Arthroscopic surgery systems and methods

Abstract

An arthroscopic surgery system and method are provided that simplifies arthroscopic surgery by using remotely controllable instruments. The system includes a frame configurable to extend over or alongside at least a portion of a patient to be operated; and one or more surgical arms extending from the frame. Each of the plurality of surgical arms includes an arthroscopic instrument. A plurality of surgical arms and associated arthroscopic instruments may be remotely controlled by a user interface to perform an arthroscopic procedure.

Description

TECHNICAL FIELD

[0001] The present invention relates to arthroscopic surgery. In particular, although not exclusively, the present invention relates to robotic arthroscopic surgery. BACKGROUND

[0002] Arthroscopy is a surgical procedure performed on a joint such as an ankle, knee, hip, spine, shoulder, elbow, or wrist, in which a small camera and surgical instruments are inserted into the joint through a small incision in the patient's skin. Arthroscopy is a "minimally invasive" procedure in which the surgeon is able to view the joint area from outside the joint and perform surgery on soft tissues such as ligaments, bone joint surfaces, and other tissues. Recovery time and tissue trauma are greatly reduced compared to traditional "open" surgery.

[0003] A problem with arthroscopy is that it is a difficult medical procedure requiring a very high level of skill. A large proportion of surgeons are not equipped to perform arthroscopic surgery, and a large proportion of the arthroscopic surgeries performed result in significant damage caused by the surgery itself.

[0004] Certain systems can assist surgeons in performing minimally invasive surgery on other parts of the body, including laparoscopic robots. One example of such a robot is the da Vinci Surgical System by Intuitive Surgical, Inc. of California, USA.

[0005] In these systems, the surgeon typically operates a mechanical arm from a console, the mechanical arm including instruments that perform the laparoscopy. Typically, the laparoscopy is performed within a large single cavity such as the abdomen, from which access is obtained by common methods. Because the cavity is large and compliant, a gas is used to inflate the cavity, creating a large void between the access and the surgical site. This makes visibility and access to the surgery simple.

[0006] A problem with such systems is that they are not suitable for arthroscopy. In contrast to laparoscopy, arthroscopic surgery involves surgery on joints, which are each small, non-compliant, often multiple compartmented, separated by body structures, and / or difficult to access.

[0007] As an illustrative example, laparoscopic equipment is typically too large to fit into a knee. Even if laparoscopic devices could be made smaller, joints are mostly formed of sensitive articular cartilage covering non-compliant bone surfaces, so it is not possible to create a large void or cavity as used in laparoscopy. Furthermore, even if the joint were inflated, the joint space is still small and narrow, often curved, and covered by cartilage that must be avoided because hitting or rubbing along the cartilage can wear and damage the cartilage.

[0008] Thus, laparoscopic robots such as the da Vinci Surgical System are not suitable for arthroscopic surgery.

[0009] Accordingly, there is a clear need for improvements in arthroscopic surgical systems and methods.

[0010] It will be clearly understood that, if a prior publication is referred to herein, this reference is not to be taken as an admission that the publication is common general knowledge in Australia or any other country at the priority date of this application. SUMMARY

[0011] The present application relates to arthroscopic surgical systems and methods which can at least partially overcome at least one of the above disadvantages, or provide the consumer with a useful or commercial choice.

[0012] In view of the above, in one form the present application is directed to an arthroscopic surgical system comprising: a frame configurable to extend over or alongside at least a portion of a patient to be operated on; and one or more surgical arms extending from the frame, each of the one or more surgical arms comprising an arthroscopic instrument; wherein the one or more surgical arms and associated arthroscopic instruments are remotely controllable by a user interface to perform arthroscopic surgery.

[0013] Advantageously, the system simplifies arthroscopic surgery by using remotely controllable instruments, thereby reducing the likelihood of damage or injury caused by the surgery itself. Furthermore, since the system is easier to use than conventional arthroscopic instruments, barriers to arthroscopic entry are reduced.

[0014] The use of a frame enables the surgical arms and associated arthroscopic instruments to be operated with reference to a single origin (defined with reference to the frame), thereby enabling simple Cartesian mapping of positions.

[0015] Preferably, the frame is rigid. Preferably, the frame extends laterally in two dimensions.

[0016] Preferably, the frame is configurable to extend laterally over at least a portion of the patient. Preferably, the at least one surgical arm is reconfigurable to extend from different lateral positions on the frame. Preferably, the one or more surgical arms comprise a plurality of surgical arms extending from different lateral positions on the frame.

[0017] Since the frame extends laterally, and the surgical arms extend downwardly from different lateral positions, multiple entry positions can be used, for example on different sides of a joint, while maintaining a common coordinate system between the surgical arms (unlike independent arms not connected by a frame).

[0018] In some embodiments, the frame is annular. The surgical arms can extend from the outer periphery of the frame.

[0019] In some embodiments, the frame is adjustable. This can be achieved by adding parts to the frame or removing a part of the frame.

[0020] Preferably, the one or more surgical arms comprise a plurality of surgical arms.

[0021] Preferably, the surgical arms are reconfigurable to extend from the frame in a plurality of different positions. In some embodiments, the surgical arms are configurable to extend from the frame in one or more predetermined positions. The surgical arms can be detachably coupled to the frame.

[0022] Alternatively, the surgical arms can be moved relative to the frame, for example by using actuators, drive assemblies or the like. The arms can be moved in accordance with user input. An end of the surgical arms can be secured to the frame by using a guide rail. Preferably, a first end of the arms is configured to be driven along the guide rail. In some embodiments, a plurality of guide rails can be employed. In this case, it is envisaged that the ends of the surgical arms can be stacked vertically, with a different arm being disposed on each guide rail.

[0023] The frame can comprise one or more roller assemblies for moving the surgical arms along the guide rails. Preferably, the one or more roller assemblies span the guide rails and are received along the guide rails. Each guide rail can comprise at least one channel for guiding the passage of the roller assemblies. As shown, it is envisaged that a plurality of guide rails can be employed. In this case, one of the one or more roller assemblies can be configured to engage with one of the plurality of guide rails.

[0024] Preferably, the first end of the at least one arm comprises an attachment portion for attachment to the frame. Preferably, the attachment portion is attached to the frame by screws, pins or similar fasteners. In some embodiments, the attachment portion is configured to be clamped to the frame or otherwise engaged with the frame.

[0025] The arms can be of different lengths to achieve different functions. For example, arms of different lengths can provide engagement with different parts of a patient, or can be used to contact a patient at different surgical locations.

[0026] Preferably, the surgical arms are electrically and mechanically coupled to the frame.

[0027] Preferably, the surgical arms are then articulatable to a variety of different positions based on user input.

[0028] Preferably, the surgical arms are configured to bend about at least one pivot point. Preferably, the surgical arms are configured to bend about two or more pivot points.

[0029] Preferably, at least a portion of the surgical arms are configured to rotate.

[0030] Preferably, the at least one surgical arm has at least six degrees of freedom. The six degrees of freedom can include one or more of forward / backward, up / down, left / right, horizontal yaw, pitch swing and roll.

[0031] In some embodiments, the surgical arm has 8 degrees of freedom.

[0032] Preferably, the surgical arms can be added to or removed from the frame in a modular fashion.

[0033] Preferably, the surgical arms have modular end plates configured to work with a variety of different instruments.

[0034] Preferably, the modular end plates have one or more buttons which can be used to control the surgical arms. In some embodiments, the buttons can be used to place the arms in a manual mode so that the user can physically reposition the arms. Similarly, the buttons can be used to save a point into a runtime program.

[0035] The modular end plates can include drive elements configured to engage with corresponding drive elements of the instruments to mechanically drive one or more aspects of the instruments.

[0036] The modular end plates can include electronic elements configured to electrically couple the instruments to the system. The electronic elements can be configured to power the instruments and / or receive data from or send data to the system.

[0037] Each of the modular end plates can include powered drive elements and electrical contacts in the same predetermined locations to enable a large number of instruments to be used in a modular fashion. The arthroscopic instruments can then use any one or more of these powered drive elements and / or electrical contacts as required.

[0038] Preferably, a hand unit is associated with the surgical arms and / or the modular end plates. The hand unit, which is located in the user's hand, is used to manually move one or more of the surgical arms. Preferably, the hand unit is operatively associated with one or more of the surgical arms such that movement of the hand unit associated with one of the surgical arms and / or the modular end plates causes movement of the remaining one or more of the surgical arms.

