Hand-simulated cutting

Abstract

Cutting of patient anatomy is facilitated by detecting actual or anticipated cutting degradation with respect to a cutting action by a robot to execute a cut of patient anatomy using a cutting tool as part of a navigated surgical procedure, and configuring the cutting action. Configuring the cutting action includes at least one of adjusting one or more parameters of the navigated surgical procedure, or configuring the cutting action to perform intermittent cutting in which the cutting action executes cuts with at least one of (i) pauses in motion or (ii) retractions in between the cuts.

Description

HAND-SIMULATED CUTTINGBACKGROUND

[0001] Total Knee Arthroplasty (“TKA”), commonly referred to as a “knee replacement”, is a procedure of orthopedic surgery in which a knee joint, such as an arthritic knee joint, is replaced with a prosthesis. In a knee replacement, a series of bone resections are made to accommodate the placement of implants.SUMMARY

[0002] Shortcomings of the prior art are overcome and additional advantages are provided through the provision of a computer-implemented method. The method includes detecting actual or anticipated cutting degradation with respect to a cutting action by a robot to execute a cut of patient anatomy using a cutting tool as part of a navigated surgical procedure. The method further includes configuring the cutting action. The configuring includes at least one of: adjusting one or more parameters of the navigated surgical procedure; or configuring the cutting action to perform intermittent cutting in which the cutting action executes cuts with at least one of (i) pauses in motion or (ii) retractions in between the cuts.

[0003] In one or more embodiments, the degradation includes cutting failure.

[0004] In one or more embodiments, the detecting detects actual cutting degradation based on detecting at least one of: end-effector motor velocity; endeffector motor current draw; actual feed rate and a comparison of the actual feed rate to a planned feed rate; feed rate of prior cuts; or resistive force in the end-effector or robot arm.

[0005] In one or more embodiments, the detecting detects anticipated cutting degradation based on at least one of: prior knowledge of anatomy against which the function is to be performed; or segmentation of the patient anatomy and identification of one or more anatomy region densities using advanced imaging. Additionally, in some embodiments, the prior knowledge includes one or more properties of at least a portion of the patient anatomy.

[0006] In one or more embodiments, the one or more parameters include feed rate, where the feed rate is increased or decreased.

[0007] In one or more embodiments, the configuring includes configuring the cutting action to perform the intermittent cutting, and, during the at least one of the pauses or the retractions, anatomical debris that accumulates at the cutting site naturally clears and cutting tool velocity increases.

[0008] In one or more embodiments, the configuring includes configuring the cutting action to perform the intermittent cutting, and the method further includes notifying a user via on-screen prompts that the robot is performing intermittent cutting.

[0009] In accordance with one or more aspects, each of the embodiments is separable and optional from one another. Further, embodiments may be combined with one another.

[0010] Additional aspects of the present disclosure are directed to systems and computer program products configured to perform the methods described above and herein. The present summary is not intended to illustrate each aspect of, every implementation of, and / or every embodiment of the present disclosure. Additional features and advantages are realized through the concepts described herein.BRIEF DESCRIPTION OF THE DRAWINGS

[0011] Aspects described herein are particularly pointed out and distinctly claimed as examples in the claims at the conclusion of the specification. The foregoing and other objects, features, and advantages of the disclosure are apparent from the following detailed description taken in conjunction with the accompanying drawings in which:

[0012] FIG. 1 depicts example resections of a total knee arthroplasty;

[0013] FIG. 2 illustrates oscillatory motion of a sagittal cutting blade;

[0014] FIG. 3 depicts an example process to facilitate cutting patient anatomy, in accordance with aspects describe herein; and

[0015] FIG. 4 depicts an example computer system to incorporate, use, and / or facilitate aspects described herein.DETAILED DESCRIPTION

[0016] Described herein are aspects (e.g., methods, systems, computer program products) for describing / determining optimized cut paths for cuts to accomplish desired resections, for instance cuts for active robotic execution of these cuts with a robot-mounted sagittal cutting instrument. For example, aspects provide for using hand-simulated cutting to address drawbacks of existing approaches.

