Surgical robotic system

Abstract

To provide devices, systems and methods for a robot-assisted surgery.SOLUTION: A surgical robotic system with integrated navigation and multiple surgical arms may assist a user with one or more surgical procedures. In addition to the multiple surgical arms, the robotic system may also have peripheral arms to position a navigation camera and surgeon displays. The robotic system is collaborative to allow easy integration into procedural workflows, for example, to install pedicle screws, interbody implants, or other surgical devices.SELECTED DRAWING: Figure 1

Description

[Technical Field]

[0001] FIELD OF THE DISCLOSURE The present disclosure relates to medical devices, and more particularly to robotic surgical systems, and related devices and methods. [Background technology]

[0002] Computer-assisted technology can be used during surgery to, for example, improve precision, reduce surgical time, and lower potential radiation exposure. Generally, navigation provides surgeons with better visualization in minimally invasive procedures, while surgical robots assist with implant trajectory alignment and positioning. The combination of robotics and navigation has automated navigation positioning as robotics augmented computer-assisted technology. Additionally, robotic arms can be used to precisely align and maintain the surgeon's desired trajectory during the procedure.

[0003] However, current robotic navigation systems have several limitations. For example, the systems may be limited by navigational fine-tuning factors such as inaccurate alignment or poor line of sight with the robotic camera, problems with passive guidance such as possible patient movement, the inability to actively move the system during the procedure, and difficulties working with long surgical structures, having only a single robotic arm limited methodology to one surgical act at a time, lack of monitor visibility for the surgeon or assistant to oversee the procedure, and being prevented from moving the entire system during surgery and / or transport.

[0004] Therefore, there remains a need for improved systems and methods for robotic-assisted surgery using robotic navigation systems that act as a tool and true assistant to the surgeon throughout the surgical procedure, with flexibility and adaptability for a variety of clinical applications and approaches. Summary of the Invention

[0005] To meet this and other needs, devices, systems, and methods for robotic-assisted surgery are provided. A surgical robotic system with integrated navigation and multiple surgical arms can assist a user with one or more surgical procedures. An end effector for engaging instrumentation and performing the desired surgical procedure may be attached to each surgical arm. In addition to the surgical arms, the robotic system may also have a peripheral arm for positioning a navigation camera and a surgeon display. The robotic system is collaborative, such that motorized subsystems can be controlled both by system software and manually by the user. These collaborative subsystems may include all robotic arms, base movement, and base lockout / stabilization. The collaborative design allows for easy integration into procedural workflows, for example, for placing pedicle screws, interbody implants, or other surgical devices.

[0006] According to one embodiment, a multi-arm surgical robotic system includes a mobile base station including an on-board computer, a display electronically coupled to the computer, a camera electronically coupled to the computer and configured to detect one or more tracking markers, a pair of surgical arms electronically coupled to the computer and movable based on commands processed by the computer, and an end effector electronically coupled to each surgical arm. The surgical arms may be configured to synchronize with one another. The surgical arms may be configured to perform independent surgical tasks simultaneously. The surgical arms may be configured to perform independent surgical tasks sequentially. Each of the surgical arms may be configured to be controlled by a different user. One of the surgical arms may be configured to perform one type of task while the other surgical arm may be configured to perform a different type of task. One of the surgical arms may control the other surgical arm during a pantograph mode. The surgical arms may automatically perform a verification procedure.

[0007] According to one embodiment, a multi-arm surgical robotic system includes a movable base station including an on-board computer, an arm positioner attached to the base station, a monitor arm attached to the arm positioner, the monitor arm supporting a display electronically coupled to the computer, a camera arm attached to the arm positioner, the camera arm supporting a camera electronically coupled to the computer and configured to detect one or more tracking markers, and a pair of surgical arms attached to the arm positioners, electronically coupled to the computer, and movable based on commands processed by the computer.

[0008] The multi-arm surgical robotic system may include one or more of the following features: The monitor arm and camera arm may be motorized and controlled by a computer for automatic positioning of the display and camera, respectively; The arm positioner may include a vertical column providing telescopic movement; Each of the surgical arms may include multiple arm segments interconnected by joints providing movement with seven degrees of freedom; The monitor arm may be connected to the arm positioner at a rotary joint, and the arm segments of the monitor arm may be interconnected by a double hinge joint; The camera arm may be connected to the arm positioner at a rotary joint, and the arm segments of the camera arm may be interconnected by a double hinge joint, and the camera may be connected to the free end of the camera arm at a tilt joint; The free end of each surgical arm may include an end effector interface for securing an end effector for precise positioning of instruments.

[0009] According to one embodiment, a method of robotic navigation may include (a) providing a multi-arm surgical robotic system including a pair of surgical arms, a display, and a navigation camera supported on a single mobile cart, (b) positioning the surgical robotic system near an operating room table, and (c) performing a surgical procedure with the assistance of surgical arms of the multi-arm surgical robotic system such that both surgical arms are synchronized with each other to perform independent tasks simultaneously or sequentially. The procedure may include installing one or more pedicle screws, such as bilateral pedicle screws, into each vertebra using one or both of the surgical arms. The procedure may include using one or both of the surgical arms to place an interbody implant through an anterior cervical discectomy and fusion (ACDF), a posterior cervical fusion (PCF), an anterior lumbar interbody fusion (ALIF), a transforaminal lumbar interbody fusion (TLIF), a posterior lumbar interbody fusion (PLIF), or a lateral lumbar interbody fusion (LLIF) procedure. The multi-arm surgical robotic system may have a deployed configuration during use and a docked configuration for transportation or storage.

[0010] According to one embodiment, a multi-arm surgical robotic system includes a mobile base station including an on-board computer and two or more motorized surgical arms mounted on the base station and electronically coupled to and controlled by the computer. Each surgical arm has seven arm links interconnected by seven joints, thereby providing movement with seven degrees of freedom. Each of the seven joints may have a single axis of rotation. Each successive joint may have an axis of rotation orthogonal to the previous joint. The seven joints may be revolute joints. Starting from the base station, the seven arm links may include a first link, a second link, a third link, a fourth link, a fifth link, a sixth link, and a seventh link, which are interconnected to each other by seven joints, including the first joint, the second joint, the third joint, the fourth joint, the fifth joint, the sixth joint, and the seventh joint. The axes of rotation of the fifth joint, the sixth joint, and the seventh joint may all intersect at a single point. The coordinate system origins of the second through seventh links may all be coplanar. The third link may be offset so that the third and fifth joint axes remain coplanar. Each surgical arm may have a docked position where the fifth, sixth, and seventh links are aligned next to the first and second links.

[0011] According to one embodiment, a multi-arm surgical robotic system includes a movable base station including an on-board computer, a monitor arm attached to the base station supporting a display electronically coupled to the computer, a camera arm attached to the base station supporting a camera electronically coupled to the computer and configured to detect one or more tracking markers, and a pair of surgical arms attached to the base station and electronically coupled to the computer, movable based on commands processed by the computer. The surgical arms have seven arm links interconnected by seven joints, thereby providing movement with seven degrees of freedom.

[0012] The multi-arm surgical robotic system may include one or more of the following features: The surgical arm, the monitor arm, and the camera arm may be motorized and controlled by a computer for automatic positioning. The surgical arm may have closed-form inverse kinematics. Each joint of the surgical arm may include a motor, a gearbox, a load encoder, and a motor encoder. The load encoder may include a load encoder sensor for measuring the rotational position, velocity, or direction of the load, and a load encoder scale for quantifying the load. A microscope camera may be incorporated into the surgical robotic system to magnify the surgical site. The microscope camera may be mounted on the underside of the monitor arm below the display.

[0013] According to one embodiment, a method of robotic navigation may include (a) providing a multi-arm surgical robotic system with a pair of surgical arms having seven arm links interconnected by seven joints, thereby providing movement with seven degrees of freedom; (b) positioning the surgical robotic system near an operating room table with the surgical arms in a square orientation; and (c) performing a surgical procedure with the assistance of one or both of the surgical arms of the multi-arm surgical robotic system. The method may include, prior to performing the surgical procedure, moving the surgical arms to a preset draping position in which both surgical arms are extended upward for sterile draping. The multi-arm surgical robotic system may have a deployed configuration and a docked configuration in which the surgical arms are folded back from the surgical field. During a surgical procedure, one of the surgical arms may be deployed while the other surgical arm remains docked for a single-arm procedure.

[0014] Kits are also provided that include various types and sizes of implants, instruments, and other components for performing the procedure. [Brief explanation of the drawings]

[0015] A more complete understanding of the present invention and its attendant advantages and features will be more readily appreciated by reference to the following detailed description when considered in conjunction with the accompanying drawings. [Figure 1] 1 illustrates a surgical robotic system having two surgical arms, according to one embodiment. [Figure 2A] 2A-2C show the surgical robotic system of FIG. 1 in a deployed system configuration and a docked system configuration, respectively. [Figure 2B] 2A-2C show the surgical robotic system of FIG. 1 in a deployed system configuration and a docked system configuration, respectively. [Figure 3A] 1A and 1B show side and front views, respectively, of a docked system, according to one embodiment. [Figure 3B] 1A and 1B show side and front views, respectively, of a docked system, according to one embodiment. [Figure 4] 1 shows a deployed surgical robotic system positioned next to an operating room table. [Figure 5A] Demonstrates surgical arm motion types and functionality, including point, vector, and rotational constraints controlled by force input from the user. [Figure 5B] Demonstrates surgical arm motion types and functionality, including point, vector, and rotational constraints controlled by force input from the user. [Figure 6] 1 illustrates an example of a simultaneous active approach using the surgical arms of a surgical robotic system. [Figure 7] An example of a two-surgeon workspace with two active users during a procedure is shown. [Figure 8A] 10 shows an example of placing pedicle screws using multiple surgical arms. [Figure 8B] 10 shows an example of placing pedicle screws using multiple surgical arms. [Figure 8C] 10 shows an example of placing pedicle screws using multiple surgical arms. [Figure 8D]10 shows an example of placing pedicle screws using multiple surgical arms. [Figure 9] An example is shown of a surgical robotic system being used in pantograph mode to expand the working volume and scale for fine adjustment. [Figure 10] An example is shown using a surgical robotic system with a pantograph aligned with an augmented reality object (here only the patient's spine is shown). [Figure 11] 1 illustrates automated two-arm instrument verification to confirm instrument tip position, according to one embodiment. [Figure 12A] 10A-10C show alternative arm configurations for a surgical robotic system, each having a vertical column and branching arm locations above and below the upper arm. [Figure 12B] 10A-10C show alternative arm configurations for a surgical robotic system, each having a vertical column and branching arm locations above and below the upper arm. [Figure 13] 1 illustrates a surgical robotic system having a positioner with five degrees of freedom of rotational joints, according to one embodiment. [Figure 14] 1 illustrates a pedestal robot with a surgical arm that launches from a base cabinet, according to one embodiment. [Figure 15A] 1A-1D illustrate a surgical robotic system having a parallelogram positioner in an extended position and a docked position, respectively, according to one embodiment. [Figure 15B] 1A-1D illustrate a surgical robotic system having a parallelogram positioner in an extended position and a docked position, respectively, according to one embodiment. [Figure 16] 1 illustrates a surgical robotic system having a parallelogram positioner with a floating column, according to one embodiment. [Figure 17A] Examples of stacked columns with two and three surgical arms, respectively, are shown. [Figure 17B] Examples of stacked columns with two and three surgical arms, respectively, are shown. [Figure 18]1 illustrates a surgical robotic system with an autonomous pedestal arm, according to one embodiment. [Figure 19] 1 illustrates a surgical robotic system having a decoupled surgical arm with 10 degrees of freedom, according to one embodiment. [Figure 20] 1 illustrates a surgical robotic system having a curved gantry for positioning dual surgical arms around a patient, according to one embodiment. [Figure 21A] 1 shows an example of a decoupled single cart system without a camera. [Figure 21B] 1 shows an example of a decoupled single cart system without a camera. [Figure 21C] 1 shows an example of a decoupled single cart system without a camera. [Figure 21D] 1 shows an example of a decoupled single cart system without a camera. [Figure 22] 1 shows the surgical robotic system in a docked position, ready for setup. [Figure 23A] 10A-10C show examples of pre-set positions for draping the robot in single-arm and multi-arm procedures, respectively. [Figure 23B] 10A-10C show examples of pre-set positions for draping the robot in single-arm and multi-arm procedures, respectively. [Figure 24A] An example of an arrangement for positioning the navigation camera for optimal line of sight while avoiding operating room lighting is shown. [Figure 24B] An example of an arrangement for positioning the navigation camera for optimal line of sight while avoiding operating room lighting is shown. [Figure 25A] 10A-10C show examples of positioning a dual display monitor with opposing displays and side-by-side displays, respectively. [Figure 25B] 10A-10C show examples of positioning a dual display monitor with opposing displays and side-by-side displays, respectively. [Figure 26]An example of a completely opposite display is shown, with multiple surgeons working on either side of the operating room table. [Figure 27] 1 shows a surgical robotic system configured with an inverted display in a microscope mode that orients the microscope toward the surgical site for magnified visualization, according to one embodiment. [Figure 28] FIG. 1 shows a surgical robotic system with side-by-side displays in a microscope mode that allows one display to provide a magnified image and the other display to provide the surgical workflow, according to one embodiment. [Figure 29] 1 shows an example of a port with fiducial marks etched into it to aid in dynamic positioning and focusing of the camera. [Figure 30] An example of a dual configuration for two surgeons working simultaneously under microscope mode is shown. [Figure 31] A surgical robotic system is shown having dual load cells at the base and end effector interface of each arm for collision detection and safe collision recovery. [Figure 32A] An example of two robotically controlled navigation cameras is shown, providing redundancy and reduced line-of-sight issues in docked and deployed configurations, respectively. [Figure 32B] An example of two robotically controlled navigation cameras is shown, providing redundancy and reduced line-of-sight issues in docked and deployed configurations, respectively. [Figure 33A] 1A and 1B show an example of a navigation camera and surgical display mounted on a selective compliance articulating robot arm (SCARA) in docked and deployed configurations, respectively. [Figure 33B]1A and 1B show an example of a navigation camera and surgical display mounted on a selective compliance articulating robot arm (SCARA) in docked and deployed configurations, respectively. [Figure 34A] 10A-10C illustrate a closed form inverse kinematic surgical arm configuration in a docked and extended position according to one embodiment. [Figure 34B] 10A-10C illustrate a closed form inverse kinematic surgical arm configuration in a docked and extended position according to one embodiment. [Figure 35] 1 illustrates a right angle position on an operating room table for a surgical robot, according to one embodiment. [Figure 36] 1 shows a schematic diagram of a joint of a surgical arm, according to one embodiment. [Figure 37] 1 illustrates a joint coordinate system for a surgical arm, according to one embodiment. [Figure 38A] 10A and 10B show examples of optimized and inefficient docking of a surgical arm, respectively. [Figure 38B] 10A and 10B show examples of optimized and inefficient docking of a surgical arm, respectively. [Figure 39A] 10 shows a comparison of right-angle crossover positions for different surgical arm configurations. [Figure 39B] 10 shows a comparison of right-angle crossover positions for different surgical arm configurations. [Figure 39C] 10 shows a comparison of right-angle crossover positions for different surgical arm configurations. [Figure 39D] 10 shows a comparison of right-angle crossover positions for different surgical arm configurations. [Figure 40A] 10 illustrates a load encoder at the output of the gearbox according to one embodiment. [Figure 40B] 10 illustrates a load encoder at the output of the gearbox according to one embodiment. [Figure 41A] 1 illustrates a load encoder in front of the motor, according to one embodiment. [Figure 41B] 1 illustrates a load encoder in front of the motor, according to one embodiment. [Figure 42] 13 illustrates a cable management system including a slip ring through the roll joint of the surgical arm, according to one embodiment. [Figure 43] 10 illustrates one embodiment of a machined reference for global arm tracking. [Figure 44A] 10 shows an example of information rings positioned on surgical arms and / or end effectors to visually convey status information about each respective arm. [Figure 44B] 10 shows an example of information rings positioned on surgical arms and / or end effectors to visually convey status information about each respective arm. DETAILED DESCRIPTION OF THE INVENTION

