Multifunctional Multi-arm Robot Surgery System

Abstract

A robotic surgical system includes at least two robotic arms having coordinate systems known relative to each other. One of the arms carries an X-ray source and the other carries an imaging detector plate. The arms are arranged to be able to generate an image on a target area of an object. One of the arms may additionally or alternatively carry a surgical tool or a tool holder such that the pose of the tool is known in the same coordinate system as the coordinate system of the image generated by the X-ray source and the detector. Thus, any surgical procedure planned based on such X-ray images can be performed by the tool with high precision because the tool position is known in the image reference system. This enables the surgeon to accurately position his tool in the real-time image without the need for an external registration process.

Description

Technical Field

[0001] The present invention relates to the field of robotic surgery, and more particularly to a system for coordinating the imaging of a patient with a robotic surgical procedure. Background Art

[0002] There are many surgical robotic systems that are capable of precisely positioning or manipulating surgical tools during a surgical procedure. One of the main problems in such systems is the ability to correlate the position and orientation (i.e., pose) of a surgical tool with a pre-operative surgical plan or intraoperative images taken during the surgery. Correlating the pose of a surgical tool with a pre-operative surgical plan is a problem solved by using a registration process that typically occurs between features desired to be manipulated according to the surgical plan as shown in pre-operative images, the true intraoperative position of a robot-guided tool, and the patient on the operating table. Pre-operative images are typically three-dimensional images, such as a set of CT or MRI images, while intraoperative surgical situations are typically obtained by using fluoroscopic images acquired using a C-arm imaging system.

[0003] There are also many systems in which historically traditional C-arm systems have been replaced by "virtual C-arm" elements with robotic alignment. The traditional C-arm system has a rigid support member that surrounds the patient, with an X-ray source at one end of the member and an X-ray collector or detector plate at the other end. In such systems, the X-ray source and detector elements are carried at the ends of separate robotic actuated arms such that they can be positioned on opposite sides of the patient. The precise pose of the fluoroscopic image can be selected by the robotic control of the arms carrying the source and imaging element, respectively. Such systems have been described in US 6,582,121 "X-ray Locator with Side-mounted, Independently Articulated Arms" assigned to GE Medical Systems Global Technology by M. Crain et al., and US 6,644,852 "Automated Configurable X-ray Locator" also assigned to GE Medical Systems by M. Crain. In US 8,611,495 "Dual-plane X-ray Imaging System" assigned to Siemens AG by M. Maschke, an imaging system is described that has two recording units mounted on C-arms in different planes. The patent also mentions the possibility of arranging each X-ray tube assembly and X-ray detector on a holding element such as a robotic arm. Similar systems using an X-ray source and X-ray detector panel mounted on separate robotic arms are also shown in US 6,200,024 "Virtual C-arm Robotic Positioning System for Use in a Radiographic Imaging Device" assigned to Picker International by D. Negrelli. The patent application number DE 102015 217059 A1 filed by Siemens Healthcare GmbH also describes an X-ray system that has an X-ray emitter and an X-ray receiver on separately controlled support arms. The US published patent application number 2011 / 0069818 assigned to Kuka Roboter GmbH by Muller also describes an X-ray system with a source and a receiver on separate robotic arms. US 6,435,715 "Radiographic Apparatus" assigned to Siemens AG by R. Betz et al. also describes a system that has an X-ray source and an X-ray receiver mounted on different robotic arms to generate a virtual C-arm arrangement. Robotic control ensures that the X-ray source is always oriented opposite to the X-ray receiver in order to acquire an image. By image analysis of markers using an external camera system connected to the robotic control system, the patient position can be related to the robotic coordinate system.

[0004] US 8,781,630, assigned to the University of Florida Research Foundation Inc. by S.A. Banks et al., describes a system that includes two robotic arm systems, one holding an imaging source and the other holding an imaging sensor, similar to the above-described system. A third robotic arm system may be included as a surgical doctor-guided tool holder. The surgical doctor manually guides the tool using haptic control and optional force feedback. The spatial poses of the imaging source arm and the tool holder arm can be related to each other by using X-ray calibration targets on the imaging source arm and the tool holding arm, or by using a tracking system of electromagnetic or optical trackers that can locate positioning markers on the imaging source arm and the tool holding arm. A touch device can be used to register the tool tip with the navigation reference frame.

