Synchronized robotic bone milling

Abstract

To provide a system and a method robotically coordinated.SOLUTION: A robotic spinal surgery system is provided with at least three robotic arms 307, 308, 309 co-located on a single mobile base, wherein the movement of the robotic arms is coordinated by a central control unit on the base. The system further comprises tools 311 for spinal decompression, elements 312 for protection of nervous tissue and navigation cameras 310. The nerve protection elements are placed between bony anatomy structures and nervous structures to prevent contact of the spinal decompression tools with the nervous structures. The nerve protection elements further include safety components that can optionally close electrical circuits with the decompression tools and sense or stimulate the nervous structures. A method of deploying the inventive system in surgery is also provided.SELECTED DRAWING: Figure 3

Description

[Technical field]

[0001] FIELD OF THEINVENTION The present invention relates to robotically controlled and coordinated surgical procedures. In particular, the present invention relates to a robotic system comprising bilateral multiple robotic elements, such as robotic arms, end effectors, surgical instruments, anatomical structure protection instruments, cameras, imaging devices, tracking devices, or other devices, that are useful for robotic surgery. The present invention also relates to a robotic system in which the placement and movement of the robotic elements is controlled and coordinated by a single control unit, and all of the robotic elements are based on a single movable rigid chassis and are therefore robotically coordinated at a single origin. In particular, multiple robotic elements may be mounted on and controlled by a single control unit and may be used to deploy and / or associate with surgical instruments, trackers, cameras, and other surgical tools as part of a robotic surgical procedure in a coordinated manner. More particularly, in the context of robotic spine surgery, multiple end effectors may be deployed bilaterally on multiple robotic arms and controlled by a single control unit and used to perform a robotic surgical procedure in a centrally coordinated manner, with the relative movement of each robotic element being coordinated by a central control unit. Most specifically, in the context of bone cutting (decompression) in robotic spine surgery, instruments for cutting bone and protecting anatomical elements such as nerves may be deployed on multiple robotic arms that are controlled in a synchronized and coordinated manner to perform safe and effective surgical procedures. [Background technology]

[0002] BACKGROUND OF THEINVENTION Robotic surgery is well known in the art, as is the application of robotic techniques to spinal surgical procedures such as spinal decompression (bone cutting). Many robotic surgical systems, such as the da Vinci robotic surgical system from Intuitive Surgical, are remotely operated. Multi-arm robotic surgical systems, such as those provided by Cambridge Medical Robotics, are available in the art, but these known systems are often also remotely operated, all consisting of a single arm deployed separately on a separate cart or chassis, with some level of coordination provided by a remotely located control unit. Systems with multiple arms on multiple carts have significant drawbacks with regard to integration into the surgical workflow, in addition to an undesirably large footprint in the operating room. Also, control of remotely operated units by a remotely located control unit does not provide the required level of control for the full range of surgical procedures, especially in the case of spinal surgery. Accuracy will necessarily be less than a system in which all robotic arms are fixed to and coordinated by a single chassis with a control unit.

[0003] The performance of the full range of robotic spine surgical procedures, including robotic spine decompression, requires robotically coordinated navigation / sensing that is not available today. A typical procedure may require the manipulation of one or more end effectors deployed by a robotic arm, the deployment of other instruments, the placement of multiple passive or active markers on the bone and / or soft tissue, one or more robotically controlled and operated cameras / sensors that may be placed at various distances and angles from the surgical field, and one or more end effectors deployed by a robotic arm. Such a bilateral multi-arm / multi-camera / sensor system mounted on and controlled by a single cart is not available in the current state of the art. There is a strong and long-felt need for such a system, as it would enable the performance of the full range of spine surgical procedures with robotically coordinated control and navigation at a level of precision not currently possible.

