INTELLIGENT HEAD SURGERY HOLDING ARM WITH TOUCH-SENSITIVE OPERATION

Description

[0001] The disclosure relates to a holding arm for medical purposes, in particular for holding a surgical mechatronic assistance system and / or surgical instrument, having a proximal end for attaching the holding arm to a base and a distal end for receiving a surgical mechatronic assistance system and / or surgical instrument; at least a first and a second arm segment, wherein the first arm segment is connected to a first joint and the second arm segment is connected to a second joint, wherein each joint is releasable and lockable. The disclosure further relates to a method for positioning a surgical mechatronic assistance system and / or surgical instrument coupled to a holding arm.The disclosure further relates to a holding arm for medical purposes, in particular for holding a surgical mechatronic assistance system, having a proximal end for attaching the holding arm to a base and a distal end for receiving a surgical mechatronic assistance system, and two or more arm segments and two or more joints by means of which the arm segments are connected to one another in an articulated manner, wherein each joint can be released and locked by means of an operating device. Furthermore, the disclosure relates to a method for controlling a mechatronic assistance system coupled to a holding arm, in particular using such a holding arm.

[0002] Holding arms of the type mentioned above have been known for some time and are used in surgery, particularly to relieve a surgeon of static holding work. Such a holding arm is used to hold a mechatronic assistance system and / or a surgical instrument, such as a manipulator, an endoscope, a surgical clamp, and the like. The holding arms mentioned above have proven particularly effective for holding endoscopes. In endoscopic surgery, a surgeon usually operates an instrument with both hands, while an assistant holds the endoscope to visualize the surgical field on a screen. Holding the endoscope for an extended period of time is very tiring. For this reason, holding arms are being used more and more.

[0003] Such a holding arm is known, for example, from DE 195 26 915 B4. The holding device for medical purposes disclosed therein comprises a connecting part and a holder for surgical tools, as well as an arm arranged between the holder and the connecting part. The arm is connected to the holder and the connecting part or to an adjacent arm via a joint and coupled to a pneumatically actuated device for selectively locking and releasing the joints. This device locks the joints under the action of a mechanical spring exerting a braking force on the joint, and the device can be pneumatically transferred into a joint-releasing state against the force of this spring. An actuating element is arranged on the holder at the proximal end of the arm, by means of which a valve can be opened so that the individual joints of the arm can be adjusted.When the actuator is released, the valve closes again, so that the joints are fixed.

[0004] A similar holding arm is disclosed in EP 1 958 587 B1. The holding arm disclosed therein also has several joints, and a touch-sensitive sensor is provided for actuating the joints. This sensor is arranged on the holding arm adjacent to the medical instrument, so that when the operator grasps the medical instrument, he comes into contact with the touch-sensitive sensor, thereby releasing the joints of the holding arm.

[0005] Both the holding arm disclosed in DE 195 26 915 B4 and in EP 1 958 587 B1 serves primarily as a type of exoskeleton for the operator, so that the surgeon can support himself on this holding arm during the operation and when the medical instrument is grasped or the actuating member is actuated, all joints are released so that the pose of the holding arm can be changed.

[0006] DE 10 2004 050 714 A1 discloses another holding arm designed to hold an endoscope. The arm has a plurality of joints that can be closed pneumatically. The holding arm is connected to a foot-operated valve. When the foot-operated valve is actuated, compressed air is applied to all joints, releasing them.

[0007] Another such holding arm is disclosed in DE 10 2011 004 926 A1. The holding arm has several arm segments and several joints by means of which the individual arm segments are coupled to one another. The holding arm according to DE 10 2011 004 926 A1 furthermore has a first interface at the proximal end for coupling the holding arm to a standard rail of an operating table. The first interface is essentially designed like a clamp. In addition, the holding arm has an interface at the distal end, which is also designed as a clamp and serves to accommodate an endoscope. Even if this arm is fundamentally well suited for simply holding endoscopes, there is nevertheless a need to make the application area of ​​such holding arms more flexible, in particular to adapt it to different tasks.Furthermore, it is desirable to improve the safety of such holding arms to reduce the risk of injury to a patient during a surgery in which the holding arm is used.

[0008] A disadvantage, however, is that precise positioning of the mechatronic assistance system and / or surgical instrument mounted on the support arm is difficult with the previously known support arms and is highly dependent on the skill of the surgeon. Positioning accuracy is limited solely to the skill of the surgeon, who positions the distal end of the arm in space.

[0009] To solve this problem, it is known to use robotically assisted holding arms. These, in addition to releaseable and lockable joints, also feature motors in the joints that can be controlled via a terminal. These robotically driven holding arms allow for precise positioning, but such robotic control is very complex and requires extensive training for the surgeon. Operation is complex and can therefore lead to problems.

[0010] In addition to the documents cited above, US 2012 / 0283747 A1 discloses a surgical system with a robotic arm that can be controlled via a controller and supports a holding arm. A surgical instrument, such as an endoscope, is then attached to the holding arm. The holding arm can only be operated manually, and as soon as an operator touches it, the robotic arm becomes immobile and immobile. The rigidity of the holding arm can be adjusted.

[0011] US 2012 / 0143048 A1 discloses a holding arm that can be set to both a manual and a robotically driven mode. Locking mechanisms are provided at each of the three joints, allowing the joints to be locked or their freedom of movement to be restricted.

[0012] US 2002 / 0177857 A1 also discloses a holding arm having two switches on the distal arm segment, located opposite one another relative to the plane of the endoscope supported by the holding arm, which can be used to release all joints of the holding arm. The position of the switches is intended to ensure that an operator always maintains the same hand position relative to the endoscope when grasping the distal segment.

[0013] The object of the present invention is to provide a holding arm of the type mentioned at the outset which is easy, in particular intuitive, to operate and at the same time allows a more precise positioning of the mechatronic assistance system and / or surgical instrument attached to the distal end of the arm.

[0014] This object is achieved by a holding arm with the features of claim 1, wherein the holding arm has an operating device for moving the holding arm into a desired pose, wherein the operating device is designed to release the associated joint upon contact between an operator and one of the first and second arm segments. According to the invention, it is therefore provided that the operating device is designed to release the first joint upon contact between an operator and the first arm segment and to release the second joint upon contact between an operator and the second arm segment. It is therefore provided according to the invention that upon contact between an operator and a corresponding arm segment, only the associated joint is released. This makes it possible to intuitively move individual joints and thus adjust the holding arm segment by segment and bring it into a desired pose.This allows for more precise positioning, as each segment can be adjusted separately incrementally. It is also possible to contact multiple segments at once, allowing multiple joints to be released and adjusted simultaneously. This makes it possible to easily, particularly intuitively, move the support arm into a desired pose. The methods described here are merely examples and are not part of the present invention.

[0015] In addition to the first and second arm segments, further arm segments are preferably provided, each of which is also assigned a joint. The arm segments themselves are essentially rigid and preferably essentially rod-shaped. The term "rod-shaped" here encompasses both essentially straight arm segments and slightly to strongly curved arm segments. In such a support arm, arm segments and joints always alternate, whereby the support arm can terminate at the distal and proximal ends with either a joint or a segment or a connecting element. The proximal end of the support arm can be attached to a base. Alternatively, the base can be permanently coupled to the arm, or the arm can be removed from the base. In one embodiment, the base is designed as an operating table, and the support arm can be coupled to an operating table. Preferably, the support arm can be coupled to a standard rail provided on the operating table.Such standard rails are usually provided with operating tables, so that a standard interface can be provided on the support arm for coupling to the standard rail of an operating table. Conventional operating tables are also composed of individual segments. For coupling, they have corresponding coupling points on the end faces of the segments, which are usually manufacturer-specific. Preferably, the support arm can be attached to the operating table via such a coupling point. For this purpose, a manufacturer-specific adapter can be provided at the proximal end. Alternatively, the base is designed as a separate device, such as a stand, which can be set up on the floor of an operating room. In a further alternative, the base is designed as a holder which can be attached, for example, to a wall or ceiling of an operating room.

[0016] The holding arm is preferably designed as a so-called passive holding arm and therefore has only actively braked joints, but no driven joints, as is often the case with robotic holding arms. Each joint can therefore only be released and locked, but not driven. This makes the holding arm simple in design and does not require a complex control system for its operation.

[0017] According to a first preferred embodiment of the invention, the operating device has contact means which are intended for an operator to come into contact with them, wherein a first contact means of the operating device is arranged on the first arm segment and a second contact means is arranged on the second arm segment. Upon contact with the first contact means, the first joint is preferably released, and upon contact with the second contact means, the second joint is preferably released. The contact means serve to detect contact between the user and the arm segment. The contact means are preferably each arranged on a surface of the corresponding arm segment. The contact means can extend over the entire arm segment or only occupy a section of it. Preferably, the contact means extends in each case approximately around half a circumference relative to a central axis of an arm segment.This makes the contact agent easily accessible in any position of the holding arm and allows an operator to easily come into contact with it.

[0018] According to a further preferred embodiment, each contact means comprises two contact means elements arranged substantially opposite one another on the arm segment. According to this embodiment, it is preferred that the associated joint is released only upon contact between the two contact means elements. The contact means preferably consists of the two contact means elements, so that contact with the contact means only occurs when both contact means elements are contacted by the operator.By arranging the two contact means elements substantially opposite one another, preferably relative to a plane containing a central axis of the arm segment, it is possible to distinguish between unintentional contact, for example by the arm of an operator, and intentional contact, i.e., an actual gripping of the arm segment. Consequently, according to this exemplary embodiment, the joint is only released when the arm segment is gripped, in particular by the operator's hand, in which case the two opposite sides of the arm segment are contacted. To operate the holding arm and to move the holding arm into a desired position using the operating device, the arm segment must be gripped by the operator in such a way that it comes into contact with the two contact means elements of the contact means. The operating device then releases the associated joint, allowing the arm segment to be moved.