[0005] However, the above systems are mainly limited to imaging functions or haptic systems, where the systems mimic the conventional C-arm imaging function of robotic control.

[0006] The disclosure of each publication mentioned in this section and other parts of this specification is hereby incorporated by reference in its entirety. SUMMARY OF THE INVENTION

[0007] There is a need for a more comprehensive robot-controlled virtual C-arm system that overcomes at least some of the disadvantages of existing technology systems and methods. Modern robot-guided surgery requires the ability to automatically associate any imaging function with the current execution of surgical planning. The present disclosure describes a new exemplary system that combines an imaging system for performing robot-guided surgery, the imaging system enabling a robot-guided tool to be related to one or more images generated using the imaging system. The system is based on a robot-controlled virtual C-arm that has a reference frame that can be related to the reference frame of a surgical tool, such that the virtual C-arm can autonomously guide the surgical tool using intraoperative images generated using the virtual C-arm. Such a system has more general functionality and higher accuracy than robotic systems that use registration or navigation or tracking to define surgical tools for performing surgical planning.

[0008] The system is based on a dual combination of at least two robotic arms so as to enable these novel features to be achieved during surgery. The robotic arms are mounted on a common base, which term is to be understood to include mounting all the arms on a single base or alternatively mounting at least some of the arms on separate bases, the mutual spatial positions of which are known relative to each other. The term "common base" is thus also claimed. Due to this feature of the common base, the coordinate system in which each robotic arm operates can be uniquely related to the coordinate systems of all the other robotic arms in the system. This feature is important because it enables all the arms to work in concert.

[0009] A first pair of arms is provided, one of which holds the imaging system source and the other of which holds a collector or detector element for generating an image of the surgical area itself. These arms are robotically guided such that their absolute positions and orientations relative to each other in space are known at all times. Thus, they can assume any desired source-sensor position in accordance with the robotic control commands issued to them. The reference frame of such an imaging system is known relative to the common base of all the robotic arms and thus also relative to the reference frames of any other robotic arms mounted on the common base. Since the robotic arms are an integral part of the robotic surgical suite, there is no need for a separate C-arm imager, which would occupy valuable space in the operating room and require medical technicians and alignment time to operate it. The imaging system can be of any suitable type, including an X-ray imager, an ultrasound imager, or any other type of imaging system having a separate source and detector element for mounting on a separate robotic arm of the system. However, since the most commonly used such imaging system is an X-ray system, such as that used on a conventional C-arm system, the disclosure herein uses an X-ray example for describing the imaging system and its operation, although it must be emphasized that the system and method are not intended to be limited to X-ray imaging.

[0010] However, the current system is different from the previously proposed virtual C-arm system, a term used to describe an imaging system in which the X-ray source and the X-ray detection device are mounted on a commonly associated controlled robotic arm, in that the surgical tool is positioned and its operation is optionally also controlled by a robotic arm whose coordinate system is known relative to the coordinate system of the X-ray imaging system. One way to achieve this is by using a third robotic arm to carry and position or manipulate the surgical tool. The third arm can even be an active robotic arm, which can be equipped with a surgical scalpel, a surgical drill, a catheter, a retractor, or some other surgical tool, and which can then perform robotically controlled surgical actions on the patient. The use of an active robotic arm in this system is advantageous because the pose of the surgical tool is then known with high precision relative to the fluoroscopic imaging data, since the coordinate system of the third robotic arm carrying the tool is known to the control system of the coordinate system of the imaging table, and the coordinate systems of all the arms are related to each other. Thus, the position of the surgical tool is achieved by the same robotic control used to align in the imaging table and can be guided to a position known on the fluoroscopic images obtained by the system.