[0017] In clinical practice with manual instruments, and in clinical practice with device(s) that rely on the user / operator to move stereotactic device(s), a user might “peck” at the bone (or other patient anatomical feature) with an apparent effect of helping to clear cutting debris from a cut channel and with the apparent effect of helping the cutter to return to an optimal cutting velocity before reengaging uncut bone (or other patient anatomical) material.

[0018] FIG. 1 depicts example cuts of a TKA, which generally includes 7 planar cuts: 5 femoral cuts to the patient femur, 1 tibial cut to the patient tibia, and 1 patella cut to the patient patella. These can all be achieved with a cutting instrument, for example a sagittal saw. Thus, a TKA generally consists of seven planar resections: a tibial cut 102, a posterior femur cut 104, an anterior femur cut 106, a distal femur cut 108, two chamfer cuts (a posterior chamfer cut 110 that provides a chamfer between the posterior femur cut and the distal femur cut, and an anterior chamfer cut 112 that provides a chamfer between the anterior femur cut and the distal femur cut), and a patella cut 114. All of these cuts can be executed with a sagittal saw, as an example.

[0019] A sagittal saw is a planar saw blade that extends distally from a drive mechanism that moves in an oscillatory, back-and-forth pattern (a cutting stroke) in the plane in which the blade is aligned.

[0020] FIG. 2 illustrates oscillatory motion of a sagittal cutting blade, specifically depicting an example sagittal cutting blade 202 that oscillates (left and right in this Figure) and is coupled to / mounted in a base portion 204. The cutting blade has teeth 206 and can cut only when its teeth, oscillating as the blade oscillates, move across the target material; side cutting is generally not possible with a sagittal saw. Thecutting tool, and more specifically the blade thereof when oscillating, is driven forward (indicated by the arrows in FIG. 2) into the material to be cut.

[0021] Thus, a limitation of sagittal cutters (e.g., sagittal saws) is that cuts are only possible by lateral movement of the toothed edge across and against the material (bone) which can result in an assortment of cutting failures. By way of nonlimiting example, if tissues do not clear the cutting region, they can become stuck to the blade teeth and dull the cutting surface. By way of nonlimiting example, the blade may not be perfectly rigid, and compliance in the system could introduce deflection of the blade off of the intended cutting plane, thereby introducing significant frictional forces. By way of nonlimiting example, if the blade enters a cut channel (“plunged” into the bone, for instance) and the cut material is not cleared from the cut channel, this can overburden the blade and motor of the cutting tool, and prevent efficient cutting. In summary, sagittal cutting, for instance cutting using a robot -mounted cutter, can result in cut failures.

[0022] Another problem with a failure to cut is that generally it is associated with increased friction and increased heat, which can cause thermal necrosis to anatomy. The ‘pecking’ approach noted above allows for cooling without the need for irrigation, which can be messy.

[0023] Aspects described herein provide for simulating hand control, which overcome limitations of sagittal cutting tools and clinical constraints of TKA for an active robot using a sagittal cutter. This could also be generalized to a rotary cutting tool as well and / or other types of cutting tools.

[0024] Robots and / or other computer integrated systems and / or equipment are increasingly utilized in surgical procedures. Often, such devices include a mounted cutting tool to perform cuts / incisions. To perform a navigated function with a tool, for instance a cutting function with a cutting tool, an active robot moves through a series of ordered coordinates (a toolpath). Generally, the tool executes its intended task at or around / about each ordered coordinate on the toolpath. For a TKA surgical procedure using a sagittal saw, the execution of these cut paths can result in a failure to cut for reasons such as those described herein.