[0016] Embodiments of the present disclosure are generally directed to surgical robotic systems and related devices and methods. In particular, surgical robotic systems may include integrated real-time surgical navigation with multiple surgical arms configured to assist a user with one or more surgical tasks. An end effector may be attached to each surgical arm to guide the trajectory of a dedicated surgical instrument and perform the desired surgical procedure. For example, a robotic system may include a pair of surgical arms that guide the instrument to follow a trajectory specified by the user. Multi-arm systems may offer opportunities to greatly expand the capabilities of computer-assisted techniques in surgery. Multiple surgical arms allow the robotic system to assist with more surgical procedures and improve the precision of the procedures. Advanced multi-arm, highly automated platforms may enable simultaneous interaction by one or more surgeons, technicians, and patients.

[0017] Surgical robotic systems can be configured for complete navigation and precise alignment during spinal surgery. Surgical robotic systems can enable locating anatomical structures and real-time navigation of surgical instruments and devices in open or minimally invasive surgical (MIS) procedures. For example, surgical arms and attached end effectors can be used during spinal surgery to position and install pedicle screws, interbody implants, or perform other surgical techniques. While generally described herein with respect to performing spinal surgery, it will be understood that the systems and methods described herein can be applied to other orthopedic locations in the body, as well as other medical procedures, such as trauma applications, cranial procedures, and oncology applications.

[0018] It is understood that the present disclosure is not limited in its application to the details of construction and arrangement of components set forth in the description herein or illustrated in the drawings. The teachings of the present disclosure may be used and implemented in other embodiments and may be practiced or carried out in various ways. It is also understood that the phraseology and terminology used herein are for purposes of description and should not be regarded as limiting. The use of "including," "comprising," or "having," and variations thereof, herein is meant to encompass the items listed thereafter and equivalents thereof, as well as additional items. Unless otherwise specified or limited, the terms "mounted," "connected," "supported," and "coupled," and variations thereof, are used broadly and encompass both direct and indirect mounting, connecting, supporting, and coupling. Furthermore, "connected" and "coupled" are not limited to physical or mechanical connections or couplings.

[0019] The following discussion is presented to enable those skilled in the art to make and use the embodiments of the present disclosure. Various modifications to the illustrated embodiments will be readily apparent to those skilled in the art, and the principles herein may be applied to other embodiments and applications without departing from the embodiments of the present disclosure. Thus, the embodiments are not intended to be limited to the embodiments shown, but are to be accorded the widest scope consistent with the principles and features disclosed herein. The following detailed description should be read with reference to the drawings, in which like elements in different drawings may have like reference numerals. The figures, which are not necessarily to scale, depict selected embodiments and are not intended to limit the scope of the embodiments. Those skilled in the art will recognize that the examples provided herein have many useful alternatives and are within the scope of the embodiments.

[0020] Multi-arm surgical robot system Turning now to the drawings, FIG. 1 illustrates a multi-arm surgical robotic system or platform 10 according to one embodiment. The multi-arm surgical robotic system 10 is configured to complete multiple surgical tasks simultaneously or sequentially, which may improve overall procedure accuracy and reduce surgical procedure time. The surgical robotic system 10 may include, for example, a robotic base station 12, an arm positioner 14 attached to the base station 12, and multiple arms 16, 18, 22 attached to the positioner 14. The two or more surgical arms 16 may help guide instruments or perform surgical tasks, for example, using end effectors 26. The monitor arm 18 is configured to support one or more displays or monitors 20. The camera arm 22 is configured to support one or more navigation cameras 24 for detecting and tracking markers, such as active and passive markers. Unlike other robotic systems that may utilize separate viewing / control stations or separate camera stands / stations, all of the system components are integrated into a single mobile unit for the robotic system 10. Integrating all components into one mobile platform may improve the usability and accuracy of the system 10 while also reducing its overall footprint in the operating room.

[0021] The robot base station 12 may include, for example, a mobile cabinet or portable frame on casters or wheels 30. The base station 12 houses an on-board computer or computing unit for controlling all functionality of the robotic system 10. The on-board computer may include a central processing unit (CPU), memory, and input / output interfaces. The central processing unit executes computer program or software instructions by performing arithmetic, logical, control, and input / output (I / O) operations specified by the instructions. Memory may include volatile and non-volatile memory storage that temporarily or permanently stores data and instructions currently in use or to be required by the central processing unit. This may include, for example, storage devices such as random access memory (RAM), read-only memory (ROM), and hard drives. The input / output interfaces allow the computer system to interact with a user, capture information, and distribute results, and may include devices such as a monitor, keyboard, mouse, and network interface for Internet connectivity.

[0022] As shown in the embodiment of FIG. 1 , the multi-arm surgical robotic system 10 may include one or more user interfaces, such as displays or monitors 20, 32, including touchscreen displays, that may be operated by one or more surgeons or other users. Before or during a medical procedure, two-dimensional (2D) and / or three-dimensional (3D) images, such as computed tomography (CT) scans, may be taken of a desired surgical area on a patient 62 and provided to an on-board computer. Using the images, a surgeon may program desired insertion points and trajectories for one or more surgical instruments 28 to reach desired anatomical targets within or on the patient's 62 body. The desired insertion points and trajectories may be planned on images that may be displayed on the monitors 20, 32. The system 10 includes 2D and 3D imaging software that enables preoperative planning, navigation, and guidance throughout the surgical procedure. Further details of surgical robots and navigation systems can be found, for example, in U.S. Patent Application Publication No. 2019 / 0021795 and U.S. Patent Application Publication No. 2017 / 0239007, which are incorporated by reference in their entireties for all purposes.

[0023] In one embodiment, a pair of monitors 20 may be secured to a monitor arm 18 that is part of the sterile field. Relevant information may be displayed and manipulated by the surgeon on the touchscreen monitor 20 before or during the procedure. Unlike systems with only a single monitor viewable by the surgeon, a dual-monitor display may provide access to a second surgeon or assistant and allow separate control of each of the respective surgical arms 16. The monitors 20 may be arranged side-by-side, back-to-back, or in another suitable configuration for user accessibility and visibility. The base station 12 may further include a cabinet-mounted terminal or touchscreen control display 32. The cabinet-mounted touchscreen display 32 may be accessible to the user when the system 10 is docked, during transport, or during the procedure. During surgery, the cabinet display 32 may be used for non-sterile user control or observation, for example, by an assistant. It will be understood that one or more of the displays 30, 32 may be supplemented or replaced with an optional wireless tablet or other suitable device.

[0024] The surgical robotic system 10 may also utilize a camera 24, for example, affixed to a camera arm 22. The camera arm 22 is configured to move, orient, and support the camera 30 in a desired position. The camera 24 may include any suitable camera or cameras, such as one or more infrared cameras (e.g., bifocal or stereo photogrammetry cameras), capable of identifying active and passive tracking markers in a given measurement volume visible from the perspective of the camera 24. The tracking markers may be arranged in a particular array or pattern, which may be useful, for example, for identifying instruments. In an exemplary embodiment, the camera 24 is a machine vision navigation camera configured to capture visual data from tracking markers, which may be present on the system 10, on the instrument 28, affixed to the patient, or in any other suitable location for tracking and navigating the surgical procedure. The camera 24 may scan the given measurement volume and detect light from the markers to identify and determine their positions in three dimensions. For example, active markers may include infrared-emitting markers activated by an electrical signal (e.g., infrared light emitting diodes (LEDs)), while passive markers may include retroreflective markers (e.g., spheres or disks) that reflect infrared light emitted by an illuminator on the camera 24 or another suitable device (e.g., reflect incident IR radiation in the direction of the incident light). In one embodiment, tracking markers may include machined fiducials, reflective disks, reflective spheres, and / or active LEDs that are visible directly or through surgical draping. The location, orientation, and position of structures bearing these types of markers may be provided to the on-board computer and shown to the user on the display 20, 32. The navigation camera 24 tracks the position in real time and provides images on the monitor 20, 32 along with images of the patient, for example, to provide guidance to the surgeon during surgery.

[0025] The base station 12 may also include a connector panel 34 that includes external connection ports for various devices, such as a potential equalization terminal, a foot pedal connector, a camera connector port, an HDMI connector, an Ethernet connector, dual USB 3.0 ports, etc. It will be appreciated that any suitable hardware, software, or combination thereof may be implemented to perform the operations and functionality of the robotic system 10.

[0026] The robotic base station 12 may include a motorized propulsion and positioning system for transporting the robotic system 10. In this manner, one or more base wheels 30 may be powered and steerable by a user before or during a procedure. The motorized propulsion and positioning system may include two primary modalities. In a first configuration, a user can transport and position the robotic system 10 via one or more handles 36. The movement of the powered base may be controlled by force input from the user to the handles 36. For example, force feedback may be measured at the handles 36 to adjust the direction and speed of movement. In a second configuration, a user may utilize smart positioning in the operating room for position recall and reachability adjustment. Smart positioning may be achieved via encoders on the wheels 30 and relative positioning tracking with the navigation camera 24. Relative tracking with the camera 24 may be achieved, for example, with patient-based tracking, simultaneous localization and mapping (SLAM), and / or machine vision. Smart positioning may enable intraoperative positioning of the system 10, for example, to account for long implant constructs or complex cases. The base station 12 may include a braking and / or stabilizer system 38 for immobilizing the base 12. The stabilizer system 38 may be rigidly secured to stabilize the system 10 in the operating room and lock the base 12 to the ground during a surgical procedure. The stabilization may be engaged and retracted via motor power and manually by the user. In this manner, the braking system may also be used to assist in transportation when the system 10 is powered down.

[0027] The arm positioner 14 is fixed to the base station 12 and is controllable via an on-board computer. In one embodiment, the arm positioner 14 may include a vertical column that provides telescopic movement along the z-axis 40, thereby functioning as a prismatic joint. The arm positioner 14 may thus extend or retract vertically, thereby moving one or more arms 16, 18, 22 of the system 10. As shown in this embodiment, the surgical arm 16 may be coupled to the arm positioner 14 near the base station 12, and the monitor arm 18 and camera arm 22 may be positioned toward the distal end of the arm positioner 14. In this manner, vertical movement of the arm positioner 14 may provide movement of the monitor 20 and camera 24 along the z-axis 40. It will be understood that other suitable configurations may be used to position the respective robotic arms 16, 18, 22.