[0011] According to a second and generally simpler embodiment of such a system, the surgical tool holder is mounted on the same robotic arm as one of the imaging components, preferably on the detection plate, since it is substantially lighter than the X-ray source, such that the pose of the surgical tool is known with high precision relative to the X-ray detection plate. The tool can most advantageously be mounted on a holder that is attached to the same robotic arm as the detection plate, such that the relative pose of the tool and the detection plate is known and fixed. This provides optimal position accuracy between the tool and the other robotically movable imaging elements. Alternatively, the detection plate can be provided with a precise detachable attachment fixture to its robotic arm, and the tool holder is equipped with a similar detachable attachment fixture, such that the tool can be mounted on the arm in a manner roughly the same as the operation of a tool changer in a machine tool rather than on the detection plate. In either of these two embodiments, the surgical tool performs surgical operations in the same reference frame as the reference frame in which the images are acquired. Once the required imaging has been performed using the imaging pair of the robotic arm, the detection plate can be removed and the tool assembly can be mounted in its place, such that the surgical tool can then perform surgical actions on the patient, with the same advantages as mentioned in the previous paragraph. Compared to the type of registration process that uses preoperative images to define the tool insertion pose, both of these two embodiments provide improved tool position accuracy, where the tool position is not directly related to the coordinates of the imaging system.

[0012] In this arrangement that uses only two robotically controlled arms, the third robotic arm can also be used to perform another related surgical action, such as a retraction or holding action in combination with the surgical operation being performed by the now "vacated" arm in the imaging arm pair.

[0013] An exemplary process in which the system can align a tool using only fluoroscopic images obtained using a robotically controlled arm during surgery can be as follows:

[0014] (i) Two or more X-ray images are generated by two imaging robotic arms to obtain a three-dimensional image set.

[0015] (ii) Then, the surgeon directly generates a surgical plan in real time on the intraoperative fluoroscopic image, and the three-dimensional property of the plan is achieved by generating the plan on two non-coplanar imaging planes, most conveniently on two perpendicular imaging planes.

[0016] (iii) As an additional and optional step, and using the case of a drilling procedure as a non-limiting example, the robotic arm carrying the detector can then be controllably moved to be generally perpendicular to the drilling trajectory determined by the surgeon, and another two-dimensional image is taken for verification to ensure that the drilling trajectory does not encroach on any prohibited area.

[0017] (iv) Finally, the robotic arm carrying the detector automatically moves to align the drill guide or drill to a point along the planned drilling trajectory, the robotic arm also having the drill guide or drill, the drill guide or drill being proximally connected to the detector, or the robotic arm having an interchangeable tool holder inserted in place of the detector.

[0018] In the above process, only two-dimensional fluoroscopic images are used to align the tool or its guide along the correct trajectory, and no registration is required at all because there is no preoperative plan - this "plan" is based on the direct visualization of the object anatomy in the fluoroscopic image. Although current registration techniques have good accuracy, eliminating the need for this step eliminates any potential inaccuracies that may occur in this registration process.

[0019] Another advantage of using the imaging robot of the present disclosure is the ability to automatically detect the correct trajectory according to an algorithm that calculates the correct trajectory from images in machine vision and machine learning modes. In such a process, the robot acquires one or more x-ray images, and based on the algorithm, moves the detector to the desired direct view of the target area and acquires continuous images until it converges to an image approved by the surgeon for applying a surgical action.

[0020] In a further embodiment of the above system, it is also possible to use an input from preoperative three-dimensional image data showing fiducial markers or anatomical details in order to register a preoperative surgical plan generated on the preoperative three-dimensional image data with a real-time fluoroscopic image obtained from an X-ray fluoroscope mounted on an imaging pair of the robotic arm. Such registration will then enable monitoring of the movement of the surgical tool and its accuracy relative to the preoperative plan. Thus, the process enables a high-resolution preoperative three-dimensional image (e.g., a CT or MRI image set) to be used as a basis for defining the pose of a tool held in one of the robotic arms. The process enables the system to perform surgery with the advantages of real-time intraoperative imaging and high-resolution preoperative three-dimensional images. Although it is less convenient and potentially has a slightly reduced accuracy compared to using the intraoperative surgical planning method previously described in this disclosure, where a combination of fluoroscopic images is used for intraoperative imaging, this use of preoperative high-resolution image-based planning can be advantageous when the target area contains features that do not provide high-quality fluoroscopic images, such as when only soft tissue is present, or when opaque bone structures predominate in the target area.

[0021] Thus, a system for a robotic surgical system is provided according to an exemplary embodiment of the apparatus described in this disclosure, the system comprising:

[0022] (i) a first robotic arm configured to carry an imager source,

[0023] (ii) a second robotic arm mounted at a known position relative to the first robotic arm and configured to carry an imager detection element, the two robotic arms being mounted such that an image of a target area of the object can be generated when the object is located between the two arms, and

[0024] (iii) a controller configured to correlate the coordinate systems of these robotic arms,

[0025] wherein one of the robotic arms is further configured to carry a surgical tool or a surgical tool holder such that the pose of the surgical tool or tool holder is known relative to the generated image of the object.