[0025] Thus, hand-simulated cutting is proposed to address these issues. In clinical practice with manual instruments, and in clinical practice with device(s) that rely on the user / operator to move stereotactic device(s), a user might “peck” at the patient anatomy (such as bone) with an apparent effect of helping to clear cutting debris from the cut channel and with the apparent effect of helping the cutter to return to an optimal cutting velocity before reengaging uncut anatomical material, such as bone material.

[0026] Accordingly, aspects (for instance algorithms / processes) are provided to detect cutting failure or degradation and / or to anticipate cutting failures or degradation. As used herein, degradation refers to a decrease in cutting efficiency and / or accuracy, and can therefore encompass failure, which refers to a decrease in cutting efficiency and / or accuracy to an extent (perhaps to a total extent) that is considered failure. When cutting degradation is detected or anticipated, a process can cause / direct the robot to adjust its movement along a cut path according to aspects / approaches described herein.

[0027] In examples, a process detects cutting degradation (which can include failure) through observing one or more of the following:-End-effector (e.g., tool or driver of the tool) motor velocity;-End-effector motor current draw;-Actual feed rate vs. planned feed rate;-Feed rate of prior cuts; and-Resistive force detected in the end-effector or robot arm.

[0028] In examples, a process anticipates cutting degradation (which can include failure) through observing one or more of the following:-Prior knowledge of anatomy against which the function is to be performed. By way of nonlimiting example, the medial portion of the anterior chamfer commonly has dense bone. By way of nonlimiting example, the tibial cut paths commonly have dense bone. By way of nonlimiting example, cancellous bone is less dense than cortical bone; and-Segmentation of the patient anatomy and identification of region density / densities (e.g., more or less dense regions; possibly based on thresholds) using advanced imaging (e.g., x-ray, CT, MRI, ultrasound, etc.).

[0029] Based on detecting or anticipating cutting degradation, a process can initiate or perform actions, activities, or the like, for example:-Adjusting parameters of the navigated surgical procedure, for instance to change (increase or decrease) feed rate;-Initiating a ’pecking’, also referred to herein as ’intermittent cutting’, which involves making short (for instance, in duration and / or distance), controlled cuts with pauses and / or short retractions in between such cuts. Instead of making one, continuous cut through the anatomy (for instance bone), the entity (robot, surgeon) making the cuts can make short, intermittent cuts. During the pauses and / or retractions, anatomical debris, for instance bone debris, that accumulates in / around the cutting site naturally clears and cutter velocity (velocity of the oscillation of the sagittal saw, for example) increases, for instance increases to an intended / unimpeded velocity. This debris could include small bone chips generated during the cutting process, for instance. The overall process for cutting can thereby be controlled and deliberate.-In addition, a user may be notified via on-screen prompts that the robot is actively pecking.

[0030] Generally, approaches discussed herein allow surgical navigation technology / sy stems, for instance those that can incorporate / encompass surgical robotic navigation technology / platforms / sy stems, to run at higher feed rates than other active robots that are unable to cut at high feed rates because they do not want to overburden the cutting system. The ‘pecking’ approach can also help prevent thermal necrosis of bone due to temperature increases.

[0031] Aspects described herein can be helpful for any navigated surgical procedure and could have other industrial applications. For instance, there may be applications outside of surgery. Aspects described herein can be helpful for surgical navigation technology / sy stems, navigated surgical procedures, and other industrial applications. Aspects could be integrated into robotic surgical systems, for example.In some embodiments, aspects are provided as software that can be integrated into target systems.

[0032] Accordingly, FIG. 3 depicts an example process to facilitate cutting patient anatomy, in accordance with aspects describe herein. The process may be executed, in one or more examples, by a processor or processing circuitry of one or more computer s / computer systems, such as those described herein. In one example, program code or instructions may, based on execution thereof by a processing circuit / processor(s), implement one, some, or all aspects of the process of FIG. 3.

[0033] Referring to FIG. 3, the process includes detecting (302) actual or anticipated cutting degradation with respect to a cutting action by a robot to execute a cut of patient anatomy using a cutting tool as part of a navigated surgical procedure. In examples, the degradation includes cutting failure of any form.

