Instrument stabilization for microsurgery

Abstract

A system for performing ophthalmic treatment includes a handpiece configured to be held by a surgeon's hand. An end effector is mounted to the handpiece and is configured to perform an operative treatment on tissue of a patient, such as eye tissue, when performing an ophthalmic treatment. The system includes: a motion sensor configured to sense a movement of the handpiece; and one or more stabilization actuators configured to stabilize movement of the handpiece in response to movement of a surgeon's hand. A controller is coupled to the motion sensor and the one or more stabilization actuators and is configured to instruct the one or more stabilization actuators to compensate for motion detected by the motion sensor. The controller may include a high-pass filter, wherein an output of the high-pass filter is used to control the stabilization actuator. Parameters of the high-pass filter can be adjusted in the whole ophthalmic treatment process.

Description

[0001] Cross-references to related applications

[0002] This application claims priority to U.S. Provisional Application No. 63 / 579,938, filed August 31, 2023, which is incorporated herein by reference in its entirety. Background Technology

[0003] This disclosure generally involves performing microsurgeries such as ophthalmic surgery.

[0004] Some surgical procedures require manipulation of very small and delicate structures. For example, ophthalmic surgeries involving the retina, vitreous body, lens, trabecular meshwork, or other structures of the eye must be performed with small and precise movements to achieve the desired therapeutic effect and avoid damage.

[0005] Facilitating the execution of microsurgery would be an advancement in this field. Summary of the Invention

[0006] In one aspect of the invention, a system for performing ophthalmic treatments includes a handheld device configured to be held by a surgeon's hand. An end effector is mounted to the handheld device and configured to manipulate tissues of a patient. The system includes: a motion sensor configured to sense movement of the handheld device; and one or more stabilizing actuators configured to stabilize the movement of the handheld device in response to movement of the surgeon's hand. A controller is coupled to the motion sensor and the one or more stabilizing actuators and configured to command the one or more stabilizing actuators to compensate for the movement detected by the motion sensor. Attached Figure Description

[0007] To gain a detailed understanding of the features described above, reference can be made to the embodiments for a more specific description of the disclosure, some of which are illustrated in the accompanying drawings. However, it should be noted that the drawings illustrate only exemplary embodiments and should not be construed as limiting the scope of the disclosure, and may allow for other equally effective embodiments.

[0008] Figure 1A Surgical instruments with remotely stabilized actuators according to certain embodiments are shown.

[0009] Figure 1B Surgical instruments with attached stabilizing actuators according to certain embodiments are shown.

[0010] Figure 2 A hand-worn device with a stabilizing actuator according to certain embodiments is shown.

[0011] Figure 3A and Figure 3BAn apparatus with a stabilizing actuator incorporated between the handheld component and the distal portion, according to certain embodiments, is shown.

[0012] Figure 4 An instrument according to certain embodiments is shown, which incorporates a stabilizing actuator between a handpiece and a surgeon's finger.

[0013] Figure 5 This is a schematic diagram illustrating a system for controlling a stabilizing actuator according to certain embodiments. Detailed Implementation

[0014] refer to Figure 1A In some embodiments, system 100 includes a handpiece 102 held by the hand 104 of a surgeon performing microsurgery (such as ophthalmic treatment of a patient's eye 106). An end effector 108 is mounted to the handpiece 102 and is used to manipulate the patient's tissues. For example, the end effector 108 may include surgical forceps, a phacoemulsification-vitrectomy tool, an optical fiber for guiding light from a therapeutic laser, tubing for supplying infusion fluid, an endoscope, or other types of surgical instruments. Ophthalmic treatments may include cataract surgery (e.g., phacoemulsification followed by placement of an intraocular lens (IOL)), glaucoma surgery (e.g., placement of an incision or shunt in the trabecular meshwork of the anterior chamber of eye 106), vitrectomy, retinal reattachment, retinal detachment, or other ophthalmic treatments.