[0039] The hand unit is configured to fit in the user's hand for manual operation by the user. The hand unit can fit in the user's hand in a typical manner, for example in the user's palm or fingers.

[0040] In use, it is envisaged that the user can use the hand unit to position the surgical arms. Advantageously, this can enable the user to manually orient the surgical arms at the appropriate site on the patient, which in turn can help to address the surgeon's responsibility problem.

[0041] The hand unit can also include a locking mechanism. Preferably, the locking mechanism is configured to lock the surgical arms in a region relative to the patient for surgery.

[0042] Preferably, the hand unit is configured to generate haptic signals. The haptic signals can be generated from data from the system and can correspond to movement and locking of the hand unit, or any other suitable information.

[0043] In alternative embodiments, one or more arthroscopic instruments are permanently or semi-permanently attached to the associated surgical arms. The arthroscopic instruments can be attached to the arms by fasteners, such as nuts and bolts, or can form part of the surgical arms.

[0044] The system can include a drape extending over each of the surgical arms. The drape can be sterile. The drape can include a rigid upper mount and a rigid lower mount, and a flexible sheath extending between the rigid upper mount and the rigid lower mount. The rigid upper mount and the rigid lower mount can include holes through which connectors of the arms and / or instruments extend.

[0045] The rigid upper mount can be adapted to be received between the frame and the surgical arms, and the rigid lower mount can be adapted to be received between the arms and the arthroscopic instruments.

[0046] Preferably, the flexible sheath provides a continuous tube between the holes of the rigid upper mount and the rigid lower mount. In one embodiment, the flexible sheath includes a tube. The tube can be within the flexible sheath tube or can be located outside the flexible sheath tube. Preferably, the tube is connected to one or more pumps and valves to regulate fluid pressure and flow. The one or more pumps can include a series of pumps. The valves can include compression valves.

[0047] The drape can include a tube that can be connected to a fluid inflow / outflow system, a suction system, a data and power supply, and / or an RF energy system.

[0048] The skilled reader will appreciate that these drapes are disposable. Preferably, the drapes are provided in a package for use with the system. The package can be of any suitable type for maintaining sterility.

[0049] Preferably, the drape is provided in a peelable sterile package so that when the package is peeled open, the drape therein remains sterile.

[0050] In embodiments in which the drape includes a rigid upper mount and a rigid lower mount, the package can also include one or more package chambers. The one or more package chambers can be configured to cover the rigid upper mount and the rigid lower mount, respectively, and the flexible sheath, so that the rigid upper mount and the rigid lower mount can be removed from the package separately, thereby reducing the risk of contamination.

[0051] Preferably, the instrument comprises a modular interface. The modular interface can comprise a plurality of drive elements configured to engage with corresponding drive elements of a modular end plate of the arm. The system can then control the arthroscopic instrument through rotation of the drive elements on the modular end plate.

[0052] The modular interface can comprise a plurality of electrical interface elements configured to engage with corresponding electrical elements of a modular end plate of the arm. The electrical elements can be used to power or communicate with the instrument (to and / or from the instrument).

[0053] The instrument can comprise internal cables interfacing to the gears of the drive elements and internal pulleys to bend and actuate the instrument.

[0054] The instrument can comprise an identifier to allow the system to identify the accessory. The identifier can comprise an RFID tag.

[0055] The instrument can comprise an arthroscopic camera.

[0056] The arthroscopic camera can be configured to capture images. The arthroscopic camera can be configured to transmit electrical signals back to the system in the form of real-time / streaming video images. The arthroscopic camera can comprise a light source powered by the robotic arm.

[0057] Preferably, the arthroscopic camera is configured to be inserted into the surgical site. In this regard, it is envisaged that the arthroscopic camera captures images of the surgical site from within the surgical site.

[0058] Preferably, a portion of the arthroscopic instrument is less than about 5mm in diameter. Preferably, the arthroscopic instrument is less than about 5mm in diameter at the portion of the arthroscopic instrument to be inserted into the surgical site. The arthroscopic instrument can be between about 1.9mm and 4.0mm in diameter. Similarly, the length of the instrument can be between about 90mm and 170mm.

[0059] The arthroscopic instrument can be in electronic communication with the controller of the system via one or more cables, wires, etc. More preferably, the surgical effector and the controller can be in wireless communication with the controller (e.g. via Bluetooth, near field communication (NFC), Wi-Fi, etc.).

[0060] The system can comprise a radio frequency (RF) energy generator configured to generate RF energy for use by one or more instruments.

[0061] Preferably, the system is configured to generate a depth map from images captured by the system. Preferably, the depth map is used to create a 3D video from images captured by a mono optical camera.

[0062] Preferably, depth data associated with the depth map is superimposed on the image data.

[0063] Preferably, the contour line is overlaid on the image data.

[0064] Preferably, the image is processed. The image can be processed to adjust or improve contrast, focus, white balance, and / or resolution.

[0065] The image can also be flipped, rotated, and / or scaled with or without user surgeon input. For example, the image can be automatically flipped, rotated, and / or scaled. Alternatively, the surgeon can rotate the image so that the surgeon works in a comfortable (e.g., upright) position regardless of the orientation of the surgical instrument.

[0066] In some embodiments, the image data is classified. One or more labels can be displayed in association with the classification.

[0067] Preferably, the system is configured to automatically identify “non-normal anatomy” and to label that “non-normal anatomy,” e.g., using image overlays, etc.

[0068] In some embodiments, training data from past cases is used to create recognition classifiers (e.g., by Haar classifiers or similar classifiers). These recognition classifiers can then be used to automatically classify the anatomy of a joint.

[0069] Preferably, the system includes a fluid management system. The fluid management system can be configured to regulate fluid, pressure, or temperature to the joint through the instrument or directly. The fluid can include saline.

[0070] For example, in the case of a cauterization or other heat-generating instrument, the fluid can be configured to prevent heat from dissipating into surrounding tissue.

[0071] One or more sensors, such as temperature sensors, can be provided on the instrument. Data from the sensors can be provided to the system.

[0072] The fluid management system can regulate flow rate based on data from the sensors.

[0073] The fluid management system can include a pump, pressure sensor, and control valve (e.g., pinch valve) to regulate pressure and flow of the instrument. The fluid management system can include one or more lines. In the case of multiple lines, each line can be independently regulated.

[0074] The fluid management system can be configured to automatically maintain temperature and pressure within certain thresholds.

[0075] The system can include a suction system for fluid egress and can be coupled to an external suction system that manages fluid suction and disposal.

[0076] The fluid management system can be configured to inflate a joint through which arthroscopic surgery is being performed.

[0077] Preferably, the inflation is achieved by adjusting fluid pressure and / or flow in the fluid management system. The pressure and / or flow can be adjusted at least partly in dependence on sensor data. The sensor data can comprise inflow pressure and / or outflow pressure. The system can be configured to use a model of the joint and / or the system to adjust the pressure and / or flow.

[0078] Preferably, the system is at least partly portable. The system can comprise a wheeled base. The wheeled base can be lockable in place.

[0079] Preferably, the frame is supported in an elevated position by articulable arms extending upwardly from the wheeled base.

[0080] In some embodiments, the surgical system comprises storage locations for storing ancillary items, wiring and other infrastructure and / or consumables.

[0081] Preferably, the storage locations are at the base of the robot. The storage locations can also comprise shelves, drawers or similar compartments to assist with inventorying. The storage locations are lockable.

[0082] Preferably, the storage locations store suction pumps, regulators, fluid collectors and the like. In this regard, the storage locations can house part of the fluid management system.

[0083] In some embodiments, the base comprises a locking mechanism for locking the base in place. The locking mechanism can be, for example, a foot pedal. It is envisaged that the base can first be wheeled into position and locked in place using the locking mechanism. Advantageously, this can prevent accidental movement of the base during surgery, and hence accidental movement of arthroscopic instruments, such as by collision by the surgeon or other medical professional, or by accidental movement due to environmental factors such as an earthquake.

[0084] As outlined, consumables can be placed in the storage locations. Preferably, the consumables comprise a readable identifier, such as a serial number, barcode or QR code. The readable identifier can be read by the system. Preferably, the readable identifier can be read by a reader. Preferably, the reader is associated with a modular end plate on the robotic arm.