[0034] In embodiments, the detecting detects actual cutting degradation based on detecting (determining, observing, etc.) at least one of (i.e., one or more of the following): end-effector motor velocity; end-effector motor current draw; actual feed rate and a comparison of the actual feed rate to a planned feed rate; feed rate of prior cuts; or resistive force in the end-effector or robot arm.

[0035] In embodiments, the detecting detects anticipated cutting degradation based on at least one of (i.e., one or more of the following): prior knowledge of anatomy against which the function is to be performed; or segmentation of the patient anatomy and identification of one or more anatomy region densities using advanced imaging. As examples, the segmentation and identification might identify more or less dense regions, and / or might identify regions based on density thresholds. Examples of advanced imaging include x-ray, computed tomography, magnetic resonance imaging, and ultrasound, though others are possible. In examples, the prior knowledge includes one or more properties (such as density as one example) of at least a portion of the patient anatomy.

[0036] Continuing with the process of FIG. 3, the process also configures (304) the cutting action. Configuring the cutting action (304) could include adjusting (306) one or more parameters of the navigated surgical procedure. In examples, the one or more parameters include feed rate, where the feed rate is increased or decreased.Additionally or alternatively, configuring the cutting action (304) could include configuring (308) the cutting action to perform intermittent cutting in which the cutting action executes cuts with at least one of (i) pauses in motion / movement or (ii) retractions in between the cuts. The executed cuts could be tailored, specific, and / or short (in duration and / or distance), for instance. Thus, configuring the cutting action could include one or both of the adjusting (306) and the configuring the cutting action to performing intermittent cutting (308), and thus configuring the cutting action includes at least one of (i.e., one or both of) the adjusting 306 or the configuring (308).

[0037] In embodiments, the configuring (304) configures the cutting action to perform the intermittent cutting (308) where, during the pauses and / or retractions, anatomical debris that accumulates at the cutting site naturally clears and cutting tool velocity increases. For example, anatomical debris such as bone debris, that accumulates at (such as in and / or around) the cutting site naturally clears and cutting tool velocity, such as velocity of the oscillation of the sagittal saw, increases, for instance it increases to an intended / unimpeded velocity.

[0038] Additionally or alternatively, the configuring (304) can include configuring the cutting action to perform the intermittent cutting (308) where the process further includes notifying a user via on-screen prompts that the robot is performing intermittent cutting.

[0039] One or more embodiments described herein may be incorporated in, performed by, and / or used by one or more computer systems, such as one or more systems that are, or are in communication with, a camera system, tracking system, and / or orthopedic surgical robot, as examples. Processes described herein may be performed singly or collectively by one or more computer systems. A computer system may also be referred to herein as a data processing device / system, computing device / system / node, or simply a computer. The computer system may be based on one or more of various system architectures and / or instruction set architectures.

[0040] FIG. 4 depicts an example computer system to incorporate, use, and / or facilitate aspects described herein. Computer system 400 may be provided as part of a surgical navigation technology / system, for example. Computer system 400 is in communication with one or more external device(s) 412 (such as one or multiplerobot(s), tracking camera(s), rigid robot tracking array(s), foot pedal(s), monitor(s), Deadman switch(es), etc.). Computer system 400 includes one or more processor(s) 402, for instance central processing unit(s) (CPUs). A processor can include functional components used in the execution of instructions, such as functional components to fetch program instructions from locations such as cache or main memory, decode program instructions, and execute program instructions, access memory for instruction execution, and write results of the executed instructions. A processor of processor(s) 402 can also include register(s) to be used by one or more of the functional components. Computer system 400 also includes memory 404, input / output (I / O) devices 408, and I / O interfaces 410, which may be coupled to the processor(s) 1102 and each other via one or more buses and / or other connections. Bus connections represent one or more of any of several types of bus structures, including a memory bus or memory controller, a peripheral bus, an accelerated graphics port, and a processor or local bus using any of a variety of bus architectures. By way of example, and not limitation, such architectures include the Industry Standard Architecture (ISA), the Micro Channel Architecture (MCA), the Enhances ISA (EISA), the Video Electronics Standards Association (VESA) local bus, and the Peripheral Component Interconnect (PCI).