[0015] Motion sensor 110 can be used to sense the position and orientation of one or both of handheld device 102 and end effector 108. Motion sensor 110 can be implemented as a device mounted on handheld device 102 or end effector 108. End effector 108 and handheld device 102 can be rigidly coupled to each other, allowing the position of one to be used to infer the position of the other. Motion sensor 110 can be implemented as a three-axis gyroscope that senses rotation about three mutually orthogonal axes. Motion sensor 110 can be implemented as a three-axis accelerometer that senses translation along three mutually orthogonal axes. Motion sensor 110 can combine both a three-axis gyroscope and a three-axis accelerometer.

[0016] Other types of sensors can also be used for motion sensor 110. For example, one or more cameras can position the handheld device 102 within their field of view. Images from the one or more cameras can then be processed to detect the position and orientation of the handheld device 102. In such embodiments, the handheld device 102 may have markings thereon to aid in identifying the handheld device 102 and its orientation in the images. In other embodiments, motion sensor 110 may include a local positioning system (LPS) using ultrasonic or radio frequency signals.

[0017] Stabilizing actuators can be used to stabilize the handpiece 102 to compensate for tremors, twitches, or other involuntary movements of the surgeon's hand 104 holding the handpiece 102. Figure 1A In some embodiments, the stabilizing actuator is implemented as a cable actuator 112 located away from the handpiece 102 and connected to the handpiece 102 via one, two, three, or more cables 118. The cables 118 may be suspended at different locations on the cable actuator 112, such that the cables 118 are connected to the handpiece 102 at different angles to allow the handpiece 102 to translate in three-dimensional space above the patient's eye 106. The cables 118 may be implemented as Bowden cables (i.e., a sheath and a cable sliding within the sheath), or may be a simple cable extending from the cable actuator 112 to the handpiece 102 and tensioned to apply force to the handpiece 102. The cables 118 may be arranged to provide clearance for a surgeon to view the patient's eye 106, to position a surgical microscope above the patient's eye 106, or to provide clearance for other devices. In addition to providing stabilization, the cables 118 may also suspend the handpiece 102 such that approximately (e.g., at least 80% of its weight) of the handpiece is supported by the cables 118.

[0018] Controller 116 is connected to motion sensor 110 and cable actuator 112 via a wired or wireless connection. Controller 116 controls cable actuator 112 based on the output of motion sensor 110 to reduce movement of end effector 108 caused by tremors, twitches, or other involuntary or excessively rapid movements of the surgeon's hand 104. The following section discusses... Figure 5 An example algorithm that controller 116 can use to perform this operation is discussed.

[0019] refer to Figure 1B In an alternative embodiment of system 100, the cable actuator 112 is replaced by one or more motors 120 mounted on the handpiece 102. The motors 120 may include three motors 120 whose rotational axes are aligned with three mutually orthogonal axes 122. Each motor 120 includes a rotating mass provided by its rotor and / or by a rotating mass driven to rotate by the motor 120. A controller 116 controls the power supply to the motors 120 based on the output of the motion sensor 110. The controller 116 can accelerate and decelerate each motor 120 to induce rotational torque on the handpiece 102, thereby reducing movement of the end effector 108 caused by tremors, twitches, or other involuntary or excessively rapid movements of the surgeon's hand 104, as described below. Figure 5In more detail, in some embodiments, motor 120 may additionally or alternatively include a linear actuator and a mass block actuated therefrom, the linear actuator being configured to cause one or more translational mass blocks to move along some or all or other mutually orthogonal axes of axis 122.

[0020] Motor 120 may be located at the end of handpiece 102 opposite to end effector 108 (e.g., within 20% of the length of handpiece 102), as shown. Alternatively, motor 120 may be placed in other locations, such as within the portion of handpiece 102 grasped by surgeon's hand 104. Motor 120 may be positioned to balance handpiece 102, for example, at the midpoint of the longest dimension of handpiece 102, at the point where it is grasped by the fingers of surgeon's hand 104, or at other points on handpiece 102.

[0021] refer to Figure 2 In an alternative embodiment, system 200 includes a stabilizing actuator 202 mounted on the surgeon's hand 104. For example, a housing 204 having the stabilizing actuator 202 mounted thereon may be attached to a wristband 206, a glove, or other structure that attaches the housing 204 to the surgeon's hand 104.

