Bilateral surgical robot system

Abstract

To provide a movable bilateral surgical robot system.SOLUTION: A bilateral mobile robotic surgical system is provided. The system may be optimized for robotic spinal surgery. The system comprises a mobile cart configured to be deployable beneath an operating table, and in particular a spinal operating table. The mobile cart may not be fixed to the floor or operating table. The cart comprises a plurality of robotic arms that can be folded to the side or into the cart to allow deployment under an operating table. The robotic arms may be relatively short and lightweight compared to known systems, and are deployed to either side of the patient. This allows a wide range of surgical procedures to be performed with high precision. The mobile cart further includes a central control unit that facilitates the system knowing the location of the robotic arm.SELECTED DRAWING: None

Description

[Technical Field]

[0001] [Earlier related application] This application claims the benefit of priority to earlier U.S. Provisional Patent Application No. 63 / 161,716, filed March 15, 2021, and U.S. Provisional Patent Application No. 63 / 253,533, filed October 7, 2021.

[0002] The present invention relates to a mobile, bilateral surgical robotic system, which may also include a robotically controlled and coordinated surgical navigation system. Specifically, the present invention relates to a low-profile mobile cart incorporating at least two robotic arms positioned on opposite sides of a surgical table, the mobile cart being deployable beneath the table. Multiple robotic elements, such as robotic arms, end effectors, cameras, imaging devices, tracking devices, or other devices useful in robotic surgery, may be included. The positioning and movement of the robotic elements are controlled and coordinated by a single control unit, and all of the robotic elements are based on a single rigid housing, thereby robotically coordinating at a single origin. Specifically, multiple robotic elements may be attached to and controlled by a single control unit and used in a coordinated manner to deploy trackers, cameras, and surgical instruments as part of a robotic surgical procedure. More specifically, in the context of robotic spine surgery, multiple robotic elements may be attached to and controlled by a single control unit and used in a centrally coordinated manner to deploy trackers and surgical instruments, hold one or more cameras, and perform surgical procedures, with the relative movements of each robotic element coordinated by the central control unit. If desired, this single-body, multi-arm, robotic cooperative system may be augmented with robotic navigation technology. [Background technology]

[0003] Robotic surgery, such as the application of robotic technology to spinal surgical procedures such as pedicle screw placement, is well known in the art. Many robotic surgical systems, such as Intuitive Surgical's da Vinci robotic surgical system, are teleoperated. While multi-arm robotic surgical systems are commercially available, such as those offered by Cambridge Medical Robotics, these known systems are also often teleoperated, each consisting of a set of independently deployed arms coordinated to some degree by a remotely located control unit. Systems with multiple arms on multiple carts have significant drawbacks regarding integration into surgical workflow and also require an unnecessarily large operating room footprint. Furthermore, when these multi-arm systems utilize a single cart, coordination between the arms is still performed by the surgeon seated at the control unit, "closing the loop" with their eyes and hands. Furthermore, control of teleoperated units by a remotely located control unit does not provide the required level of control over the entire surgical procedure, particularly in the case of spinal surgery. Accuracy would necessarily be less than in a system where all robot arms are fixed and coordinated in a single enclosure with a control unit.

[0004] For example, US2018 / 0193101 to Hashimoto discloses a multi-arm robotic system positioned under the operating table. However, such a system is not mobile and does not provide any disclosure of centralized control of the robotic arm movement and navigation. Bed-mounted systems are also known, such as those in US2010 / 0286712 to Won. However, such systems are by definition not mobile and present significant barriers to surgical workflow and available space in the operating room. WO2020 / 079596 to Zehavi discloses another non-mobile robotic surgical system incorporating multiple arms for imaging and optional instrument deployment. However, the robotic arms are floor-standing and large, which would suffer from reduced precision, significantly disrupt surgical workflow, and be expensive. None of these known systems provide a mobile solution with centralized control of the robot arm's movement and navigation, and all deploy relatively large robotic arms that, due to their size and the fact that they are non-mobile, can suffer from a lack of precision and low utilization and acceptance rates.