[0041] Memory 404 can be or include main or system memory (e.g., Random Access Memory) used in the execution of program instructions, storage device(s) such as hard drive(s), flash media, or optical media as examples, and / or cache memory, as examples. Memory 404 can include, for instance, a cache, such as a shared cache, which may be coupled to local caches (examples include LI cache, L2 cache, etc.) of processor(s) 402. Additionally, memory 404 may be or include at least one computer program product having a set (e.g., at least one) of program modules, instructions, code or the like that is / are configured to carry out functions of embodiments described herein when executed by one or more processors.

[0042] Memory 404 can store an operating system 405 and other computer programs 406, such as one or more computer programs / applications that execute to perform aspects described herein. Specifically, programs / applications can include computer readable program instructions that may be configured to carry out functions of embodiments of aspects described herein.

[0043] Examples of I / O devices 408 include but are not limited to microphones, speakers, Global Positioning System (GPS) devices, RGB, IR, and / or spectral cameras, lights, accelerometers, gyroscopes, magnetometers, sensor devices configured to sense light, proximity, heart rate, body and / or ambient temperature, blood pressure, and / or skin resistance, registration probes and activity monitors. An I / O device may be incorporated into the computer system as shown, though in some embodiments an I / O device may be regarded as an external device (412) coupled to the computer system through one or more VO interfaces 410.

[0044] Computer system 400 may communicate with one or more external devices 412 via one or more I / O interfaces 410. Example external devices include a keyboard, a pointing device, a display, and / or any other devices that enable a user to interact with computer system 400. Other example external devices include any device that enables computer system 400 to communicate with one or more other computing systems or peripheral devices such as a printer. A network interface / adapter is an example I / O interface that enables computer system 400 to communicate with one or more networks, such as a local area network (LAN), a general wide area network (WAN), and / or a public network (e.g., the Internet), providing communication with other computing devices or systems, storage devices, or the like. Ethernet-based (such as Wi-Fi) interfaces and Bluetooth® adapters are just examples of the currently available types of network adapters used in computer systems (BLUETOOTH is a registered trademark of Bluetooth SIG, Inc., Kirkland, Washington, U.S.A.).

[0045] The communication between I / O interfaces 410 and external devices 412 can occur across wired and / or wireless communications link(s) 411, such as Ethernetbased wired or wireless connections. Example wireless connections include cellular, Wi-Fi, Bluetooth®, proximity-based, near-field, or other types of wireless connections. More generally, communications link(s) 411 may be any appropriate wireless and / or wired communication link(s) for communicating data.

[0046] Particular external device(s) 412 may include one or more data storage devices, which may store one or more programs, one or more computer readable program instructions, and / or data, etc. Computer system 400 may include and / or be coupled to and in communication with (e.g., as an external device of the computersystem) removable / non-removable, volatile / non-volatile computer system storage media. For example, it may include and / or be coupled to a non -removable, nonvolatile magnetic media (typically called a “hard drive”), a magnetic disk drive for reading from and writing to a removable, non-volatile magnetic disk (e.g., a “floppy disk”), and / or an optical disk drive for reading from or writing to a removable, nonvolatile optical disk, such as a CD-ROM, DVD-ROM or other optical media.

[0047] Aspects of the present invention may be a system, a method, and / or a computer program product, any of which may be configured to perform or facilitate aspects described herein. Computer system configured to perform these and other methods, and computer program products that include a computer readable storage medium storing instructions for execution to perform these and other methods are also provided.