[0022] The stabilizing actuator 202 can be implemented as a plurality of motors 120 (e.g., rotary motors and / or translational actuators as described above). The housing 204 may further have a motion sensor 208, which is mounted on the housing and implemented using any of the methods described above with respect to motion sensor 110.

[0023] The controller 210 can be mounted to the housing 204, or it can be located off-site and wired or wirelessly connected to the stabilizer 202 and the motion sensor 208. The controller 210 can control the stabilizer 202 based on the output of the motion sensor 208, as described below. Figure 5 As described.

[0024] refer to Figure 3A In some embodiments, system 300 uses a stabilizing actuator 302 inserted between the handheld component 102 and the end effector 108 to perform stabilization. System 300 can be used with other systems 100, 200, 300, 400 described herein (see [link to documentation]). Figure 4 Any combination of the following can be used. The stabilizing actuator 302 can be controlled based on the output of the motion sensor 308 that senses the movement of the surgeon's hand 104. The motion sensor 308 can be implemented according to any of the methods described above with respect to the motion sensor 110.

[0025] The stabilizing actuator 302 may include three to six stages 302a, 302b, 302c, each stage causing translation or rotation about one of three mutually orthogonal axes 304a, 304b, 304c. In the illustrated embodiment, the end effector 108 is mounted to and translated or rotated by the first stage 302a. The first stage 302a is mounted to and translated or rotated by the second stage 302b. The second stage 302b is mounted to and translated or rotated by the third stage 302c. Any number of stages can be stacked in this manner, with the last stage (the third stage 302c in the illustrated example) mounted to the handpiece 102.

[0026] Stages 302a, 302b, and 302c can be combined with motors, linear actuators, or other actuators to control the movement of stages 302a, 302b, and 302c based on signals from controller 306. Controller 306 controls stages 302a, 302b, and 302c based on the output of motion sensor 308. Controller 306 can be installed within handheld device 102, or it can be located away from handheld device 102 and connected wired or wirelessly to stages 302a, 302b, 302c and motion sensor 308. Controller 306 can control stages 302a, 302b, and 302c based on the output of motion sensor 308, as described below. Figure 5 As described.

[0027] like Figure 3B As shown, stages 302a, 302b, and 302c can be actuated by force transmitted via lines 310a, 310b, and 310c, which are implemented as cables (bare cables or Bowden cables), conduits for conducting pressurized air or fluid, or other types of wires used for transmitting force. The force transmitted via lines 310a, 310b, and 310c can be provided by one or more remote actuators 312, such as one or more cable actuators, one or more pneumatic pumps and valves, and / or one or more hydraulic pumps and valves. The force supply to the remote actuators 312 can be controlled by controller 306 based on the output of motion sensor 308. Controller 306 can be connected to the remote actuators wired or wirelessly.

[0028] refer to Figure 4In some embodiments, system 400 includes a handpiece 102 incorporating a motion sensor 402, such as a motion sensor according to any method described above with respect to motion sensor 110. One or more stabilizing actuators 404 are inserted between the handpiece 102 and the surgeon's hand 104. For example, one or more stabilizing actuators may be inserted between the surgeon's thumb and forefinger and the handpiece 102. The stabilizing actuators 404 may be mounted to the handpiece 102 itself or to a glove worn on the surgeon's hand 104.

[0029] One or more stabilizing actuators 404 may each include three to six actuator stages 404a, 404b, 404c, each actuator stage 404a, 404b, 404c performing translation or rotation about a corresponding axis 406a, 406b, 406c, which are orthogonal to each other. In the illustrated embodiment, the surface rotated or translated by the first stage 404a is exposed and contacted by the surgeon's hand 104. The first stage 404a is mounted on and translated or rotated by the second stage 404b. The second stage 404b is mounted on and rotated or translated by the third stage 404c. In some embodiments, the third stage 404c is mounted on the handpiece 102. In other embodiments, the first stage 404a is mounted on a surgeon's glove, and the third stage 404c is positioned to contact the handpiece 102 during use. In another embodiment, the first stage 404a and the third stage 404c are respectively attached to the glove and the handpiece 102. Any number of stages can be stacked as described above, wherein the first stage contacts or is mounted on the surgeon's hand 104, and the last stage contacts or is mounted on the handpiece 102. Actuator stages 404a, 404b, and 404c may have some or all of the properties of stages 302a, 302b, and 302c described above.