[0028] One or more surgical arms 16 may be provided to provide a wide range of motion and adjustment, for example, to mimic the movements of a human arm, hand, and / or fingers and closely replicate the dexterity and precision of a skilled surgeon. In one embodiment, the surgical arms 16 include a pair of left and right surgical arms arranged around the base of the arm positioner 14. Each surgical arm 16 may include multiple arm segments or links interconnected by various types of joints, as described in more detail with respect to FIGS. 34A-34B . Each joint may enable a particular type of motion or may provide specialized movements. The joints may include rotary joints, prismatic joints, spherical joints, universal joints, cylindrical joints, planar joints, or other suitable joints that contribute to the arm's range of motion, flexibility, and reach. In the illustrated embodiment, the system 10 includes left and right surgical arms 16, each capable of movement with seven degrees of freedom (7 DoF). For example, the movements may include three translational movements (along the x-, y-, and z-axes), three rotational movements (about the x-, y-, and z-axes), and an additional rotation or translation to provide greater precision and dexterity. It will be appreciated that the surgical arms 16 may be configured with any suitable orientation or movement that allows each arm 16 to move forward / backward, left / right, up / down, yaw left / right, pitch / tilt up / down, roll about its own axis, or otherwise translate or rotate for complex movements. The surgical arms 16 may be configured with zero backlash to ensure that movements are highly precise, accurate, and directly reflect the surgeon's commands without any delay.

[0029] The distal end of each surgical arm 16 includes an end effector interface 42 for securing an end effector 26 to the end of the surgical arm 16. The end effector 26 is a device or tool attached to the end of the robotic surgical arm 16 to interact with a surgical site. In some cases, the end effector 26 may include a guide tube to provide precise positioning of an instrument 28 placed therethrough. In other cases, the end effector 26 may include an active or functional instrument, such as a retractor for retracting soft tissue, controlled by the system 10 or manually. The end effector 26 may be provided as a separate component that is sterilized before use. The end effector interface 42 may include the mechanical and / or electronic coupling of the end effector 26 to the distal end of the surgical arm 16. The end effector interface 42 includes a power and communication interface for the end effector 26. The end effector interface 42 allows for a rigid connection of the end effector 26 to the surgical arm 16 through a sterile drape.

[0030] The end effector 26 may be configured to guide or hold an integrated or separate navigated instrument 28. For example, the end effector 26 may include a tubular element or guide tube aligned along a planned trajectory. A separate navigated instrument 28 may be positioned through the guide tube and along the planned trajectory to perform a given function. For example, the navigated instrument 28 may include, for example, a drill, tap, driver, or other instrument for inserting a screw. The navigated instrument 28 may further include, for example, a dilator, a disc preparation instrument (e.g., a curette, a Cobb elevator, an osteotome, a rasp, a scraper, etc.), a trial, a retractor / distractor, an inserter, and other instruments for placing an interbody implant. It will be understood that any suitable instrument may be used for a given surgical procedure.

[0031] Each surgical arm 16 may include one or more load cells 44, 46 configured to monitor and measure forces applied to the surgical arm 16. A distal load cell 44 may be provided near the free end of each surgical arm 16. For example, a six-axis load cell 44 may be located at the end effector interface 42, which provides a coordinated ad-hoc motion mode when a user moves the arm 16 by directly applying forces to the end of the arm 16 or to the end effector 26. A base load cell 46, such as a six-axis load cell 46, may also be provided on each arm 16 near its connection to the arm positioner 14 to provide real-time feedback to the control system of the robot 10.

[0032] Each surgical arm 16 may include a ring of information (ROI) 48 for status indication. Each ring of information 48 may provide independent information regarding the status of each respective arm 16. For example, the ring of information 48 may provide an individual color, such as green for system ready, red for error, or yellow for user action, to convey information to the user. The ring of information 48 may also flash or provide other visual indicators to the user. The ring of information 48 may be positioned anywhere along each arm 16 or in another suitable location.

[0033] The monitor arm 18 is attached, for example, near the top of the positioner 14. The monitor arm 18 includes a motorized arm having multiple arm segments interconnected by various types of joints 50. The motorized monitor arm 18 can be controlled by the system 10 and / or a user for optimal visibility of the monitor 20. In one embodiment shown in FIGS. 25A-25B, the monitor arm 18 is connected to the positioner 14 at a rotary joint 52, the arm segments are interconnected by a double hinge joint 54, and the monitor 20 is coupled to the free end of the monitor arm 18 via two rotary joints 56, 58, respectively. As shown, the monitor arm 18 can enable movement with four degrees of freedom (4DoF). For example, the movement can include x, y, z, and yaw with a folding butterfly providing angular control. It will be appreciated that the monitor arm 18 may be configured to have any suitable orientation or movement that allows the arm 18 to support and position the monitor 20 for optimal viewing.

[0034] The camera arm 22 is attached to the positioner 14, for example, at its distal-most end. The camera arm 22 includes a motorized arm with multiple arm segments interconnected by various joints. The motorized camera arm 22 can be controlled by the system 10 and / or a user for optimal viewing of the camera 24 throughout the procedure. In one embodiment, the camera arm 22 is connected to the positioner 14 at a rotary joint, the arm segments are interconnected by a double-hinge joint, and the camera 24 is connected to the free end of the arm segment at a pivot or tilt joint. As shown, the monitor arm 22 can enable movement with six degrees of freedom (6 DoF). For example, the movement can include x, y, z, yaw, pitch, and tilt. In one embodiment, the navigation camera 24 is mounted on the arm 22 in a SCARA configuration (horizontal articulated robotic arm) with a prismatic vertical joint for height adjustment followed by two in-plane rotational joints for xy positioning. The camera itself has three axes of orientation control (pan, tilt, and roll), for a total of six axes of camera positioning. All joints are motorized and may use absolute single-turn encoder feedback, allowing the system 10 to know the camera position immediately upon system power-up without the need for a homing routine. The camera arm 22 may be bimodal, active, and passive, meaning the camera arm 22 can be positioned robotically or through manual surgeon interaction, achieving a collaborative approach for the system 10. Unlike systems that provide cameras on separate stands, the system 10 incorporates the camera 24 into a single cart solution. This may help improve the line of sight of the camera 24, which can navigate only when the camera 24 can see the patient reference and the instrument of interest. The motorized camera arm 22 also allows for adjustment of the camera 24 during the procedure, minimizing possible line-of-sight disturbances and eliminating the need to manually position the camera.

[0035] 2A-2B and 3A-3B, the multi-arm surgical robotic system 10 can have a deployed position and a docked position. In the deployed position shown in FIG. 2A, one or more of the robot's arms 16, 18, 22 are extended and positioned for active participation in a surgical procedure. In the deployed configuration, the surgical arm 16 can be positioned to provide optimal access to the surgical site, the camera arm 22 can be extended to provide an optimal line of sight for the machine vision navigation camera 24, and the monitor arm 18 can be extended for optimal viewing of and engagement with the touchscreen monitor 20. In the docked position shown in FIG. 2B, all of the arms 16, 18, 22 are folded to allow the surgical robot 10 to be in a compact configuration, for example, for transport or storage. The cabinet touchscreen display 32 remains accessible while the system 10 is docked. Further, focusing on the docked system 10 shown in FIGS. 3A-3B , all of the robotic arms 16, 18, 22 are docked in a compact configuration for easy transportation and to allow for selective deployment of individual arms 16, 18, 22. This arrangement allows all four arms 16, 18, 22 in the system 10 to be docked in a compact form factor, allowing a user to selectively deploy a subset of the arms 16, 18, 22 depending on the particular use case. For example, a use case in which one surgical arm 16 is needed and the video output is sent to a large operating room (OR) monitor rather than using the integrated monitor 20 may result in the monitor 20 remaining retracted while one surgical arm 16 is deployed. Deployment and docking may be motorized and automated, allowing for simple and elegant setup in situations where setup may be cumbersome or complex.

[0036] Turning now to FIG. 4 , the positioning of the system on the operating room table 60 is flexible and can be based on the surgeon's preferences for a given procedure. The multi-arm surgical robotic system 10 can be positioned next to or across from the surgeon, or it can be positioned toward the feet or head of the patient 62. In all of these combinations, the surgical arms 16 have a large working volume on both sides of the table 60 without moving the system base 12, and the monitor 20 and camera 24 can be positioned along the centerline of the table 60. This camera location limits line-of-sight issues, and the monitor position is more ergonomic for the surgeon than other systems. In the embodiment shown in FIG. 4 , both surgical arms 16 are the same length and configuration. Alternatively, the surgical arms 16 can be different. The length of one arm 16 can be increased, for example, through an attachment at the end between the end of the arm 16 and the end effector 26, or two distinct arm configurations can be provided. This distinction in length and / or type can lead to a primary and secondary arm when positioning in the OR and when deploying for the procedure.

[0037] 5A-5B, the surgical arm 16 may have improved precision, articulation, and enhanced movement capabilities while directly interacting with the patient 62. Enhanced surgical arm movement 70 may be grouped into four motion mode categories: passive guidance 72, active guidance 74, active assistance 76, and active control 78. During passive guidance 72, the system 10 moves the surgical arm 16 to a position and holds that position. Once in position, the system 10 is static, passively guiding the surgeon-controlled instrument 28. During active guidance 74, the system 10 moves the surgical arm 16 to a position, servos it in place, and makes dynamic adjustments to maintain its position relative to the patient 62 as the anatomy moves. During active assistance 76, the surgical arm 16 is controlled by force input from the user, allowing movement within a specified set of constraints. As shown in FIG. 5B, the constraints may include point constraints 80, vector constraints 82, and rotational constraints 84. Point constraints 80 may include free, defined, on a vector, on a plane, and / or inside a volume. Vector constraints 82 may include free, defined, parallel to a vector, and / or perpendicular to a plane. Rotation constraints 84 may include free and / or defined. During active control 78, planned robot movement may be enabled by successive activations of a deadman switch. Some examples may include drilling, tapping, screw placement, disc removal, cage placement, and bone removal.

[0038] Active modes 74, 76, 78 enable tissue volume removal such as facetectomy, laminectomy, and discectomy, in addition to milling, drilling, tapping, screw driving, and other functions. All active motion modes 74, 76, 78 can be enabled by a supervisor safety control system. The supervisor is a redundant control system in parallel with the primary motion control system that monitors all feedback devices (encoders, switches, force sensors), motor currents, and joint velocities and compares these readings with the primary motion control system. The supervisor also compares readings with expected values ​​when a commanded movement is given. If there is a discrepancy between the supervisor and the primary motion control system, or between expected values ​​and supervisor readings, the supervisor control safely stops all movement.

[0039] Active motion and multiple surgical arms 16 allow the system 10 to support more surgical procedures, such as active milling, longer instrument placement, and simultaneous robotic actions (e.g., holding retractors and assisting with disc preparation). This can help improve overall procedure accuracy and reduce the surgeon's cognitive load. The dual surgical arms 16 and dual monitors 20 also allow multiple surgeons to be actively involved in the procedure simultaneously, thereby reducing the overall procedure time. The non-sterile monitor 32 allows non-sterile staff to actively assist without disturbing the surgical monitor 20. Integrating all components into one mobile platform reduces the overall footprint of the computer-assisted technology in the OR. The reduced footprint can also improve the usability of the system 10 for staff, as it does not disrupt standard staff layouts. The automated peripheral arms 18, 22 and the overall coordinated movement of the system 10 can streamline setup and reduce the need for fine-tuning navigation during the procedure. Automatic camera adjustment ensures that the patient / robot is within the field of view of the camera 24 and therefore there are no disturbances to active navigation. Enhanced line of sight reduces wasted time by eliminating manual adjustments, improving the accuracy and overall usability of the system.

[0040] 6-10, a multi-arm surgical robotic system 10, according to some embodiments, is configured to complete multiple surgical tasks simultaneously or sequentially. For example, in a dual-arm system, each surgical arm 16 is integrated into a single system 10, enabling coordinated procedure use cases and methods. Each surgical arm 16 may be capable of performing independent operations while working together in a synchronized manner. Each surgical arm 16 may function simultaneously or coordinate sequentially, depending on the type of procedure.

[0041] During a spinal procedure, the surgical arms 16 may be configured to place implants, such as pedicle screws and interbody implants, to optimize surgical workflow and reduce surgical time. For example, the surgical arms 16 may be positioned to place bilateral pedicle screws simultaneously in the same vertebrae. The surgical arms 16 may be positioned to place pedicle screws on either side of the same spinal rod simultaneously. The surgical arms 16 may be coordinated to place multiple pedicle screws in a stepwise manner along a series of vertebrae. One or both of the surgical arms 16 may be configured to place interbody implants, for example, through an anterior cervical decompression and fusion (ACDF), posterior cervical fusion (PCF), anterior lumbar interbody fusion (ALIF), transforaminal lumbar interbody fusion (TLIF), posterior lumbar interbody fusion (PLIF), or lateral lumbar interbody fusion (LLIF) procedures. For example, the surgical arms 16 may be positioned to place two interbody implants simultaneously or in a stepwise coordinated manner at multiple levels. Each surgical arm 16 may be aligned along a different surgical approach, for example, one level positioned through a transforaminal approach and another level positioned through a posterior approach. One surgical arm 16 may be configured to perform one type of task, while the other arm 16 performs a different surgical task. For example, one surgical arm 16 may install pedicle screws, while a second surgical arm 16 installs interbody implants. It is contemplated that the system 10 may be configured to install any suitable implants or perform other surgical tasks in any suitable order to optimize surgical workflow. These procedures are merely exemplary, and other suitable features and workflows may be used based on a given procedure.

[0042] During other orthopedic procedures, the surgical arms 16 may be configured to install implants such as plates, screws, and intramedullary nails to optimize surgical workflow and reduce surgical time. For example, the surgical arms 16 may be aligned along different trajectories to install screws or anchors in fracture plates or intramedullary nails for the treatment of traumatic fractures. The surgical arms 16 may be configured to guide or position one or more components of a knee or hip reconstruction. The surgical arms 16 may be used separately or together for cranial procedures. Each of the surgical arms 16 may perform distinct operations independently, while working in unison in a coordinated manner depending on the specific requirements of the surgical procedure.