[0048] Computer system 400 may be operational with numerous other general purpose or special purpose computing system environments or configurations.Computer system 1100 may take any of various forms, well-known examples of which include, but are not limited to, personal computer (PC) system(s), server computer system(s), such as messaging server(s), thin client(s), thick client(s), workstation(s), laptop(s), handheld device(s), mobile device(s) / computer(s) such as smartphone(s), tablet(s), and wearable device(s), multiprocessor system(s), microprocessor-based system(s), telephony device(s), network appliance(s) (such as edge appliance(s)), virtualization device(s), storage controlled s), set top box(es), programmable consumer electronic(s), network PC(s), minicomputer system(s), mainframe computer system(s), and distributed cloud computing environment(s) that include any of the above systems or devices, and the like.

[0049] In some embodiments, aspects of the present invention may take the form of a computer program product, which may be embodied as computer readable medium(s). A computer readable medium may be a tangible storage device / medium having computer readable program code / instructions stored thereon. Example computer readable medium(s) include, but are not limited to, electronic, magnetic, optical, or semiconductor storage devices or systems, or any combination of the foregoing. Example embodiments of a computer readable medium include a hard drive or other mass-storage device, an electrical connection having wires, randomaccess memory (RAM), read-only memory (ROM), erasable-programmable read-only memory such as EPROM or flash memory, an optical fiber, a portable computer disk / diskette, such as a compact disc read-only memory (CD-ROM) or Digital Versatile Disc (DVD), an optical storage device, a magnetic storage device, or any combination of the foregoing. The computer readable medium may be readable by a processor, processing unit, or the like, to obtain data (e.g., instructions) from the medium for execution. In a particular example, a computer program product is or includes one or more computer readable media that includes / stores computer readable program code to provide and facilitate one or more aspects described herein.

[0050] As noted, program instruction contained or stored in / on a computer readable medium can be obtained and executed by any of various suitable components such as a processor of a computer system to cause the computer system to behave and function in a particular manner. Such program instructions for carrying out operations to perform, achieve, or facilitate aspects described herein may be written in, or compiled from code written in, any desired programming language. In some embodiments, such programming language includes object-oriented and / or procedural programming languages such as C, C++, C#, Java, etc.

[0051] Program code can include one or more program instructions obtained for execution by one or more processors. Computer program instructions may be provided to one or more processors of, e.g., one or more computer systems, to produce a machine, such that the program instructions, when executed by the one or more processors, perform, achieve, or facilitate aspects of the present invention, such as actions or functions described in flowcharts and / or block diagrams described herein. Thus, each block, or combinations of blocks, of the flowchart illustrations and / or block diagrams depicted and described herein can be implemented, in some embodiments, by computer program instructions.

[0052] While several aspects of the present invention have been described and depicted herein, these are only examples, and alternative aspects may be affected by those skilled in the art to accomplish the same objectives. Accordingly, it is intended by the appended claims to cover all such alternative aspects as fall within the true spirit and scope of the invention.

[0053] The terminology used herein is for the purpose of describing particular embodiments only and is not intended to be limiting. As used herein, the singular forms “a”, “an” and “the” are intended to include the plural forms as well, unless the context clearly indicates otherwise. It will be further understood that the terms “comprises” and / or “comprising”, when used in this specification, specify the presence of stated features, integers, steps, operations, elements, and / or components, but do not preclude the presence or addition of one or more other features, integers, steps, operations, elements, components and / or groups thereof.

[0054] The corresponding structures, materials, acts, and equivalents of all means or step plus function elements in the claims below, if any, are intended to include any structure, material, or act for performing the function in combination with other claimed elements as specifically claimed. The description of one or more embodiments has been presented for purposes of illustration and description, but is not intended to be exhaustive or limited to in the form disclosed. Many modifications and variations will be apparent to those of ordinary skill in the art. The embodiment was chosen and described in order to best explain various aspects and the practical application, and to enable others of ordinary skill in the art to understand various embodiments with various modifications as are suited to the particular use contemplated.