[0026] In such a system, in addition to the source or the detection element, the surgical tool or tool holder can be carried on one of the first or second robotic arms, or it can be carried on one of the first or second robotic arms in place of the source or the detection element.

[0027] In addition, in such a system, the robotic arm configured to carry the surgical tool or the surgical tool holder can be the second robotic arm. The second robotic arm can be adapted to carry the surgical tool or the tool holder and the detection element simultaneously in a known spatial relationship. Additionally, the second robotic arm can include an attachment element adapted to attach to the surgical tool or the tool holder, or to the detection element, such that the spatial relationship between the surgical tool or the tool holder and the detection element is precisely known.

[0028] In any of the above systems, the known relationship between the tool or the tool holder and at least one of the robotic arms can be configured such that the surgical tool can be autonomously guided to a position on an image obtained by using the first and second robotic arms and determined by the user.

[0029] Furthermore, any of the above systems can also include a third robotic arm, the coordinate system of which is correlated with the coordinate systems of the first and second robotic arms, and the third robotic arm is adapted to hold additional surgical elements.

[0030] In all of the above systems, the imager can be an X-ray imager or an ultrasonic imager.

[0031] According to further embodiments of the robotic surgical system of the present disclosure, there is further provided a system including at least a first robotic arm, a second robotic arm, and a third robotic arm, which are mounted to each other such that their coordinate systems are known relative to each other. At least the first robotic arm and the second robotic arm are disposed on opposite sides of a support element on which an object can be positioned, and are configured to carry an imager source and an imager detection element, respectively, such that an image of a part of the anatomical structure of the object can be generated.

[0032] Wherein the third robotic arm can be configured to carry a surgical tool holder or a tool such that the pose of the surgical tool or the tool holder is known relative to the image generated by the first and second robotic arms. In such a system, the imager can be an X-ray imager or an ultrasonic imager.

[0033] According to still further embodiments, there is provided a method for performing a surgical procedure on a region of an object, the method comprising:

[0034] (i) generating at least one image including the region of the object by means of a source carried on a first robotic arm and a detector element carried on a second robotic arm, the first and second robotic arms having a jointly related coordinate system;

[0035] (ii) determining in real time on the at least one image a trajectory required for performing the procedure; and

[0036] (iii) After aligning the robotic arm carrying the tool to ensure the determined trajectory on the at least one image, the procedure is performed using a surgical tool carried on one of the first robotic arm or the second robotic arm or the third robotic arm.

[0037] In such a method, if the surgical tool is carried on one of the first or second robotic arms, the surgical tool can be carried in addition to or instead of the imager source or the detector element. Further, if it is carried on the third robotic arm, the trajectory required for performing the procedure is ensured by means of a coordinate system of the third robotic arm that is co-related with the coordinate systems of the first and second robotic arms. In any of these methods, the procedure can be performed using intraoperative alignment of the tool trajectory in at least one image generated using an imaging system having a coordinate system common with the coordinate system of the tool.

[0038] A method for performing a surgical procedure on a region of an object is further provided, the method comprising:

[0039] (i) Generating a preoperative three-dimensional image set including the region of the object,

[0040] (ii) Planning a trajectory for a surgical tool based on the three-dimensional image set before the surgery to perform the surgical procedure,

[0041] (iii) Registering the three-dimensional image set with at least one intraoperative two-dimensional image generated by an imager source carried on a first robotic arm and an imager detector element carried on a second robotic arm, the first and second robotic arms having a commonly known coordinate system,

[0042] wherein the surgical tool can be carried on the second robotic arm or on the third robotic arm, the coordinate system of the third robotic arm being co-related with the coordinate systems of the first and second robotic arms such that manipulation of the robotic arm carrying the tool implements the preoperatively planned trajectory in real time. In such a method, the surgical tool can be carried on the second robotic arm in addition to or instead of the imager detector element.