[0004] The need for a centrally coordinated, multi-faceted approach is strongly felt in spinal decompression procedures. In spinal decompression, there is a need to cut bone in various ways, shapes, configurations, and orientations. In many cases, the decompression process is performed to relieve the pressure that the bony anatomical structures are exerting on sensitive nerves. In many such cases, the nerves and / or spinal cord are in practice touched, if not completely pressed and / or attached, by the bony anatomical structures of the spine (e.g., "scar tissue"). This demonstrates the fundamental problems and dangers associated with bone cutting, whether performed robotically or by other techniques. That is, conventional robotic or non-robotic approaches, regardless of the degree of accuracy, directly abut or actually touch delicate nerve or spinal structures when the cutting instrument performs the bone cut. This creates an unacceptable risk of catastrophic injury.

[0005] In conventional procedures, whether performed robotically or non-robotically, protective surgical instruments may be placed between bony anatomical structures and nerve or spinal structures to attempt to protect and / or isolate those nervous system structures from the cutting instruments. This approach is time-consuming, stressful, and very difficult for the surgeon. Existing robotic technology does not support this need for multi-arm, isolated, but coordinated robotic motion. Thus, attempting to use existing robotic technology would necessarily result in a lack of precision between the two surgical instruments. If there is a risk resulting from a lack of precision, there is a risk that the protective instruments are not completely protecting the nerve or spinal cord, and therefore, there is a risk of damage to those structures. Also, precise synchronization of protective and cutting instruments by the robot allows for automated robotic cutting, which allows for advance planning of the required cuts and precise execution by the robotic system, which would necessarily improve clinical outcomes.

[0006] A system for robotically synchronizing the placement and movement of bone cutting instruments and anatomical protection instruments would ameliorate this concern to a great extent, since the instruments would be held by a robotic arm whose movements are synchronized with each other, thus reducing the risk of injury. Holding and placing the instruments by a synchronized robotic arm provides more precision and therefore more safety. Such a system is provided in the context of the present invention. Furthermore, when utilizing the system and autonomous robotic capabilities, the need for cutting instruments and protection instruments to be coordinated robotically, rather than just coordinated by traditional navigation techniques, is significantly higher and more important. Summary of the Invention [Means for solving the problem]

[0007] SUMMARY OF THEINVENTION Provided herein is a robotically controlled surgical system. Specifically, the system of the present invention is a centrally coordinated and synchronized robotic system for bone cutting applications (e.g., spinal decompression, orthopedic applications, skull, ENT, etc.). The system comprises multiple robotic arms, each of which may hold at least one end effector, camera / sensor, or navigation element for use in a related application, e.g., spinal decompression procedure. The end effectors may include cutting instruments and instruments for the purpose of protecting the nerve or spinal elements of the spinal anatomy, e.g., anatomical protection instruments such as spatulas. The camera / sensor and navigation elements are for providing guidance and / or tracking for the movement of the robotic arms and / or anatomical parts, and the deployment of the end effectors and instruments.

[0008] The present invention comprises multiple robotic arms that can cut bone, protect anatomical structures, and provide navigational support in an automatic and safe manner, as they are robotically synchronized, through holding and deploying end effectors and / or cameras / sensors. In one embodiment, there may be three robotic arms, one holding a cutting instrument, one holding a protection instrument, and one holding a navigation / tracking sensor, e.g., a navigation camera. In such an embodiment, the first arm holds a protection instrument that can serve to retract, deflect, protect, or steer sensitive organs, e.g., nerves, spinal cord, etc., from the bone anatomical structure that is about to be cut. The second arm holds a cutting instrument (e.g., a high-speed burr), which cuts the bone. The third arm holds a surveillance camera / sensor that provides images and / or other important data of the process from an optimal distance and angle portion. The camera can operate from an optimal distance and angle portion, due to its proper sizing and its deployment on a properly sized and positioned robotic arm. Optionally, the robotic arm holding the cutting or protective instrument may also carry an additional imaging or navigation camera to provide redundancy and diverse information.

[0009] Synchronized movement of the robotic arms is made possible by the interaction of navigation cameras and active or passive markers that are placed on the bony anatomical structures at the start or during the procedure. The movement of the robotic arms is synchronized by a central control unit from a single mobile base that knows where the arms are based on the navigation information provided by the markers and cameras.