[0019] According to a preferred embodiment, the contact elements are designed as push buttons. Push buttons are particularly simple elements that can be both visually detected by the operator and provide immediate tactile feedback when the button is pressed. Such a button can be designed, for example, as a simple contact in an electrical circuit or as a capacitive switch. According to this embodiment, as long as both buttons are pressed, the joint assigned to the corresponding arm segment is released; as soon as the operator releases both or even just one of the two buttons, the joint is re-locked by the operating device.

[0020] According to a preferred alternative embodiment, the contact elements are designed as touch-sensitive sensors. The sensors are preferably substantially planar and extend over a substantial portion of the surface of the corresponding arm segment. The sensors are preferably designed as pressure-sensitive sensors, capacitive sensors, heat-sensitive sensors, and / or optical sensors. Such sensors have the advantage that they can cover a larger area, meaning the operator does not need to contact the arm segment as precisely. Instead, it is sufficient for the operator to essentially grasp the arm segment and thus come into contact with the sensor(s).

[0021] In a further preferred embodiment, the operating device is designed to release the associated joint depending on the intensity of the contact. Intensity here refers to a pressure and / or a force applied by the operator. This makes it possible for the operator to control the degree of release through the force applied when gripping. It is conceivable and preferred that the associated joint is only partially released when the intensity of the contact is low, so that the arm segment can only be moved slowly and against resistance. When the intensity is high and a firm grip is therefore applied, the joint is then fully opened, so that the arm segment can be moved essentially without resistance. Partial release can also be achieved by intermittent release at different frequencies.

[0022] According to a further preferred embodiment, the operating device has display means for indicating contact between an operator and the arm segment. The display means are preferably configured to output a tactile, visual, and / or automatic signal. Thus, according to this embodiment, upon contact between the operator and the arm segment, not only is the associated joint released, but simultaneously a signal is output as feedback for the operator, in particular a tactile, visual, and / or audio signal. For example, it is preferred that contact elements of contact means comprise a light source, such as an LED or the like, which illuminates upon contact between the operator and the contact element. A tactile signal includes, for example, a vibration. An audio signal can include a simple tone or a voice output such as "Joint released."

[0023] According to a further preferred embodiment, the operating device further comprises a switch for releasing all joints. Such a switch, by means of which all joints can be released, can be referred to as a master switch. It can be designed, for example, as disclosed in EP 1 958 587 B1, i.e., as a switch at the distal end of the holding arm, or as disclosed in DE 195 26 915 B4, as a foot switch arranged at a distance from the holding arm. Such a switch, which acts as a master switch, is advantageous for roughly positioning the holding arm, for example, at the beginning of a surgical procedure. It is then possible to release all joints simultaneously and bring the holding arm into a rough pre-positioning. Subsequently, by releasing the switch, all joints can be locked again and adjusted accordingly only by contact with individual arm segments in order to achieve a desired pose.Preferably, the switch has two different switching positions, wherein the joints are released in a first switching position such that a tool center point of a mechatronic assistance system and / or surgical instrument attached to the support arm can be rotated, and in a second switching position of the switch, the joints are released such that the tool center point can be moved translationally in three spatial directions. In this way, a particularly preferred coarse positioning of the support arm can be achieved.

[0024] In a preferred embodiment of the invention, the first joint is arranged at a proximal end of the first arm segment and the second joint is arranged at a proximal end of the second arm segment. Each arm segment has a proximal and a distal end, wherein the proximal end of the arm segment is the end which lies proximal to the proximal end of the holding arm in the arm direction, and the distal end of the arm segment is the end which is aligned along the holding arm towards the distal end. According to this embodiment, the first joint is therefore located between the first arm segment and the proximal end of the holding arm, such that the first arm segment is movable upon contact with the first arm segment. The same applies to the second arm segment and the second joint.This design allows for particularly intuitive operation of the holding arm, as the arm segment that the operator is in contact with is always movable.

[0025] In a preferred alternative, the operating device releases all joints arranged between the first and second arm segments upon contact between the operator and these arm segments. If the operator grasps two arm segments that are adjacent to or distant from one another in a holding arm according to this embodiment, all joints (one or more joints) located between these arm segments are consequently released. The operator is therefore able to move the distal arm segment essentially freely towards the proximal arm segment of the two grasped arm segments when grasping two arm segments. The operator can also release all joints of the holding arm, namely when grasping both the distal and the proximal arm segment. This enables simple and intuitive release of one or more joints.

[0026] According to a further preferred embodiment of the invention, the joints have brakes by means of which the joints can be released and locked. The holding arm is preferably designed as a passive holding arm. The brakes serve to slow or prevent movement of the arm segments relative to each other, i.e., movement of the joints. When the brakes are released, the joints are released.

[0027] Preferably, the brakes are preloaded in a resting state such that the joints are locked. This ensures that the holding arm is locked when in a resting state, improving the safety of the holding arm when used in the medical field. If, for example, a power supply failure occurs due to a malfunction, the holding arm is locked, and the position of the holding arm remains unchanged. Furthermore, this preload design reduces the energy consumption of the holding arm.

[0028] Particularly preferably, the brakes are designed as electromagnetic brakes and each have a permanent magnet that preloads the brakes into the locked position when de-energized. This is a particularly practical brake design. To release, the brakes must be energized, so that a braking element is released against the force of the permanent magnet. If the power supply fails, the brake closes again due to the permanent magnet, so that the joint is then locked. Electromagnetic brakes have the advantage that they can exert a high holding force or torque relative to their weight, compared to spring-loaded brakes.

[0029] According to a further preferred embodiment, the support arm has six degrees of freedom. Particularly preferably, the support arm has seven degrees of freedom. While six degrees of freedom are sufficient to reach any point in space, seven degrees of freedom allow each point to be reached with different poses, so that the support arm can always be aligned in such a way that, for example, the surgical field is easily accessible. Therefore, it is particularly preferred that the support arm has seven degrees of freedom.

[0030] According to a preferred embodiment, the support arm has seven arm segments and seven joints, with each arm segment being assigned a joint. According to this exemplary embodiment, each joint preferably has one degree of freedom, so that the support arm has a total of seven degrees of freedom. It is also possible for each joint to have two or more degrees of freedom, with joints with one degree of freedom being preferred due to their stability. Preferably, all joints are designed as rotary joints. Preferably, some of the joints are designed as rotary joints and some as translatory joints. Preferably, the joints, if all of them are designed to be rotary, are arranged in the support arm in such a way that axes of successive joints along the support arm, from the proximal to the distal end of the support arm, are each perpendicular to one another.

[0031] According to a further preferred embodiment, the support arm has a weight compensation device for at least partially supporting the weight of one or more arm segments of the support arm when one or more joints are released. For example, if a joint near the proximal end of the support arm is released, the operator must manually support the entire weight of the remaining support arm up to the distal end. To prevent the support arm from sagging after release, a weight compensation device is preferably provided that at least partially compensates for the weight accordingly. As a result, the operator only needs to support a smaller weight after release, which further simplifies handling.

[0032] In a preferred embodiment, the weight compensation device comprises a gas spring element coupled to at least two arm segments. Such a gas spring element is a simple way to implement a weight compensation device. Preferably, the gas spring element is coupled to the two arm segments arranged at the proximal end of the support arm. These two arm segments are preferably connected to a joint whose pivot axis is oriented perpendicular to a longitudinal extension of the arm segments. This achieves a particularly expedient arrangement of the gas spring element, and forces acting on the support arm can be advantageously supported.

[0033] Furthermore, it is preferred that the weight compensation device comprises at least one spring element, in particular a torque-generating spring, such as a coil spring or a torsion bar spring, in at least one joint. In addition or alternatively to the gas spring element, one or more spring elements are accordingly provided in the joints. For example, a coil spring is provided in a rotary joint and applies a torque to the joint such that a portion of the support arm is supported when the joint is released. Such coil springs are another simple way of providing weight compensation.

[0034] In a further preferred embodiment, it is further provided that alignment indicators are arranged on the arm segments, which indicate a basic pose of the support arm. This is particularly preferred if spring elements are provided in the joints for weight compensation. By providing alignment indicators, a user can always easily recognize whether a support arm is in a basic pose or in a pose that deviates from it. This can prevent a weight compensation device from preloading the support arm in the direction of movement when a joint is released, thus not compensating for the weight but additionally increasing it.As an alternative, for example, an inner side, or a side of the holding arm that is oriented toward the surgical field during normal operation, is designed in a first color, while an outward-facing side of the holding arm, or oriented away from the surgical field, is designed in a second color. Alternatively, projections, labels, or the like are provided to serve as alignment indicators.

[0035] Furthermore, it is preferred that at least one cable channel is provided within the arm segments for routing cables from the proximal to the distal end of the support arm. It is preferred to route such cables, for example, for electrical power supply, compressed air supply, light transmission, and the like, within the support arm, so that no cabling runs outside of it, which could cause complications during operation.

[0036] In a further preferred embodiment, the first arm segment, relative to the proximal end of the support arm, has first mechanical coupling means for releasably coupling the support arm to second corresponding coupling means of an operating table. This allows the support arm to be easily coupled to an operating table, in particular to the standard rail.