[0043] According to yet another exemplary embodiment of the present system, a robotic surgical system is provided, the robotic surgical system comprising:

[0044] At least a first, a second, and a third robotic arm, the robotic arms being mounted to each other such that the coordinate systems of the robotic arms are known relative to each other,

[0045] At least the first robotic arm and the second robotic arm can be disposed on opposite sides of a support element on which an object is to be positioned, and are configured to carry an imager source and an imager detection element, respectively, such that an image of a part of the anatomical structure of the object can be generated, and

[0046] wherein a third robotic arm is adapted to carry a first surgical tool, and

[0047] wherein the second robotic arm is further configured to carry a second surgical tool such that a surgical procedure can be performed using the first surgical tool and the second surgical tool, and

[0048] wherein the poses of the first surgical tool and the second surgical tool are known relative to the coordinate system of the image of the object generated using the first robotic arm and the second robotic arm.

[0049] Finally, according to yet another embodiment of the system of the present disclosure, a robotic surgical system is provided that includes:

[0050] At least a first robotic arm and a second robotic arm, which are mounted in known positions relative to each other such that their coordinate systems are known relative to each other, and are disposed on opposite sides of a support element on which an object is to be positioned, the first robotic arm being configured to carry an imager source and the second robotic arm being configured to carry an imager detection element such that an image defining a part of the anatomical structure of the object can be generated,

[0051] wherein one of these robotic arms can further be configured to carry a surgical tool or a tool holder such that the pose of the surgical tool or the tool holder is known relative to the generated image of the object. BRIEF DESCRIPTION OF THE DRAWINGS

[0052] The present invention will be more fully understood and appreciated by reference to the following detailed description taken in conjunction with the accompanying drawings, in which:

[0053] Figure 1 A robotic surgical system as described in the present disclosure is shown, showing three robotic actuated and coordinated arms;

[0054] Figure 2 Is shown Figure 1 An alternative embodiment of the system, in which only two robotic arms are used;

[0055] Figure 3 Is shown Figure 2 An alternative embodiment of the embodiment, in which a tool or a tool holder and an X-ray detector plate are both held together in the same robotic arm, and the robotic control system knows their relative positions by means of a known mechanical arrangement connecting them; and

[0056] Figure 4 An example of the structure of a system controller having a storage unit is shown, showing how the relationship between a robotic imaging arm and a tool holding arm can be used to guide the tool to perform its required functions. DETAILED DESCRIPTION

[0057] Now refer to Figure 1 , which schematically depicts a robotic surgical system described in the present disclosure, which includes three robotic actuating arms 12, 13, 14. Figure 1 The arms of the illustrated system are mounted on separate bases 10, 11, 101, and their relative positions are known such that they can be considered as a single common base 103. Any other base arrangement can also be considered, as long as the positions where the robotic arms are attached to the bases are known such that the poses of each arm can be related to each other. Generally, the arms 13, 14 operating on the top side of the operating table 102 can be mounted on an upper console. The arms are controlled by a controller 104, which registers or coordinates the reference frames of the three arms and can be connected to each arm, its control motors, and position encoders through the base 104. The patient 18 is shown lying on the bed or operating table 102, but the system can also be used with a standing patient or a patient in any other desired position if appropriately adapted and aligned. A pair of arms 12, 13 are shown aligned above and below the patient, with one arm 12 carrying an X-ray source 15 and the other arm 13 carrying an image detector plate 16. By controlling the joints of these two arms 12, 13, the X-ray source and the detector plate can be aligned at any suitable angle relative to the patient's anatomy to generate a fluoroscopic image of the desired features of the surgical area. If two or more of these fluoroscopic images are generated, the control system of the surgical robot kit can provide three-dimensional image data of the surgical site, which can then be used to determine the real-time position of the patient's target surgical area in three dimensions. Alternatively, this three-dimensional information can be registered and compared with any preoperative three-dimensional image for which the surgical plan has been determined, provided that some fiducial position features have been used in the preoperative image.

[0058] The third robotic arm 14 can carry a surgical tool 17 or a surgical tool holder, and since the reference frame of this third robotic arm 14 is known relative to the reference frames of the first and second arms 12, 13, the position and orientation of the surgical tool are known relative to the coordinate system of the fluoroscopic image generated on the imagers arranged on the first arm 12 and the second arm 13. Therefore, the relative position and progress of the surgical tool 17 during the surgery can be directly related to the fluoroscopic image of the patient's surgical site without the need for further external registration.