[0010] Thus, in various embodiments of the system of the present invention, passive or active markers may be placed on the bone anatomy or on additional surfaces, such as the patient's skin, the surgical table, etc., and may be used to aid navigation / tracking during spinal decompression procedures or other cutting applications. These procedures may require the placement of single or multiple passive or active markers on the bone anatomy of one or more vertebrae. In certain embodiments, small markers may be preferred. Vertebrae are relatively small, so it may be advantageous to use relatively very small markers (1 cm or less in size) to place multiple markers on different vertebrae (indeed, on different components of the bone anatomy of the vertebrae). When using small markers, it may be advantageous to deploy one or more cameras / sensors very close to the surgical field, for example, at a distance of 30 cm or less from the surgical field, and at an advantageous angle to the surgical field, so that the markers can be visualized. For example, if a small marker is deployed at a non-convenient angle inside the patient's body, it would be advantageous to position the camera / sensor at a close distance and appropriate angle. The arrangement can thus provide the appropriate navigation / sensing information to the central control unit to provide coordinated movement of the cutting and protective instruments. Besides the ability to bring the camera / sensor close to the organ or target and within an optimal angle, the centrally coordinated system can also calculate and determine the best position to place the robotic arms and each other, particularly in relation to the patient and the ever-changing positions of the clinical staff, to prevent collisions and enable a convenient workflow.

[0011] The inventive approach allows for synchronized operation of multiple robotic arms, and in most embodiments three arms are chosen: the cutting arm carrying the cutting tool runs at all times in synchrony with the arm carrying the protective tool and the sensor / navigation camera.

[0012] Optionally, the three robotic arms can hold two cutting instruments and one protection instrument in addition to any navigation elements present. In this embodiment, there is a synchronized working pattern between the three arms. The two cutting arms are working in sync with the cutting instruments and protection instruments with the bone to be cut in the center at all times. In this way, both arms can be aligned with each other in relation to the bone at all times while the bone is protected at all times. The third arm holding the camera is also synchronized so that it is also positioned in an optimal place to view the bone markers and the bone to be cut, while naturally the surgical arm can also be equipped with an additional navigation camera and in addition provide an additional sensing angle. Also, since the system allows for the deployment of the arms from both sides of the patient (bilateral), the mass of the robotic arms is mainly positioned on both sides of the patient so that the surgical field is clear for surgery and for clear imaging / sensing by the third arm.

[0013] In an alternative embodiment of the invention, the two end effectors (e.g., the cutting end effector and the protective end effector) have the ability to sense contact or near contact between them. This can be achieved using various technologies such as conductive, magnetic inductive, and capacitive sensing. Simply by way of example, when a signal is generated, signifying that the cutting tip is close to or in contact with the protective instrument, the system controller can perform several actions such as stopping the cutting action or continuing the cutting in a different direction. The robotic synchronization of the system of the invention provides perfect alignment of the cutting and protective instruments with the bone anatomical and neural structures to achieve optimal bone cutting. The ability of the cutting and protective instruments to sense each other by closing an electrical circuit provides a vital safety feature, preventing overcutting and allowing smooth continuation of the spinal decompression procedure without risk or delay.

[0014] In various embodiments of the present invention, the protective end effector or protective instrument comprises at least two portions, most often located on opposite sides of the instrument. One side is often, but not exclusively, made from metal so that it can close an electrical circuit upon contact with a bone cutting instrument. The other side of the protective instrument is constructed and configured to be capable of sensing neural structures. It may be configured to detect the presence and / or proximity of neural structures, as well as to stimulate the neural structures.

[0015] In some alternative embodiments, the second part of the protective end effector or instrument that touches the nerve is made of a different material that acts as a sensor for the nerve condition. This can simply be a sensing part that senses the nerve condition or proximity (e.g., impedance measurement) and reports to the main controller, or it can also be a stimulator that provides a measured stimulus (e.g., 10ma) to the nerve and receives a feedback signal. This capability can act as a second feedback loop to protect delicate nerve structures while cutting bone. If the central controller receives a signal that can be interpreted as, for example, the end effector placing too much pressure on the nerve, the main controller can modify the relative cutting position between the two arms to create a better cutting posture between the two arms that applies less pressure to the nerve.