[0043] Although the robots and associated systems described herein are generally described with reference to spinal and orthopedic applications, it is also contemplated that the robotic systems are configured for use in other surgical applications, including, but not limited to, surgery in trauma or other orthopedic applications, cranial, neuro, cardiothoracic, vascular, colorectal, oncological, dental, and other surgical procedures and procedures.

[0044] Further focusing on FIG. 6 , a simultaneous active approach of both surgical arms 16 is shown, according to one embodiment. During simultaneous active approach, each surgical arm 16 works in unison to actively and independently perform multiple surgical tasks. In this embodiment, the surgical arms 16 may simultaneously align their end effectors 26 along different respective trajectories or may be mirror-positioned across the patient's midline. For example, the patient 62 may be positioned prone on the OR table 60 so that the end effectors 26 may be aligned along trajectories suitable for bilateral pedicle screw placement. A simultaneous approach may improve the efficiency of single-site surgical procedures, for example, with lateral and prone access to simultaneous vertebral levels. By moving the surgical arms 16 in unison, the system 10 also facilitates the alignment and engagement of implants that require an in situ secondary actuation step, such as highly articulated expandable cages or cross-pinning / cross-screwing of plates or screw spacers. Other examples of active applications may include simultaneous electrode placement in cranial procedures or simultaneous targeting in trauma applications.

[0045] According to another embodiment, one or more of the surgical arms 16 may be configured to hold retractors, distractors, cannulas, or other access tools, for example, for minimally invasive surgical procedures. If multiple surgical arms 16 are available, one surgical arm 16 may be dedicated to positioning and holding a retractor, for example. Because both the surgical arm 16 and the patient 62 are tracked, one surgical arm 16 may be used to dynamically adjust the retractor position as the patient moves. Additionally, force sensing in the surgical arm 16 may be used to monitor the force being exerted on the patient. While one surgical arm 16 is dedicated to dynamically positioning the retractor, the remaining arms 16 may work through the openings provided by the retractor to perform surgical tasks such as volume removal, drilling, driving, etc. Because the surgical arms 16 are controlled by the same system 10, the surgical arms 16 may synchronize their movements to follow any adjustments made by the retractor arm 16.

[0046] In addition to positioning manually-actuated retractors, system 10 can be used to position robotically-actuated retractors. In other words, end effector 26 can be replaced with a dedicated robotic retractor end effector configured to provide better visibility and access to the surgical site. Surgical arm 16 provides hardwired power and communication through the sterile barrier to flexible end effector interface 42. End effector interface 42 can be used to power and control the robotically-actuated retractor. Robotic retractors can include two, three, or more retractor blades that can be adjusted and controlled robotically and / or manually. Further details of retractors can be found, for example, in U.S. Pat. No. 11,234,788, which is incorporated herein by reference in its entirety for all purposes. Force sensors can also be incorporated into the retractor to characterize and monitor the retraction force induced on the patient.

[0047] With further focus on FIG. 7 , according to one embodiment, a multi-player mode may allow each surgical arm 16 to be controlled by a different user. In dual-user mode, two users may have separate workspaces 86, 88 for controlling each respective surgical arm 16. If there are two surgeons, the first surgeon may have the first workspace 86 and the second surgeon may have the second workspace 88. For example, each surgical arm 16 may be assigned to an individual surgeon, with the surgeons positioned on either side of the OR table 60. In this dual-user mode, the system software enables a two-player mode in which the system 10 understands that there are two active users during the procedure. Each surgeon may have a customized viewport and can independently activate their own surgical arm 16. The non-sterile monitor 32 may also have a custom viewport that includes a mirror of one of the surgical viewports. The system software may be configured to detect and avoid any collisions between the two players and / or surgical arms 16. This dual-user configuration allows for simultaneous work, increasing efficiency and decreasing surgical time for patient 62. An exemplary case of this mode may include simultaneous pedicle screw placement on both sides of patient 62. Simultaneous screw placement may be beneficial in large deformities where many screws are used in the construct, thereby streamlining the procedure and decreasing operative time. It will be appreciated that other surgical procedures may also benefit from a dual-user configuration.

[0048] 8A-8D , an active fixation workflow is illustrated according to one embodiment. Having multiple integrated surgical arms 16, as opposed to a single-arm robotic system, enables a multipart workflow, for example, for complex deformities. For example, in one workflow, a patient 62 may be positioned prone on an OR table 60 for posterior pedicle screw fixation, with surgical arms 16 positioned on either side of the patient 62. The surgical arms 16 are configured to rigidly attach to the pedicle screws in an alternating fashion to serve as anchor points, thereby improving precision throughout the procedure. This specific use case for pedicle screws can be generalized to apply to any case where bony anatomy is mobile and can benefit from fixation. Some non-limiting examples may include fusing one or more vertebral bodies while correcting a deformity such as scoliosis, fusing vertebral bodies while performing bone removal, fusing vertebral bodies while cleaning the adjacent disc space, fusing vertebral bodies while placing an interbody spacer, fusing the femur or tibia while performing a total or partial knee replacement, fusing one or more bones to treat orthopedic trauma, and other orthopedic procedures.

[0049] In FIG. 8A, the first surgical arm 16A holds an end effector 26 with a guide tube aligned along the planned trajectory. An instrument 28, such as a first drill, passes through the guide tube with minimal disruption of the anatomy. After drilling, the first tap or screw can be placed. As shown in FIG. 8B, the first robotic arm 16A remains rigidly attached to the patient while the free surgical arm 16B drills the contralateral side. The first arm 16A provides a fixed anchor point for the vertebral body, dramatically reducing motion and providing spatial information about the vertebral body's location through kinematics. The second arm 16B then places its own tap or screw and then remains rigidly attached while the first arm 16A is detached and proceeds to the next level. As shown in FIG. 8C, the free arm 16A moves to the next level to place the next pedicle screw. As shown in FIG. 8D, this process is repeated until all screws for the construct have been placed. Systematically transitioning from anchor point to anchor point allows the last screw to be as precise as the first. Maintaining precision during a long procedure is especially important when the anatomy is highly mobile, such as in the cervical spine. After one or more pedicle screws have been placed, a spinal rod can be connected to the pedicle screws to prevent migration and stabilize the spinal segment.

[0050] One surgical method for placing pedicle screws may include the following steps: (1) (as shown in FIG. 8A) Drill, tap, and drive a first screw, keeping the surgical arm 16 firmly attached to the patient 62 via the screw. (2) (as shown in FIG. 8B) Drill, tap, and drive a contralateral screw while the system remains firmly attached to the first screw. Because the vertebral body is held in place by the first screw, the second screw is placed with improved precision. Keep at least one surgical arm 16 firmly attached to the patient at all times. (3) (as shown in FIG. 8C) Use the free arm 16 to move to the next level and drill, tap, and drive the next screw. Because the system is firmly holding the adjacent level, precision for this third screw is also improved. (4) (as shown in FIG. 8D) Repeat this process until all screws for the construct are placed.

[0051] 9-10 , a sterile robotic pantograph or master-slave workflow is illustrated according to one embodiment. A pantograph is a mechanical linkage used to replicate tool paths identically or with a scaling factor according to the ratio of link lengths. Using two or more surgical arms 16, the system 10 is configured to robotically emulate pantograph functionality in 3D space, providing the surgeon with an expanded working volume and scaling down the surgeon's movements to fine adjustments of the patient 62. In pantograph mode, one surgical arm 16 controls the other surgical arm 16, which performs surgical tasks. As shown in FIG. 9 , the patient 62 may be positioned, for example, face-down on the OR table 60, with the robotic system 10 positioned to one side near the patient's 62 head. In this mode, the surgeon has the option of standing next to or across from the system 10. This allows an unobstructed line of sight with the camera 24 and easy viewing of the display 20, which may show a magnified visualization of the surgical site. Each surgical arm 26 has a six-axis load cell 44 at the distal end of the surgical arm 26 .

[0052] In a sterile pantograph mode system configuration, the first surgical arm 16A may include a motorized end effector 26 with a tool 28 to perform a surgical task. For example, the first arm 16A may be equipped with a typical instrument 28 (e.g., a burr) that directly interacts with the patient 62. The second arm 16B is equipped with a tool, such as a stylus 90, for surgeon interface. The surgeon-input stylus 90 may be held or manipulated directly by the surgeon to control the first surgical arm 16A. The stylus arm 16B positions the stylus 90 in space above the surgical site to maintain the surgeon's direct line of sight. A load cell 44 at the end of the stylus arm 16B reads the force input from the surgeon and moves accordingly. Inverse kinematics from the stylus arm 16B is used to control the position and orientation of the instrument, replicating the stylus path but scaled down for fine adjustment. The scaling factor may be flexible and user-selectable. As the stylus 90 is manipulated in space by the surgeon, the working surgical arm 16A performs a given procedure in real time.

[0053] Other notable attributes of the pantograph use mode may include one or more of the following: (1) The system may provide tactile feedback to the surgeon at the stylus 90 of the second arm 16B based on the force sensed at the load cell 44 of the first arm, preserving the surgeon's sense of touch. (2) Force input from the surgeon may be decoupled from any reactive force from the patient 62 via the instrument 28. This decoupling allows the load cell 44 in the instrument arm 16A to sense forces applied to the patient 62 and implant using the full dynamic range of the load cell 44. (3) The stylus 90 may be integrated into the sterile end effector 26, allowing the surgeon to enter and exit pantograph mode without violating sterility and while maintaining a natural line of sight to the anatomy. (4) The system may be combined with an endoscope or exoscope to provide magnified visualization of the surgical site and improve visual feedback. (5) As shown in FIG. 10 , the system may be combined with an augmented reality solution, such as a headset with an anatomical overlay. The input movements are aligned with the augmented surgical volume, and the augmented input movements are scaled to the same magnification as the virtual object 92. The augmented virtual object 92 can be, for example, an enlarged portion of the patient's spine 94. (6) The system can be combined with an additional monitor showing an enlarged view of the surgical anatomical 3D volume (CT / MRI) or a cartoon of the anatomical structures, with which the surgeon interacts using the stylus 90.

[0054] Turning now to FIG. 11 , two-arm instrument verification is shown, according to one embodiment. During the verification procedure, the tip of any instrument 28 can be seated within a precision divot on another instrument or end effector for software verification. Software verification ensures that the instrument 28 is visible and registered to the robot software. The navigation camera 24 tracks both arrays while the tip is seated, thereby confirming the instrument tip position. With two or more surgical arms 16, this procedure can be automated with robotic movements, as shown in FIG. 11 . One surgical arm 16 positions the tip of the instrument 28 within the rear divot of the end effector 26 held by the other surgical arm 16. The navigation camera 24 tracks the instrument 28 as it moves to the verification position, and the camera 24 can continue to be used to verify tip position. The repeatability of two-arm verification is dramatically increased compared to a manual process. Alternatively, the process can improve verification accuracy by integrating cameras and kinematic feedback. In another embodiment, the system allows for kinematics-only verification, not requiring a camera, and instead relying on precision encoder feedback in the surgical arm 16. In another embodiment, the system introduces the capability for bent tip or runout verification by robotically rotating the instrument 28 through known increments and rechecking the tip location. In yet another embodiment, the system may move the instrument 28 into the field of view (FOV) of a camera for automated machine vision identification, verification, and calibration. It will be understood that any suitable method may be employed for automated instrument verification with the dual arm system 10.

[0055] Alternative Robotic Systems 12A-17B, the arrangement of robotic system components can be modified into different configurations, thereby providing different component movements and positioning. Referring to FIGS. 12A-12B, multi-arm surgical robotic systems 100A, 100B with bifurcated arms according to further embodiments are shown. The robotic systems 100A, 100B are similar to the multi-arm surgical robotic system 10, except that the vertical arm positioner 14 is replaced with a three-axis positioner 104. In this embodiment, all surgical arms, peripheral arms, and non-sterile components are integrated into a single mobile cart. The integrated cart configuration simplifies setup, disassembly, and storage while minimizing the total footprint required in the operating room. During use, the mobile cart is positioned on the operating room table 60 to support surgery, as described herein.

[0056] The three-axis positioner 104 may include a vertical positioner link or arm 108 and a horizontal positioner link or arm 110. The vertical arm 108 provides a prismatic vertical joint that allows linear movement along a single vertical axis. Following the prismatic vertical joint are two parallel revolute or rotary joints that allow rotation. The prismatic joint allows the three-axis positioner 104 to reach higher or lower to adjust its vertical position, while the two parallel revolute joints allow the surgical arm 16 to be optimally extended and positioned in the operating room. For example, the positioner 104 may have a common swivel point approximately at the centerline of the OR table. The surgical arm 16 may be attached to the free end of the horizontal arm 110 by a respective swivel mount. In FIG. 12A , the system 100A includes the surgical arm 16 mounted below the horizontal positioner link 110. In FIG. 12B , system 100B includes surgical arms 16 mounted above horizontal positioner link 110. The surgical arms 16 can be similar to those described for system 10, with each of the left and right surgical arms 16 capable of movement with seven degrees of freedom (7 DoF). For example, a 7 DoF arm arrangement can include roll x pitch x roll x pitch x roll x pitch x roll. A monitor 20 and navigation camera 24 can be mounted to the free end of horizontal positioner arm 110, for example, using a vertical support. The monitor 20 and camera 24 can be stationary or can be coupled via an accessory arm for positioning the respective components. As shown, the monitors 20 can be positioned back-to-back so that an assistant can view the procedure from outside the surgical space. Similar to system 10, multi-arm surgical robotic systems 100A, 100B can have deployed and docked system configurations.