Claims

CLAIMSWhat is claimed is:

1. A computer-implemented method comprising: detecting actual or anticipated cutting degradation with respect to a cutting action by a robot to execute a cut of patient anatomy using a cutting tool as part of a navigated surgical procedure; and configuring the cutting action, the configuring comprising at least one of: adjusting one or more parameters of the navigated surgical procedure; or configuring the cutting action to perform intermittent cutting in which the cutting action executes cuts with at least one of (i) pauses in motion or (ii) retractions in between the cuts.

2. The method of claim 1, wherein the degradation comprises cutting failure.

3. The method of claim 1, wherein the detecting detects actual cutting degradation based on detecting at least one of: end-effector motor velocity; endeffector motor current draw; actual feed rate and a comparison of the actual feed rate to a planned feed rate; feed rate of prior cuts; or resistive force in the end-effector or robot arm.

4. The method of claim 1, wherein the detecting detects anticipated cutting degradation based on at least one of: prior knowledge of anatomy against which the function is to be performed; or segmentation of the patient anatomy and identification of one or more anatomy region densities using advanced imaging.

5. The method of claim 4, wherein the prior knowledge comprises one or more properties of at least a portion of the patient anatomy.

6. The method of claim 1, wherein the one or more parameters comprises feed rate, wherein the feed rate is increased or decreased.

7. The method of claim 1, wherein the configuring comprises configuring the cutting action to perform the intermittent cutting, and wherein, during the at least one of the pauses or the retractions, anatomical debris that accumulates at the cutting site naturally clears and cutting tool velocity increases.

8. The method of claim 1, wherein the configuring comprises configuring the cutting action to perform the intermittent cutting, and wherein the method further comprises notifying a user via on-screen prompts that the robot is performing intermittent cutting.

9. A computer system comprising: a memory; and a processing circuit in communication with the memory, wherein the computer system is configured to perform a method comprising: detecting actual or anticipated cutting degradation with respect to a cutting action by a robot to execute a cut of patient anatomy using a cutting tool as part of a navigated surgical procedure; and configuring the cutting action, the configuring comprising at least one of: adjusting one or more parameters of the navigated surgical procedure; or configuring the cutting action to perform intermittent cutting in which the cutting action executes cuts with at least one of (i) pauses in motion or (ii) retractions in between the cuts.

10. The computer system of claim 9, wherein the detecting detects actual cutting degradation based on detecting at least one of: end-effector motor velocity; end-effector motor current draw; actual feed rate and a comparison of the actual feed rate to a planned feed rate; feed rate of prior cuts; or resistive force in the end-effector or robot arm.

11. The computer system of claim 9, wherein the detecting detects anticipated cutting degradation based on at least one of: prior knowledge of anatomy against which the function is to be performed; or segmentation of the patient anatomy and identification of one or more anatomy region densities using advanced imaging.

12. The computer system of claim 9, wherein the configuring comprises configuring the cutting action to perform the intermittent cutting, and wherein, during the at least one of the pauses or the retractions, anatomical debris that accumulates at the cutting site naturally clears and cutting tool velocity increases.

13. The computer system of claim 9, wherein the configuring comprises configuring the cutting action to perform the intermittent cutting, and wherein the method further comprises notifying a user via on-screen prompts that the robot is performing intermittent cutting.

14. The computer system of claim 9, wherein the degradation comprises cutting failure, and wherein the one or more parameters comprises feed rate, wherein the feed rate is increased or decreased.

15. A computer program product comprising: a computer readable storage medium readable by a processing circuit and storing instructions for execution by the processing circuit for performing a method comprising: detecting actual or anticipated cutting degradation with respect to a cutting action by a robot to execute a cut of patient anatomy using a cutting tool as part of a navigated surgical procedure; andconfiguring the cutting action, the configuring comprising at least one of adjusting one or more parameters of the navigated surgical procedure; or configuring the cutting action to perform intermittent cutting in which the cutting action executes cuts with at least one of (i) pauses in motion or (ii) retractions in between the cuts.