[0016] Further, another advantage arises from the fact that (for example) the protective instruments and the cutting instruments are not just connected to different robotic arms and utilized together as one device on one robotic arm. Moreover, by being on separate arms, which are of course robotically connected and synchronized, the robot controller, through algorithms built into it, can have several options for optimal cutting and safety measures. For example, in some cases, it is more preferable to simply stop the high-speed bur from rotating as a safety measure, but this action is not always optimal in surgery, since sometimes simply stopping the high-speed bur during cutting will cause it to get stuck in the bone. Sometimes the optimal safety measure would be to lower the high-speed bur back a few millimeters away from the anatomy. Sometimes, due to clinical or convenience considerations, the cutting instruments and / or protective instruments should be close in area from a specific angle / location etc., i.e., separating the cutting instruments from the protective instruments but still allowing them to work precisely in conjunction with each other is of significant value in a robotic bone cutting procedure. Another example of the benefit of separating cutting instruments from protection instruments through different synchronized robotic arms would be that the method would allow, for example, an arm to move sideways and change cutting instruments while the other arm is still holding and protecting the nerve. Also, if more than two arms are busy cutting, one can step in and change instruments while the other is still working. This has the potential to significantly improve the efficiency of the surgical process.

[0017] All of these needs and factors benefit greatly from the centralized coordination and synchronized control of the single-cart, multi-arm, bilateral, non-teleoperated robotic system of the present invention. Based on the placement of properly sized markers and navigational cameras at the proper distance and orientation relative to the target anatomical structures and markers, the movements of the robotic arms, carrying the end effectors and cameras, can be coordinated to provide a safe and precise robotic spinal decompression procedure. The present specification also provides, for example, the following items: (Item 1) 1. A system for safe surgery, comprising: a robotic surgical apparatus including at least three robotic arms disposed on a single cart and a central control unit disposed within said cart; a bone cutting instrument carried by one of the at least three robotic arms; and a sensitive organ protection device held by another of the at least three robotic arms; and a camera or sensor carried by a third of the at least three robotic arms; Equipped with The system wherein movement of the robotic arm is coordinated by the central control unit such that the protective device is positioned to provide protection to a criticality sensitive structure. (Item 2) 2. The system of claim 1, wherein the single cart is mobile. (Item 3) 2. The system of claim 1, wherein at least one of the at least three robotic arms is deployed on each side of a patient. (Item 4) 2. The system of claim 1, wherein the critical sensitive structure is a critical nervous system structure. (Item 5) The sensitive organ protection device comprises: a portion configured to close an electrical circuit upon contact with the bone cutting instrument; a second portion configured to protect the critical nervous system structure; and 5. The system according to item 4, comprising: (Item 6) 6. The system of claim 5, wherein the second portion is additionally configured to sense or stimulate the critical nervous system structure. (Item 7) 2. The system of claim 1, wherein the camera or sensor is selected from the group consisting of a navigation system, a tracking system, an X-ray, and an MRI. (Item 8) The system of any of the preceding items, wherein at least one small active or passive marker is placed on the patient's vertebral bony anatomical structure as part of a spinal decompression procedure. (Item 9) 9. The system of claim 8, wherein at least two small active or passive small markers are placed on the bony anatomical structures of the patient's vertebrae. (Item 10) 10. The system of claim 9, wherein the camera or sensor is held in proximity to the bony anatomical structure of the patient's vertebrae. (Item 11) 11. The system of claim 10, wherein the small markers are less than 1 cm in size and the camera or sensor is held less than 50 cm from the bony anatomical structure of the patient's vertebrae. (Item 12) 11. The system of claim 1, wherein additional cameras or sensors are mounted on the robotic arm holding the bone-cutting instrument and on the robotic arm holding the sensitive organ protection instrument. (Item 13) 11. The system of any of the preceding items, wherein the robotic arm holding the bone-cutting instrument and the robotic arm holding