[0059] According to an alternative operating mode, once one or more fluoroscopic images have been generated to define the characteristics of the patient's surgical site, at least one element of the X-ray imaging device can be removed from its support robotic arm (preferably the detector plate 16 is removed from the robotic arm 13 as that is the lighter element), and the robotic arm 13 is then freely equipped with a surgical tool or a tool holder, the pose of the surgical tool or tool holder being known relative to the previously generated X-ray images since the tool is attached to the robotic arm 13 at known positions and angles, the position of the robotic arm 13 being known relative to the X-ray image axis. Thus, the alignment and progression of the tool of the robotic control system using the robotic arm 13 can be directly correlated with the previously obtained fluoroscopic images without the need for any registration transformation. Since there is no longer a need to hold the tool holder or the tool, the third robotic arm 14 can be used to perform additional surgical tasks, such as retracting or holding the patient's tissue.

[0060] Now refer to Figure 2 , which shows this alternative embodiment of the system of the present disclosure, where only two robotic arms are used, the first robotic arm 12 carrying the X-ray source 15, while the second robotic arm 13 is equipped with an adapter mount 19 that can be connected to the X-ray sensor plate 16 by means of a matching adapter 20, or to a tool or tool holder 17 by means of an adapter 21, these adapters making the relative positions of the X-ray sensor plate and the tool or tool holder known at a high precision level. In this embodiment, the robotic control system 104 controls the movement of the two robotic arms 12, 13. Each robotic arm is adapted to hold at least one surgical tool or other item for use during the surgical procedure. The robotic arm 13 has a base 10 that can be equally well attached to the ceiling in the room or to another immovable support element, or to the control cabinet. The second robotic arm 12 shown is also attached to an immovable support element 11. The controller 104 can manipulate the movement of each robotic arm such that the positions of the surgical tools or other items held and carried by each arm are precisely known relative to each other.

[0061] Now refer to Figure 3 , which shows Figure 2 an alternative embodiment of the embodiment of, where both the tool or tool holder 17 and the X-ray detector plate 16 are held in the robotic arm 13, and the robotic control system knows the relative positions of the robotic arms by means of a known mechanical arrangement connecting them. Thus, the position of the tool 17 relative to the imaging view of the patient generated on the detection plate 16 is precisely known. This embodiment avoids the need to replace the detector plate with a tool holder.

[0062] In any of the above-described embodiments, the image processing of the X-ray image can be used to define the position of the patient or the anatomical features of the patient to be operated on, and the known relationship between the imaging reference system and the tool reference system enables the precise positioning of the tool relative to the patient or the anatomical features of the patient to be operated on. Such a system can be configured to autonomously guide the surgical tool to a position known on the X-ray image obtained by the system itself without any additional alignment, since the reference system used to generate these images can be spatially and angularly related to the reference system in which the tool is mounted.

[0063] Now referring to Figure 4 , which schematically illustrates a possible structure of the control system 104 that enables the system to operate. The controller and system functions use the memory unit 41, which contains the robotic arm coordinate relationships 44 and the instructions 45 for operating the robotic arm.

[0064] The processor 46 controls the overall controller operation, including input-output and calculations. The input-output unit includes the user interface 43, the robotic arm drive interface 47, the robotic arm position sensor interface 48, and the network interface 49.

[0065] Those skilled in the art should understand that the present invention is not limited to what has been specifically shown and described above. On the contrary, the scope of the present invention includes combinations and sub-combinations of the various features described above, as well as variations and modifications that occur to those skilled in the art after reading the above description and are not in the prior art.

Claims

1. A robotic surgical system, comprising: A first robotic arm configured to carry an imager source; A second robotic arm mounted at a known position relative to the first robotic arm and configured to carry an imager detection element, the two robotic arms being mounted such that when an object is located between the two arms, an image of a target region of the object can be generated; And A controller configured to correlate the coordinate systems of the robotic arms; Wherein the second robotic arm is further configured to carry a surgical tool or a surgical tool holder and the imager detection element in a fixed spatial relationship such that the pose of the surgical tool or the surgical tool holder is known relative to the generated image of the object.