[0005] Performance of the full range of spinal surgical procedures (beyond pedicle screw placement, which encompasses only a small portion of the majority of procedures) requires a bilateral system with high-precision robotic arms and would also significantly benefit from robotically coordinated navigation. A typical procedure may require placement of multiple passive or active markers on bone or soft tissue, one or more robotically controlled and operated cameras that can be positioned at various distances from the surgical field, and one or more end effectors deployed by the robotic arms. Such a multi-arm / multi-camera system mounted and controlled on a single mobile cart is not available in the current state of the art. There is a strong and long-felt need for such a system because it would enable the full range of spinal surgical procedures to be performed with robotically coordinated control and navigation at a level of precision not currently possible. Summary of the Invention [Means for solving the problem]

[0006] A bilateral robotic surgical system is provided herein that includes a mobile cart configured to be selectively positioned beneath a surgical table, particularly a spinal surgical table, and that incorporates at least two robotic arms configured to be positioned on either side of the surgical table during surgery.

[0007] The mobile cart has a significantly lower profile than previously known systems, and the robotic arms can be folded down to the sides of the operating table from their deployed state, or actually folded into the cart itself. The low profile of the mobile cart and the ability to fold the arms into or to the sides of the cart provide for optional deployment of the mobile cart under the operating table, a critical capability given the space savings in the operating room and the lack of interference with surgical workflow by the system and its arms.

[0008] The mobile cart design allows relatively short and lightweight robotic arms to be deployed on either side of the operating table. This bilateral approach not only enables the performance of a wider range of robotic surgical procedures, particularly robotic spinal procedures, but also improves the precision of the robotic arms. The relatively short and lightweight robotic arms of the current invention system are inherently more precise than the larger arms of systems known in the art. In particular, systems with only one robotic arm to deploy instruments must cover a much larger surgical field than the smaller arms of the present system, whereas in the present system, each arm carries an instrument and covers a much smaller surgical field. Furthermore, it is known in the art that a single robotic arm extended to its full reach will perform tasks with less precision than the same robotic arm used in a more retracted deployment.

[0009] A key feature of the system of the current invention is that the robotic arms originate from a common base, which also incorporates a central control unit. In this design, the movements of the robotic arms are centrally coordinated by the control unit on the common base. The advantage of having a single starting point for the arms is that the system knows the spatial position and trajectory of all elements of the system, as well as their relative positions and trajectories to each other. Thus, the provided robotic system does not strictly require navigation (as a positioning method), although adding navigation can be an optional choice to enhance the system.

[0010] In an alternative embodiment of the system of the present invention, the mobile cart may optionally include two component mobile units that can be coupled to approach the operating table from either side when deployed underneath the operating table. In this embodiment, with appropriate mechanical and electrical connections, two component mobile units can be coupled underneath the operating table to form a single mobile cart. Each component mobile unit houses one or more robotic arms that can be deployed from the side or top of the unit. Furthermore, in this embodiment, one of the component mobile units houses a central control unit, and once the mobile units are coupled together, the central control unit controls the deployment and movement of all of the robotic arms by means of the mechanical and electrical connections between the component mobile units. In this manner, a single-enclosure mobile robotic surgical system can be created from two components and centrally controlled by a single control unit.

[0011] Also provided herein is a robotically controlled surgical navigation system for enhancing bilateral robotic surgical systems. Specifically, provided herein is a robotically controlled surgical navigation system for robotic spine surgery. The system is configured to perform all aspects of a robotic spine surgical procedure, going beyond simple procedures such as pedicle screw placement performed by currently known robotic systems.

[0012] In a representative embodiment, the system includes a central control unit housed by a surgical cart. At least two arms or other holders are mountable to the cart. The at least two arms or holders are configured to hold cameras, end effectors, or other instruments to be used in surgery, more particularly spinal surgery. The at least two arms or holders may also be used to track passive or active markers within the surgical field that are attached to soft or hard tissue, particularly preferentially the bones of the spine, and that are typically deployed by the physician or surgeon near the beginning of the surgical procedure. Optionally, the active or passive markers may also be attached to various relevant surfaces, such as the operating table, surgical and auxiliary columns or stands, and the arms or holders themselves.