[0057] Referring to FIG. 13 , a multi-arm surgical robotic system 120 is shown according to one embodiment. In the robotic system 120, the vertical arm positioner 14 is replaced with a five-degree-of-freedom positioner 124. The robotic system 120 has a pedestal configuration in which the positioner 124 sits atop the system 120. Unlike the vertical axis on system 10, the positioner 124 is positioned above the base 12 rather than extending into the body of the system. This allows the overall size of the cabinet 12 to be reduced compared to system 10. In this embodiment, a single monitor 20 and navigation camera 24 are mounted on the free end of the positioner 124, and the surgical arm 16 can be positioned below the monitor 20.

[0058] The positioner 124 may include multiple positioner links or arms 128 with rotational joints therebetween. In one embodiment, the positioner 124 includes a five degree of freedom (5DoF) arrangement. For example, the 5DoF arm arrangement may include roll x pitch x pitch x pitch x roll. The clevis 126 may be attached to the base 12 about a first roll joint that allows the clevis 126 to rotate about the base 12. The first positioner arm 128 is attached to the clevis 126 at a first pitch joint that allows the positioner 124 to tilt forward and backward. The second positioner arm 128 is attached to the first positioner arm 128 about a second pitch joint that provides an additional degree of up and down tilt. The third positioner arm 128 is attached to the second positioner arm 128 about a third pitch joint, which provides additional forward and backward adjustment of the angle of the third pitch joint. The third positioner arm 128 terminates in a surgical arm 16 having a second roll joint, which allows rotation of each surgical arm 16. The surgical arms 16 may be attached to the free end of the positioner 124 by respective swivel mountings. As with the other surgical arms 16, the system 120 may include left and right surgical arms 16, each capable of movement with seven degrees of freedom (7 DoF), i.e., roll x pitch x roll x pitch x roll x pitch x roll. The positioners 124 may be optimally extended and positioned in the operating room for the procedure. For example, the positioners 124 may orient a common swivel point approximately at the centerline of the OR table. The system 120 also includes a dockable storage configuration to minimize the system's footprint.

[0059] 14 , a multi-arm surgical robotic system 130 is shown, according to one embodiment. The robotic system 130 is a pedestal robot having dual surgical arms 16 originating from a base cabinet 12. A dual-arm pedestal robot may include only a single degree of freedom. For example, a vertical arm positioner 134 may include a swivel mount to the base cabinet 12 to provide one degree of freedom (1 DoF). The swivel mount may allow rotational movement about the axis of the vertical arm 134. As shown, monitors 20 may be positioned back-to-back on top of the vertical arms 134 so that an assistant can view the procedure from outside the surgical space. A camera 24 may be positioned above the monitors 20. The swivel positioner 134 may be common to both surgical arms 16. As with the other surgical arms 16, the system 130 may include left and right surgical arms 16, each capable of movement with seven degrees of freedom (7 DoF). Limiting a robot's motion to one degree of freedom simplifies the design and focuses the robot's capabilities on the robot's specific task.

[0060] 15A-15B, a multi-arm surgical robotic system 140A is shown according to one embodiment. In the robotic system 140A, the arm positioner 144 includes a parallelogram positioner configured to extend the surgical arm 16 into the surgical space. The parallelogram positioner 144 includes a first positioner link 146 and a second positioner link 148 that support the surgical arm 16. The first positioner link 146 may be a single-axis positioner with both pitch joints connected by a timing belt or chain, thereby synchronizing the motion of the pitch joints. The second positioner link 148 may always be parallel to the ground using a mechanism controlled by a single motor. The parallelogram linkage ensures that the second positioner link 148 remains parallel to the ground as the mechanism articulates. The use of a single motor may simplify the control system, improve reliability, and reduce maintenance needs. Alternatively, both positioner joints may be decoupled and controlled by independent motors, allowing the second positioner link 148 to achieve any angle relative to the ground. In use, the positioner 144 may position both surgical arms 16 approximately at the centerline of the OR table. Similar to the other surgical arms 16, the system 140A may include left and right surgical arms 16, each capable of movement with seven degrees of freedom (7 DoF). The surgical arms 16 may be positioned on the second positioner link 148. The monitor 20 and camera 24 may also be mounted on the second positioner link 148 and positioned above the surgical arms 16. Similar to system 10, the multi-arm surgical robotic system 140A may have a deployed system configuration and a docked system configuration. FIG. 15A shows the surgical robotic system 140A in a deployed position, and FIG. 15B shows the surgical robotic system 140A in a compact, docked position.

[0061] 16 , a multi-arm surgical robotic system 140B is shown, according to one embodiment. Robotic system 140B is similar to system 140A, except that the surgical arms 16 are mounted below a second positioner link 148 so that the arms 16 hang downward. The monitor 20 and camera 24 can still be mounted on top of the second positioner link 148. In this embodiment, the surgical arms 16 are mounted from the bottom of the second positioner link 148, with the first link of each surgical arm 16 mounted in series to form a hanging column. A parallelogram positioner 144 serves as overhead support for the pair of surgical arms 16. During a procedure, the positioner 144 is configured to position the two 7DoF surgical arms 16 approximately at the centerline of the OR table. This allows the surgical arms 16 to overhang the workspace without obstructing the area below, thereby maximizing space efficiency. The parallelogram configuration also allows for compact docking of system 140B.

[0062] 17A-17B, multi-arm surgical robotic systems 150A, 150B according to further embodiments are shown. In these embodiments, the surgical arms 16 may be mounted directly to the base 12 without a positioner, thereby forming a stacked column 154. The first link 156 of each surgical arm 16 may be mounted in series on the base 12, forming a column shape. The first link 156 of each arm 16 may define a revolute or rotary joint that allows rotation about a single axis. The links 156 may be coaxial so that all links 156 rotate about the same vertical axis. Like the other surgical arms 16, the systems 150A, 150B may provide a surgical arm 16 with movement having seven degrees of freedom (7 DoF). The surgical arms 16 may extend laterally from the first link 156. FIG. 17A shows a system 150A with two stacked links 156 supporting two surgical arms 16, and FIG. 17B shows a system 150B with three stacked links 156 supporting three surgical arms 16. The stacked links 156 may have "n" surgical arms 16 by vertically stacking more arms 16, thereby increasing the overall column height. The monitor 20 and camera 24 may be mounted to the top of the stacked arm column 154, for example, using one or more positioners 158. The positioner 158 may include any suitable joint for positioning the monitor 20 and camera 24, which may be offset relative to the axis of the stacked column 154. Like other systems, the multi-arm surgical robotic systems 150A, 150B may have a deployed system configuration and a docked system configuration.

[0063] 18-21D, a distributed system may be provided in which the major system components (surgical arms, navigation cameras, and surgeon displays) are decoupled either completely or in different subset arrangements. In the case of a fully decoupled option, each element may be positioned to optimize its own individual task. Specifically, surgical arms 16 may be arranged to be on their own mobile platforms. The exact number of surgical arms 16 needed for a given portion of a surgical procedure may be dynamically adjusted by positioning additional surgical arms 16 or removing excess surgical arms 16. A separate viewing station with one or more monitors 20 may be positioned for the surgeon's use, or an external monitor in the OR suite may receive the video output signal from the system. The navigation camera 24 may also be positioned for optimal line of sight. In one embodiment, a subset system may be arranged to decouple the surgical arms 16 while being used in concert with a separate full navigation and control system. In another embodiment, the subset system may integrate the surgical arm 16 into the full navigation and control system while the camera is separated from the system for line of sight optimization. It will be appreciated that different components may be coupled together or decoupled to optimize results.

[0064] 18 , an autonomous pedestal arm system 160 is shown, according to one embodiment. In this embodiment, a single surgical arm 16 is mounted on top of the base 12. The surgical arm 16 may be attached to the base 12, for example, using a swivel mounting to allow rotational movement of the arm 16 about the base 12. The surgical arm 16 may work alone or in coordination with another autonomous pedestal arm system 160 or other systems. As shown, the navigation camera 24 and surgeon displays 20, 32 are not present in this decoupled system 160. Accordingly, additional stations having these components may be combined to complete a distributed system.

[0065] 19 , a distributed subsystem 170 is shown, according to one embodiment. Subsystem 170 is similar to system 100A, except that subsystem 170 has only a single surgical arm 16, and navigation camera 24 is omitted from system 170. The single surgical arm 16 may be used alone or may be combined with another armed robotic system. Navigation camera 24 may be supplied on a separate stand, permanently mounted in the operating room, or otherwise provided in another robotic or navigation system to provide an optimal line of sight.

[0066] With further focus on FIG. 20 , a dual arm subsystem 180 is shown, according to one embodiment. The dual arm subsystem 180 may utilize a curved arm positioner 184, such as a C-shaped gantry, to position the surgical arm 16. Similar to other surgical arms 16, the subsystem 180 may include a pair of surgical arms 16, each capable of movement with seven degrees of freedom (7 DoF). In this embodiment, the arm positioner 184 may curve or bend along a non-linear path. The arm positioner 184 may include one or more curved tracks 186 configured to position the surgical arm 16 around the patient. A pair of parallel curved tracks 186 may be offset to guide each respective arm 16. Alternatively, the tracks 186 may take different paths to guide the arm 16 to different positions. In the embodiment shown, the track 186 allows the attached surgical arm 16 to move along a semicircular or open curve of the curved arm positioner 184. The center of rotation of arm positioner 184 is approximately coaxial with the long axis of the OR table, allowing for a large, clinically relevant working volume with a relatively simple mechanism.

[0067] 21A-21D, multi-arm surgical robotic subsystems 100C, 100D, 130A, and 120A are shown according to further embodiments. Each of these subsystems is provided without the navigation camera 24. FIG. 21A shows multi-arm surgical robotic subsystem 100C, which is identical to multi-arm robotic system 100A, but without the navigation camera 24. FIG. 21B shows multi-arm surgical robotic subsystem 100D, which is identical to multi-arm robotic system 100B, but without the navigation camera 24. FIG. 21C shows multi-arm surgical robotic subsystem 130A, which is identical to multi-arm robotic system 130, but without the navigation camera 24. FIG. 21D shows multi-arm surgical robotic subsystem 120A, which is identical to multi-arm robotic system 120, but without the monitor 20 and navigation camera 24. The navigation camera 24 may be supplied on a separate stand, permanently mounted in the operating room, or otherwise provided in a separate robotic or navigation system to provide optimal line of sight. If desired, the surgeon display 20 may be provided on a separate viewing station, wireless tablet, or other external monitor. Distributed subsystems may be combined in any suitable combination to optimize the surgical procedure. It is further envisioned that any of the systems, subsystems, or components described herein may have permanent installations. For example, one or more surgical arms 16 may be integrated and mounted to the OR ceiling or floor, or integrated into the OR table.

[0068] Smart Arm Positioning The multi-arm surgical robotic system 10 can be configured with advanced automated adjustment of the surgical arm 16, monitor arm 18, and / or camera arm 22. Smart positioning can enable the arms 16, 18, 22 to automatically adjust to predefined positions or actively adjust. For example, the surgical arm 16 can automatically adjust for optimal surgical site access, collision avoidance, and / or ergonomic support. The monitor arm 18 can be automated for optimal viewing position or synchronization with the surgical phase. The camera arm 22 can automatically adjust for optimal viewing angles during various phases of the procedure.

[0069] Turning now to FIGS. 22 and 23A-23B, examples of predefined draping techniques are shown. Surgical draping is a safety operation to ensure sterility of the surgical field. Surgeries are often complex due to both the geometry being draped and the drape itself. This process requires sterile and non-sterile personnel to perform. The surgical robotic platform 10 can leverage the dexterity of the surgical arm 16 to facilitate draping along with embedded control in the non-sterile terminal 32. In this embodiment, the surgical arm 16 can be draped in the same manner as a surgeon dons a gown and gloves. FIG. 22 shows the surgical robotic system 10 in a docked position, which is how the system 10 can enter the operating room for subsequent setup.

[0070] Once in place in the surgical space, the system 10 can be deployed for surgical draping. From the non-sterile display or terminal 32, a technician or assistant can deploy the system 10 for draping, for example, by simply pressing a button. The surgical arms 16 can be moved to a preset draping position, for example, as shown in FIGS. 23A-23B, to simulate a gowned and gloved surgeon position. FIG. 23A illustrates draping for a single-arm procedure, where a single arm 16A is extended upward for draping and an additional arm 16B remains docked. FIG. 23B illustrates draping for a multi-arm procedure, where both surgical arms 16 are extended vertically upward for draping. For example, the arms 16 can be bent at the elbow and then extended straight upward, with the arms 16 aligned parallel to one another. From this position, the sterile technician can apply a surgical drape to the arms 16. The position of the arms 16 promotes stability during draping and prevents the drape from falling to the floor and compromising sterility. From this point, the non-sterile technician can finish placing the drape on the rear of the system 10. If the procedure at hand requires a single arm 16, the unused arm 16 can remain undraped in the docked position, as shown in FIG. 23A. The pre-set position allows for easy sterile application of the drape and ensures that the drape envelops the system 10 without contaminating the sterile field.

[0071] Similarly, monitor arm 18 and camera arm 22 can be deployed into a draping position with the push of a button. System 10 can provide guidance to the user regarding the steps to take to drape each element, while allowing for flexibility when only a subset of robotic arms 16 need be used. Because all four arms 16, 18, 22 are robotically controlled, system 10 has knowledge of each arm position and can ensure there are no collisions between arms or movements that would compromise the sterility of the newly draped arms.