[0030] The controller is connected to motion sensor 402 and actuator stages 404a, 404b, and 404c. The controller operates based on the output of the motion sensor, for example, according to the following... Figure 5 The described method controls actuator stages 404a, 404b, and 404c.

[0031] refer to Figure 5 System 500 includes motion sensors 502, such as motion sensors 110, 208, 308, 402 according to any of the embodiments disclosed above. System 500 further includes one or more stabilizing actuators 504, such as cable actuator 112, motor 120, stabilizing actuator 202, stabilizing actuator 302, or stabilizing actuator 404 according to any of the foregoing embodiments.

[0032] System 500 includes a high-pass filter 506. The high-pass filter 506 removes low-frequency motion information from the signal received from motion sensor 502. Specifically, low-frequency motion (i.e., motion at frequencies below the cutoff frequency of the high-pass filter 506) most likely corresponds to intentional and / or safe movements of the surgeon's hand 104, and therefore low-frequency motion is not compensated for by activating the stabilizing actuator 202. The high-pass filter 506 can filter each dimension of the output of motion sensor 502 individually (i.e., each translation dimension and each rotation dimension). Alternatively, all dimensions can be filtered simultaneously. The output of the high-pass filter 506 can be input to a compensation calculation module 508, which calculates the corresponding instruction to the stabilizing actuator 504. For example, a movement (translation and / or rotation) represented in the output of the high-pass filter 506 can be converted into an equal and opposite movement. This equal and opposite movement can then be converted into an instruction to the stabilizing actuator 504 to achieve a near-equal and opposite movement. The compensation calculation module 508 calculates equal and opposite movements and transmits the command to the stabilizing actuator 504 at a frequency that is greater than the movement being compensated, for example, greater than the frequency response of the combination of the stabilizing actuator 504 and the structure thereby actuated.

[0033] In some embodiments, filter parameters 510 used for high-pass filtering performed by high-pass filter 506 can be dynamically adjusted, such as cutoff frequency, filter roll-off slope, order (first, second, third, etc.), or other coefficients that determine other aspects of the operation of high-pass filter 506. Filter parameters 510 can be dynamically adjusted by the surgeon. For example, one phase of ophthalmic treatment may require higher precision than another. Therefore, the cutoff frequency can be increased for the first phase requiring lower precision and then decreased for the second phase requiring higher precision. In some embodiments, filter parameters 510 for each phase of ophthalmic treatment can be specified in treatment plan 512. Thus, the surgeon can change filter parameters 510 by providing the system 500 with input (key press, touchscreen gesture, voice command, etc.) indicating a transition from one phase of treatment plan to another.

[0034] Additional considerations

[0035] The foregoing description is provided to enable any person skilled in the art to practice the various embodiments described herein. Various modifications to these embodiments will be apparent to those skilled in the art, and the general principles defined herein can be applied to other embodiments. For example, changes can be made to the function and arrangement of the elements discussed without departing from the scope of this disclosure. Various examples may be appropriately omitted, substituted, or added to various procedures or components. Furthermore, features described with respect to some examples may be combined in some other examples. For example, any number of aspects set forth herein can be used to implement an apparatus or practice. Additionally, the scope of this disclosure is intended to cover such apparatus or methods practiced using other structures, functions, or structures and functions other than or different from the aspects of this disclosure set forth herein. It should be understood that any aspect of this disclosure may be embodied by one or more elements of the claims.

[0036] As used herein, the phrase “at least one of a series of items” refers to any combination of those items, including a single member. For example, “at least one of a, b, or c” is intended to cover a, b, c, ab, ac, bc, and abc, as well as any combination of multiples of the same element (e.g., aa, aaa, aab, aac, abb, acc, bb, bbb, bbb, cc, and ccc, or any other order of a, b, and c).

[0037] As used herein, the term "determine" encompasses a wide variety of actions. For example, "determine" can include calculation, operation, processing, derivation, investigation, searching (e.g., searching in a table, database, or other data structure), ascertainment, etc. Furthermore, "determine" can include receiving (e.g., receiving information), accessing (e.g., accessing data in memory), etc. Additionally, "determine" can include parsing, selecting, picking, building, etc.