[0013] The robotic collaborative surgical navigation system of the present invention provides centralized coordination of arms or other holders by a control unit housed in a surgical cart. By way of example only, this allows one arm or holder to deploy surgical instruments relative to bone markers, while another arm or holder deploys a navigation / tracking camera at an appropriate distance and angle, all enabling coordinated instrument deployment and marker tracking. As a further example, centralized control and coordination of multiple arms or holders by a control unit housed in a single cart allows one or more cameras, deployed at appropriate distances and angles, to be used for navigation during a surgical procedure, in which one or more end effectors carried by one or more robotic arms are actuated within a surgical field using guidance facilitated by positioning multiple surgical instruments and devices relative to passive or active markers.

[0014] One key feature of various embodiments of the present invention is that one or more navigation cameras can be mounted on one or more robotic arms, with their movements coordinated by a central control unit. Thus, the camera angles are controlled and coordinated with the robotic system and markers so that the markers are visualized at the appropriate distance and angle. This approach avoids disruptions to surgical workflow that would otherwise occur if multiple robotic carts were brought into the operating room. This approach also solves the commonly encountered problem of spine surgery, where cameras are maintained at greater distances from the surgical field (e.g., two meters or more), necessitating the use of larger markers that obscure various aspects of the spine and / or surgical field. If large markers shift due to bony anatomy movement during surgery, they may experience undesired movement relative to the anatomy, again compromising accuracy.

[0015] The robotic collaborative surgical navigation system of the present invention has multiple feedback loops. For example, in a first feedback loop, as described above, multiple robotic arms carrying various instruments are deployed from the same cart. These robotic arms are coordinated with each other and with radiopaque markers (e.g., made of tungsten material) on the anatomy, for example, by scanning the patient (e.g., with an X-ray or CT scan) while the radiopaque markers are attached to the bones and / or while at least one marker attached to at least one robotic arm is in the scan image.

[0016] Because multiple robotic arms are deployed on a single chassis with a single control unit, their movements can be coordinated and the feedback loop between them is closed. More specifically, by sharing the same common axis origin and using robot kinematics, both robotic arms can be precisely robotically controlled relative to the bone anatomy, even without the aid of navigation as a positioning method.

[0017] In a second exemplary feedback loop, various robotic arms carrying any desired combination of, for example, robotic navigation cameras, end effectors, and surgical navigation markers or instruments are all mounted in a single housing that houses a single control unit that coordinates the movements of the robotic arms, thus closing the feedback loop.

[0018] In this regard, these robotically operated navigation cameras do not blindly search for fiducial navigation markers, but rather actively aim at desired markers or locations because the central controller knows the location of the target from images (e.g., CT), and the central controller coordinates the movement of the robotic navigation system to reach the target at the optimal distance and angle.

[0019] In yet another example of a feedback loop, active or passive markers may be placed on a robot arm that is deployed on a single housing along with other robot arms that may hold robot navigation cameras or end effectors. This third example of a feedback loop is closed because the single housing contains a control unit that coordinates the movement of the robot arms; for example, if a robot navigation camera visualizes markers on one or all of the robot arms and the position of one or more of the robot arms is changed accordingly, the feedback loop is also closed.