[0085] It is envisaged that the reader can detect whether the consumable is a genuine consumable associated with the system. In the event that a non-genuine consumable is detected, the system can restrict use.

[0086] Preferably, use of the consumable is recorded. This use can be recorded by operation of the system, that is to say, the use can be recorded as the system is running. Alternatively, the use can be recorded when the reader associated with the modular end plate reads the consumable.

[0087] Advantageously, recording the use of consumables can enable the system to identify consumable inventory levels. The system can be configured to access the internet to automatically order consumables.

[0088] The order interface displays the consumable order and requires the user and / or hospital procurement department to confirm the consumable order before placing the order. Preferably, however, the order interface is separate from the user interface used to remotely control the arthroscopic surgical robot.

[0089] In alternative embodiments, the system can be configured to generate a report summarizing consumable inventory levels for consideration by the user and / or hospital procurement department.

[0090] Preferably, the system is configured to generate a map to display the relative positioning of the instruments. Preferably, the map includes the relative position of the patient.

[0091] Preferably, the system includes a head-mounted device. Preferably, the system includes one or more controllers. The surgeon can interact with the one or more controllers to control the instruments to perform the surgery.

[0092] Preferably, image data from the arthroscopic camera is displayed on the head-mounted device.

[0093] Preferably, the controllers are configured to control the operation and movement of the camera and the instruments.

[0094] In some embodiments, the system can be configured to generate haptic signals through the controllers.

[0095] The haptic signals can be generated in accordance with data from the system and can correspond to warnings, confirmations, or any other suitable information.

[0096] Preferably, the system includes a console including a display and one or more user input devices to enable a user to interact with the system. The user input devices can be in the form of joystick controllers and / or a keyboard.

[0097] The system can include a central controller to control various aspects of the system. The central controller can include one or more processors, and memory coupled to the processors, the memory including various instruction codes to perform the functions of the system.

[0098] In another form, the present invention is directed primarily to a surgical system including: one or more surgical arms, each surgical arm including a surgical instrument; an intraoperative fluid management system associated with at least one of the one or more surgical arms and / or surgical instruments; wherein the one or more surgical arms and associated surgical instruments are remotely controllable to perform an arthroscopic surgery.

[0099] The fluid management system can include one or more pumps and valves to regulate fluid pressure and / or flow. The one or more pumps can include a series of pumps. The valves can include compression valves.

[0100] The fluid management system can be configured to regulate fluid flow, pressure, or temperature to the body through the instrument or directly. The fluid can include saline.

[0101] The fluid can be configured to prevent heat loss into surrounding tissue, for example in the case of a cautery or other heat generating instrument.

[0102] One or more sensors, such as temperature sensors, can be provided on the instrument. Data from the sensors can be provided to the fluid management system.

[0103] The fluid management system can regulate flow rate based on data from the sensors.

[0104] The fluid management system can regulate pressure and flow of the instrument. The fluid management system can include one or more lines. In the case of multiple lines, each line can be independently regulated.

[0105] The fluid management system can be configured to automatically ensure that temperature and pressure are maintained within certain thresholds.

[0106] In yet another form, the present invention is generally directed to a surgical drape for mounting to a target during a surgical procedure, the surgical drape comprising: a shield configured to at least partially cover the target; and at least one tube for delivering fluid to or from the patient during the procedure.

[0107] Preferably, the drape is configured to mount to a remotely controllable surgical arm of a surgical system. The drape can extend over the surgical arm.

[0108] Preferably, the shield is flexible.

[0109] The drape can further comprise a rigid upper mount and a rigid lower mount, wherein the shield extends between the rigid upper mount and the rigid lower mount. The rigid upper mount and the rigid lower mount can comprise apertures through which connectors of the arm and / or instrument extend.

[0110] Preferably, the flexible shield provides a continuous tube between the apertures of the rigid upper mount and the rigid lower mount.

[0111] The rigid upper mount can be adapted to be received between the frame and the surgical arm, and the rigid lower mount can be adapted to be received between the arm and the surgical instrument.

[0112] Preferably, the tubes of the at least one tube are configured to deliver intraoperative fluid. The intraoperative fluid can comprise saline.

[0113] In another form, the present invention is directed primarily to an arthroscopic instrument comprising: a shaft comprising a distal end configured to enter a joint during a procedure; and an articulable joint located near a tip of the shaft at the distal end, the articulable joint configured to enable the tip of the shaft to change pose.

[0114] Preferably, the articulable joint comprises a pivot joint. Preferably, the articulable joint comprises a rotational joint. The articulable joint can comprise a pivot joint and a rotational joint.

[0115] Preferably, the rotational joint is a ball and socket joint. The ball can be at least partially contained in one end of the surgical arm. Preferably, the ball is rotatably fixed in place, with an end cap extending partially over the ball at an opposite end of the surgical arm. A support can extend between the end cap and the surgical arm to hold the ball in place. Preferably, the support is generally elongate.

[0116] Preferably, the support is resilient such that the support can move to enable the ball contained therein to move. In this regard, the support can be made of an elastomeric polymer.

[0117] In some embodiments, the support comprises two or more support members. In some such embodiments, a first support member and a second support member can be associated by their respective ends or the like.

[0118] The arthroscopic instrument can comprise one or more cables configured to cause movement of the articulable joint. The cables can be coupled to one or more pulleys.

[0119] Preferably, the cables extend along the length of the shaft. Preferably, the cables extend inside the shaft.

[0120] The arthroscopic instrument can comprise one or more drive elements coupled to the one or more cables. Preferably, rotation of the one or more drive elements can cause translation of the one or more cables in the shaft. Preferably, the drive elements are located at or near the proximal end of the shaft.

[0121] Preferably, the instrument comprises a modular coupling. The modular coupling can comprise a plurality of drive elements. The modular coupling can comprise a plurality of electrical coupling elements.

[0122] The instrument can comprise a marker to identify the instrument. The marker can comprise an RFID marker.

[0123] In another form, the present invention is directed primarily to a surgical camera comprising: a reusable base comprising an interface for providing images from the camera; and a disposable distal portion releasably coupled to and extending outwardly from the reusable base.

[0124] Preferably, the disposable distal portion is at least partially configured to enter the patient's body during surgery. In one embodiment, the camera is an arthroscopic camera. At least a portion of the distal portion is configured to enter a joint during surgery.

[0125] Preferably, the disposable distal portion comprises an image sensor. Preferably, the disposable distal portion comprises one or more articulable joints.

[0126] Preferably, the reusable base and the disposable distal portion are electrically coupled. Preferably, the reusable base and the disposable distal portion are mechanically coupled. The reusable base and the disposable distal portion can be mechanically coupled by one or more drive members, such as a cog or a gear.

[0127] The disposable distal portion can be single-use. The disposable distal portion can be multi-use.

[0128] In other embodiments, the camera can comprise a disposable cover at least at its distal portion.

[0129] In another form, the present invention is directed to a surgical system comprising: a camera configured to capture images during surgery; and a processor configured to generate depth data from the captured images.

[0130] The camera can comprise a single optical camera. The camera can be configured to enter the patient's body during use, i.e. during operation.

[0131] Preferably, the system is further configured to overlay the depth data or a derivative thereof on one or more of the captured images for display. The system can be configured to overlay a depth cue, such as an outline, on the images.

[0132] The system can be configured to overlay operational information and / or device information. As illustrative examples, the system can be configured to overlay pre-operative planning information, runtime data (such as distance or angle), system performance information (such as instrument load), availability information, or any other suitable and relevant information.

[0133] The system can comprise a display on which the captured images with the overlaid depth data or a derivative thereof are displayed. The display can be configured to display the overlaid images in real-time or near real-time.

[0134] The system can comprise a surgical instrument on which the camera is disposed. The camera can comprise an arthroscopic camera.

[0135] The camera can be configured to capture video as the camera moves relative to the patient. The depth data can be generated at least in part from differences between images captured by the camera at different points in time.

[0136] The system can include a dedicated camera control unit (CCU) for managing camera signals and controlling camera sensors. Various image processing functions can be performed using the CCU.

[0137] The camera can include an LED light source associated therewith to illuminate the area being captured. The LED light source can be adjustable and can be associated with the tip of the camera.

