by the user into the laser guidance robot 1.

[0070] The control unit 14 of the laser guidance robot 1 can determine the target position and orientation of the projection laser 8 in relation to the patient's surgical area and control the robot arm 2. In particular, the control unit 14 can control the robot arm 2 such that the projection laser 8 is moved to the target position and orientation. The control unit 14 calculates the target position and orientation and an intervention axis 32 from preoperative images of a patient. The preoperative images are acquired by computed tomography and / or magnetic resonance imaging of the patient and are provided to the control unit 14 via a data provision unit. The control unit 14 moves the projection laser 8 accordingly so that the guidance axis 16 corresponds to the intervention axis 32.

[0071] The robot head 4 has, for example, an (intervention) camera 34 through which the user can examine a procedure or surgical site. The projection laser 8, which emits the laser radiation 12, is attached to the robot head 4. The laser radiation 12 emitted by the projection laser 8 indicates the guide axis 16 at the surgical area or a surgical plan. The surgical plan can, for example, be the surgical site where the surgeon is to make the incision. The surgical plan can also be a trajectory from the incision site to a target such as a biopsy area, a tumor, or a (surgical) screw, and the trajectory can be visualized at least in sections via corresponding guide axes.

[0072] Fig. 3 shows the distal end of the robot arm 2 with the robot head 4, the tracker 22, and the projection laser 8. Using the tracker 22, which is specifically the laser tracker, the (optical) navigation system 18 can detect the position and orientation of the robot head 4 in space in real time. Thus, the control unit 14 can detect when the robot head 4 has reached the target position and target orientation.

[0073] Fig. 4 shows the calculated intervention axis 32 in a preoperative image of the patient 100. For this purpose, the body or tissue 102 of the patient 100 is captured or scanned before the operation. The control unit 14 or an external computing unit (not shown) calculates the surgical plan with at least one surgical trajectory 50 based on these preoperative images. The intervention axis 32 is also calculated and, in this case, also a target point on the intervention axis of the surgical trajectory with appropriate distances. The goal of the operation is for a medical instrument or product 36 to follow the calculated intervention axis 32 as precisely as possible and to be stopped accordingly at the target depth in order to then perform appropriate manipulations there. For this purpose, the calculated intervention axis 32 must be made visible so that the surgeon can follow the intervention axis 32 with the medical product 36. This is realized by the present disclosure.In particular, the target point can be displayed at the target depth using intersecting laser beams.

[0074] Fig. 5 shows a laser guidance robot system of the present disclosure with the laser guidance robot 1 and the medical product or instrument 36. The projection laser 8 emits the laser radiation 12, which represents the guidance axis 16. A longitudinal axis of the medical product 36 is aligned along the projected guidance axis 16. If the longitudinal axis of the medical product 36 corresponds to the guidance axis 16, the medical product 36 is also aligned along the calculated engagement axis 32. The degrees of freedom of the robot arm 2 allow the projection laser 8 to be aligned and positioned such that the emitted laser beams 12 correspond to the projected guidance axis 16. The tracker 22 detects the positioning and / or orientation of the robot head 4 with the projection laser 8 so that the target position and target orientation can be precisely controlled.A proximal portion 40 of the medical device 36 has a marking in the form of concentric rings that indicate whether the medical device 36 is aligned with a longitudinal axis 42 in the guide axis 16. If a straight laser beam of the projection laser is displayed centrally in the concentric rings, a coaxial alignment of the engagement axis 32 and the guide axis 16 can be assumed.

[0075] Fig. 6a to 6c show different embodiments of a projection laser 8 with differently configured laser radiation, each of which can be used in a laser guidance robot 1 or laser guidance robot system of the present disclosure.

[0076] Fig. 6a shows a projection laser 8 according to a first embodiment. Laser beams 12 are emitted from the projection laser 8 in the shape of a double cone. The ring-shaped laser beams 12 are at an angle to one another and therefore intersect at an intersection point 38. The intersection point 38 of the laser beams 12, which form the double cone contour, can be used to display a calculated depth of cut. More precisely, the laser beams 12 converge in the shape of a cone. The tip of the cone marks the calculated / desired depth of cut. As long as the depth of cut is not reached, this projection displays rings or oval shapes in the cut. When the depth of cut is reached, only a point is visible. If the penetration goes deeper than the calculated depth of cut, the rings become larger again with increasing distance from the depth of cut. Fig. 6b shows a projection laser 8 according to a second embodiment.The projection laser 8 is designed as a point laser or a line laser. If the projection laser 8 is designed as a line laser, it has a special lens (not shown) that expands a point laser into a line laser (i.e., a constant cross-sectional contour along the longitudinal axis of the laser beam as lines). In this configuration, the laser beam 12 cannot indicate a calculated or desired depth of the incision. However, the laser beam 12 can indicate the guide axis 16 very precisely.