[0020] All of these needs and factors greatly benefit from the central coordination and control of the single-cart, multi-arm, non-teleoperated robotic system of the present invention. The present invention provides, for example, the following. (Item 1) 1. A mobile surgical robotic system, comprising: A single housing and At least two robotic arms mounted on the single housing; a central control unit mounted in the single housing and robotically coordinating the movements of the at least two robotic arms; Equipped with the mobile surgical robotic system is configured to be selectively positioned and removed from under a surgical table before, during, or after a surgical procedure. Mobile surgical robot system. (Item 2) 2. The mobile surgical robot system of claim 1, wherein the at least two robotic arms are configured to be housed within the single housing when stored and during placement under the operating table, and the at least two robotic arms are deployable from the single housing after the single housing is placed under the operating table for use during the surgical procedure. (Item 3) 3. The mobile surgical robotic system of claim 2, wherein the at least two robotic arms are deployed for use during the surgical procedure such that at least one robotic arm is deployed on one side of the operating table and at least one robotic arm is deployed on the other side of the operating table. (Item 4) Item 4. The mobile surgical robot system of item 3, wherein the at least two robotic arms are folded into respective sides of the single housing during storage and placement of the system under the operating table. (Item 5) Item 4. The mobile surgical robot system of item 3, wherein the at least two robotic arms are mounted on a platform within the single housing, the platform being elevable and lowerable to selectively deploy the robotic arms from respective sides of the single housing. (Item 6) 6. A mobile surgical robot system according to any one of items 1 to 5, further comprising a monitor screen for a user interface with the mobile surgical robot system. (Item 7) 7. The mobile surgical robotic system of any one of claims 6 to 7, wherein the system is capable of performing a range of bilateral spinal surgical procedures without the assistance of a navigation camera or other imaging equipment. (Item 8) Item 7. A mobile surgical robot system according to item 6, further comprising at least three robotic arms, wherein at least one of the at least three robotic arms is equipped with a robotic navigation camera. (Item 9) 9. The mobile surgical robot system of claim 8, further comprising a radiopaque marker placed on the patient's anatomy. (Item 10) 10. The mobile surgical robot system of claim 9, wherein one of the at least three robotic arms coordinates the mobile surgical robot system to the patient's anatomy by placing a marker between the radiopaque marker and the robot navigation camera. (Item 11) Item 11. The mobile surgical robot system of item 10, wherein after aligning the mobile surgical robot system with the patient, the central control unit robotically coordinates the movements of the at least two robotic arms holding surgical instruments and the at least one arm carrying a robotic navigation camera during the performance of the surgical procedure. (Item 12) 12. The mobile surgical robot system according to any one of items 1 to 11, further comprising at least three sets of wheels for moving the mobile surgical robot system, wherein one or more of the at least three sets of wheels may be selectively retractable. (Item 13) Item 13. The mobile surgical robot system of item 12, wherein the system is configured such that the one or more sets of retractable wheels can be retracted and redeployed during placement of the system under the operating table. (Item 14) 14. The mobile surgical robot system of any one of claims 1 to 13, further comprising a modality that applies pressure to an underside of the operating table to fix the position of the system relative to the operating table. (Item 15) 15. The mobile surgical robot system according to any one of items 1 to 14, wherein the system is not teleoperated or remotely controlled. (Item 16) 1. A mobile surgical robotic system, comprising: A single housing and two robotic arms mounted on the single housing, one of the robotic arms configured to hold a surgical instrument and one of the robotic arms configured to provide a navigation modality; a central control unit mounted in the single housing and robotically coordinating the movements of the at least two robotic arms; Equipped with the mobile surgical robotic system is configured to be selectively positioned and removed from under a surgical table before, during, or after a surgical procedure. Mobile surgical robot system. (Item 17) Item 17. The mobile surgical robot system according to item 16, wherein the two robotic arms wherein the robotic arms are configured to be housed within the single housing during storage and placement under the operating table, and the two robotic arms are deployable from the single housing after the single housing is placed under the operating table for use during the surgical procedure. (Item 18) Item 18. The mobile surgical robotic system of item 17, wherein the two robotic arms are deployed for use during the surgical procedure such that one robotic arm is deployed on one side of the operating table and one robotic arm is deployed on the other side of the operating table. (Item 19) Item 18. The mobile surgical robotic system of item 17, wherein the two robotic arms are deployed for use during the surgical procedure such that both robotic arms are deployed on the same side of the operating table. [Brief explanation of the drawings]