[0037] Furthermore, it is preferred that the last arm segment at the distal end of the support arm has a mechatronic interface for coupling the surgical mechatronic assistance system and / or surgical instrument to the support arm. Such a mechatronic interface preferably has mechanical coupling means for mechanically holding the assistance system and / or surgical instrument, and, on the other hand, electronic interfaces for transmitting electrical energy and / or data or signals to the mechatronic assistance system.

[0038] Furthermore, the object is achieved in a holding arm of the type mentioned at the outset, in particular a holding arm for medical purposes, in particular for holding a surgical mechatronic assistance system, having a proximal end for fastening the holding arm to a base and a distal end for receiving a surgical mechatronic assistance system, and two or more arm segments and two or more joints by means of which the arm segments are connected to one another in an articulated manner, wherein each joint can be released and locked by means of an operating device, by a first interface at the proximal end for connecting the holding arm to an energy source and to an external control unit for transmitting signals to and from the holding arm; a second interface at the distal end for coupling the holding arm to the assistance system for controlling the assistance system;and a transmission device arranged within the support arm and connecting the first interface to the second interface for transmitting power and signals between the interfaces;

[0039] Assistance systems in the sense of the invention are understood to mean any type of mechatronic manipulator used in surgery, such as, in particular, endoscopes, exoscopes, laparoscopes, trocars, and the like. The second interface at the distal end of the support arm is designed both to mechanically couple to the assistance system in order to hold it in a defined position relative to the support arm, and to provide the necessary additional connections, such as, in particular, a connection for electrical energy and a connection for transmitting signals, in particular control signals. A transmission device, which preferably has a bus system, is formed within the support arm. Furthermore, the transmission device has means for transmitting electrical energy.As a result, all cables required to transmit electrical energy and / or data from the first interface to the second interface are arranged inside the holding arm and are thus protected during operation of the holding arm. Means are also provided at the first interface for coupling the holding arm to a power source and an external control unit, such as a computer and / or an operating room system. This increases the range of applications of the holding arm, and it can be used flexibly for various assistance systems. At the same time, safety is improved because the attachment of additional cables or the like is not necessary; instead, the assistance system only needs to be coupled to the second interface at the distal end, and the holding arm itself can in turn be coupled to a power source and an external control unit via the first interface at the proximal end.

[0040] Particularly preferably, the first interface has a connection for an external rechargeable battery. This makes the holding arm independent of a stationary power supply, and cables can also be avoided. The holding arm also remains operational in the event of a power failure, thereby improving safety. The first interface preferably has a connection for connecting the holding arm to a navigation device, in particular an operating room navigation device. Modern operating rooms usually use several robotic systems. By connecting the holding arm to such a navigation system, it is possible for the system to transmit and receive position data, thus avoiding a collision with other robotic systems. Furthermore, the first interface preferably has a Bluetooth®, a USB, an RS-232, and / or an optical connection.Using a Bluetooth® connection, for example, it is possible to transmit signals to the support arm and make them available via the transmission device at the second interface, where they are then transferred to a surgical mechatronic assistance system, such as a manipulator. The same applies to USB and RS-232 interfaces. USB and RS-232 interfaces are particularly suitable for connecting conventional PCs or surgical systems to the support arm.

[0041] In a further preferred embodiment, the first interface has a connection for an X-ray device, an ultrasound device, or a medical laser, and the transmission device is designed to transmit X-rays, ultrasound signals, and / or a medical laser beam, and the second interface is designed to deliver X-rays, ultrasound signals, and / or laser beams to an operating field or to provide them to a surgical mechatronic assistance system. This also makes it possible to use the holding arm flexibly, and cabling in the operating area can be largely avoided. X-ray devices, ultrasound devices, and medical lasers can be arranged distal to the patient and transmitted to and provided by the holding arm to the operating field.

[0042] In a further preferred embodiment, the support arm has a position sensor in at least one joint for detecting a position of the joint. Preferably, a position sensor for detecting the position of a joint is arranged in each joint. Such a position sensor can be designed, for example, as a capacitive displacement sensor that mechanically records a movement path of the joint and thus determines an angular position, or as an acceleration sensor that determines a movement of the joint in space. Additionally or alternatively, motion sensors are provided in the arm segments so that the position of the arm segments in space can be determined. This makes it possible to determine a pose of the support arm, which in turn can be provided to the assistance system and / or to the external control unit via the first and / or second interface.This is particularly advantageous when a surgical navigation system is used, which uses information about the pose of the holding arm to coordinate navigation. Furthermore, the pose of the holding arm can be used to determine whether a collision with other devices or the holding arm itself is imminent. This further improves the safety of the holding arm.

[0043] If an acceleration sensor is used as a position sensor, it is also possible to detect a movement of the support arm as a whole without changing its position. For example, if the operating table is moved during surgery, the support arm can detect this movement. The support arm can be configured to emit a warning signal when the operating table reaches a certain inclination, for example, from 15 degrees. If the inclination of the operating table is set too steeply, it is possible that a patient could slip on the operating table, which could cause injury.For example, if an endoscope is arranged at the distal interface of the support arm, which is inserted into a patient's nose, for example, and the inclination of the table is then adjusted, the support arm detects the inclination of the table using motion sensors. Torque sensors in the joints also detect a change in the load on the endoscope, which can also indicate a patient slipping on the operating table. The support arm is preferably configured to emit a signal, such as an acoustic signal, when predetermined limits are exceeded.It can also be provided that the holding arm outputs a signal, for example to an operating system or directly to an operating table, when the holding arm is coupled to an operating system or the operating table via the proximal interface, such that movement of the table is blocked if an endoscope arranged at the distal interface is located in the site. Furthermore, it can be provided that after a detected patient movement or a table movement relative to the holding arm, a previously moved position of an assistance system, in particular an endoscope, relative to the patient may no longer be moved. This can also prevent injury.

[0044] If an operating room navigation system is also present, the holding arm according to the invention also makes it possible to integrate non-navigated instruments that do not have localizers assigned to the navigation system into the navigation system via the holding arm. Using the holding arm, it is possible to determine the position of a non-navigated instrument that is arranged at the distal interface of the holding arm. For this purpose, a localizer is arranged on the holding arm or on the base to which the holding arm is coupled, so that the position of the holding arm is known in the navigation system. The holding arm can transfer data representing the position of the instrument to the navigation system via the proximal interface, which can process the data and thus integrate the non-navigated instrument into the navigation. In addition to acceleration sensors, other position and gyroscope sensors are also preferred.By holding instruments that do not have any sensors or the like (such as surgical clamps and the like) using the holding arm, their position relative to the table is known. Operating tables often consist of individual segments that can be adjusted manually. For example, a headrest can be raised, tilted or moved. This often changes the relative position of the patient to instruments, which can cause injuries. By having position sensors in the holding arm, it can detect movement of the operating table or segments of the operating table and thus warn of any relative movement of the patient to the assistance system (e.g. the surgical clamp) by emitting a signal when such a relative movement is detected.It is also possible for the holding arm to transmit data about its pose to other systems such as C-arms (for example the Artis zeego system from Siemens AG, Erlangen, Germany) via the proximal interface, thereby avoiding collisions.

[0045] In a further preferred embodiment, a torque sensor for detecting a torque acting on the joint is arranged in at least one joint. Preferably, such a torque sensor is arranged in all joints. By detecting torques acting on the joints, it is possible to determine a force acting on the distal end of the holding arm. This makes it possible, on the one hand, to determine the weight of an assistance system coupled to the distal end. On the other hand, forces acting on the holding arm when it is in use can also be determined. For example, it is conceivable for an endoscope to be arranged at the second interface. When handling the endoscope, for example inserting the endoscope into a patient's body orifice, the resistance encountered by the endoscope can be determined. This makes it possible to determine whether there is a risk of injury to the patient. This further improves safety.Preferably, the acquired torque data is provided at the first and / or second interface. This allows the torque data to be processed by the external control unit, which can then output a warning signal or the like, for example, in the aforementioned case of an endoscope colliding with a resistance in a patient's body.

[0046] The torque sensors can also be used to determine the weight of an assistance system arranged at the distal interface. The holding arm is preferably designed to block poses in which a specific torque threshold of a joint would be exceeded due to the weight of the assistance system. If, for example, a relatively heavy endoscope is arranged at the distal end of the holding arm, a pose in which the holding arm projects very far from the base, thus causing a very high torque to act in a proximal pivot joint, is blocked. A surgeon cannot move the holding arm into such a pose because brakes in joints previously prevent the holding arm from being moved into such a pose. This further improves the safety of the holding arm.It is also conceivable that the weight of the assistance system is not determined by the support arm, but rather the assistance system transmits its own weight to the second interface at the distal end, and the support arm stores and processes data representing this weight accordingly. Additionally or alternatively, it is preferably provided that a signal tone is emitted when certain threshold values ​​are exceeded. Furthermore, it is preferred that lights are provided on the joints that light up when a predetermined threshold value of a joint is exceeded. Thus, if a joint is loaded with too high a torque, a light at this joint is triggered, and a surgeon can thus determine which joint requires relief in order to achieve a stable pose.

[0047] To transmit this data, the first and / or second interface preferably has transmission means for transmitting the data acquired by the sensor(s). These transmission means preferably comprise the interfaces mentioned above, such as, in particular, Bluetooth®, USB, RS-232, or similar.