[0077] Fig. 6c shows a projection laser 8 according to a third embodiment. The hollow cylindrical laser beams 12 mark a predetermined area using circles. The marked area can be used, for example, to identify a tumor to be removed.

[0078] Fig. 7 shows a flowchart of a projection method according to the disclosure for visually projecting a guide of a surgical plan onto an intervention area of ​​a patient 100 using the projection laser 8, which is attached to the robot head 4 of the robot arm 2.

[0079] In a first step S1, the tracking system 6 detects the position and orientation of the robot head 4 and the projection laser 8 in space.

[0080] In a step S2, the control unit 14 plans / calculates the intervention axis 32 based on preoperative images.

[0081] In step S3, the control unit 14 calculates the target position and target orientation of the projection laser 8.

[0082] In step S4, the robot arm 2 moves the robot head 4 with the projection laser 8 to the predetermined target position and target orientation. In step S5, the projection laser 8 projects laser radiation 12 in its target orientation such that the guide axis 16 projected by the projection laser 8 corresponds to the engagement axis 32.

[0083] In this way, the projection method can show the surgeon an axis.

[0084] List of reference symbols

[0085] 1 projection device

[0086] 2 robot arm

[0087] 3 Robot base

[0088] 4 Robot head

[0089] 6 Tracking system

[0090] 8 projection lasers

[0091] 10 Input and output unit

[0092] 12 Laser radiation

[0093] 14 Control unit

[0094] 16 Guide axis

[0095] 18 Navigation system

[0096] 19 Navigation camera

[0097] 20 camera lens

[0098] 22 trackers

[0099] 24 arms

[0100] 26 Tracker ball

[0101] 28 Laser T rackers

[0102] 30 patient trackers

[0103] 32 engagement axis

[0104] 34 intervention camera

[0105] 36 medical device

[0106] 38 Intersection

[0107] 40 proximal section

[0108] 42 Longitudinal axis

[0109] 50 Operation trajectory

[0110] 100 patients

[0111] 102 fabrics

Claims

Claims 1. Laser guidance robot (1) for the visual projection of a guidance axis, in particular a preoperatively calculated surgical plan, onto a surgical area of ​​a patient (100), comprising: a guidance robot (1) with a robot arm (2) movably articulated to a robot base (3) and a terminal robot head (4) connected to the robot arm (2); a tracking system (6), in particular an optical navigation system, which is adapted to detect a position and / or an orientation of the robot head (4) and further preferably to detect a position and / or an orientation of the patient (100) and thus of the surgical area;a projection laser (8) whose emitted laser radiation (12) is preferably in a range visible to the human eye, and which is arranged on the robot head (4), in particular statically fixed, so that a position and orientation of the projection laser (8) can be adjusted indirectly via the robot head (4); and a control unit (14) adapted for determining a target position and orientation of the projection laser (8) in relation to the patient's surgical area (100), in particular based on the preoperatively calculated surgical plan or a predetermined surgical axis (32), and for controlling the robot arm (2) with the robot head (4) and the projection laser (8) such that the projection laser (8) is moved into the target position and orientation and, via its projection of the laser radiation (12) in the target orientation, visually represents at least one guide axis (16) on the surgical area.

2. Laser guidance robot (1) according to claim 1, characterized in that the control unit (14) is adapted to calculate at least a first target position and target orientation of the projection laser (8) on the basis of an operation plan stored in a storage unit (17) and to control the robot arm (2) accordingly so that the projection laser (8) moves into the target position and target orientation is moved and its laser beam (12) is projected onto a calculated point of intervention in order to visually indicate the guide axis (16).

3. Laser guidance robot (1) according to one of the preceding claims, characterized in that the control unit (14) positions and orients the projection laser (8) relative to a predefined point of engagement via the robot arm (2) such that a longitudinal axis of the laser radiation (12) and thus the guidance axis (16) is at a predetermined angle to the predefined point of engagement.