[0038] The methods disclosed herein include one or more steps or actions for implementing the methods. The method steps and / or actions may be interchanged without departing from the scope of the claims. In other words, unless a specific order of steps or actions is specified, the order and / or use of specific steps and / or actions may be modified without departing from the scope of the claims. Furthermore, the various operations of the above methods can be performed by any suitable means capable of performing the corresponding functions. These means may include various hardware and / or software components and / or modules, including but not limited to circuits, application-specific integrated circuits (ASICs), or processors. Typically, where operations are illustrated in the figures, those operations may have corresponding means and functional components with similar numbering.

[0039] The various illustrative logic blocks, modules, and circuits described in connection with this disclosure may be implemented or executed using a general-purpose processor, digital signal processor (DSP), application-specific integrated circuit (ASIC), field-programmable gate array (FPGA) or other programmable logic device (PLD), discrete gate or transistor logic, discrete hardware components, or any combination thereof, designed to perform the functions described herein. The general-purpose processor may be a microprocessor, but alternatively, the processor may be any commercially available processor, controller, microcontroller, or state machine. The processor may also be implemented as a combination of computing devices, such as a combination of a DSP and a microprocessor, multiple microprocessors, one or more microprocessors incorporating a DSP core, or any other such configuration.

[0040] The processing system can be implemented using a bus architecture. Depending on the specific application and overall design constraints of the processing system, the bus can include any number of interconnect buses and bridges. The bus can link together various circuits, including processors, machine-readable media, and input / output devices. User interfaces (e.g., keypads, displays, mice, joysticks, etc.) can also be connected to the bus. The bus can also link various other circuits, such as timing sources, peripherals, voltage regulators, power management circuits, etc., which are well known in the art and therefore will not be described further. The processor can be implemented using one or more general-purpose and / or special-purpose processors. Examples include microprocessors, microcontrollers, DSP processors, and other circuit systems capable of executing software. Those skilled in the art will recognize how best to implement the described functions for the processing system, depending on the specific application and the overall design constraints imposed on the system as a whole.

[0041] If implemented in software, functionality can be stored or transmitted as one or more instructions or code on or through a computer-readable medium. Software should be interpreted broadly as instructions, data, or any combination thereof, whether referred to as software, firmware, middleware, microcode, hardware description language, or others. Computer-readable media includes both computer storage media and communication media (such as any medium that facilitates the transfer of computer programs from one place to another). The processor may be responsible for managing the bus and general processing, including the execution of software modules stored on the computer-readable storage medium. The computer-readable storage medium may be coupled to the processor, allowing the processor to read information from and write information to the storage medium. Alternatively, the storage medium may be integrated into the processor. For example, the computer-readable medium may include a transmission line, a carrier wave modulated by data, and / or a computer-readable storage medium on which instructions separate from the wireless node are stored, all accessible to the processor via a bus interface. Alternatively or additionally, the computer-readable medium or any portion thereof may be integrated into the processor, for example, in cases where it may have a cache and / or a general-purpose register file. Examples of machine-readable storage media may include RAM (random access memory), flash memory, ROM (read-only memory), PROM (programmable read-only memory), EPROM (erasable programmable read-only memory), EEPROM (electrically erasable programmable read-only memory), registers, disks, optical disks, hard disks, or any other suitable storage media, or any combination thereof. Machine-readable media may be embodied in computer program products.

[0042] Software modules can comprise a single instruction or a number of instructions, and can be distributed across several different code segments, across different programs, and across multiple storage media. Computer-readable media can include multiple software modules. Software modules include instructions that, when executed by a device such as a processor, cause the processing system to perform various functions. Software modules can include transmission modules and reception modules. Each software module can reside in a single storage device or be distributed across multiple storage devices. For example, when a triggering event occurs, a software module can be loaded from a hard disk drive into RAM. During the execution of a software module, the processor can load some instructions into a cache to improve access speed. Then, one or more cache lines can be loaded into a general-purpose register file for processor execution. When referring to the functionality of a software module, it should be understood that this functionality is implemented by the processor when executing the instructions from that software module.