the sensitive organ protection instrument are equipped with torque sensing capabilities. (Item 14) 1. A method for performing a safe decompressive spinal surgery, comprising: a robotic surgical apparatus comprising at least three robotic arms disposed on a single mobile cart and a central control unit disposed within the mobile cart; a bone cutting instrument carried by one of the at least three robotic arms; and a neuroprotection device held by another of the at least three robotic arms; and a camera or sensor carried by a third of the at least three robotic arms; and deploying the neuroprotection device in a surgical field, the movement of the robot arm being is coordinated by the central control unit to be positioned to provide protection to critical nervous system structures, and the neuroprotection device comprises: a portion configured to close an electrical circuit upon contact with the bone cutting instrument; a second portion configured to protect, sense, and / or stimulate neural tissue; and and advancing the bone cutting instrument to achieve a desired spinal decompression until the electrical circuit is closed or the second portion of the neuroprotection instrument senses neural activity consistent with a risk from the bone cutting instrument. A method comprising: (Item 15) Item 15. The method of item 14, wherein at least one of the at least three robotic arms is deployed on each side of a patient. (Item 16) 15. The method of claim 14, wherein the critical sensitive structure is a critical nervous system structure. (Item 17) The sensitive organ protection device comprises: a portion configured to close an electrical circuit upon contact or near contact with the bone cutting instrument; a second portion configured to protect the critical nervous system structure; and Item 17. The method of item 16, comprising: (Item 18) 20. The method of claim 17, wherein the second portion is additionally configured to sense or stimulate the critical nervous system structure. (Item 19) The method of any of the preceding items, wherein at least one small active or passive marker is placed on the patient's vertebral bony anatomical structure as part of a spinal decompression procedure. (Item 20) 20. The method of claim 19, wherein the camera or sensor is held in proximity to the bony anatomical structure of the patient's vertebrae. (Item 21) 21. The method of claim 20, wherein the small markers are less than 1 cm in size and the camera or sensor is held less than 50 cm from the bony anatomical structure of the patient's vertebrae. (Item 22) 10. The method of any of the preceding items, wherein additional cameras or sensors are mounted on the robotic arm holding the bone-cutting instrument and on the robotic arm holding the sensitive organ protection instrument. (Item 23) 13. The method of any of the preceding items, wherein the robotic arm holding the bone-cutting instrument and the robotic arm holding the sensitive organ protection instrument are equipped with torque sensing capabilities. [Brief description of the drawings]

[0018] [Figure 1a] 1a, 1b, and 1c show various views of the spinal anatomy with portions of bone adjacent to nerve or spinal structures that may require cutting. [Figure 1b] 1a, 1b, and 1c show various views of the spinal anatomy with portions of bone adjacent to nerve or spinal structures that may require cutting. [Figure 1c] 1a, 1b, and 1c show various views of the spinal anatomy with portions of bone adjacent to nerve or spinal structures that may require cutting. [Diagram 2] FIG. 2 is a close-up view of a portion of a vertebra directly adjacent to neural structures that may require cutting. [Diagram 3] FIG. 3 shows a robotic system according to an exemplary embodiment of the present invention, in which multiple, centrally coordinated robotic arms hold cutting and protective instruments. [Figure 4] FIG. 4 illustrates a protective end effector according to an exemplary embodiment of the present invention that includes a conductive sensing element. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0019] Detailed Description of the Invention Referring now to the figures and several representative embodiments of the present invention, the following detailed description is provided.

[0020] In an embodiment of the invention, illustrated by FIG. 1, several views of the vertebral anatomy are shown. In each of the three views, a vertebra 104 is shown. In each case, a portion 101 of the vertebra 104 requires cutting, for example, because it is pressing against adjacent neural structures. In various of the views, a nerve root 102 and / or spinal cord 103 are shown. The use of a system of the invention, for example, with three coordinated robotic arms, with cutting instruments deployed by the three arms, neural protection instruments, and cameras, allows for precise cutting of the bone portion 101 while greatly minimizing the risk of catastrophic damage to the nerve root 102 or spinal cord 103 or other neural structures.