[0138] The light source can be located within the camera. Preferably, the light source is positioned in the vicinity of the camera. Most preferably, the light source is positioned in the vicinity of the camera and can be associated with the surgical arm on which the camera is mounted.

[0139] In alternative embodiments, the light source is mounted separately from the camera. Preferably, the light source is mounted on a movable member associated with the surgical arm on which the camera is mounted. Advantageously, this can enable the camera to be oriented separately to illuminate the field of view of the camera without casting shadows or obstructing the surgical site.

[0140] In another form, the present invention primarily relates to an arthroscopic surgical system comprising: an arthroscopic camera configured to capture images during a surgical procedure; and a head-mounted device configured to display the captured images.

[0141] The head-mounted device can be configured to display three-dimensional images. The three-dimensional images can comprise stereoscopic images. The stereoscopic images can be generated from monaural images from the arthroscopic camera.

[0142] The arthroscopic surgical system can include a controller through which a surgeon can interact.

[0143] In another form, the present invention primarily relates to an arthroscopic surgical system comprising: one or more surgical arms each comprising an associated arthroscopic instrument; and a hand-held controller comprising more than three degrees of freedom; wherein the one or more surgical arms and associated arthroscopic instruments are remotely controllable by the hand-held controller to perform an arthroscopic surgical procedure.

[0144] The hand-held controller can comprise one or more joysticks.

[0145] Within the scope of the present invention, any feature herein can be combined with any one or more of the other features herein in any combination.

[0146] The reference in this specification to any prior publication is not, and should not be taken as, an acknowledgment or any form of suggestion that this prior publication forms part of the common general knowledge. BRIEF DESCRIPTION OF DRAWINGS

[0147] Various embodiments of the present invention will be described with reference to the following drawings, in which: Figure 1 An arthroscopic surgical system according to an embodiment of the application is shown.

[0148] Figure 2 An arthroscopic grasper according to an embodiment of the application is shown in the form of Figure 1 a side view of an arthroscopic instrument of the system of

[0149] Figure 3a An arthroscopic camera according to an embodiment of the application is shown in the form of Figure 1 a side view of an arthroscopic instrument of the system of

[0150] Figure 3b A side view of an arthroscopic instrument of the system of Figure 3a in a split configuration according to an embodiment of the application is shown.

[0151] Figure 4 A side view of an articulatable joint of the system of Figure 1 according to an embodiment of the application is shown.

[0152] Figure 5a A perspective view of a sterile drape of the system of Figure 1 according to an embodiment of the application is shown.

[0153] Figure 5b A simplified side view of a sterile drape of the system of Figure 5a according to an embodiment of the application is shown.

[0154] Figure 6 A simplified view of an end plate of the system of Figure 1 according to an embodiment of the application is shown.

[0155] Figure 7a A perspective view of an end plate of an arthroscopic instrument of the system of Figure 1 according to an embodiment of the application is shown.

[0156] Figure 7b A perspective view of an attachment portion of an arthroscopic instrument of the system of Figure 1 according to an embodiment of the application is shown.

[0157] Figure 7c An exploded view of an end plate of the system of Figure 7a and Figure 7b and an attachment portion according to an embodiment of the application is shown.

[0158] Figure 8a A screenshot of a camera image of the system of Figure 1 is shown without any image overlay.

[0159] Figure 8b A screenshot of a camera image of the system of Figure 1a screenshot of a camera image of the system of

[0160] Figure 9 a screenshot of a screen of the system of Figure 1 four different image screens (i.e. images viewed by the surgeon during the procedure).

[0161] Figure 10 a perspective view of a portion of an arthroscopic surgical system according to another embodiment of the application.

[0162] Figure 11 a screenshot of a screen of an arthroscopic surgical system according to an embodiment of the application.

[0163] Figure 12 a top perspective view of an attachment portion of the system of Figure 1

[0164] a handle for connecting to the attachment portion of the system of Figure 13 Figure 12 a rear view of an arthroscopic instrument of the system of Figure 1

[0165] a side view of an arm of an arthroscopic instrument of the system of Figure 14 Figure 1 a side view of a frame of an arthroscopic surgical system according to an embodiment of the application.

[0166] Figure 15 Figure 1 a magnified side view of a portion of the frame of

[0167] Figure 16 a magnified side view of a portion of the frame of Figure 15

[0168] The preferred features, embodiments and variations of the application can be seen from the following detailed description, which provides sufficient information for those skilled in the art to perform the application. The detailed description should not be regarded as limiting the scope of the aforementioned in any way. DETAILED DESCRIPTION

[0169] Embodiments of arthroscopic surgical methods and systems are described below that simplify arthroscopic surgery, thereby reducing the likelihood of injury from the procedure itself. Furthermore, because these methods and systems are easier to use than traditional arthroscopic instruments, barriers to entry into arthroscopic examination are reduced.

[0170] Figure 1 An arthroscopic surgical system 100 according to an embodiment of the application is shown.​​​​

[0171] The arthroscopic surgical system 100 is portable and includes a wheeled base 105 that can be moved to a desired location in the operating room and locked in place. In use, the wheeled base 105 will be moved to a position adjacent to a patient 110 on an operating table 115, ready for surgery, and locked in place prior to and during the performance of surgery using the system 100.

[0172] The system 100 includes a rigid frame 120 supported in an elevated position by articulable arms 125 that extend upwardly from the base 105. The frame 120 includes a plurality of surgical arms 130, each of which includes a plurality of remotely operable arthroscopic instruments 135, as outlined in further detail below.

[0173] The system 100 is used for arthroscopic surgery, i.e. surgery on a joint such as an ankle, knee, hip, spine, shoulder, elbow or wrist. In use, after the wheeled base 105 is locked in place, the frame 120 is positioned above the joint of the patient 110 to be operated on. The frame 120 extends laterally above the patient, which enables the surgical arms 130 and arthroscopic instruments 135 to be operated from different sides of the joint, whilst having a common reference point through the rigid frame 120.

[0174] The system 100 includes a head-mounted device 140 and a controller 145 that can be operated by a surgeon 150 to remotely control the surgical arms 130 and arthroscopic instruments 135. In particular, the arthroscopic instruments 135 include arthroscopic cameras and instruments such as cutters and graspers.

[0175] The controller 145 has more than three degrees of freedom (e.g. up / down, left / right and forward / back). In a preferred embodiment, the controller 145 has at least 6 degrees of freedom. The degrees of freedom can be provided by movement of the controller itself and / or interaction with components thereof.

[0176] Image data from the arthroscopic cameras is processed and displayed to the surgeon 150 on the head-mounted device 140, which controls the operation and movement of the cameras and instruments 135. Thus, the head-mounted device 140 and controller 145 can work like a virtual reality (VR) system.

[0177] The head-mounted device 140 can be configured to display three-dimensional images, such as stereoscopic images, which can be generated from depth data estimated from the images.

[0178] The system 100 can be configured to generate haptic signals through the controller 145 to assist the surgeon 150. The haptic signals can be generated from data from the system 100 and can correspond to warnings, confirmations or any other suitable information.

[0179] Similarly, the system 100 can be configured to generate and display a position map on the head mounted device 140 to show the relative positions of the instruments 135 and the patient 110. The system 100 can allow the surgeon 150 to zoom in and out and rotate the model, enabling the surgeon 150 to operate from various angles in a conventional (e.g. upright) position.

[0180] The system 100 also includes a console 155, which includes a display 160 and user input devices in the form of a joystick controller 165 and a keyboard 170. The console 155 can be used to perform the surgery, or to adjust the parameters of the system 100 in smaller volumes prior to surgery, to input patient details, and / or to assist the surgeon 150 during surgery. Preferably, the head mounted device 140 and the console 155 are arranged to operate in parallel.

[0181] However, those skilled in the art will readily appreciate that any number and type of suitable user interface can be used. As an illustrative example, the console 155 can be used by the surgeon 150, rather than the head mounted device 140 and the controller 145.

[0182] As outlined above, arthroscopic surgery typically requires the use of multiple entry positions. The surgical arms 130 and arthroscopic instruments 135 can therefore be positioned on the frame 120 such that the surgical arms and arthroscopic instruments can be positioned on various sides of the joint being operated on.