[0043] The following claims are not intended to be limited to the embodiments shown herein, but are given the full scope consistent with the language of the claims. In the claims, references to singular elements, unless specifically stated otherwise, are not intended to mean “one and only one”, but rather “one or more.” Unless otherwise specifically stated otherwise, the term “some” means one or more. No element of any claim shall be interpreted in accordance with 35 U.SC §112(f) unless such elements are expressly described using the phrase “means for…” or, in the case of a method claim, using the phrase “steps for…”. All structural and functional equivalents of the elements of the various aspects described throughout this disclosure that are known to or will be known hereafter by one of ordinary skill in the art are expressly incorporated herein by reference and are intended to be covered by the claims. Furthermore, nothing disclosed herein is intended for public disclosure, whether or not such disclosure is expressly stated in the claims.

Claims

1. A system for performing ophthalmic treatments, the system comprising: a handpiece configured to be held by a surgeon's hand; an end effector mounted to the handpiece and configured to manipulate tissue of a patient; a motion sensor configured to sense movement of the handpiece; one or more stabilizing actuators configured to stabilize movement of the handpiece in response to movement of the surgeon's hand; and a controller coupled to the motion sensor and the one or more stabilizing actuators, the controller configured to instruct the one or more stabilizing actuators to compensate for motion detected by the motion sensor. The one or more stabilizing actuators are mounted to the handpiece.

2. The system of claim 1, wherein, The one or more stabilizing actuators are mounted to the handpiece between the end effector and the handpiece.

3. The system of claim 2, wherein, The one or more stabilizing actuators are configured to be interposed between a finger of the surgeon's hand and the handpiece.

4. The system of claim 2, wherein, The one or more stabilizing actuators comprise a plurality of motors, each motor of the plurality of motors configured to rotate about one of a plurality of mutually orthogonal axes.

5. The system of claim 2, wherein, The one or more stabilizing actuators comprise a plurality of translation stages, each stage configured to translate along one of a plurality of mutually orthogonal axes.

6. The system of claim 2, wherein, The one or more stabilizing actuators comprise a plurality of cable actuators mounted to the handpiece by a plurality of cables.

7. The system of claim 2, wherein, The one or more stabilizing actuators are configured to be mounted to the surgeon's hand.

8. The system of claim 1, wherein, The motion sensor comprises at least one of a tri-axial accelerometer or a tri-axial gyroscope.

9. The system of claim 1, wherein, The controller comprises a high-pass filter, the controller configured to:

10. The system of claim 1, wherein, process an output of the motion sensor using the high-pass filter to obtain a filtered output; and instruct the one or more stabilizing actuators to compensate for movement indicated in the filtered output. The controller is further configured to: receive an input; and 11. The system of claim 10, wherein, in response to the input, adjust one or more parameters of the high-pass filter. The input is a treatment plan for an ophthalmic treatment. The one or more parameters comprise one or more of:

12. The system of claim 11, wherein, a cutoff frequency; 13. The system of claim 11, wherein, a roll-off slope; and an order.

14. A method for performing ophthalmic treatments, the method comprising: sensing, by a motion sensor, movement caused by a surgeon's hand holding a handpiece, the handpiece having an end effector mounted to the handpiece, the end effector configured to manipulate tissue of a patient; and instructing, by a controller coupled to the motion sensor, one or more stabilizing actuators to reduce an amount of movement imparted to the tissue of the patient by the end effector. The one or more stabilizing actuators are mounted to the handpiece. The one or more stabilizing actuators are mounted to the handpiece between the end effector and the handpiece.

15. The method of claim 14, wherein, ​ 16. The method of claim 14, wherein, ​ 17. The method of claim 14, the one or more stabilizing actuators configured to be interposed between a finger of the surgeon's hand and the handpiece.

18. The method of claim 14, wherein, the one or more stabilizing actuators mounted to the surgeon's hand.

19. The method of claim 14, further comprising: processing an output of the motion sensor using a high-pass filter to obtain a filtered output; and instructing the one or more stabilizing actuators by the controller as a function of the filtered output.

20. The method of claim 14, wherein, the motion sensor comprises at least one of a three-axis accelerometer or a three-axis gyroscope.

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