[0048] According to a further preferred embodiment, the holding arm has a recognition unit for recognizing an assistance system coupled to the second interface, wherein the operating device is adapted to release or lock the joints depending on the assistance system coupled to the second interface. Such a recognition unit preferably has a barcode scanner, a QR code scanner, or an RFID scanner. Preferably, an assistance system coupled to the second interface is equipped with a corresponding barcode, QR code, or RFID chip, which contains an identification of the assistance system and preferably information about it. As a result, the holding arm is able to recognize which assistance system is coupled to the second interface and thus partially or completely prevent certain joints from being released. For example, an endoscope is arranged at the second interface.The endoscope's RFID chip contains information about the endoscope, such as its geometric dimensions. This information is recognized by the recognition unit and forwarded to the operating device of the holding arm and / or the external control unit. The operating device is designed to prevent the holding arm from assuming positions in which the endoscope would collide with the holding arm. Furthermore, the operating device can also be designed to prevent the holding arm from assuming positions in which the endoscope would collide with, for example, an operating table or other objects.

[0049] The recognition unit is preferably further configured to recognize an instrument that is introduced into the surgical area and to provide data representing this instrument at the first interface. The recognition unit is preferably further configured to recognize an instrument that is removed from the surgical area and to provide data representing this instrument at the first interface. For this purpose, the instrument preferably has a transmitter, such as an RFID chip, which communicates via a corresponding receiver, such as an RFID sensor, provided in the recognition unit. This makes it possible to determine at what time which instrument is introduced into the surgical area and whether it has left the surgical area again.For example, if at the end of a surgical procedure it is discovered that seven instruments have been brought into the surgical area but only six have been removed from it, this may be an indication that an instrument is still in the surgical area, which may pose a risk to the patient.

[0050] According to a further preferred embodiment, the support arm has a camera, which is preferably arranged at the distal end. The camera is intended to observe a surgical field and is coupled to the first interface for transmitting image data at the first interface. This advantageously allows the surgical field to be observed. Due to the coupling to the support arm, the camera is arranged particularly close to the surgical field and has a "clear view" of the surgical field. Furthermore, its position is adjustable by means of the support arm. The camera can also be used to observe objects such as other surgical instruments and the like in the vicinity of the support arm and thus prevent a collision with them.If, for example, the camera detects that the holding arm is being brought too close to an instrument in the operating field, the operating device can lock one or more joints to prevent a collision. In such a case, it is preferred that the operating device has a controller equipped with image recognition software designed for this purpose. The camera can be integrated into the holding arm itself and permanently connected to it, or the camera can be part of an exoscope that is coupled to the second interface. The camera is preferably designed as a full HD camera or as a 3D camera. If the camera is part of an exoscope, it is connected to a voltage interface, a fiber optic interface, and a data interface at the second interface. In use, the camera of an exoscope is typically arranged approximately 25 cm to 75 cm from a operating field.By coupling the exoscope's camera directly to the distal interface, data can be transmitted at the proximal interface, for example to a surgical system. The user can then view images captured by the camera on a corresponding 2D or 3D monitor of the surgical system. Since the support arm allows the camera or camera lens to be positioned relatively close to the surgical field, high magnifications of, for example, 12x magnification can be easily achieved using appropriate monitors. This eliminates the need for a large and cumbersome surgical microscope; the support arm, equipped with a camera or exoscope, is sufficient to observe the surgical field.Because the holding arm additionally features sensors for determining the pose of the holding arm, the position from which the images are acquired by the camera or the exoscope's camera is also known when using the holding arm according to the invention. Temporal position information can thus be assigned to the acquired image data. This makes it possible to assign the viewing angle and position to each individual image after the operation. This allows postoperative conclusions to be drawn for documentation regarding which surgical strategy was chosen from which perspective.

[0051] Preferably, the support arm further comprises a microphone coupled to the controller and / or operating device, and the controller and / or the operating device comprises corresponding speech recognition software so that audio signals received by the microphone are converted into actuating and control signals for the support arm. Thus, upon receipt of a corresponding audio signal via the microphone, it is preferred to control a camera arranged on the support arm or integrated therein such that it captures a still image, a so-called snapshot, and transmits it to the support arm at the second interface, so that data representing this snapshot can be transmitted to a system at the first interface of the support arm.This makes it possible for the surgeon to give a command during the operation, such as saying the word "snapshot," and for speech recognition software built into the controller to send a signal from the controller to the camera, taking a snapshot and providing data representing it to the second interface. Position data can also be transferred to these snapshots via the support arm.

[0052] Furthermore, if a navigation system is present in the operating room in which the holding arm is used, the holding arm can be connected to this navigation system via the first interface. Such navigation systems are available, for example, from Karl Storz GmbH & Co. KG, Tuttlingen, Germany or Olympus Deutschland GmbH, Hamburg, Germany. In such a case, an optical localizer is preferably attached to the base of the holding arm, which interacts with the navigation system. The navigation camera of the navigation system thus records the holding arm and also the operating field. The patient is also equipped with localizers so that the patient position in the room can be recorded by the navigation system. However, the defined working spaces of a navigation system are usually limited. If a camera or an exoscope is now provided on the holding arm, it is possible to attach the camera or exoscope to the holding arm.to position the exoscope outside the working space of the navigation system and to determine the position of the camera or the exoscope using the holding arm. This allows the limited working space of the navigation system to be kept free of additional tools and the navigation system to be used more effectively. Furthermore, position data of the camera can be stored alongside the data representing recorded images and linked to data from the navigation system. In a further preferred embodiment, a safety element is provided at the second interface, which is coupled to the operating device such that the operating device locks all joints if the safety element indicates a faulty coupling between the assistance system and the second interface. Such a safety element can be designed as an electronic safety element or as a mechanical safety element.For example, it can be provided that an electrical circuit is closed when the assistance system and the second interface are correctly coupled. In one alternative, a magnet is arranged on the assistance system, and the second interface has a corresponding sensor designed to detect the magnetic field of the sensor arranged on the assistance system. Other alternatives are conceivable. This also further improves the safety of the holding arm. If an assistance system is not correctly coupled to the second interface, all joints are locked, and the holding arm cannot be moved. The risk of a holding arm being used with an incorrectly coupled assistance system during an operation can thus be reduced.

[0053] In a third aspect of the disclosure, the object mentioned at the outset is achieved by a method for positioning a surgical mechatronic assistance system and / or surgical instrument coupled to a holding arm, preferably a holding arm according to one of the above-described preferred embodiments of a holding arm according to the first or second aspect, wherein the holding arm has at least six degrees of freedom, with the steps: maintaining a pose of the holding arm; detecting contact of an operator with a first arm segment of the holding arm; releasing a first joint assigned to the first arm segment as long as the contact is detected; locking the first joint as soon as the contact is no longer detected.Such a method provides a method for positioning an assistance system and / or surgical instrument coupled to a holding arm, by means of which the latter can be positioned intuitively and in a simple manner by an operator.

[0054] In a resting state, the pose of the holding arm is preferably maintained. Only when contact is detected between an operator and a first arm segment is the associated first joint released as long as the contact is detected. When the contact is broken, the joint is locked. The joint is thus released as long as there is contact between the operator and the arm segment, so that upon contact with the arm segment the operator can move this and adjoining arm segments in order to position the assistance system and / or the surgical instrument in space. This type of positioning is intuitive, which also improves the safety of a surgical procedure using such a holding arm, as incorrect operation can be avoided. The method is preferably carried out in head surgery. The method preferably comprises the step of holding an endoscope during a head surgical treatment.Especially in the field of head surgery, precise positioning is required because the space for manipulating tissue is limited and, depending on the position, tissue manipulation is highly sensitive.

[0055] The method preferably further comprises the steps of: detecting contact of an operator with a second arm segment of the support arm; releasing a second joint associated with the second arm segment as long as the contact is detected; and locking the second joint as soon as the contact is no longer detected. The steps are preferably carried out simultaneously or after the above-mentioned steps. It is possible and preferred for an operator to contact only one arm segment or two or more arm segments. Therefore, all joints associated with the respectively contacted arm segments are released. This enables particularly simple and rapid positioning of the assistance system and / or surgical instrument.

[0056] In a preferred embodiment, contact is detected on two essentially opposite sides of the arm segment. This makes it possible to distinguish between unintentional contact and intentional gripping, thus eliminating unintentional contacts in which the operator touches an arm segment, for example, with only one arm or the back of the hand without intentionally intending to cause contact. Only when contact is detected on two opposite sides, which usually occurs when the corresponding arm segment is grasped, is the associated joint released.

[0057] According to a further preferred embodiment of the method, the intensity of the contact is detected and, depending on the intensity, the joint is partially or completely released. Preferably, the joint is continuously released from partially to completely depending on the intensity of the contact. If, for example, an operator only lightly grips the corresponding arm segment and applies only a small amount of force, the joint is only partially released, such that the joint can move against resistance. If, on the other hand, a firm grip is applied and a high force is therefore applied, the joint is completely released, such that the arm segment can move essentially without resistance. This still enables intuitive operation, and an operator can control the release of the joints through the force they apply when gripping.For example, a quick tap can release the joint briefly, allowing fine positioning of the arm.

[0058] Furthermore, the method preferably comprises the step of outputting a signal indicating contact between the operator and the arm segment. This step provides the operator with direct feedback about the contact and thus about the release of the associated joint.

[0059] It should be understood that the support arm according to the first aspect of the disclosure and the method according to the third aspect of the disclosure have identical and similar aspects. Therefore, for the preferred embodiments of the method and their advantages, reference is also made in full to the above description of the support arm.