[0183] The frame 120 is typically wide and extends laterally in two dimensions. In one embodiment, as outlined in further detail below, the frame 120 is annular and the surgical arms 130 are positionable around the frame.

[0184] In some embodiments, the surgical arms 130 are positionable in a plurality of predetermined positions around the frame 120. In other embodiments, the surgical arms 130 are movable relative to the frame, for example by actuators, drive assemblies, etc., for example based on user input.

[0185] The surgical arms 130 themselves are then able to articulate to a variety of different positions according to user input. In some embodiments, the arms 130 comprise a robotic wrist having at least one horizontal pivot and two vertical pivots, providing 8 degrees of freedom. The arms 130 can be configured to bend at their ends to enable the "pose" of the instrument end to be changed.

[0186] This configuration enables the arthroscopic instruments 135 to move in all Cartesian directions and rotate about all planes to access the joint from the required angle.

[0187] Although Figure 1The system 100 is shown with three surgical arms 130, but arms 130 can be added and removed as needed. Thus, the skilled audience will readily appreciate that any suitable number of arms can be used.

[0188] The arthroscopic instruments 135 are coupled to the arms 130 through modular end plates. The modular end plates include a plurality of motors (e.g., 3 motors) to drive various aspects of the arthroscopic instruments 135, and a plurality of electrical contacts to power, control, and / or communicate with the arthroscopic instruments 135. This configuration enables various arthroscopic instruments 135 to be used with the system 100 in a modular fashion without requiring modification of the arms 130.

[0189] While motors (mechanical control) and electrical contacts (electronic control) are described, those skilled in the art will readily appreciate that some components can be purely mechanical and / or electronic.

[0190] Figure 2 A side view of an arthroscopic instrument 200 in the form of an arthroscopic grasper according to embodiments of the application is shown. The instrument 200 can be similar or identical to one of the arthroscopic instruments 135 of the system 100. Figure 1 A side view of an arthroscopic instrument 300 in the form of an arthroscopic camera according to embodiments of the application is shown. The instrument 300 can be similar or identical to one of the arthroscopic instruments 135 of the system 100.

[0191] The arthroscopic instrument 200 includes a plurality of drive elements 205 that are configured to interface with corresponding drive elements of the modular end plates of the arms 130, such that the system 100 can control the arthroscopic instrument 200 through rotation of the drive elements on the modular end plates.

[0192] The instrument 200 includes internal cables that interface to the gears of the drive elements 205 and internal pulleys to bend and actuate the instrument 200. Two drive element 205 / cable can be used to control bending of the instrument 200 (i.e., relative motion of the components 210 about a joint), and a third drive element cable can be used to control the grasper 215 at the tip of the instrument 200. While not shown, the cables can bend the instrument 200 through internal pulleys, etc.

[0193] A joint is located at the distal end of the instrument 200 to allow the instrument to change "pose" in the joint and work through new methods. This enables the instrument 200 to work in areas that would otherwise be inaccessible.

[0194] The joint can include a pivot joint and a rotational joint, enabling the tip to bend in any direction with only two cables.

[0195] Figure 3a A side view of an arthroscopic instrument 300 in the form of an arthroscopic camera according to embodiments of the application is shown. The instrument 300 can be similar or identical to one of the arthroscopic instruments 135 of the system 100. Figure 1 A side view of an arthroscopic instrument 300 in the form of an arthroscopic camera according to embodiments of the application is shown. The instrument 300 can be similar or identical to one of the arthroscopic instruments 135 of the system 100.

[0196] Similarly, the instrument 300 includes internal cables that are coupled to the gears of the drive elements 205 and internal pulleys to bend and actuate the instrument 300. However, instead of a punch, the tip includes a camera 315.

[0197] The camera 315 is coupled to a plurality of electrical contacts 320 such that, in use, the camera 315 is electrically coupled to the system to power the camera 315 and to send electrical signals back to the system in the form of real-time / streamed video images.

[0198] The instrument 300 includes a reusable portion and a base.

[0199] Figure 3b A side view of an arthroscopic instrument 300 in a disassembled configuration according to an embodiment of the application is shown. In particular, the instrument includes a reusable base 300a that includes an interface for providing images from a camera and a disposable distal portion 300b that is releasably coupled to and extends outwardly from the reusable base 300a.

[0200] The disposable distal portion 300b is configured to at least partially enter a patient's body and is preferably provided in a sterile form (e.g., in a sterile package). The reusable base 300a does not enter the patient's body and can be draped, thus not requiring sterility.

[0201] The disposable distal portion 300b and the reusable base 300a are electrically and mechanically coupled when connected. A mechanical and electrical interface 325 is disposed between the disposable distal portion and the reusable base and can include electrical contacts and mechanical drive members, such as cogs or gears, to move cables therein.

[0202] The reusable base 300a includes a camera control unit in addition to the interface, which can include a Bluetooth or similar interface.

[0203] This configuration is less expensive than a fully disposable surgical camera because the relatively expensive CCU and data interface can be reused and the need to clean and sterilize parts is mitigated, as with a fully reusable surgical camera.

[0204] The modular end plate includes powered drive elements and electrical contacts in the same predetermined locations. The arthroscopic instrument 135 can then use any one or more of these powered drive elements and / or electrical contacts as needed. As an illustrative example, a fixed camera used only for gross positioning of a patient can not be coupled to any drive elements. Similarly, the modular end plate can include fluid in / out, suction, and RF power connections.

[0205] While the above instruments are shown, those skilled in the art will readily understand that various instruments can be used due to the modular nature of the system 100. In general, however, the arthroscopic instrument 135 will have a diameter of less than about 5 mm, more typically even smaller (e.g., between 1.9 mm and 4.0 mm in diameter). Similarly, the length of the instrument can be between about 90 mm and 170 mm.

[0206] The instrument 135 can be curved, or be able to be passively bent or bent by active bending, as outlined above.

[0207] Similarly, the instrument 135 can include internal functionality, such as a processor, gearbox, etc., to assist in the operation of the instrument. As an illustrative example, an arthroscopic shaver can be coupled to the modular end plate through an intermediate gearbox. Similarly, the instrument can include an identifier, such as an RFID identifier, to enable the instrument to be identified.

[0208] The instrument 135 can be coupled to a fluid management system to provide irrigation and regulated pressure, flow, and to prevent heat loss into surrounding tissue, for example, in the case of a cauterizing or other heat generating instrument.

[0209] In some embodiments, in addition to performing a function during a procedure, the arthroscopic instrument 135 includes sensors, such as temperature sensors, and provides data from the sensors to the system 100 through the modular end plate. These data can then be used to control the system, such as a fluid management system, as outlined below.

[0210] Regardless of whether the instrument 135 is a disposable instrument or an instrument that can be reused after sterilization, the instrument is generally sterile. It is impractical to sterilize the arm 130. Thus, a disposable sterile drape is placed over the arm.

[0211] Figure 4 A side view of an articulable joint 400 of an arthroscopic instrument of the system 100 is shown.

[0212] The articulable joint 400 is associated with the moving component 210 and forms an end of the surgical arm 130 to which the arthroscopic instrument 135 is attached.

[0213] The articulable joint 400 includes a sheath 410 that includes a first end that fits around the end of the moving component 210 and a second end that houses a ball 420. The ball engages with an end cap 405 and enables rotational movement of the end cap 405 relative to the moving component 210. Various elements can then be attached to the end cap 405 to perform different functions.

[0214] The end cap 405 is secured over a portion of the ball 420 by a support 425. The support 425 is positioned away from the ball 420 such that the support does not interfere with the rotational movement of the ball 420. The articulatable joint 400 provides an alternative way of providing movement to the instrument, instead of the pulley / cable system described above.

[0215] As outlined above, the system 100 can include a sterile drape on the arm 130.

[0216] Figure 5a A perspective view of a sterile drape 500a of the system 100 according to embodiments of the application is shown.

[0217] The drape 500a includes a rigid upper mount 505 and a rigid lower mount 510, and a flexible sheath 515 extending between the rigid upper mount and the rigid lower mount.

[0218] The rigid upper mount 505 is adapted to be received between the frame 120 and the arm 130 (i.e. at the arm mount on the frame 120), and the rigid lower mount 510 is adapted to be received between the arm 130 and the arthroscopic instrument 135 (i.e. at the modular end plate).