[0072] A draping strategy that mimics a surgeon's orientation during draping greatly facilitates the application of drapes to the sterile portion of the robot 10. It also reduces the number of people required to complete the draping, streamlining setup. The vertical position of the arms 16 maintains stability during the draping process, preventing the drape from falling off the arms 16 before a non-sterile technician can finish securing the drape to the back of the system 10. The ability to deploy a single arm 16 or any number of arms 16 to complete a procedure represents efficiency for the hospital by avoiding the time and costs associated with draping unused components. The ability to keep additional arms 16 off-site during a procedure also provides the most efficient use of space in environments where space is at a premium.

[0073] 24A-24B, an example is shown for positioning the navigation camera 24 with an optimal line of sight while avoiding the operating room lights 64. The camera arm 22 is configured to position the camera 24 above the OR table 60 and track the procedure from top to bottom. The advantage of this is that it provides a direct line of sight to the surgical site and minimizes occlusion by staff or equipment in the operating room. The challenge with this tracking approach is ensuring that the camera 24 does not interfere with the OR lights 64 above the table 60 while still achieving the required line of sight. The arm arrangement can allow the camera 24 to avoid the illumination space of the OR lights either by positioning the camera 24 adjacent to the OR lights 64 (as shown in FIG. 24A) or by positioning it between the OR lights 64 if there are two sets of lights on the table 60 (as shown in FIG. 24B). In all cases, positioning the camera 24 above the patient table 60 ensures an optimal line of sight for capturing a clear, unobstructed view of the surgical area.

[0074] The motorized camera positioning arm 20 can be configured to dynamically and automatically optimize tracking throughout the procedure. Because camera position control is integrated with the procedure application, the system 10 knows the full set of objects to be tracked during the procedure. As the procedure progresses, the system 10 anticipates when objects will enter and exit the scene and knows the hierarchy of importance of a given object in the scene depending on the procedure step. Using this contextual knowledge, the system 10 can track all objects of interest in the scene and center the field of view on the relevant objects by physically moving the camera 24. Centering the field of view can be performed automatically, periodically, or fully continuously, upon request from the user.

[0075] Additionally, the camera positioners 14, 22 can use the overall system kinematics and procedure context to predict when the monitor 20 and surgical arm 16 will be within the camera's field of view. The camera 24 can be actively positioned to minimize self-occlusion by the monitor 20 or surgical arm 16 while optimizing the scene for tracked objects.

[0076] One step that often requires numerous camera manipulations is intraoperative image registration. Fluoroscopy or computed tomography (CT) images can be taken while both the patient and the imaging system are tracked as a preliminary step to enable navigation. In practice, this requires that the camera 24 must be moved from a position of the camera 24 centered at the surgical site to a position where both the patient tracking fiducials and the tracking array on the imaging equipment are within the field of view. After registration is complete, the camera 24 is returned to its position at the center of the surgical site. Motorized robotic camera positioners 14, 22 can be used to automate this entire process, including large-scale movements and centering and optimizing the field of view.

[0077] Camera positioning can be controlled by the user, for example, via one of the touchscreen displays 20. Camera positioning can also be controlled from a non-sterile user terminal 32 at the rear of the system 10. The camera view can be displayed directly on the monitor or control panel 20, 32, where the user can visually aim the camera 24 at the area of ​​interest, for example, via a touchscreen control or a discrete jog button. Automation and improved navigation continuity provide enhanced navigation and relieve the user from tedious camera adjustments. For the user experience, the navigation camera 24 begins to fade into the background, and the technology blends into a comfortable workflow that focuses on the procedure, not the system, which is a major step toward eliminating the art of navigation.

[0078] 25A-25B and 26, one or more intelligent monitors 20 may be used to improve visibility by one or more users of the system 10. Dual intelligent displays 20 enable visibility of workflow, tracking, and system status from either or both sides of the operating table 60. The displays 20 may be mounted on high-performance arms 14, 18 that allow for extended reach and highly dexterous positioning. The display arm architecture may include multiple joints 50, such as a double hinge 54 and rotary joints 52, 56, 58. The rotary joint 52 may connect the arm 18 to the vertical positioner 14. The double hinge 54 allows the display 20 to be positioned at the surgeon's preferred location. Display-specific concentric rotary joints 56, 58 may control the angular positioning of each display 18 relative to one another. The first display rotary joint 56 may couple one display 20 to the free end of the arm 18, and the second display rotary joint 58 may couple the other display 20 to the free end of the arm 18. For example, as shown in FIG. 25A, the display position may include fully opposed displays 20, while in FIG. 25B, the display position may include adjacent displays 20 in butterfly mode. It will be understood that positioning between the displays 20 may be possible at any angle between 0° and 180°.

[0079] As shown in FIG. 26 , fully opposing displays 20 can be useful when multiple surgeons are working simultaneously on either side of the operating room table 60. Butterfly mode provides an enhanced user interface for single-surgeon procedures by making both screens 20 available for use and reference by the surgeon. The dual displays 20 can be mounted on a bimodal active / passive arm with encoded motor-driven joints so that the arm position is always known to the system 10. Specifically, all joints use absolute single-turn encoders, allowing the system 10 to immediately know the arm position upon system power-up without the need for a homing routine. This allows for unique opportunities for intelligent positioning of the displays 20 to coordinate with the portion of the procedure being performed. The system 10 can have preset, customizable configurations for the monitor arm 18 so that the displays 20 can be moved toward the surgeon during planning and review and away from them during navigation, ensuring optimal and ergonomic viewing at all times. If the surgeon has a given preference for a different viewing position, the position can be manually manipulated to the preferred orientation while maintaining position tracking for future automatic movement.

[0080] From a user experience perspective, the dual monitors 20 represent improved workflow efficiency. The dual monitors 20 allow a single surgeon to have better visibility of the procedure and workflow. It also allows multiple surgeons to utilize the robot 10 without competing for resources or compromising visibility during navigation. Automating display movement reduces the mental burden on the surgeon who must continuously adjust the display 20 during different parts of the procedure. The second monitor 20 also enables additional functionality, such as microscope mode.

[0081] 27-30 , magnified visualization may be integrated into the surgical robotic platform 10, emulating the functionality of a traditional orthopedic microscope. In this embodiment, a video feed of the magnified surgical site may be captured via one or more magnification devices 66, such as an endoscope, an exoscope, a port-mounted camera, or other camera mounted on the robotic system 10. The magnification devices 66 provide variable magnification levels, allowing the surgeon to see fine details of the surgical site, such as bone, nerves, and soft tissue, that may not be visible to the naked eye. This integrated magnification capability may eliminate the need for a microscope entirely. The magnification devices 66 may have integrated lighting, e.g., LED-based lighting, to provide bright, focused light directly onto the surgical field. The magnification devices 66 may deliver high-resolution images to the surgical displays 20, allowing the surgeon to clearly view the surgical field. For example, the video feed may be ported to one or both of the surgical displays 20. As shown in the embodiment of FIG. 27, the display 20 can be presented directly to both surgeons at eye level in the fully folded position, emulating the workflow and ergonomics that surgeons are already familiar with using a microscope.

[0082] The microscope camera 66 may be mounted on one or both of the monitor arm 18, the surgical arm 16, and / or the end effector 26, or another suitable location on the robot 10. In one embodiment, the microscope camera 66 is mounted on the underside of the monitor arm 18, utilizing the intelligent display arm 18 as both the microscope camera mounting point and positioner. The motorized arm 18 facilitates fine adjustment of the microscope camera position so the surgeon can easily visualize and magnify specific anatomical structures of interest. Fine positioning controls for the camera view may be located on the display or non-sterile terminal. Alternatively, the system-mounted microscope camera 66 may have camera optics mounted on the end effector 26. The end effector 26 may be centered at the surgical site and is unlikely to have an obstructed line of sight. The video signal may be externally cabled or internally routed through the robot arm's main data communications.

[0083] Alternatively, a loose magnification camera 66 may be mounted in a separate remote location. For example, the magnification camera 66 may have a spring-loaded clamping mechanism, such as a tip-clip attachment, that allows for quick attachment and detachment. This remote camera 66 may be fixed to an arm attached to a table, a pre-installed retractor for direct access on the patient, or another suitable attachment site. In the case of an MIS, the magnification camera 66 may be mounted so as to overlook a port attached to the patient. As shown in FIG. 28 , the system 10 may include a downward-facing magnification camera 66A suspended below each monitor 20 and a clip-on magnification camera 66B on the surgical port. One monitor 20A may display a magnified camera image of the surgical site for detailed viewing, while the other monitor 20B may display the surgical workflow, providing a comprehensive view of the procedure's progress and steps.

[0084] 29 , one or more ports 94 may be attached to the patient 62. The port 94 may include a small, tubular device inserted into the patient 62 to provide direct access to the surgical site. The port 94 may allow surgical instruments to be precisely inserted and manipulated during minimally invasive surgical procedures. For expanded embodiments, the port 94 may be customized with fiducial marks 96, such as graduated or incremental markings along the inside of the tube, that act as a reference scale allowing the system 10 and / or surgeon to precisely adjust the magnification on the camera 66. The fiducial marks 96 may assist in establishing the camera focal length and, using the motorized display arm 18, in maintaining the camera position within a field of view that changes due to patient movement.

[0085] Microscope mode also lends itself to a dual configuration for two surgeons working simultaneously by duplicating microscope functionality and utilizing dual displays 20. For example, in FIG. 30, surgeons are positioned on either side of the patient 62. The displays 20 are positioned back-to-back. Dual microscopes 68 can be positioned above the patient 62 so that a magnified image is sent to each display 20. In this way, each surgeon has a surgeon-specific view on their own display 20 and can independently activate their own surgical arm 16. This dual-user configuration enables simultaneous work, increasing efficiency and decreasing surgical time for the patient 62.

[0086] Traditionally, optical visualization under magnification requires separate, autonomous assets in the operating room and surgical field. Where space is at a premium, the ability to provide this capability integrated with system 10 without additional equipment is a significant advantage. Combining microscope mode functionality with intelligent monitor 20 facilitates automated visualization of the patient's anatomy under magnification, further reducing the surgeon's mental burden by eliminating the need to operate a separate microscope in the surgical field to achieve the surgeon's desired field of view.

[0087] Turning now to FIG. 31 , the integrated and collaborative robotic system 10 is configured for collision detection and avoidance. Operating rooms and surgical fields are crowded spaces. Encoders can be integrated on all moving parts of the deployed system 10, not just the robotic arm joints. Combined with known system geometry, it can be ensured that all automated system movements are accomplished without self-contact of the different moving components of the system 10. While not all potential collision sources are within the system's control, the system 10 is configured to detect and safely recover from collisions with external sources.

[0088] Each robotic axis may have a motor to enable movement. Each motor may have a known and understood power profile for moving each joint during different postures under normal operation. If the power for movement rises above expected values, it may be because the robot has encountered an obstacle, either human or inanimate. Resistance to movement may be regularly encountered during procedural functions such as bone removal, screw placement, and discectomy, but additional factors may help distinguish between a collision and a clinical need for additional power.

[0089] In one embodiment, each surgical arm 16 includes a dual load cell configuration: a first 6-DOF load cell 44 at the end effector attachment point 42 configured to measure procedural loads, and a second 6-DOF load cell 46 at the base of the robotic arm 16 for measuring any load on the surgical arm 16. The dual load cells 44, 46 can isolate surgical loads from all other loads placed on the arm 16. Thus, if motor power exceeds normal and a non-surgical load is detected, it is assumed that the robotic arm 16 is experiencing a collision, and a safety shutdown protocol can be initiated. Due to the high refresh rate of the robot kinematic solution, corrective action can be achieved at a speed that mitigates damage to both the patient, staff, and equipment.

[0090] Collision detection and avoidance allows for safe, reliable, and predictable use of the surgical robotic platform 10. With multiple independently movable arms 16, 18, 22 and axes susceptible to unpredictable external inputs, safety is paramount while performing surgery on a patient 62, both for the patient 62 and all hospital staff involved in the procedure. These safety systems are also designed to be leveraged for additional performance gains during robotic operation.

[0091] According to some embodiments, coordinated movement of the robotic arms 16 can be achieved through a layout manager algorithm. In traditional graphical user interface (GUI) design, layout managers are employed to position UI elements based on relative constraints, such as upper and lower bounds, alignment preferences, and inter-object spacing. This concept can also be applied to spatial coordination of the robotic arms 16 in a surgical environment. In terms of functionality, each robotic arm has its operating “space” defined relative to other robotic arms and the surrounding environment, similar to UI components in a graphical interface. Constraints can be set for each arm 16 considering the entire operating room scene, including other arms, surgical tools, the patient, and medical staff. These constraints can include distance limits, alignment commands, and priority levels for movement and positioning. In terms of algorithms, the robotic system 10 can employ advanced algorithms similar to layout managers. The algorithms can dynamically calculate optimal positions and trajectories for each arm 16 and ensure that movements are coordinated, collision-free, and efficient, taking into account established constraints. The algorithm can adapt in real time to changes in the surgical environment, such as the position of moved equipment or adjusted surgical personnel. Regarding integration with existing systems, this coordinated motion can be integrated with existing collision detection and avoidance systems to enhance overall spatial awareness and operational safety. The system 10 can utilize encoded joint positions and dual load cells 44, 46 to gather real-time feedback on arm position and applied forces to ensure accurate and safe motion. By implementing relative positioning and motion constraints, the risk of collision between the arms 16 and other objects in the surgical field is significantly reduced. The system 10 can optimize the positioning of each arm 16 for a surgical task to improve procedural efficiency and reduce surgical time. The layout manager allows for easy adaptation to various surgical setups and procedures, making the system 10 highly versatile and scalable for different operating room environments.