[0060] In a fourth aspect of the disclosure, the object mentioned at the outset is achieved by a method for controlling a mechatronic assistance system coupled to a support arm, in particular using a support arm according to one of the above-described preferred embodiments of a support arm, for navigation during a surgical treatment, comprising the steps of: coupling a mechatronic assistance system to a second interface of the support arm at its distal end; transmitting electrical energy and signals from a first interface of the support arm at its proximal end; wherein the transmission is carried out by means of a transmission device which is arranged within the support arm and connects the first interface to the second interface for transmitting energy and signals between the interfaces.

[0061] Such a method for controlling a mechatronic assistance system coupled to a holding arm improves, in particular, the safety of a holding arm used and the safety of surgical steps performed with it.

[0062] Preferably, the method further comprises the steps of: detecting positions of joints of the support arm; determining a pose of the support arm using the detected position of the joints; and providing data representing the determined pose at the first interface. The data provided at the first interface are preferably transferred by this interface to an external control unit, in which the data are further processed and / or evaluated. Such an external control unit can be embodied, for example, as a conventional PC or as an operating system.

[0063] Furthermore, it is preferred that the method comprises the steps of: detecting torques acting on joints of the support arm; determining a force acting on the distal end of the support arm; and providing data representing the determined force at the first interface. This data is also preferably transferred to an external control unit. The external control unit can further process and / or evaluate this data. For example, the external control unit can output a signal if a limit value of a force acting on the support arm is exceeded.

[0064] In a further preferred embodiment, the method comprises the steps of: detecting an assistance system coupled to the second interface; releasing and locking joints of the support arm depending on the detected assistance system; and providing data representing the detected assistance system at the first interface. These steps further improve the safety of the support arm and the use of this support arm in a surgical procedure. As soon as a critical and / or "illegal" pose is reached with the support arm or the support arm is moved into such a pose, the corresponding joints are locked so that this critical or "illegal" pose cannot be reached. This further improves the safety of the support arm.

[0065] Furthermore, the method preferably comprises the steps of: detecting, by means of a detection unit, an instrument introduced into a surgical area; providing data at the proximal interface that represents the instrument and indicates that the instrument has been introduced into the surgical area. According to these method steps, instruments that are not coupled to the distal end of the holding arm are detected by means of the detection unit. For this purpose, the detection unit preferably has a receiver, such as an RFID sensor, while the instrument(s) brought into the surgical area have a transmitter, such as an RFID tag. It is also possible for the holding arm to have a near-field sensor and the instrument to have a near-field chip. Other transmitter-receiver models are also possible. This method therefore detects when an instrument is introduced into the surgical area.At the first interface, data representing the instrument and indicating which instrument it is, as well as data indicating that the instrument has been introduced into the surgical area, are provided. This data is preferably stored.

[0066] In a preferred development, it is further provided that the method comprises the steps of: detecting, by means of a detection unit, an instrument removed from the surgical area; providing data at the first interface that represents the instrument and indicates that the instrument has been removed from the surgical area. The above description applies accordingly here. However, according to these method steps, it is detected whether and when the corresponding instrument was removed from the surgical area. If, after completion of the operation, a discrepancy arises between the inserted and removed instruments, this indicates that instruments are still in the surgical area. This can reduce the risk during the operation.

[0067] In a preferred embodiment, the method comprises the steps of: acquiring image data of a surgical field; and providing the image data at the first interface. The image data includes both two-dimensional and three-dimensional image data and is preferably acquired by means of a camera arranged at the distal end of the support arm.

[0068] In a preferred embodiment, the image data is linked to position data of the assistance system. The assistance system preferably has a camera. By linking the image data to position data of the assistance system, in particular by image metadata containing data about the position of the camera, it is possible to determine from which position the corresponding image was taken.

[0069] In a preferred development of the method, it comprises the following steps: capturing an audio signal using a microphone; recognizing a voice command in the audio signal; converting the voice command into a control signal for the assistance system; and providing the control signal at the second interface. Preferably, known speech recognition software is used to process the audio signal. Certain voice commands can be linked to certain control signals. For example, it is possible for a voice command "screenshot" to be assigned to a control signal that causes a camera arranged at the second interface to take an image. Other control signals are conceivable and preferred.

[0070] Furthermore, it is preferred that the method further comprises the following steps: determining whether the assistance system is correctly coupled to the second interface; locking all joints of the support arm if the assistance system is not correctly coupled to the second interface. This also further improves safety. In addition, the method can comprise the step of outputting an alarm signal if the assistance system is not correctly coupled to the second interface. Such an alarm signal can be embodied, for example, as an audio signal or a visual signal.

[0071] In a preferred embodiment of the method, this further comprises the step of displaying a representation of data transferred at the first and / or second interface. Such a representation can, for example, comprise displaying an identification of an assistance system arranged at the distal end. Information about this assistance system can be displayed, such as capabilities, restrictions, positioning parameters, and the like. Furthermore, it is also possible to display a pose of the support arm or forces acting on individual joints.

[0072] In a further preferred embodiment, the method comprises the steps of: storing the data provided at the first interface; creating a surgical protocol using the stored data. Preferably, all recorded and provided data are saved, and the surgical protocol is created on the basis of this data. The recorded data includes position and orientation data of the joints, as well as forces acting on the distal end. Based on this data, it is possible to recreate each individual pose of the support arm during an operation and thus to know the spatial position of an assistance system arranged on the support arm during the entire surgical process. This makes it possible to recreate how the assistance system was moved relative to the patient and, consequently, which steps were performed.According to this aspect of the disclosure, it is therefore not necessary for an operator to log every single step; this can be done retrospectively by reading and processing the data. This further improves safety by reducing the risk of protocol errors.

[0073] Furthermore, the method preferably comprises the steps of: storing all data provided at the first interface; generating a DICOM file based on the stored data. A DICOM file is a well-known data exchange format for surgical systems and can be used by a variety of systems to subsequently analyze and follow up on a surgery. A DICOM file can also be used to be stored in an electronic patient record. These steps are preferably performed automatically after completion of a surgical procedure.

[0074] It should be understood that the holding arm according to the second aspect of the disclosure and the method according to the fourth aspect of the disclosure have identical and similar sub-aspects. For individual embodiments of the holding arm and the advantages of the method, reference is made in full to the above description of the first aspect of the disclosure.

[0075] The invention will be explained in more detail below using an exemplary embodiment with reference to the accompanying figures. Figure 1 shows a side view of a holding arm, showing the contact means; Figure 2 shows a partially broken away view of the holding arm from Figure 1 ; Figure 3 a schematic representation of the fourth arm segment; Figure 4 another schematic representation of the fourth arm segment; Figure 5 the holding arm from Figure 1, coupled to an external control unit; Figure 6 shows a top view of the interface at the proximal end of the support arm; Figure 7 shows a perspective view of an external energy storage device; Figure 8 shows a perspective schematic representation of the first arm segment with a mechanical interface for coupling the support arm to a standard rail of an operating table; Figure 9 shows a perspective representation of the seventh arm segment including the interface at the distal end; Figure 10 shows a top view of the interface at the distal end of the support arm; Figure 11a shows an embodiment of the support arm with a partially structured surface; Figure 11b shows an embodiment of a support arm with a partially colored surface; Figure 12 shows a partial section through a brake in a joint of the support arm; Figure 13 shows a flowchart of a method according to a first embodiment; and Figure 14 shows a flowchart of a method according to a second embodiment.

[0076] Figure 1 shows a holding arm 1 for medical purposes, in particular for holding a surgical mechatronic assistance system and / or surgical instrument. The holding arm 1 has a proximal end 2 and a distal end 4. At the proximal end 2, a first interface 6 and a mechanical interface 7 are formed, which with respect to the Figures 6 and 8 be described in more detail. The interface 7 serves to attach the holding arm 1 to a base, such as, in particular, an operating table. The interface 7 serves to transfer energy and to couple the holding arm 1 to an external control unit (see Fig. 5). A second interface 8 is provided at the distal end 4, via which a mechatronic assistance system and / or a surgical instrument, such as in particular a manipulator, can be coupled to the holding arm 1. Preferably, a manipulator for holding and manipulating an endoscope is arranged here.

[0077] The holding arm 1 according to Figure 1 has seven arm segments 10, 12, 14, 16, 18, 20, 22, each of which is essentially rod-shaped and, except for the last arm segment 22, all of which are essentially the same length. The seven arm segments 10, 12, 14, 16, 18, 20, 22 are each coupled to one another by joints 11, 13, 15, 17, 19, 21, 23, wherein the zeroth joint 11 connects the holding arm 1 to the base (in Fig. 1 not shown, see Fig. 7) is coupled. The joints 13, 15, 17, 19, 21, 23 are, according to this embodiment, all designed as rotary joints, each with one degree of freedom. According to this embodiment, the zeroth joint 11 is assigned to the zeroth segment 10, the first joint 13 is assigned to the first arm segment 12, the second joint 15 is assigned to the second arm segment 14, the third joint 17 is assigned to the third arm segment 16, the fourth joint 19 is assigned to the fourth arm joint 18, the fifth joint 21 is assigned to the fifth arm segment 20, and the sixth joint 23 is assigned to the sixth arm segment 22. The joint 11 is designed as a translatory joint, so that the arm segment 10 can be extended telescopically in order to adjust the height of the holding arm 1, as will be explained later with reference to Figure 8will be explained. The joints 13, 15, 17, 19, 21, and 23 each have pivot axes A 1 , A 2 , A 3 , A 4 , A 5 , and A 6 , with adjacent joints having pivot axes that are perpendicular to one another. This allows for easy positioning of the distal end 4 in space.