[0021] 2 shows a close-up of a portion of the bony anatomical structure 201 directly adjacent to a nerve root 202 or other neural structure. With this arrangement of bone and neural structures, bone resection (i.e., decompression) will often be required as a proper surgical treatment due to portions of the bony anatomical structure 201 pressing or impinging on the nerve root 202 or other neural structure. This problem requiring surgery is often caused by stenosis or other compression, which may be caused by a variety of reasons, such as age-related degeneration, congenital and non-congenital deformities, trauma, etc.

[0022] 3 shows a robotic system for bone cutting, according to an embodiment of the present invention. The robotic arms of the system of the present invention are mounted on a single mobile rigid chassis with a centralized control unit, allowing for synchronized movement and control of the robotic arms. In the context of a spinal decompression procedure, this synchronized control allows for precision bone cutting at optimal angles and orientations.

[0023] The structure and configuration of the present system allows optimal deployment of multiple robotic arms bilaterally from both sides of the patient. This particular deployment of the robotic arms keeps its main mass on both sides of the patient, so that the surgical field is clear for surgery and imaging / sensing by a third arm and / or surgeon. This method of deployment and positioning of the robotic arms also allows the arms to access the surgical area, specifically the bone to be cut in most cases, while in a partially folded position. It is known in the art that robots are more rigid and therefore more accurate when they are partially folded, i.e., not in a fully extended position. Unlike the system of the present invention, standard robotic systems known in the art today position the arms relatively far from each other and from the patient, which requires the arms to reach a far, often fully extended configuration, thus losing accuracy.

[0024] In FIG. 3, robotic arms 307, 308, and 309 are shown mounted on a rigid chassis 301, which may be optionally movable. Robotic arm 307 holds a cutting instrument 311. Robotic arm 308 holds a neuroprotection instrument 312. Robotic arm 309 holds a camera 310. In this embodiment, a "navigation camera" is used as the primary method for robot / instrument / patient tracking, while it may consist of several alternative technologies such as visible light imaging, x-ray, MRI, magnetic tracking, laser sensing, and more. Also shown in FIG. 3 is a surgical table 302 (which, if movable, may be optionally deployed below the table and / or removed before, during, and after the surgical procedure) and a patient body 303 under which the robotic system fits. Within the patient body, neural structures 304 and a portion of the bony anatomical structure 305 requiring cutting are shown. A protective tool 312 is placed between the neural structures 304 and a portion of the bony anatomical structure 305 so that the cutting tool 311 can perform precise cuts without risk of damage to the neural structures 304. The camera 310 helps bring the robotic arms 307, 308, and 309 into the proper position relative to the surgical field with the aid of small markers 306, which are placed at the start of the surgical procedure. The camera 310 can then monitor the progress of the surgical procedure from an optimal angle.

[0025] Today, the common way to track the organs to be operated on, e.g., bone anatomical structures and / or more specifically, vertebral bodies, is to place a marker on it, while the marker must stand out high, e.g., 5-25 cm above the open wound, for the basic reason that it needs to be visible to a camera / sensor that is passively placed 1-3 meters away. Thus, the ability of this long, lightweight marker to keep its position relative to the bone anatomical structures is limited, and therefore its accuracy is very low. For this reason, to date, this tracking technology has hardly been used for delicate and precise tasks such as spinal decompression. In the present invention, thanks to the active proximity range and the manipulating robot arm that can hold the camera / sensor and bring it within close proximity to the open wound, the marker can be very small (e.g., 1 cm or less), thereby rigidly connected to the bone to be cut, and very precise. The markers can be passive or active and can support several tracking / sensing technologies, such as different color combinations and contrasts of visible light, infrared reflection, magnetic resonance, laser, and more. Also, due to their small size, i.e., small size and weight of a few grams, they can be screwed (e.g., 3-6 mm thread) directly into the bone and remain fixed, thereby providing unprecedented accuracy. Those skilled in the art will understand that with the present small size of the markers and a navigation camera held close to the surgical field to achieve optimal angles, multiple small active or passive markers can be placed on several sides of a single vertebra for optimal visualization.