[0092] In addition to the coordinated movement of the robotic arm 16, integration of a light detection and ranging (LIDAR) sensor on the motorized display 20 may be provided to enhance collision avoidance capabilities in the surgical robotic system 10. With regard to functionality, a LIDAR sensor may be equipped on the motorized display 20 to continuously scan the LIDAR sensor's immediate surroundings. This real-time spatial data may be fed into the system's scene modeling algorithm, enabling a more comprehensive understanding of the operating room environment. The LIDAR sensor may enable integration with scene modeling. LIDAR data may complement existing navigation and camera-based systems, providing more detailed and accurate environmental awareness. This enhanced scene modeling may help avoid collisions not only between the display 20 and the robotic arm 16, but also with other elements in the surgical field, such as medical staff, patients, and surgical tools. Algorithm enhancements, including collision avoidance algorithms that may include LIDAR input, may enable more precise and proactive adjustments to the position of the motorized display 20. This may ensure that the display 20 maintains optimal positioning for the surgical workflow while avoiding any potential collisions. LIDAR sensors provide a level of detail and accuracy in environmental sensing that complements camera-based systems and can lead to more robust collision avoidance capabilities. The integration of LIDAR into collision avoidance systems ensures a safer surgical environment by reducing the risk of unintended contact between the display 20 and other elements in the operating room. The use of LIDAR can contribute to the reliable functioning of the robotic system 10, especially in complex and dynamically changing surgical environments.

[0093] Alternative Camera and Display Configurations 32A-32B, system 10 may include additional navigation cameras 24 to provide redundancy and further reduce line-of-sight issues. As shown in the deployed configuration shown in FIG. 32B, camera arm 22 may include a bifurcated distal arm section 23 for supporting two separate navigation cameras 24. Bifurcated distal arm section 23 may include two arm segments attached at a revolute joint or other suitable joint. The split or bifurcation at the distal end of camera arm 22 allows cameras 24 to be positioned at different locations or angles, thereby reducing blind spots and improving the overall field of view. As shown in FIG. 32A, system 10 may include a docked storage configuration in which arms 18, 22 are retracted and folded to protect camera 24 and display 20.

[0094] 33A-33B show a simplified embodiment in which the navigation camera 24 and display 20 share a single positioning arm 22. FIG. 33A shows the camera 24 and surgical display 20 in a docked position, and FIG. 33B shows the camera 24 and display 20 in a deployed position. In this embodiment, the navigation camera 24 and surgical display 20 are mounted on SCARA arms 14, 22. The navigation camera 24 may be positioned above the arm 22, and the display 20 may be suspended from below the arm 22. This configuration may simplify the system 10 and provide a more user-friendly system.

[0095] Surgical Arm Configuration 34A-34B and 35-37, a configuration for each surgical arm 16 is shown, according to one embodiment. Each surgical arm 16 may include multiple arm segments or links interconnected by numerous joints such that the arm 16 is configured to replicate the complex movements of a human arm, hand, and / or fingers. Each joint may enable a particular type of movement or may provide specialized motion. The surgical arm 16 described herein may include one or more of the following: (1) increased degrees of freedom and improved joint motion, (2) improved precision through encoding the output of each joint and direct machine vision tracking of the arm links, (3) enabling faster motion control loops, closed-form kinematics, and collaborative functionality with haptic feedback, (4) force sensing along the length of the arm for surgeon control and collision detection, (5) improved power transmission to enable a powered end effector, (6) improved communications to enable two-way data communication between the end effector and robot for smart devices, (7) eliminating the need for system homing, eliminating potential confusion for the user, improving reliability, and streamlining workflow, and / or (8) enabling active movement of the arm using motor encoders, enabling a safety architecture for the system and facilitating enhanced procedure impacts, such as milling. These improvements may enable the surgical robot to perform more of the procedure and create more value for the surgeon.

[0096] For example, a typical configuration of a surgical robotic system tailored for orthopedic and neurosurgical procedures may include positioning the system next to an OR table 60 with the robotic arm in a square orientation, as shown in FIG. 35 . This allows the surgeon to comfortably stand next to or across from the system without affecting their workspace. Additionally, elbow motion and volume are generally away from the surgical site. The configuration shown in FIG. 35 provides only five degrees of freedom (5DoF) and is arranged in such a way that the inverse kinematics does not have a closed-form solution. To achieve a generalized trajectory in 3D space at any orientation, it may be preferable to have a minimum of 6DoF. Systems with only a 5DoF arm rely on the user to set the sixth DoF, which is the rotational position of the instrument in the guide tube. This may be useful for some procedures, especially for instruments where rotational position control is not critical, such as drilling and driving. However, for a given reachable trajectory, a 5DOF system may only be able to achieve the trajectory in one or two specific orientations. This limits the flexibility of the system to work around other objects that may be in the surgical field, such as retractors, pedicle screw towers, fiducial arrays, etc.

[0097] As shown in FIGS. 34A-34B, the surgical arm 16 has seven degrees of freedom (7 DoF). The surgical arm 16 may include seven arm segments or links that begin at the base 12 or positioner 14 and terminate at a free end of the end effector interface 42, including: a first link L1, a second link L2, a third link L3, a fourth link L4, a fifth link L5, a sixth link L6, and a seventh link L7. The seven links may be interconnected via seven joints, including: a first joint J1, a second joint J2, a third joint J3, a fourth joint J4, a fifth joint J5, a sixth joint J6, and a seventh joint J7. The surgical arm 16 may have seven degrees of freedom (7 DoF) consisting exclusively of revolute joints, each allowing a single axis of rotation. Each successive joint has an orthogonal axis of rotation compared to the previous joint. The seven degrees of freedom provide redundant axes for general trajectory solutions, thus allowing a versatile solution space to solve trajectories with multiple poses. In effect, this allows the user to manipulate the arm pose and move the links while remaining locked on the trajectory to provide more clearance where desired.

[0098] In FIG. 34A, the surgical arm 16 is shown in a docked position. In the docked position, the fifth, sixth, and seventh links (L5-L7) may be aligned adjacent to the first and second links (L1-L2). For example, the fifth, sixth, and seventh links (L5-L7) may be aligned along an axis that is generally parallel to the axis of the first and second links (L1-L2). The compact, docked position allows the arm 16 to be folded, for example, for storage or transportation. FIG. 34B shows the surgical arm 16 in a deployed position. In this view, the arm 16 is fully extended. However, it will be understood that the arm 16 may be deployed such that the joints are flexed and the arm segments are positioned or extended in any suitable manner for active participation in a surgical procedure.

[0099] Unlike other systems where the inverse kinematics is arranged so that it does not have a closed-form solution, the surgical arm 16 has closed-form inverse kinematics. To achieve a single trajectory, the motion controller uses numerical methods to iteratively solve simultaneous equations until the solution converges. Iterative calculations are time-consuming and can limit the speed of the motion control loop. In contrast, closed-form inverse kinematics allows the motion controller to calculate a trajectory by solving simultaneous equations once per trajectory. In a closed-form solution, the inverse kinematics problem is solved by deriving exact analytical expressions that provide the joint parameters (angles, distances) needed to achieve a specified end-effector position and orientation. All else being equal, eliminating the need for iterative calculations dramatically increases control loop speed. This increase in control loop speed provides a weightless experience to the user moving the arm via force input (pushing / pulling the end-effector or arm) and enables haptic user feedback.

[0100] Referring to FIG. 36, a schematic diagram of the joint arrangement according to one embodiment is shown. FIG. 37 illustrates the joint coordinate system of the surgical arm 16. The joint arrangement is configured to allow the following mathematical assumptions to be used in the inverse kinematics calculations: (1) The rotation axes for the fifth joint J5, the sixth joint J6, and the seventh joint J7 all intersect at point P1 and are all orthogonal to their respective immediately preceding joints. As best seen in FIG. 37, the coincident origins of joints J5, J6, and J7 intersect at point P1, allowing the system to combine three unknowns into one and solve for this single intersection point P1. (2) The coordinate system origins of links 2 through 7 (L2 through L7) are all coplanar. As best seen in FIG. 37, the constant plane for the J2 through J7 origins is plane P2 (illustrated as a triangle), regardless of any joint orientation. The angle of this plane P2 with respect to the ground is set by the first joint J1. Again, this given information eliminates the unknowns. In this way, the position and orientation of the surgical arm 16 and end effector 26 are calculated directly from a given set of coordinates or desired poses using explicit equations.

[0101] 38A-38B and 39A-39D, the surgical arm 16 is configured to have compact docking and occupy a minimal volume while deployed within the surgical field. Compact docking is useful for visibility, for example, while transporting the system 10 and during use in low-profile, single-arm mode. Because two or more arms 16 can be simultaneously deployed, each surgical arm 16 is configured to occupy a minimal volume within the surgical field. The docking and volume minimization requirements can be achieved by offsetting the third link L3 of the surgical arm 16. The offset of link L3 can include a bend or curve between the second link L2 and the fourth link L4. As best seen in FIG. 38A, the offset of link L3 allows the arm 16 to fold back for compact docking. In contrast, FIG. 38B illustrates the inefficient storage volume when the arm 16 is docked with a straight third link L3. The offset of link L3 therefore provides an efficient, streamlined, and compact storage solution for surgical arm 16 when docked. The offset of link L3 is also configured to keep the third joint J3 axis and the fifth joint J5 axis coplanar, which is important kinematically and for minimizing the volume occupied by arm 16 while both are deployed.

[0102] As shown in FIGS. 39A-39D, surgical workflows involving a right-angle arm crossover are compared for different configurations of link L3. As shown in FIGS. 39A and 39C, offsetting link L3 allows each surgical arm 16 to occupy a minimal volume in the surgical space. As best seen in FIG. 39A, the surgical arms 16 require a reduced spatial volume 190 when both arms 16 are deployed. In an alternative embodiment, the third joint J3 axis and the fifth joint J5 axis can be offset relative to a parallel plane to achieve an equally low-profile docked storage configuration. However, this causes the arms 16 to occupy approximately twice the volume when in the crossed right-angle orientation, as shown in FIGS. 39B and 39D. A surgical workflow that positions the robotic system 10 in a right-angle orientation allows the system 10 to be positioned next to the OR table 60, allowing the surgeon to comfortably stand next to or across from the system 10 without affecting their workspace. The surgical arm 16 is configured to take up minimal space within the surgical area to avoid overcrowding the surgical environment and to enhance visibility.

[0103] The arm joint and link geometry is arranged to minimize obstruction while deployed within the surgical field and minimize envelope volume while docked. Streamlined docking with both arms 16 allows one arm 16 to remain unobstructed when a procedure requires that only one arm 16 be docked and deployed. The additional degrees of freedom increase the reachability of the robotic arm 16, facilitating more procedures. The joint configuration also enables closed-loop kinematic solutions that increase control loop velocity, leading to better haptics and overall motion.

[0104] 40A-41B, each joint of the surgical arm 16 may be motorized, enabling precise automated movement and adjustment of the surgical arm 16. Backlash can affect the controllability of the arm. Backlash in a motion system, sometimes referred to as play, can be seen when an axis reverses direction (i.e., changing rotation from clockwise to counterclockwise) and can be defined as the amount of input movement required before the output also changes direction. Backlash is typically caused by clearances in the drive system; a classic example is the clearance between the teeth of a spur gear. Clearance allows for gear assembly and allows free-running motion, but it also introduces play into the system. When the drive gear changes direction, the drive tooth must move through a clearance zone before the output gear can change direction in turn. While within this clearance window, the system cannot correct the output position, which contributes to position error and generally reduces the accuracy of the arm. Therefore, the surgical arm 16 may be configured with zero backlash to provide precise control and movement accuracy. Zero backlash can be achieved by using a direct drive input (e.g., cycloidal or distorted wave) to a gearbox specifically designed to have zero backlash. A direct drive arrangement can ensure that no backlash is introduced from the coupling to the motor, as opposed to a spur gear, miter gear, or planetary gear input.

[0105] The joint may use a frameless motor, meaning that the motor stator (windings) are integrated directly into the link housing, saving volume compared to motors with built-in frames. The motor rotor may be mounted on a hollow shaft. The gearbox may also have through-holes that provide paths for routing cables and rigid members, which are discussed in the following section. Overall, zero backlash may improve the accuracy of the arm and therefore the overall robotic system.

[0106] Each joint may use an absolute encoder on the load (gearbox output) to directly measure joint position and an absolute encoder on the motor for commutation feedback. The encoders convert mechanical motion into electrical signals to determine position, velocity, or direction, thereby accurately reflecting the movement of the connected load and providing feedback for controlling the system. Using absolute encoders on the load ensures that the system knows absolute joint position at power-up or after power loss, eliminating the need to perform a homing routine. This is particularly important for seamlessly resuming a procedure in the event of an intermittent power loss. This feature also improves the efficiency with which the system can be set up and deployed during a procedure. The load encoder also ensures that torsional bending in the gearbox can be actively compensated for, since joint position after any bending is directly measured.

[0107] The load encoder may be located at the joint interface and measure the gearbox output directly. Alternatively, the gearbox output may extend back through the bore of the actuator and be measured inside the body of the immediately preceding link. This arrangement can save space and provide the opportunity to collocate the encoder with the motor encoder. FIGS. 40A-40B show an example of a load encoder system 200A with a load encoder at the output of the gearbox, while FIGS. 41A-41B show an example of a load encoder system 200B in front of the motor via an extension through the bore.