[0078] The holding arm 1 according to Figure 1further comprises an operating device 28. By means of the operating device 28, the holding arm 1 can be moved into a desired position, wherein the operating device 28 is configured to release the associated joint upon contact between an operator and one of the seven arm segments. For this purpose, the operating device 28 according to this exemplary embodiment has seven contact sections 30, 32, 34, 36, 38, 40, 42, wherein a contact means 30, 32, 34, 36, 38, 40, 42 is arranged on each arm segment 10, 12, 14, 16, 18, 20, 22. Thus, a zeroth contact means 30 is arranged on the zeroth arm segment 10, a first contact means 32 on the first arm segment 12, a second contact means 34 on the second arm segment 14, a third contact means 36 on the third arm segment 16, a fourth contact means 38 on the fourth arm segment 18, a fifth contact means 40 on the fifth arm segment 20 and a sixth contact means 42 on the sixth arm segment 22.

[0079] Furthermore, according to this exemplary embodiment, each contact means 30, 32, 34, 36, 38, 40, 42 comprises two contact means elements 30a, 30b, 32a, 32b, 34a, 34b, 36a, 36b, 38a, 38b, 40a, 40b, 42a, 42b arranged substantially opposite one another. The contact means 30, 32, 34, 36, 38, 40, 42 serve to detect contact of an operator with the corresponding arm segment 10, 12, 14, 16, 18, 20, 22. When gripping an arm segment 10, 12, 14, 16, 18, 20, 22, the operator comes into contact with both contact elements 30a, 30b to 42a, 42b, and only upon contact with both contact elements 30a, 30b to 42a, 42b of a contact element 30 to 42 is the associated joint released. This means that when gripping the first arm segment 12 and simultaneously coming into contact with the two contact elements 32a, 32b, the first joint 13 is released by the operating device 28.This allows the operator to pivot the holding arm 1 or the arm segments 12 to 22 about the axis A1. Upon release of one or both of the contact elements 32a, 32b, the joint 13 is locked again, and pivoting about the axis A1 is no longer possible. Even if only one of the two contact elements 32a, 32b is accidentally touched, for example, with an arm or elbow of the operator, the joint 13 is not released, and the holding arm 1 remains in the locked state and maintains its position.

[0080] The same applies to the second arm segment 14. Here, too, the second contact means 34 has two contact means elements 34a, 34b, which are provided essentially opposite one another circumferentially on the arm segment 14. When grasping this arm segment 14 and coming into contact with the two contact means elements 34a, 34b, this contact is detected by the operating device 28, and the joint 15 assigned to the arm segment 14 is released. Now, pivoting about the axis A 2 is possible, so that the distal end 4, relative to Figure 1 , can be pivoted up or down. At the same time, all other joints 13, 17, 19, 21, and 23 remain locked, preventing any movement.

[0081] The operating device 28 can have a controller or microprocessor which is designed to detect a contact between contact means elements 30a, 30b to 42a, 42b and to convert it into electrical signals.

[0082] According to this embodiment, the contact means 30 or the contact means elements 30a, 30b to 42a, 42b are designed as touch-sensitive sensors and detect a pressure of contact between the operator and the corresponding contact means element 30a, 30b to 42a, 42b. Preferably, the contact means elements 30a, 30b to 42a, 42b are designed as capacitive touch-sensitive sensors.

[0083] With the illustrated holding arm 1, it is also possible for an operator to simultaneously grasp two arm segments, for example, arm segment 14 and arm segment 18, and thus simultaneously contact the contact elements 34a, 34b and 38a, 38b. Consequently, the joints 15 and 19 are released, and pivoting about both the A2 axis and the A4 axis is possible. With this simultaneous release, it is possible to maintain an angular orientation of the arm segments 18 and 20 in space, while only the arm segments 34, 36 are pivoted. This also enables a translational movement of the distal end 4. In a preferred embodiment of the holding arm, when two arm segments, according to this example the arm segments 14 and 18, come into contact simultaneously, it is not the joints 15 and 19 that are released, but all the joints located between these arm segments 14 and 18, i.e. according to this embodiment the joints 17 and 19. The joint 15 remains locked.The pose of the support arm 1 can now be adjusted to allow rotation around the A3 and A4 axes. This allows for particularly intuitive operation of the support arm. Accordingly, joints 15, 17, 19, and 21 are released, for example, upon contact between the operator and the support arm segments 12 and 20.

[0084] Furthermore, in the Figure 1 It can be seen that the holding arm 1 has a weight compensation device 50. According to this exemplary embodiment, the weight compensation device 50 comprises a gas pressure spring element which is coupled to the arm segment 14 and the arm segment 12. Alternatively, the weight compensation device can also comprise a cable pull and / or a balanced counterweight. In the holding arm 1 according to Figure 1The greatest moment is exerted on joint 15 about its rotation axis A2. Consequently, it is preferable to support precisely this joint 15 by means of the weight compensation device 50. When joint 15 is released by contacting arm segment 14, a weight exerted on arm segment 14 is supported by the weight compensation device 50 due to the additional arm segments 16, 18, 20, 22 and a manipulator arranged at interface 8, so that distal end 4 does not immediately "sag" when segment 14 is grasped.

[0085] The holding arm 1 (see Fig. 2) has a recognition unit 52 for recognizing an assistance system coupled to the second interface 8, wherein the operating device 28 is adapted to release or lock the joints 11, 13, 15, 17, 19, 21, 23 depending on the assistance system coupled to the second interface 8. Such a recognition unit 52 preferably has a barcode scanner, a QR code scanner, or an RFID scanner. Preferably, an assistance system coupled to the second interface 8 is equipped with a corresponding barcode, QR code, or RFID chip, which contains an identification of the assistance system and preferably information about it. As a result, the holding arm 1 is able to recognize which assistance system is coupled to the second interface 8 and thus partially or completely prevent the release of certain joints 11, 13, 15, 17, 19, 21, 23.For example, an endoscope is arranged at the second interface 8. The endoscope's RFID chip contains information about this endoscope, such as, in particular, the endoscope's geometric dimensions. This information is recognized by the recognition unit and forwarded to the operating device 28 of the holding arm 1 and / or the external control unit. The operating device 28 is designed to prevent poses of the holding arm 1 in which the endoscope would collide with the holding arm. Furthermore, the operating device 28 can additionally be designed to prevent poses of the holding arm 1 in which the endoscope would collide with, for example, an operating table or other objects.

[0086] In Figure 2 are included in the holding arm 1 in addition to the Figure 1The brakes 60, 62, 64, 66, 68, 70, 72 are shown, by means of which the joints 11, 13, 15, 17, 19, 21, 23 can be released and locked. The same and similar elements are given the same reference numerals as in Figure 1 and in this respect, reference is made in full to the above description. Even if in Figure 2 the reference numerals on the contact means elements of the contact means 30, 32, 34, 36, 38, 40, 42 are not shown for reasons of clarity, they are nevertheless present, as can be seen from a comparison of the Figures 1 and 2 results.

[0087] Each joint 11, 13, 15, 17, 19, 21, and 23 is assigned a brake 60, 62, 64, 66, 68, 70, and 72, respectively. Brake 60 is assigned to joint 11, brake 62 to joint 13, brake 64 to joint 15, brake 66 to joint 17, brake 68 to joint 19, brake 70 to joint 21, and brake 72 to joint 23. All brakes 60 to 72 are electromagnetic brakes with a permanent magnet, such that they are preloaded into a locked state when deenergized. The permanent magnet is designed such that it can lock the respective joint on its own, maintaining the position of the holding arm 1. An electronic control unit 74 is provided in the zeroth arm segment 10. This is connected via a bus system 76 (in Figure 2 only shown in arm segment 10; cf. Fig. 3 and 4) is coupled to all contact means 30 to 42 of the operating device 28 as well as to all brakes 60 to 72. To supply energy to the brakes 60 to 72 and the contact means 30 to 42, a power line 78 is also provided, which can be coupled to a power source via the interface 6 at the proximal end 2 of the holding arm 1.

[0088] The Figures 3 and 4 show two different embodiments of an arm segment, where in the Figures 3 and 4 The fourth arm segment 18 is shown as an example. It should be recognized that the other arm segments 10, 12, 14, 16, 20, 22 can also be designed in the same way.

[0089] The arm segment 18 has an arm segment body 90 (in the Fig. 1 and 2 not shown; it should be understood that each arm segment 10 to 22 has an arm segment body) which is arranged according to the Figures 3 and 4is essentially rod-shaped or cylindrical. Inside, the arm segment body 90 has a cavity 92 in which various elements, such as the brake 70, are arranged. Schematically shown in the Figures 3 and 4 are the joints 19, 21 and the two pivot axes A 4 , A 5 of the joints 19, 21, which each interact with the holding arm segment 18. The joint 19 is assigned to the holding arm segment 18 (see above description of the Fig. 1 and 2 ). The arm segment body 90 has an outer surface 93 that is substantially cylindrical. The arm segment body 90 is formed, for example, from a metal such as, in particular, aluminum or titanium, an aluminum- or titanium-based alloy, or a fiber composite material such as fiberglass or carbon fiber reinforced plastic (CFRP), and is preferably designed as a lightweight construction.