[0026] In an alternative embodiment of the present invention, an additional navigation camera can be installed on the robot arm that holds the cutting instrument. In another alternative, an additional navigation camera can be installed on an end effector that is also held by the robot arm that holds the cutting instrument. The installation of additional cameras on the operating / surgical arm can further provide additional information to enhance the view of the surgical field and provide small markers. Those skilled in the art will appreciate that the cameras can be installed with great precision and provide an enhanced view of the surgical field due to the coordinated movement of the robot arms, each mounted on a single mobile chassis with a central control unit.

[0027] FIG. 4 provides a close-up view of a neuroprotection instrument 400 according to an embodiment of the present invention. The protection instrument 400 has a metal portion 401 and a sensing portion 402. The instrument can have several sizes and shapes to suit various decompression and bone cutting techniques. Some are in a small spoon-shaped profile, starting from 1-2 mm wide and becoming long, curved or flat spatulas. Also, there are hundreds of bone cutting high-speed burrs and dozens of instruments commonly used manually by surgeons as "protection instruments" on the market today. The specific design of the cutting burr and protection instrument is not only application dependent, but also driven by the specific surgeon's personal taste, preferences, surgical philosophy, and training. The robotic arm can adjust its robotic motion and cutting technique according to the surgeon's planning and the technique and instruments selected.

[0028] The metal portion 401 can be seated adjacent to the bone anatomical structure 404 and can interact with the cutting instrument during the procedure. In one embodiment, when the cutting instrument contacts the metal portion, a circuit is closed and a signal is sent to a control unit in the rigid chassis of the robotic system, which can then send feedback to stop the cutting instrument, reverse the cutting instrument, or take some other action to ensure precision and safety in the surgical procedure. There can be several material combinations that can facilitate this requirement, and this is not limited to one specific material. The electrical closed circuit between the cutting instrument and the protective instrument can be achieved approximately by any biocompatible metallic substance (e.g., steel, titanium, aluminum, etc.). Additional related technologies can consist of the use of magnetic induction, capacitive sensing, and more. All based on the close proximity of the cutting instrument and the protective instrument, which is centrally controlled. The sensing portion 402 of the protective instrument 400 can either sense or stimulate the neural structures 403 during the surgical procedure, again ensuring precision and safety in performing the procedure.

[0029] The protective device acts as a barrier between the cutting tool and the sensitive organ, which requires a positive, active, dynamic, constantly changing protection. The device has several functions. On the one hand, it physically separates the sensitive organ from immediately becoming the cut bone (sometimes the organ is pressed against the bone and physically attached). The device may be made of at least two different materials with at least two different functionalities. The upper part facing the bone and the cutting tool is made of a material compatible with the technique chosen to close the circuit with the cutting tool. The lower part, touching the sensitive organ, e.g. the nerve, can also be made of several materials. It can be passive from soft materials, e.g. plastic, silicon, etc., it can be made of non-conductive insulating materials, e.g. plastic, ceramic, etc., that prevent any electrical flow to the nerve, it can also be made of a sensing / electrode material with the ability to sense chemical and / or electrical signals from the nerve (nervous system) unilaterally. It can also be active by delivering low current, e.g., 10ma, and having the ability to sense neural responses. This sensing technology is well established in the art, but not in conjunction with a multi-arm robotic system. The present systems, instruments, and techniques can provide multiple tools and methods to cut bone, protect sensitive organs, and sense passively or actively at any given step of the procedure. The sensing can be done by surgeon's choice, by the robot's algorithm, or randomly, for specific cycles or actions. This combination of robots, sensing, and intelligent instruments can enable a multi-layered system with several layers of safety.