[0219] In particular, the rigid upper mount 505 and the rigid lower mount 510 include apertures 510a through which connectors of the arm 130 and the instrument 135 extend. The flexible sheath 515 provides a continuous tube between the apertures 510a of the rigid upper mount 505 and the rigid lower mount 510, thereby encasing a substantial portion of the arm 130, and thus providing a sterile outer surface of the arm.

[0220] In some embodiments, the drape can include tubes that can be connected to a fluid inflow / outflow system, a suction system, and / or an RF energy system, as described below.

[0221] Figure 5b A simplified side view of a sterile drape 500b according to embodiments of the application is shown. The drape 500b can be similar to the drape 500a, but includes an internal tube 520.

[0222] The internal tube 520 is used to deliver fluid to or from a patient during a procedure. The fluid can include saline or another intra-operative fluid. However, those skilled in the art will readily appreciate that several tubes can be provided for various purposes, including suction tubes, and tubes that are not necessarily used for fluid delivery, such as tubes containing electrical wires.

[0223] The inner tube 520 extends between the rigid upper mount 505 and the rigid lower mount 510, and the interface of the tube 520 is provided at the rigid upper mount 505 and the rigid lower mount 510. In some embodiments, the rigid upper mount 505 and the rigid lower mount 510 are provided to align with the respective ports of the system 100 to simplify installation of the tube. As an illustrative example, the upper mount 505 and the lower mount 510 can include a locking mechanism configured to lock the upper mount and the lower mount in place.

[0224] As outlined above, the surgical arm 130 includes a modular end plate to which the arthroscopic instrument 135 is coupled.

[0225] Figure 6 A simplified view of the modular end plate 600 of the system 100 according to an embodiment of the application is shown.

[0226] The modular end plate 600 is coupled to the surgical arm 130 by an attachment portion 605, which includes various mounting interfaces. The modular end plate 600 becomes the distal end of the surgical arm 130.

[0227] The modular end plate 600 includes a plurality of drive elements 610, which are configured to engage and drive corresponding drive elements of the arthroscopic instrument 135. While three drive elements 610 are shown, those skilled in the art will readily understand that any number of drive elements can be used.

[0228] Similarly, the modular end plate 600 includes electrical connectors 615, which are configured to engage corresponding electrical connectors of the arthroscopic instrument 135.

[0229] A drape connection 620 is provided near the drive elements 610 and the electrical connectors 615 to enable a drape to be coupled to the end of the surgical arm to cover the surgical arm 130.

[0230] A plurality of interface buttons are then provided to enable a person to interact with the modular end plate, as outlined below.

[0231] Initially, a manual override button 625 is provided to enable a user to manually override movement of the surgical arm 130. A plurality of manual control buttons 630 are then provided, including an up button, a down button, a pitch up swing button, and a pitch down swing button. Such buttons are particularly useful for coarse movement of the arm.

[0232] A "save position" button 635 is provided to enable the system to save a position of the arm 130. That position can then be later reused, or saved for record keeping purposes.

[0233] A "primary action" button 640 is provided to perform one or more primary action functions.

[0234] Finally, a 9-way directional key 645 is provided to enable fine movement of the arm. The 9-way directional key 645 includes forward, backward, left, and right, as well as diagonal directions between the directions. The center portion of the directional key 645 can be pressed to provide alternative functions to the above functions. These functions can move the arm left, right, forward, and backward, as well as left offset, right offset, left scroll, and right scroll. In addition, up, down, pitch up swing, and pitch down swing can be provided.

[0235] However, those skilled in the art will readily appreciate that any suitable interface can be used to provide these functions.

[0236] Now returning to Figure 1 The system 100 includes a fluid management system 175 for regulating the flow of fluid (e.g., saline) that is directed to the joint through the instrument 135 and thus into the joint. The fluid management system 175 includes a pump, pressure sensors, and control valves (e.g., pinch valves) to regulate the pressure and flow rate to the instrument. The fluid management system 175 can include one or more lines, in the case of multiple lines, each line can be independently regulated.

[0237] During a surgical procedure, the joint is typically sensitive to thermal changes and fluid pressure. For example, when using an ablation wand or a rotating knife / shaver, the temperature, flow, and pressure within the joint will almost always change. Temperatures above 50 degrees can relate to the death of chondrocytes, and high fluid pressure can relate to swelling, compartment syndrome, and limb risk. Likewise, changes in flow can collapse the joint, causing collisions between the joint surface and the instrument.

[0238] Accordingly, the fluid management system can be configured to ensure that the temperature and pressure remain within certain thresholds.

[0239] The system 100 also includes a suction system 180 for fluid flow out and can be coupled to an external suction system that manages the fluid suction and disposal.

[0240] As outlined above, the instrument 135 includes sensors. In some embodiments, the fluid management system 175 utilizes data from the sensors to regulate joint temperature, pressure, and visibility by regulating operating pressure and / or flow rate.

[0241] In preferred embodiments, the fluid management system 175 includes one or more peristaltic pumps. A sterile saline bag is coupled to the fluid management system 175 and pre-primed the system prior to use. The suction channel operates in a similar fashion but either drains into a suction container or connects to a waste port, such as a wall suction port in the operating room.

[0242] The fluid management system 175 and the suction system 180 are disposed within the articulable arm 125 to avoid or reduce the number of external hoses.

[0243] Finally, the system 100 includes a radio frequency (RF) energy generator 185 that coordinates and controls the generation of RF energy for use by one or more instruments 135.

[0244] The RF energy generator 185 is a modular component of the system 100, and thus can be installed when needed, and replaced with a similar or different system.

[0245] The RF energy generator is used to generate RF signals on the instruments 135 for radio frequency ablation (RFA). The RF signals are coupled to the instruments 135 through internal wiring in the arm 125.

[0246] The system 100 can include various other modules coupled thereto as needed.

[0247] While not shown, the system 100 includes a central controller to control various aspects of the system. The central controller can include one or more processors, and memory coupled to the processors, the memory including various instruction codes to perform system functions.

[0248] Thus, the central controller can control movement and operation of the instruments 135, receive data related to the procedure (e.g., joint temperature and pressure), system data (e.g., pump pressure, flow rate), and provide coordinated control of various components.

[0249] As an illustrative example, in the case of using an RF wand, the system can control the fluid irrigation rate and RF energy generation according to temperature data related to the joint to avoid tissue damage.

[0250] As outlined above, the system 100 includes a camera for capturing image data inside the joint. Due to the limited size of the instruments 135, the camera is a monoscopic camera.

[0251] One problem with conventional monoscopic camera systems is that it is difficult to perceive depth in such systems, which can lead to misinterpretation of the image data, which is obviously undesirable.

[0252] In some embodiments, the image data from the camera is used to create a depth map, and 3D video from a 2D source is overlaid on the image along with contour lines and / or depth data (or derivatives thereof).

[0253] In one embodiment, multiple images from regions of different points are processed together to create a depth map. As the instrument 135 is moved slowly in a deliberate manner, images of the joint can be captured from slightly different angles as the instrument passes through the joint. Since the patient / joint is generally static, these images can be used together to create a depth map even though they are captured at slightly different points in time.

[0254] To this end, several different algorithms can be used, but generally based on geometry and differences between images from slightly different angles. In short, common points are identified in the images and the relative translation of these points between images is used to estimate depth.

[0255] As outlined above, the arthroscopic instrument 135 is coupled to the surgical arm 130 by a modular end plate. Figure 7a An end plate 700 for an arthroscopic system 100 is shown. Figure 7b An attachment portion of the modular end plate 700 for an arthroscopic instrument of the system 100 is shown. Figure 7c An exploded view of the end plate 700 and Figure 7a the attachment portion is shown. Figure 7b An exploded view of the end plate 700 and

[0256] The end plate 700 comprises a receiving portion 705 for receiving an attachment portion 705a. Three motors 710a are received in respective motor couplers 710. As Figure 7c shown, a fixation plate 715 is positioned over the three motors 710a and respective motor couplers 710 to secure the motors 710 in place. A connection device 720 is configured to be received in a connection device 720a, thereby connecting the end plate and the attachment portion. Preferably as Figure 7b shown, the attachment portion comprises struts 725 that provide support.