[0090] The arm segment 18 has, according to the Figures 3 and 4the contact means 38, which is part of the operating device 28 (cf. Fig. 1 and 2 ). The contact means 38 has two contact means elements 38a, 38b, which are designed as touch-sensitive sensors and are arranged flush with the outer surface 93 of the arm segment 18. The two contact means elements 38a, 38b are arranged substantially opposite one another with respect to the axis A5, so that an operator comes into contact with both contact means elements 38a, 38b when gripping the arm segment 18, as described above.

[0091] The two contact elements 38a, 38b are coupled to the bus system 76 by means of lines 94a, 94b. The contact elements 38a, 38b are connected to the electronic control unit 74 (see Fig. 2) and via this in turn with the brake 70, so that the brake 70 is released by the operating device 28 when an operator comes into contact with the contact means elements 38a, 38b.

[0092] In addition to the bus system 76, a power transmission system 78, a cable duct 80, and a working duct 82 are arranged within the arm segment body 90. The contact elements 38a, 38b and the brake 70 are connected to a power supply via the power transmission system 78.

[0093] Alternatively or additionally, an electronic module 96 is arranged in each arm segment, which is coupled to the bus system 76 via a line 96a. In such a case, the contact elements 38a, 38b, which are connected to the data bus system 76 via the line 94a, 94b, interact only with the electronic module 96, which converts the contact detected by the contact elements 38a, 38b into an actuating signal for the brake 70 and sends this actuating signal via the bus system 76 to the brake 70 to release the joint 19. If such an electronic module 96 is arranged in each arm segment, an essentially modular design of the holding arm 1 is realized, and the individual arm segments 10 to 22 are independent of the electronic control unit 74, which is arranged in the proximal arm segment 10.

[0094] The cable channel 80 serves to guide cables that run from the proximal end 2 to the distal end 4, in particular to supply the interface 8. The working channel 82 serves to accommodate hoses or light guides and the like, which are required depending on the type of manipulator arranged at the interface 8. If, for example, an endoscope is arranged at the interface 8, a light guide is preferably guided through the working channel 82, which can transmit an image captured by an endoscope camera. The working channel 82 therefore serves to accommodate appropriate transmission media depending on the field of application.

[0095] Furthermore, a sensor 98 is arranged in the arm segment 18. Preferably, a sensor is arranged in each arm segment 10 to 22, and it should be understood that the sensors in the arm segments 10, 12, 14, 16, 20, and 22 can be designed in the same way as the sensor 98 in the arm segment 18. The sensor 98 is preferably designed as an acceleration sensor. By providing such an acceleration sensor in each arm segment, it is possible to determine the pose of the holding arm 1 at any time. For this purpose, the sensor 98 is coupled to the data bus system 76 via a line 98a, so that the data detected by the sensor 98 is transmitted to the electronic control unit 74, which then determines the pose of the holding arm 1 from all sensor data from all arm segments. Furthermore, by providing such a sensor 98, the absolute and relative position of an end effector or manipulator arranged at the interface 8 can also be determined.It is also possible, if the support arm 1 is arranged on an operating table, to detect a movement of this operating table. If all sensors in all arm segments detect a movement in the same direction, this indicates that the entire support arm 1 has been moved while maintaining its position, for example, by the operating table or an operating table top being rotated or shifted relative to a column of the operating table. Such a movement can also be detected by the sensors 98. Furthermore, external impulses, such as impacts on the support arm 1, can be detected.

[0096] According to Figure 4 is additionally in the arm segment 18 according to Figure 3A storage element 100 and a power generation device 102 are provided. The storage element serves to store electrical energy so that sensors provided in the specific arm segment can be supplied with power even when disconnected from the power grid. This is particularly necessary when, for example, bump sensors of a camera or the like are provided, which must also function when the support arm is at rest in order to detect possible damage to the support arm 1. The power generation device 102 serves to provide energy for, for example, a laser, an ultrasound device, or the like, which are coupled to the support arm.Additionally or alternatively, the energy generation device 102 may also comprise a device for supplying the storage element 100, for example an energy harvesting element, which converts kinetic energy or energy due to a magnetic field, for example inductively, into electrical voltage for the storage element 100.

[0097] Figure 5 illustrates again the holding arm 1, which has already been described with reference to the Figures 1 and 2 has been described. In Figure 5 The holding arm 1 is shown integrated into a system. At the distal end 4, a surgical mechatronic assistance system 200 is arranged by means of the interface 8, which is coupled to the interface 8 via an interface 201. Both the surgical mechatronic assistance system 200 and the interface 201 are in Figure 5shown only schematically. It should be understood that the surgical mechatronic assistance system 200 can be designed, for example, as an endoscope or laparoscope or the like. The assistance system 200 has a working section 202, which can be, for example, the tip of the endoscope. At the proximal end 2, the holding arm 1 is arranged according to Figure 5 coupled to a base 204 via the mechanical interface 7. The base 204 is also shown only schematically here. It can be designed, for example, as a standard rail of an operating table.

[0098] According to this exemplary embodiment, the first interface 6 is coupled to an external control unit 206. For this purpose, the interface 6 is connected to the external control unit 206 via a cable 208. According to this exemplary embodiment, the external control unit 206 is designed as an operating room system, which, for example, comprises a conventional computer and an input / output interface for operating the operating room system. The operating room system preferably comprises software components designed to store and process data transferred from the holding arm 1 to the interface 6.

[0099] Depending on the design of the interface 6, it can also be provided that it communicates wirelessly with the surgical system 206, for example via Bluetooth ®< , Wi-Fi ®< or similar.

[0100] According to this exemplary embodiment, the support arm 1 further comprises a display 55, which according to this exemplary embodiment is designed as an LCD display. The display 55 is connected to a control unit and displays representations of data transferred to the first interface 6 or second interface 8. For example, the weight of an assistance system 200 coupled to the interface 8 is displayed on the display. Alternatively, a representation of the pose of the support arm is shown on the display, with corresponding loads on individual joints. Further possibilities are conceivable here. It is also conceivable that warnings are displayed here.

[0101] The interface 6 (see Fig. 6 ) has a connection 77 for the bus system 76. Via this connection 77, data which is received from sensors (cf. Fig. 3 u. 4) and the contact elements (cf. Fig. 2 - 4) to the bus system 76, can be transmitted to the external control unit 206. The connection 77 can be designed as a USB interface, RS-232 interface, Bluetooth ®< interface, Wi-Fi ®< interface or the like. A connection 79 for transmitting electrical energy is also provided centrally at the interface 6. By means of this connection 79, the holding arm 1 can be coupled to an energy source, for example the power grid. Furthermore, at the interface 6, three outlets 80a, 80b, 80c of the cable duct 80 (cf. above description of the Fig. 2 , 3, and 4). Cables which are guided into the cable duct 80 are accessible via these outlets 80a, 80b, 80c. In addition, three outlets 82a, 82b, 82c of the working channel 82 are provided in the interface 6. The working channel 82 is accessible via the outlets 82a, 82b, 82c. For example, a hose can be guided through the outlet 82b into the working channel 82 by means of the interface 6 and through this to the distal interface 8 (cf. Fig. 10 ) can be carried out.

[0102] Mechanical coupling means 210a, 210b are provided on a circumferential area of ​​the arm segment 10 in the area of ​​the interface 6. The coupling means 210a, 210b correspond to coupling means 212a, 212b of an external energy storage device 214 (see Fig. 7). The external energy storage device 214 has a housing 216 which is designed to be attached proximally to the arm segment 10. The external energy storage device 214 has cells inside for storing electrical energy (in Fig. 7(not shown). The external energy storage device 214 has an interface 218 that corresponds to the interface 6 of the support arm 1. The interface 218 has a connection 220, by means of which the electrical energy stored in the external energy storage device 214 can be transferred to the support arm 1 via the connection 79 of the interface 6. Furthermore, the interface 218 has a connection 221, which corresponds to the interface 77, for passing through signals of the bus system 76. Furthermore, the external energy storage device has passages 222a, b, c, 224a, b, c, which correspond to the outlets 80a, b, c and 82a, b, c of the interface 6, so that cables guided through the cable duct 80 can also be guided through the energy storage device 214 and the outlets 82a, 82b, 82c of the working channel 80 are also accessible on the energy storage device 214.

[0103] Fig. 8illustrates the arm segment 10, which forms the proximal end 2 of the holding arm, and in particular the mechanical interface 7. At the first interface 6, the external energy storage device 214 (cf. Fig. 7 ) so that the holding arm 1 according to this embodiment ( Fig. 8 ) can be operated autonomously, without the need to connect it to an external power source. A connection to a control unit 206 can nevertheless be provided and is preferred. The arm segment 10 has a contact means 30, which has two contact means sections 30a, 30b (see also Fig. 2). The interface 7 is formed according to this embodiment as a recess 226, which corresponds to the outer contour of the base 204, which is designed here as a standard rail of an operating table. The base 204 can be guided into the recess 226, and mechanical clamping means 228 are provided on the arm segment 10 for clamping the arm segment 10 against the base 204. The clamping means comprise a linearly guided clamping body 230, which is drivable via a linkage 232 with a lever 224. The joint 11, which can be released via the contact means 30 of the operating device 28, is consequently oriented as a translatory joint 11. The operating device is for this purpose via an electrical actuating means, which is in Figure 8 not shown, coupled to the lever 228 so that the clamping means 230 can be disengaged from the base 204.

[0104] The Figures 9 and 10finally illustrate the second interface 8 at the distal end 2 of the holding arm 1. While Figure 9 the interface 8 in a perspective view including the arm segment 22, Figure 10 the interface 8 in a frontal view.