[0108] Encoder systems 200A, 200B may include a motor 202 having a motor shaft 204 that serves as a primary source of mechanical power, a gearbox 206 attached to the motor 202, and an output plate 208 that applies a load. The encoder may be mounted before the gearbox 206 (e.g., on the motor shaft 204) or after the gearbox 206 (e.g., on the load side). In FIGS. 40A-40B, a load encoder sensor 210 for measuring the rotational position, speed, or direction of the load and a load encoder scale 212 for quantifying the load are mounted on the load side of system 200A. In FIGS. 41A-41B, the load encoder sensor 210 and the load encoder scale 212 are attached to an output extension 218 extending from the output plate 208.

[0109] The systems 200A, 200B may also include a motor encoder to provide commutation feedback and precise control of the motor 202. For example, a motor encoder sensor 214 and a motor encoder scale 216 may be attached to the motor 202. The use of an absolute encoder for the motor 202 supports a safety architecture capable of achieving a Safety Integrity Level of 3 (SIL3), which allows for active movement in patient space.

[0110] Incorporating a zero-backlash harmonic gearbox into the robotic arm 16 provides greater positional accuracy and minimizes noise during operation. This can be beneficial to surgeons when performing delicate procedures, allowing them to be more confident in tool placement and not be distracted or hindered by the overwhelming sound of the motors at work. The use of absolute encoders with each motor allows arm position to be known without the extra step of homing the robot. This saves time during surgical preparation and prevents collisions, especially when both arms 16 are active in the surgical field. Using motors with dominant torque instead of braking reduces heat generation and energy consumption in the system.

[0111] Turning now to FIG. 42 , the surgical arm 16 may be configured for cable management. In particular, all arm wires or cables 220 may be routed internally through the arm joints. This prevents externally routed cables from snagging or pulling on drapes and objects while the arm 16 moves through its highly articulating range of motion. The challenge then is to ensure that the internal cables are not damaged, for example, from shear, abrasion, fatigue, pulling, or otherwise, from relative motion within the limited arm volume. In one embodiment, miniature slip rings 222 are provided at each joint to route the cables 220 through the axis of rotation. The slip rings 222 may extend through the central gearbox and motor bore. When the slip ring stator and rotor are fixed to the joint input and joint output, respectively, relative motion is eliminated and the cable routing is effectively static. This eliminates cable winding and provides a theoretically infinite range of rotation for joints (e.g., roll joints J1, J3, J5, and J7) where link bodies do not collide with one another. Requiring all cables 220 to be internal to the robotic system 10 makes the draping process more efficient and simpler, while reducing potential surgical site injury. The use of slip rings 222 reduces cable wear at the arm joints, which may increase the lifespan of the arm joints beyond that expected for external cables or cables that endure repeated twisting and bending. Overall, routing the cables 220 internally through the arm 16 enhances the efficiency, safety, and functionality of the system 10.

[0112] As described above with reference to FIG. 31 , the surgical arm 16 integrates a six-axis load cell 44 at the distal end of the arm 16, which is used to measure force input from the user and convert the force into a movement command. The load cell 44 may also be used to measure the force applied to the patient to monitor skiving and generally ensure that no unsafe forces are applied to the patient. In addition to the distal load cell 44, the arm 16 integrates a proximal load cell 46 at the base of each arm 16, before joint J1. The proximal load cell 46 is configured to monitor external forces on the arm 16 that are separate from the external forces on the end effector 26. The external forces on the arm 16 are separated from the forces on the end effector 23 by subtracting the distal load cell measurements from the proximal load cell measurements. The system may also account for kinematic posture, arm geometry, and weight distribution and subtract the corresponding expected measurements from the actual load cell readings. This net reading can be used to back-calculate the resultant force / torque vector and where it must be applied along the arm 16 to give the net measurement. With this information, the system can move the arm 16 to follow the force vector, allowing the user to push or pull anywhere on the arm 16 and change orientation while remaining locked on track. This information can also be used as a collision detection function with automatic safety features to avoid collisions with the patient or other objects in the surgical field.

[0113] Utilizing dual six-degree-of-freedom load cells 44, 46 allows system 10 to calculate the differential forces acting on arm 16. Being able to distinguish between procedural loads and arm loads allows robotic system 10 to react to unexpected obstacles and collisions. For example, if the force a surgeon applies to a tool in the surgical field is acceptable, system 10 may generate an error or disable a move if the tool is pushing against an obstacle in the surgical field during a trajectory move. This feature also allows system 10 to cooperate so that, in addition to the automatic robotic movement of arm 16, a user can manually adjust the position of arm 16.

[0114] Braking for the surgical robot acts as a safety and control mechanism, ensuring stability and precision during a surgical procedure. In one embodiment, system 10 may not use a separate electromechanical brake. In particular, surgical arm 16 may not have electromagnets to apply or release mechanical resistance (friction) to the joints. This minimizes arm volume and conserves power by not having to constantly power electromagnets that hold the brake open while arm 16 moves. Nevertheless, braking may be required while system 10 is unpowered, in active use or active servo mode, and during E-stop conditions.

[0115] Instead of using braking in static conditions, the system 10 can utilize the friction inherent in the high-reduction gearbox 206. The friction is sufficient to support the arm 16's own weight in an unpowered state, meaning that the arm 16 will maintain its static position even without power. If the system 10 requires a higher static holding force than the gearbox 206 can provide, the joint can be augmented using a dominating torque mechanism. The additional torque can be gradually increased until the desired holding force is achieved. The trade-off is that the motor 202 must be powerful enough to consistently drive through this additional torque. Some examples of dominating torque augmentation can include a spring-loaded clutch plate, a compression-fit nylon or bronze sleeve, a radial nylon-tipped set screw, and / or a friction hinge in series with the gearbox output.

[0116] During active use, or active servo mode, precise positioning of the surgical arm 16 can be achieved through active control. While under power, the primary mode of operation is to actively servo in place so that the servo motors 202 actively control and maintain the position of the arm 16. The servo motors 202 are capable of precise position control due to a feedback mechanism (e.g., from an encoder) that constantly monitors and adjusts the motor's position. In this active mode, motor power, rather than braking power, maintains position. If a joint is back-driven, the feedback system recognizes this motion and the arm 16 corrects its position.

[0117] During an emergency stop condition, or E-stop condition, power to the motor 202 is cut off in the event of an emergency. If the surgical arm 16 is moving while the E-stop is engaged, the arm 16 must stop motion within a safe stopping distance. This must be done without servo control because motor power is cut off. Friction in the gearbox alone is not sufficient to achieve this safe stopping distance while the arm 16 has momentum. To achieve the safe stopping distance in the E-stop, the motor phases are shorted together, electromechanically locking the rotor and stator together. This is done because when the phases are depowered and shorted together, arm movement induces a current and corresponding magnetic field that opposes the original movement. More movement results in a higher restoring force, creating a motion stop with a faster response time. By utilizing a robotic arm 16 that does not use separate electromechanical braking, arm volume can be minimized, conserving power. Minimal arm volume helps ensure the user's direct line of sight is unobstructed and also reduces the occurrence of potential collisions.

[0118] 43 , in addition to tracking the end effector 26, the surgical arm 16 may be tracked directly by the navigation system, for example, as a redundancy and safety mechanism. For example, one or more tracking elements or markers 98 may be incorporated into the robotic arm 16 to support global tracking. Tracking markers 98 may be provided on one or more individual arm links L1-L7. In the embodiment shown, tracking markers 98 may be provided on links L2, L4, and L6, respectively. The tracking markers 98 may include machined fiducials, reflective disks, reflective spheres, and / or active LEDs that are all visible through a sterile drape using machine vision. In one embodiment, a ring of machined fiducials may be provided around a given arm link (e.g., links L2, L4, and L6) to assist in accurate and reliable positioning of the arm 16. Fine tracking elements may also be incorporated into the end effector 26 and tool 28 outside the drape.

[0119] By tracking individual arm links (e.g., one or more of links L1-L7) in addition to the end effector 26, the system 10 can continue to navigate for a period of time if the end effector 26 is occluded. In such cases, the system 10 relies on kinematics from the most distal tracked link to fill in the navigation gap until the end effector 26 is again in line of sight and can be tracked directly. This significantly improves the workflow of the system 10 by reducing the disruption of navigational losses and allowing the user to seamlessly progress through a case. Holistic arm tracking can help improve tracking accuracy because more positional data is collected via machine vision than from the end effector or tool array alone. This additional positional information can streamline workflow and reduce disruption during a procedure because the system can continue to move even with small obstructions to the line of sight.

[0120] 44A-44B, information rings (ROIs) 48 may be integrated into the robotic platform 10 to visually communicate arm status to the user. The information rings 48 may be used to display active / inactive arm status in dual-arm use. Other states may include off, start, servo, moving, home position, error, user force input mode, and orbit mode. These states may be communicated through a sequence of colors (e.g., green, red, yellow, blue, etc.) and intensities (e.g., off, on, blinking, pulsing, comet, etc.). The information rings 48 may also communicate active and passive modes. As shown in FIG. 44A, one information ring 48A may be positioned toward the distal end of each surgical arm 16 to ensure it is in the surgeon's line of sight during use. Alternatively, as shown in FIG. 44B, the information rings 48B may be integrated into the end effector 26. This location is ideal for efficient use status to be effectively communicated outside the drape in the surgeon's direct line of sight. Arm status communication enhances surgical safety and efficiency by providing the user with visual cues indicating the status of each surgical arm 16, thereby enabling the user to quickly assess the state of the system and respond appropriately.

[0121] Clear and prominent display of arm status enables safe and efficient use of the robotic platform 10, providing actionable information for the user and reducing the unknown when using computer-assisted technology. Introducing a second arm 16 into the configuration also creates new status cases, such as arms that are active / inactive, and has a clear distinction between arms 16 when using, for example, two-player mode. Clear status communication helps surgeons and OR staff use and monitor the system efficiently.

[0122] While several embodiments of the present invention have been disclosed in the foregoing specification, it will be understood that many modifications and other embodiments of the invention to which this invention pertains will come to mind with the benefit of the teachings presented in the foregoing descriptions and the associated drawings. It is therefore understood that the present invention is not limited to the specific embodiments disclosed in the above specification, and that many modifications and other embodiments are intended to be included within the scope of the appended claims. It is further contemplated that features from one embodiment may be combined or used with features from different embodiments described herein. Moreover, although certain terms are employed in the specification and the following claims, they are used in a generic and descriptive sense only and not for purposes of limiting either the described invention or the following claims. The entire disclosure of each patent and publication cited herein is incorporated by reference in its entirety, as if each such patent or publication was individually incorporated by reference herein. Various features and advantages of the present invention are defined in the following claims.

Claims

1. 1. A multi-arm surgical robotic system, comprising: a mobile base station including an on-board computer; a display electronically coupled to said computer; a camera electronically coupled to the computer and configured to detect one or more tracking markers; a pair of surgical arms electronically coupled to the computer and movable based on commands processed by the computer; an end effector electronically coupled to each surgical arm; A multi-arm surgical robotic system, wherein each end effector is positioned to enable a tool to perform a surgical procedure on a spinal element.

2. The system of claim 1 , wherein the surgical arms are configured to be synchronized relative to one another.

3. The system of claim 1 , wherein the surgical arms are configured to perform independent surgical tasks simultaneously.

4. The system of claim 1 , wherein the surgical arms are configured to perform independent surgical tasks sequentially.

5. The system of claim 1 , wherein each of the surgical arms is configured to be controlled by a different user.

6. The system of claim 1 , wherein one of the surgical arms is configured to perform one type of task while the other surgical arm is configured to perform a different type of task.

7. The system of claim 1 , wherein one of the surgical arms controls the other surgical arm during a pantograph mode.

8. The system of claim 1 , wherein the surgical arm automatically performs a verification procedure.

9. 1. A multi-arm surgical robotic system, comprising: a mobile base station including an on-board computer; an arm positioner attached to the base station; a monitor arm attached to the arm positioner, the monitor arm supporting a display electronically coupled to the computer; a camera arm attached to the arm positioner, the camera arm supporting a camera electronically coupled to the computer and configured to detect one or more tracking markers; a pair of surgical arms attached to the arm positioner and electronically coupled to the computer, the arms movable based on commands processed by the computer; A multi-arm surgical robotic system, wherein the pair of surgical arms are configured to allow tools to access spinal elements.

10. 10. The system of claim 9, wherein the monitor arm and the camera arm are motorized and controlled by the computer for automatic positioning of the display and the camera, respectively.

11. The system of claim 9 , wherein the arm positioner includes a vertical column that provides telescoping movement.

12. each of said surgical arms 10. The system of claim 9, comprising a plurality of arm segments interconnected by joints that provide movement with seven degrees of freedom.

13. 10. The system of claim 9, wherein the monitor arm is connected to the arm positioner at a rotary joint, the arm segments of the monitor arm are interconnected by a double hinge joint, and the display is connected to a free end of the monitor arm at a rotary joint.

14. 10. The system of claim 9, wherein the camera arm is connected to the arm positioner at a rotary joint, the arm segments of the camera arm are interconnected by a double hinge joint, and the camera is connected to a free end of the camera arm at a tilt joint.

15. The system of claim 9 , wherein the free end of each surgical arm includes an end effector interface for securing an end effector for precise positioning of the instrument.

Images