[0257] As Figure 7c shown, a retaining clip 730 is secured to the attachment portion. The retaining clip 730 is configured to retain a portion of the flexible drape 515 to the attachment portion to maintain the sterility of the arthroscopic instrument 135 and the surgical field.

[0258] Figure 8a A screenshot 800a of a camera image of the system 100 is shown, without any image overlay. As can be seen from the image, it is difficult to perceive depth, especially on relatively smooth surfaces.

[0259] Figure 8b A screenshot 800b of a camera image from the system 100 is shown, with an outline 805 overlaid on the image.

[0260] The contour line 805 is superimposed onto the image using a sequence of points that can be color coded. However, using points is just one example of displaying the contour line, and those skilled in the art will readily appreciate that solid lines can be used instead.

[0261] In other embodiments, shading, coloring, and the like can be used to represent depth and / or distance in the image. Alternatively, the image can be marked with depth cues in various ways.

[0262] In addition to creating a depth map, the image can be processed in various ways before being presented to the user.

[0263] As an illustrative example, the image can be flipped and / or scaled to provide a more intuitive user experience. In this case, the image can be flipped and / or scaled instead of operating based on the inverse view, thereby providing a consistent working environment for the surgeon.

[0264] Similarly, image processing can be used to improve image quality, such as improving contrast, focus, white balance, resolution. Since the movement of the camera is carefully controlled, the use of super-resolution techniques can be simplified, and multiple images can be enhanced to produce images with higher resolution than the camera itself.

[0265] In some embodiments, the image data can be classified during use. This classification can be performed manually and / or automatically using artificial intelligence (AI).

[0266] In one embodiment, training data from past cases is used to create recognition classifiers (e.g. by Haar classifiers or similar classifiers). These recognition classifiers can then be used to automatically classify the anatomy of the joint.

[0267] In one embodiment, the system is configured to automatically identify “abnormal anatomy” and label it using classifiers, image overlays, and the like.

[0268] Figure 9 A screenshot 900 is shown that includes four different image screens of the system 100 (i.e. the images viewed by the surgeon during surgery), according to embodiments of the present application.

[0269] The top left image includes a region labeled with a bounding box 905 and an associated label indicating “regressive changes”. As outlined above, the system can use recognition classifiers to automatically identify this anatomy.

[0270] The top right image does not include any boxes or labels, thus illustrating a case where no “abnormal anatomy” was identified.

[0271] The bottom left image includes multiple bounding box elements 905, each with a different label.

[0272] Finally, the bottom right image includes a single bounding box element 905 with an associated label.

[0273] Those skilled in the art will readily understand that anything can be identified using such a classifier, including normal anatomical structures as well as aspects unrelated to anatomy (e.g. equipment).

[0274] As outlined above, in addition to the above-described manual control of the instruments, the system 100 can also include one or more automated functions to assist the surgeon in performing the procedure.

[0275] As an illustrative example, the system 100 can perform automated tracking of the first instrument 135 with a second instrument 135. In this case, the first and second instruments can operate in a "master-slave" type arrangement, where movement of the master instrument causes the slave instrument to follow.

[0276] Similarly, the system 100 can automatically move one or more instruments 135 according to a desired target or path. The instruments 135 can move according to a desired position and use image recognition-based object avoidance. Alternatively, the instruments 135 can simply follow the path taken by another instrument 135.

[0277] Similarly, the system 100 can perform automated implementation of one or more procedures, such as milling. As an illustrative example, the surgeon can select one or more areas on which to perform a task or function. Parameters can also be defined for the task or function.

[0278] In one embodiment, the area can be selected by defining a bounding box using the user interface. A milling operation can then be selected for the area, which is automatically performed on the area.

[0279] The task or function can include a repetitive task (loop), or an operation of multiple sub-tasks. The repetitive or sub-task operation can be performed without further interaction by the surgeon.

[0280] The task or function can be performed by sending motion data to the arms in a particular order, or by setting parameters and initiating functions on the system.

[0281] The system 100 can also be configured to monitor tasks performed by the surgeon and perform the task at a later time. In this case, the system can monitor position, vision, environmental, and operational data to train an AI program to automatically perform the tasks.

[0282] Further, the system 100 can monitor operational and instrument data to create inventory adjustments, place purchase orders, and support logistics.

[0283] As outlined above, the framework enables precise relative positioning of the instruments 135, even if different portals are used. In some embodiments, the surgeon can use a graphical user interface to view the relative positions of the instruments relative to each other.

[0284] The graphical user interface can show a portion of the patient and show the positions of the instruments relative to each other and to the patient. This configuration enables the surgeon to quickly understand the positions of the various instruments during the procedure.

[0285] In some embodiments, image data is captured of the patient’s external anatomy. This can be performed using a camera associated with the framework. This image data can then be used to identify the position of the patient relative to the system 100.

[0286] In some embodiments, a mark or indicia can be made on the patient and then the system can identify the mark or indicia for use as a reference point. As an illustrative example, a mark on the patient identified using the system can be used to identify a portal position.

[0287] Movement of the arms 130 can be controlled and coordinated in any suitable manner. In some embodiments, control of the arms is performed using forward kinematics and / or inverse kinematics.

[0288] As outlined above, the system 100 is modular and can use a variety of different arms and instruments as needed. In some embodiments, the arms and / or instruments are registered to the system 100, for example using a serial number, QR code, or RFID.

[0289] Once registered, the system is configured to the arm or instrument, for example by obtaining parameters from a data store associated with the arm or instrument. Similarly, a command interface can be defined between the arm or instrument and the controller of the system.

[0290] While Figure 1 While three arms 130 and instruments 135 are shown, those skilled in the art will readily understand that any suitable number of arms and instruments can be used.

[0291] In addition to the above controls and features, the system can be configured and reconfigured in a variety of different ways. For example, the system (e.g., using a console) can adjust the strength, speed of the system, or even manually reposition portions of the system (e.g., the arms).

[0292] In addition to assisting the surgeon in performing a procedure, the system 100 can be configured to capture procedure data and document the procedure. Such procedure data can include image data captured during the procedure, as well as time series data of the system and instruments.

[0293] In some embodiments, the system can be configured to further capture data directly from the surgeon, such as a microphone configured to record surgeon speech and / or a data entry form enabling the surgeon to record the procedure (e.g. clinical notes and note taking).

[0294] The system can then share this data with one or more applications or third party systems. As an illustrative example, the clinical notes can be automatically uploaded to a clinical notes system.

[0295] In some embodiments, the procedure can be linked to a particular surgeon using a pairing based QR code. In this case, the surgeon can install an application on a smart device that is configured to scan a QR code associated with the system. The QR code can be displayed on a screen and updated over time to provide data security.

[0296] Alternatively, the account can be directly associated with the system 100.

[0297] As will be readily appreciated by those skilled in the art, aspects of the system 100 can have various shapes and / or functions without departing from the scope of the present invention.

[0298] Figure 10 A perspective view of a portion of an arthroscopic surgical system 1000 according to another embodiment of the present invention is shown.

[0299] The arthroscopic surgical system 1000 is similar to the system 100 and includes a wheeled base 1005, an articulatable arm 1025 extending upwardly from the wheeled base, and a frame 1020 from which a plurality of surgical arms 1030 extend.

[0300] Rather than showing arthroscopic instruments 135 in the system 1000, modular mounting plates 1030a are provided at the ends of the arms 1030 to mount different instruments as required.

[0301] The frame 1020 is annular and rotatable.

[0302] As outlined above, a user interface is provided that enables the surgeon to remotely control the arthroscopic instruments. As outlined above, the user interface can be provided in a head mounted device or a display screen.

[0303] Figure 11 A screenshot of a procedure screen of an arthroscopic surgical system according to an embodiment of the present invention is shown.

[0304] The surgical screen includes a real-time image element 1105 for displaying images from an arthroscopic camera. The image element 1105 is updated in real-time or near real-time and includes various configuration elements for adjusting the image, such as white balance, contrast, brightness, focus, adding depth cues / contours, or automatically generating and displaying 3D images based on 2D image data and depth information.

[0305] The surgical screen also includes an instrument configuration element 1110, through which instruments can be configured. This may include setting one instrument as a master instrument and setting other instruments as slave instruments that follow the master instrument.