[0105] The interface 8 is designed essentially corresponding to the interface 6. Two securing elements 240a, 240b are arranged on the side sections of the interface, on the arm segment 22. The securing elements can be used to determine whether an assistance system 200 (see Fig. 5 ) is correctly coupled to the interface 8. The securing elements 240a, 240b simultaneously serve as mechanical coupling means for mechanical coupling to the assistance system 200, for example by means of clamping or locking.

[0106] Furthermore, a connection 277 is arranged at interface 8, which corresponds to connection 77 of interface 6. Connection 277 is coupled to bus system 76, so that data and signals can be transmitted from connection 77 via bus system 76 to connection 77 and vice versa. Likewise, a connection 279 is provided at interface 8, by means of which electrical energy can be transmitted from interface 8 to assistance system 200. Connection 279 corresponds to connection 79 of interface 6, and the two connections 279 and 79 are coupled by means of transmission means 78 for transmitting electrical energy between these two connections 79, 279.

[0107] Furthermore, outlets 280a, 280b, 280c of the cable duct 80 are provided at the interface 8, so that cables routed through it are accessible at the interface 8. The same applies to the working channel 82, of which three outlets 282a, 282b, 282c are provided at the interface 8. Through this interface 8, an assistance system 200 can be advantageously coupled to the support arm 1 without the need for additional transmission means or cabling on the support arm 1.

[0108] The Figures 11a and 11b show two further embodiments of the holding arm 1, which essentially corresponds to the first embodiment according to the Figures 1 and 2 In addition to the features described therein, the holding arm has, according to the Figures 11a, 11b Alignment indicators 310, 312, 314, 316, 318, 320, 322, 330, 332, 334, 336, 338, 340, 342 respectively. According to Fig. 11aThe alignment indicators 310, 312, 314, 316, 318, 320, 322 are formed as a surface structure. The individual arm segments 10, 12, 14, 16, 18, 20, 22, which essentially have a cylindrical basic shape, have a structuring approximately along half of the cylinder surface. According to this embodiment, the structuring is arranged such that the alignment indicators 310, 312, 314, 316, 318, 320, 322 of the holding arm 1 in a basic pose of the holding arm 1, as shown in Fig. 11a shown, are oriented toward the surgical field. The structuring, which acts as an alignment indicator 310, 312, 314, 316, 318, 320, 322, allows an operator to tactilely determine whether an arm segment 10, 12, 14, 16, 18, 20, 22 is aligned in the basic pose, or whether the support arm is inverted, i.e., oriented with the structured surface away from the surgical field. This can be important for weight compensation.

[0109] Alternatively, Fig. 11b An embodiment in which the alignment indicators 330, 332, 334, 336, 338, 340, 342 are designed as colored markings. A color gradient is provided on the sides of the arm segments 10, 12, 14, 16, 18, 20, 22 facing the surgical field, which is visually perceptible to a surgeon. This allows the surgeon to directly recognize the orientation of the holding arm 1.

[0110] Fig. 12 shows a schematic partial sectional view of an exemplary brake, such as is provided, for example, as brake 64 in joint 15. It should be understood that the other brakes 60, 62, 66, 68, 70, 72 can also be designed accordingly. The brake 74 is, according to this embodiment ( Fig. 12) is designed as an electromagnetic permanent magnet brake. A first joint element 400, here designed as a shaft, is rigidly connected to the arm segment 12, and a second joint element 402 is rigidly connected to the arm segment 14. It should be understood that this can also be the other way around. The second joint element 402 is firmly coupled to a housing 406 of the brake 64 via a screw 404. A flange hub 408 is correspondingly firmly coupled to the first joint 400. A permanent magnet 410 is arranged in the housing 406, which serves to press an armature 412, which in turn is firmly connected to the flange 408, against the housing 406. This creates static friction that acts as a braking force. Also arranged in the housing 406 is an excitation winding 414, which, when energized, creates a field that counteracts the field of the permanent magnet 410.A spring element 416, which preloads the armature 412 in a ventilated state, lifts the armature 412 from the housing 406, thus ventilating the brake 64. Rotation of the second joint element 402 around the first joint element 400 about the axis A2 is thus possible.

[0111] Figure 13 shows a method 1000 for controlling a mechatronic assistance system 200 coupled to a support arm 1 according to the first exemplary embodiment. According to this exemplary embodiment, the method 1000 comprises five steps, which are carried out successively or partially simultaneously. In the first step 1002, the support arm 1 is attached to a standard rail of an operating table and put into operation. For this purpose, the first interface 4 is connected to an operating system 206 (see also Figure 5) so that data and electrical energy are transmitted at the first interface 6 to the support arm 1. In step 1004, a mechatronic assistance system 200 is coupled to a second interface 8 of the support arm 1 at its distal end 4. The following steps 1006 to 1010 are then preferably carried out simultaneously. In step 1006, electrical energy and signals are transmitted from the first interface 6 of the support arm 1 at a proximal end to the support arm. From the first interface 6, the data and electrical energy are transmitted by means of a transmission device 76, 78 within the support arm 1 to the second interface 8. At the second interface at the distal end, data and electrical energy are then transmitted to the assistance system in step 1010 so that the assistance system 200 can be operated.

[0112] In Figure 14A further embodiment of the method 1000 is shown. The steps 1002 to 1010 are carried out in accordance with the embodiment according to Figure 13 formed and in this respect, reference is made in full to the above description. After step 1004, a branch in this method (see Figure 14 ) to step 1012. In step 1012, positions of joints of the holding arm are detected.

[0113] From the detected positions of the joints, a pose of the support arm is determined in step 1014 using the detected position of the joints. Data representing the determined pose is then provided in step 1016, specifically at the first interface 6, and transmitted in step 1006. This allows the pose of the support arm to be transmitted to a surgical system at the first interface and used there.

[0114] In a similar manner, the further preferred embodiments of the method described above are formed, wherein the steps can each be carried out substantially simultaneously and continuously.

Claims

1. A holding arm (1) for medical purposes, in particular for holding surgical mechatronic assistance systems (200) and / or surgical instruments, with a proximal end (2) for attaching the holding arm (1) to a base and a distal end (4) for receiving a surgical mechatronic assistance system and / or surgical instrument; at least one first and one second arm segment (12, 14), wherein the first arm segment (12) is connected to a first joint (13) and the second arm segment (14) is connected to a second joint (15), wherein each joint (13, 15) is releasable and lockable; and an operating unit (28) for bringing the holding arm (1) into a desired pose, characterized in that the operating unit (28) being configured to release upon contact between an operator and one of the first and second arm segments (14, 16) the associated joint (13, 15) such that upon contact between an operator and the first arm segment (12) the first joint (13) is released and upon contact between the operator and the second arm segment (14) the second joint (15) is released.

2. The holding arm according to claim 1, wherein the operating unit (28) comprises contact means (30-42), which are provided for an operator to come into contact with therewith, wherein a first contact means (32) of the operating unit (28) is arranged on the first arm segment (12) and a second contact (34) means is arranged on the second arm segment (14).

3. The holding arm according to claim 1, wherein each contact means (30- 42) has two contact elements (30a, 30b-42a, 42b) arranged substantially opposite one another on the segment (10-22).

4. The holding arm according to claim 2 or 3, wherein the contact elements (30a, 30b-42a, 42b) are provided in the form of push buttons or touch-sensitive sensors.

5. The holding arm according to any one of the preceding claims, wherein the operating unit (28) is designed to release the associated joint (11-23) depending on the intensity of contact.

6. The holding arm according to any one of the preceding claims, wherein the operating unit (28), upon contact between the operator and both the first and the second arm segment (12, 14), releases all the joints (13, 15) disposed between said arm segments.

7. The holding arm according to any of the preceding claims, wherein the joints (11-23) comprise breaks, by means of which the joints (11-23) are releasable and lockable, wherein the brakes are preferably configured as electromagnetic breaks and comprise a permanent magnet each, which biases the break into the locked state in the unpowered state.

8. The holding arm according to any of the preceding claims, with a first interface (6) at the proximal end (2) for connecting the holding arm (1) to an energy source and to an external control unit (206) for transmitting signals to and from the holding arm (1); a second mechatronic interface (8) at the distal end (4) for coupling the holding arm (1) to the assistance system (200) for controlling the assistance system (200); and a transmission unit (76, 78) which is arranged inside the holding arm (1) and which connects the first interface (6) to the second interface (8) in order to transmit energy and signals between the interfaces (6, 8).

9. The holding arm according to claim 8, wherein the transmission unit comprises a bus system (76, 78).

10. The holding arm according to any of the preceding claims, wherein at least one arm segment comprises a sensor for detecting a position of the arm segment.

11. The holding arm according to claim 8, comprising a recognition unit for recognizing an assistance system coupled to the second interface, wherein the operating unit (28) is adapted to release or to lock the joints (11, 13, 15, 17, 19, 21, 23) according to the assistance system (200) coupled to the second interface (8).

12. The holding arm according to claim 8, comprising a camera which is preferably disposed at the distal end (4), wherein the camera is provided to observe an operating area and is coupled to the first interface (6) to transfer image data at the first interface (6).

13. The holding arm according to claim 8, wherein at the second interface (8) a safety element (240a, 240b) is provided, which is coupled to the operating unit (28) in such a way that the operating unit (28) locks all the joints (11, 13, 15, 17, 19, 21, 23) when the safety element (240a, 240b) indicates a faulty link between the assistance system (200) and the second interface (8).