[0030] All of the embodiments shown in Figures 1-4 can be used in the method of the present invention to perform a spinal decompression procedure. In one such example, the robotic system shown in Figure 3 can deploy cutting instrument 311 on robotic arm 307, protective instrument 312 on robotic arm 308, and camera 310 on robotic arm 309. The camera 310 and end effector are deployed in the optimal position for the procedure in part by navigation, enabled by the placement of markers 306. Once the robotic arms 307, 308, and 309 are in the optimal location and angle portion, protective instrument 312 can be deployed between the portion of the bony anatomical structure 305 requiring cutting and the neural structure 304 requiring protection, and cutting can proceed. Use of the system and method of the present invention allows for precise and safe cutting to be performed with appropriate safeguards to stop or reverse the cutting as required.

[0031] In an alternative embodiment of the invention, the operating / surgical robotic arm (one that holds the surgical instruments for decompression / cutting or other tasks) is also equipped with torque sensing capabilities. It is known that the bone anatomical structures of the spine move during spinal surgical procedures due to patient movement and also forces applied during the surgical procedure. Thus, if the robotic arm is capable of sensing torque feedback, this can aid in tracking the bone anatomical structures (in addition to the information provided by the navigation camera that tracks markers placed on the bone anatomical structures). Again, since the robotic arm is robotically coordinated on a single mobile chassis by a central control unit, the torque information can be taken into account by the central control unit (e.g., in addition to the navigation information) to more accurately track the anatomical structures and the robotic arm. This in turn results in more accurate results of delicate procedures such as bone cutting.

[0032] Those skilled in the art will appreciate that several variations of the disclosed embodiments are possible while remaining within the bounds of the invention. By way of example only, variations in the number of navigation cameras, robotic arms, markers, and end effectors may be used without departing from the invention. As another example, markers of various sizes may be used. The embodiments provided are representative in nature.

Claims

1. A system for safe surgical procedures, comprising: a robotic surgical device comprising at least three robotic arms disposed on a single cart and a central control unit disposed within said cart; an end effector held by one of the at least three robotic arms; a sensitive organ protection device held by another of the at least three robotic arms; a camera or sensor carried by a third of the at least three robotic arms; and Equipped with The system, wherein the central control unit is configured to automatically coordinate movement of the robotic arm such that the protective device is positioned to provide protection to a criticality sensitive structure.

2. The system described in claim 1, wherein the single cart is movable.

3. The system of claim 1, wherein at least one of the at least three robotic arms is deployed on each side of the patient.

4. The system described in claim 1, wherein the critical sensitive structure is a critical nervous system structure.

5. The sensitive organ protection device comprises: a portion configured to close an electrical circuit upon contact with the end effector; a second portion configured to protect the critical nervous system structure; and The system of claim 4 , comprising:

6. The system of claim 5, wherein the second portion is additionally configured to sense or stimulate the critical nervous system structure.

7. The system of claim 1, wherein the camera or sensor is selected from the group consisting of a navigation system, a tracking system, an X-ray, and an MRI.

8. A system described in any one of claims 1 to 7, wherein at least one small active or passive marker is placed on the bony anatomical structure of a patient's vertebrae as part of a spinal decompression procedure.

9. The system described in claim 8, wherein at least two small active or passive small markers are placed on the bony anatomical structure of the patient's vertebrae.

10. The system described in claim 9, wherein the camera or sensor is held in close proximity to the bony anatomical structure of the patient's vertebrae.

11. The system described in claim 10, wherein the small markers are less than 1 cm in size and the camera or sensor is held less than 50 cm from the bony anatomical structure of the patient's vertebrae.

12. A system described in any one of claims 1 to 11, wherein additional cameras or sensors are installed on the robotic arm holding the end effector and on the robotic arm holding the sensitive organ protection instrument.

13. A system described in any one of claims 1 to 12, wherein the robotic arm holding the end effector and the robotic arm holding the sensitive organ protection instrument are equipped with torque sensing capability.

Images