2. The system according to claim 1, wherein the second robotic arm includes an attachment element adapted to attach to the surgical tool or the surgical tool holder, the attachment element making the fixed spatial relationship between the surgical tool or the surgical tool holder and the imager detection element precisely known.

3. The system according to any one of claims 1-2, wherein the pose of the surgical tool or the surgical tool holder is such that the surgical tool can be autonomously guided to a position on the generated image of the object.

4. The system according to any one of claims 1-2, further comprising a third robotic arm, the coordinate system of the third robotic arm being correlated with the coordinate systems of the first robotic arm and the second robotic arm, and the third robotic arm being adapted to hold additional surgical elements.

5. The system according to any one of claims 1-2, wherein the imager source is an X-ray imager or an ultrasonic imager.

6. A robotic surgical system, comprising: At least a first robotic arm and a second robotic arm, the first robotic arm and the second robotic arm being mounted relative to each other such that their coordinate systems are known relative to each other, the first robotic arm and the second robotic arm being disposed on opposite sides of a support element on which an object is positioned and configured to carry an imager source and an imager detection element respectively such that an image of a part of the anatomical structure of the object can be generated, Wherein the second robotic arm is configured to carry a surgical tool or the surgical tool holder and the imager detection element in a fixed spatial relationship such that the pose of the surgical tool or the surgical tool holder is known relative to the image generated by the first robotic arm and the second robotic arm.

7. The robotic surgical system according to claim 6, wherein the imager source is an X-ray imager or an ultrasonic imager.

8. A computer-readable storage medium comprising instructions that, when executed by a processor, cause the processor to perform a method of performing a surgical procedure on a region of an object, the method comprising: Generating at least one image of the region of the object by a source carried on a first robotic arm and a detector element carried on a second robotic arm, the first robotic arm and the second robotic arm having a mutually related coordinate system; Determining in real time on the at least one image a trajectory required to perform the surgical procedure; And Implementing the surgical procedure using a surgical tool carried on the second robotic arm, wherein the second robotic arm is configured to carry the surgical tool and the detector element in a fixed spatial relationship such that the pose of the surgical tool is known relative to the at least one generated image of the object.

9. The computer-readable storage medium according to claim 8, wherein in the at least one generated image having a coordinate system common to the coordinate system of the surgical tool, the surgical procedure is performed using intraoperative alignment of the tool trajectory.

10. A computer-readable storage medium, the computer-readable storage medium comprising instructions that, when executed by a processor, cause the processor to perform a method for performing a surgical procedure on a region of an object, comprising: Generating a preoperative set of three-dimensional images of the region of the object; Planning a trajectory of a surgical tool based on the set of three-dimensional images preoperatively to perform the surgical procedure; Registering the set of three-dimensional images with at least one intraoperative two-dimensional image generated by an imager source carried on a first robotic arm and an imager detector element carried on a second robotic arm, the first robotic arm and the second robotic arm having a mutually known coordinate system; Wherein the second robotic arm is configured to carry the surgical tool and the imager detection element in a fixed spatial relationship such that the pose of the surgical tool is known relative to the at least one intraoperative two-dimensional image.

11. A robotic surgical system, comprising: At least a first robotic arm, a second robotic arm, and a third robotic arm, the robotic arms being mounted to each other such that the coordinate systems of the robotic arms are known relative to each other; Wherein at least the first robotic arm and the second robotic arm are disposed on opposite sides of a support element on which the object is positioned and are configured to carry an imager source and an imager detector element, respectively, such that an image of a portion of the anatomical structure of the object can be generated, and Wherein the third robotic arm is adapted to carry a first surgical tool; And Wherein the second robotic arm is further configured to carry a second surgical tool and the imager detector element in a fixed spatial relationship such that the pose of the second surgical tool is known relative to the generated image of the object.

12. A robotic surgical system, comprising: At least a first robotic arm and a second robotic arm, the robotic arms being mounted in mutually known positions such that their coordinate systems are known relative to each other and being disposed on opposite sides of a support element on which the object is positioned, the first robotic arm being configured to carry an imager source and the second robotic arm being configured to carry an imager detector element such that an image defining a portion of the anatomical structure of the object can be generated, The second robotic arm is further configured to carry the surgical tool or tool holder and the imager detector element in a fixed spatial relationship such that the pose of the surgical tool or the tool holder is known relative to the generated image of the object.

Images