[0306] A fluid / electronic control element 1115 is provided, which displays temperature and electrical data and is capable of setting alarms based on this data. As an illustrative example, element 1115 is capable of setting an alarm when the fluid temperature or pressure exceeds a certain threshold.

[0307] The surgical screen includes map element 1120, which displays the system's relative positioning and configuration according to the coordinate system.

[0308] Those skilled in the art will readily understand that the coordinate system includes various other functions, such as configuration functions, menus, settings, document elements, status elements, etc.

[0309] Figure 12 The mounting end of the arthroscopic instrument is shown, including the handle of system 100.

[0310] like Figure 13 As shown, the mounting end 1200 includes a mounting plate 1205 configured to engage with a handle 1300. The handle includes a rotary joystick 1305 and a motor 1310.

[0311] In use, it is conceivable that the handle 1300, together with the mounting end 1200, is fixed to the surgical arm 130. The surgeon then grasps the handle 1300 and moves it into position. The handle 1300 is coupled to one or more surgical arms 130 such that movement at the handle 1300 causes a corresponding movement of the remaining surgical arms 130. Those skilled in the art will understand that this configuration is useful for initially positioning the surgical arms 130 at the surgical site.

[0312] Figure 14 A side view of the surgical arm 1400 of the arthroscopic system 100 is shown. As shown, the surgical arm 1400 includes a mounting plate configured to engage with a handle 1300. Those skilled in the art will understand that the surgical arm 1400 may include any suitable arthroscopic instrument.

[0313] The surgical arm 1400 includes two handles 1405, which are used to assist in the movement of the surgical arm 1400. The handles are used to position the surgical arm 1400 in a suitable location. For example, when the system 100 is not in use, a suitable location can be at the surgical site, or near the articulatable arm 125 of the system 100.

[0314] The surgical arm 1400 includes a mounting end 1200 and a mounting plate 1205. The mounting plate 1205 is configured to engage with the handle 1300.

[0315] Figure 15 A side view of an articulatable arm 1500 according to an alternative embodiment is shown. The articulatable arm 1500 is similar to the articulatable arm 125 and the frame 120 of the system 100. The articulatable arm 1500 includes pivot holes and pivot pins that enable the segments 1510a, 1510b, 1510c of the arm to pivot.

[0316] The ring frame 1515 includes two protrusions 1520 that extend at a right angle from the center of the ring frame 1515 and along the diameter of the ring frame 1515. A movement assembly 1525 is mounted to the bottom location of the ring frame 1515 for connecting the surgical arm 130 to the ring frame 1515 so that the surgical arm can move around the ring frame 1515.

[0317] Figure 16 An enlarged side view of the ring frame 1515 and the movement assembly 1525 of the system 100 is shown. Figure 15 The movement assembly 1525 includes four rollers 1535 that are configured to engage with guide rails 1530 defined in the ring frame 1515.

[0318] Advantageously, the above-described arthroscopic surgical methods and systems simplify arthroscopic surgery, thereby reducing the likelihood of damage or injury caused by the surgery itself. Furthermore, because these methods and systems are easier to use than traditional arthroscopic instruments, they reduce the obstacles to entry into arthroscopy.

[0319] Unlike laparoscopic robots, which are large and bulky and cannot be effectively used for arthroscopy, the above-described arthroscopic surgical methods and systems are not only sized for arthroscopy, but also enable the instruments to enter the joint from multiple portals while remaining accurately positioned on a common reference point.

[0320] Furthermore, instead of systems that promote energy dissipation into adjacent tissue, which can damage cartilage, flow, pressure, or temperature regulation is provided.

[0321] In this specification and in the claims, the word "comprise" and its derivatives, include "consist of" and "consist essentially of", include each of the stated integers but do not exclude the inclusion of one or more additional integers.

[0322] In this specification, reference to "one embodiment" or "an embodiment" means that a particular feature, structure, or characteristic described in connection with the embodiment is included in at least one implementation of the application. The appearances of the phrase "in one embodiment" or "in an embodiment" in various places in the specification are not necessarily all referring to the same embodiment. Furthermore, the particular features, structures, or characteristics can be combined in any suitable manner in one or more combinations.

[0323] In compliance with the statute, the application has been described in language more or less specific to structural or methodical features. It is to be understood that the application is not limited to the specific features, areas, or steps described since the means herein described comprises preferred forms of putting the application into effect. The application is, therefore, claimed in any of its forms or modifications within the proper scope of the appended claims, appropriately interpreted in accordance with the statute.

Claims

1. An arthroscopic surgical system comprising: a frame configurable to extend over or alongside at least a portion of a patient to be operated on; one or more surgical arms extending from the frame, each of the one or more surgical arms comprising an arthroscopic instrument; wherein the one or more surgical arms and associated arthroscopic instruments are remotely controllable by a user interface to perform arthroscopic surgery.

2. The arthroscopic surgical system of claim 1, wherein, The frame is ring-shaped.

3. The arthroscopic surgical system of claim 1, wherein, The one or more surgical arms comprise a plurality of surgical arms extending from the frame at a plurality of different locations.

4. The arthroscopic surgical system of claim 1, wherein, The one or more surgical arms are detachably coupled to the frame.

5. The arthroscopic surgical system of claim 1, wherein, At least one of the one or more surgical arms is secured to the frame by a rail.

6. The arthroscopic surgical system of claim 1, wherein, At least one of the one or more surgical arms comprises a modular end plate configured to interface with each arthroscopic instrument, wherein the modular end plate comprises one or more electronic, sensing, and / or actuating elements configured to interface with corresponding elements of the arthroscopic instrument.

7. The arthroscopic surgical system of claim 1, wherein, The instrument comprises an arthroscopic camera configured to capture images during surgery; and wherein the system further comprises a head-mounted device configured to display the captured images.

8. The arthroscopic surgical system of claim 1, wherein, At least one of the one or more arthroscopic instruments comprises an articulatable joint configured to access a joint of the patient during surgery.

9. The arthroscopic surgical system of claim 8, wherein, The articulatable joint comprises a rotational joint configured to enable a tip of the articulatable joint to change pose.

10. The arthroscopic surgical system of claim 1, further comprising a hand-held controller having more than three degrees of freedom, wherein, The one or more surgical arms and associated arthroscopic instruments are remotely controllable by the handheld controller to perform arthroscopic surgery.

11. The arthroscopic surgical system of claim 1, comprising at least one drape configured to extend over at least one of the one or more surgical arms, wherein, Each of the at least one drape comprises: one or both of 1) a rigid upper mount configured to be received between the frame and one of the one or more surgical arms and 2) a rigid lower mount configured to be received between one of the one or more surgical arms and the arthroscopic instrument, and a cover extending from one or both of the rigid upper mount and the rigid lower mount.

12. The arthroscopic surgical system of claim 1, wherein, At least one of the arthroscopic instruments comprises a surgical camera comprising: a reusable base comprising an interface for providing images from the camera; and a disposable distal portion releasably coupled to and extending outwardly from the reusable base.

13. The arthroscopic surgical system of claim 1, comprising a fluid management system including one or more pumps and valves to regulate fluid pressure and flow at the surgical site, wherein, The one or more pumps and valves are connected to the surgical site by tubing.

14. The arthroscopic surgical system of claim 13, wherein, The tubing is associated with one or more drapes configured to extend over at least one of the one or more surgical arms.

15. The arthroscopic surgical system of claim 1, wherein, At least one arthroscopic instrument comprises a camera, and wherein the camera is configured to be inserted into a surgical site.

16. The arthroscopic surgical system of claim 15, wherein, Images generated by the camera are processed and presented to a surgeon, and wherein the processing comprises one or more of changing a color, contrast resolution, exposure, flipping, and / or zooming of the images, converting the images into a three-dimensional image.

17. The arthroscopic surgical system of claim 15, wherein, Images generated by the camera are presented to a surgeon in a manner that overlays such as contour lines and / or depth indicators, surgical information, or device information.

18. The arthroscopic surgical system of claim 1, wherein, At least one of the arthroscopic instruments includes one or more sensors, such as temperature sensors, load sensors, or position sensors, wherein data from the sensors is provided to the system.

19. The arthroscopic surgical system of claim 1, wherein, At least one of the one or more surgical arms is in wireless communication with a controller of the system.

20. The arthroscopic surgical system of claim 1, comprising a console including a display and one or more user input devices to enable a user to interact with the system.

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