4. Laser guidance robot (1) according to one of the preceding claims, characterized in that the operation plan has an operation trajectory, intermediate target points and / or outlines of an operation target; and / or has at least one intervention point, an intervention axis (32) and / or an intervention angle, and the control unit (14) adjusts the target orientation of the projection laser (8) such that the guidance axis (16) projected via the laser radiation corresponds to the operation trajectory, or that the guidance axis (16) corresponds to the intervention axis (32).

5. Laser guidance robot (1) according to one of the preceding claims, characterized in that the laser radiation (12) emitted by the projection laser (8) is adapted in such a way that it visually indicates a focal point at a predetermined intervention depth, and in particular indicates this focal point in a direction-dependent manner.

6. Laser guidance robot (1) according to one of the preceding claims, characterized in that the laser radiation (12) projected by the projection laser (8) forms a double cone, with a focal point for a visual representation of the penetration depth at the common apex of the double cone, such that rings or oval shapes are formed in a penetration area above the penetration depth, which in The incision depth converges at the focal point, and the incision depth diverges again below the incision depth as rings or oval shapes.

7. Laser guidance robot (1) according to one of the preceding claims, characterized in that the projection laser (8) emits at least two laser beams (12) which have an angle to each other and intersect each other, wherein an intersection point of the at least two laser beams indicates the calculated penetration depth.

8. Laser guidance robot (1) according to one of the preceding claims, characterized in that the tracking system (6) has an optical navigation system (18) with a navigation camera (19) and at least one optical tracker (22) which is arranged at least on the robot head (4), and in particular can also be attached to the patient, so that a position and orientation in space is precisely detected by the navigation camera (19) in order to move the projection laser (8) into the calculated target position and target orientation relative to the intervention area.

9. Laser guidance robot (1) according to one of the preceding claims, characterized in that the position and orientation of the robot head (4) and thus the position of the projection laser (8) are detected via actuators of the guidance robot (1).

10. Laser guidance robot (1 ) according to one of the preceding claims, characterized in that the projection laser (8) is adjustable in its orientation relative to the robot head (4) via at least one bearing and in particular is actively adjustable to a predetermined orientation relative to the robot head (4) via an actuator motor.

11. Laser guidance robot (1) according to one of the preceding claims, characterized in that preoperative images of the patient (100), in particular CT images and / or MRI images, are stored in a storage unit (17), and based on a registered patient (100) a The intervention axis (32) integrated into the preoperative images is used to calculate a target position and target orientation via the control unit (14) and the projection laser (8) is moved into this target position and target orientation, so that the guide axis (16) corresponds to the intervention axis (32).

12. Laser guidance robot system comprising a laser guidance robot (1) according to any one of claims 1 to 11 above and a medical, in particular surgical, instrument or medical product (36), wherein the laser guidance robot (1) projects the guidance axis (16) onto an intervention area via the projection laser and the medical instrument or product (36) is alignable with a longitudinal axis (42) along the guidance axis (16), preferably by having a, in particular proximal, section (40) of the instrument or product (36) having a projection surface onto which the projection laser (8) projects the laser radiation (12) when the medical product (36) is aligned with its longitudinal axis (42) substantially coaxially to the guidance axis (16).

13. Projection method for the visual projection of a guide axis, in particular a preoperatively calculated surgical plan, onto a surgical area of ​​a patient (100) with a projection laser (8) arranged on a robot head (4) of a robot arm (2), comprising the following steps: - Detecting (S1) a position and / or orientation of the projection laser (8) in space by a tracking system (6), in particular indirectly via the position of the robot head (4); - Calculating (S2) an intervention axis (32), in particular based on preoperative images by a control unit (12); - Calculating (S3) a target position and target orientation of the projection laser (8) by a control unit (12) which is located near, in particular on, the intervention axis (32); - Moving (S4) the robot head (4) with the projection laser (8) into the predetermined target position and target orientation by the robot arm (2); and - Projection of laser radiation (12) in the target orientation by the projection laser (8), so that a guide axis (16) is projected by the projection laser (8) and indicates the calculated intervention axis (32).

14. Computer-readable storage medium comprising instructions which, when executed by a computer, cause it to perform the steps of the projection method according to claim 13.

15. Computer program comprising commands which, when executed by a computer, cause it to perform the steps of the projection method according to claim 13.

Images