[0021] [Figure 1a] 1a-1h show various side and top views of a multi-arm mobile surgical robotic system according to various embodiments of the present invention. [Figure 1b] 1a-1h show various side and top views of a multi-arm mobile surgical robotic system according to various embodiments of the present invention. [Figure 1c] 1a-1h show various side and top views of a multi-arm mobile surgical robotic system according to various embodiments of the present invention. [Figure 1d] 1a-1h show various side and top views of a multi-arm mobile surgical robotic system according to various embodiments of the present invention. [Figure 1e] 1a-1h show various side and top views of a multi-arm mobile surgical robotic system according to various embodiments of the present invention. [Figure 1f]1a-1h show various side and top views of a multi-arm mobile surgical robotic system according to various embodiments of the present invention. [Figure 1g] 1a-1h show various side and top views of a multi-arm mobile surgical robotic system according to various embodiments of the present invention. [Figure 1h] 1a-1h show various side and top views of a multi-arm mobile surgical robotic system according to various embodiments of the present invention. [Figure 2a] 2a-2b show two side views of the side door operation of a multi-arm mobile surgical robotic system according to various embodiments of the present invention. [Figure 2b] 2a-2b show two side views of the side door operation of a multi-arm mobile surgical robotic system according to various embodiments of the present invention. [Figure 3a] 3a-3c show alternate side views of a wheeled deployment of a multi-arm mobile surgical robotic system according to various embodiments of the present invention. [Figure 3b] 3a-3c show alternate side views of a wheeled deployment of a multi-arm mobile surgical robotic system according to various embodiments of the present invention. [Figure 3c] 3a-3c show alternate side views of a wheeled deployment of a multi-arm mobile surgical robotic system according to various embodiments of the present invention. [Figure 4a] 4a-4g show various top, side, and end views of the deployment of the robotic arms of a multi-arm mobile surgical robotic system according to various embodiments of the present invention. [Figure 4b] 4a-4g show various top, side, and end views of the deployment of the robotic arms of a multi-arm mobile surgical robotic system according to various embodiments of the present invention. [Figure 4c] 4a-4g show various top, side, and end views of the deployment of the robotic arms of a multi-arm mobile surgical robotic system according to various embodiments of the present invention. [Figure 4d] 4a-4g show various top, side, and end views of the deployment of the robotic arms of a multi-arm mobile surgical robotic system according to various embodiments of the present invention. [Figure 4e] 4a-4g show various top, side, and end views of the deployment of the robotic arms of a multi-arm mobile surgical robotic system according to various embodiments of the present invention. [Figure 4f] 4a-4g show various top, side, and end views of the deployment of the robotic arms of a multi-arm mobile surgical robotic system according to various embodiments of the present invention. [Figure 4g] 4a-4g show various top, side, and end views of the deployment of the robotic arms of a multi-arm mobile surgical robotic system according to various embodiments of the present invention. [Figure 5a] 5a-5d show various top and side views of surgical instrument deployment for a multi-arm mobile surgical robotic system according to various embodiments of the present invention. [Figure 5b] 5a-5d show various top and side views of surgical instrument deployment for a multi-arm mobile surgical robotic system according to various embodiments of the present invention. [Figure 5c] 5a-5d show various top and side views of surgical instrument deployment for a multi-arm mobile surgical robotic system according to various embodiments of the present invention. [Figure 5d] 5a-5d show various top and side views of surgical instrument deployment for a multi-arm mobile surgical robotic system according to various embodiments of the present invention. [Figure 6] FIG. 6 illustrates the deployment of navigation modalities for a multi-arm mobile surgical robotic system according to various embodiments of the present invention. [Figure 7a] 7a-7b show side views of alternative methodologies for deploying the robotic arms of a multi-arm mobile surgical robotic system according to various embodiments of the present invention. [Figure 7b]7a-7b show side views of alternative methodologies for deploying the robotic arms of a multi-arm mobile surgical robotic system according to various embodiments of the present invention. DETAILED DESCRIPTION OF THE INVENTION

[0022] The following detailed description will now be provided with reference to the drawings and several exemplary embodiments of the present invention.

[0023] In one embodiment of the present invention, a mobile cart incorporating at least two robotic arms is provided, with at least one arm positioned on each side of the operating table. The mobile cart has a significantly lower profile than previously known systems, allowing the entire system to be deployed under any standard operating table (e.g., up to about one meter high) so that, when the robotic arms are folded, they can be deployed on either side of the operating table and the patient lying thereon. Locating the entire robotic system under the operating table has significant benefits in terms of saving valuable operating room floor space and not interfering with the surgical team and their workflow.

[0024] In various embodiments, the robotic arms may be folded in multiple ways to the side or inside the mobile cart. They may optionally be folded down onto the side of the cart, or they may be folded into the cart, which may be either into the side of the cart or down into the top of the cart. Regardless of the folding modality, the desired end result is that a mobile cart with foldable arms is easily deployable under the operating table.

[0025] The cart includes at least two wheel pairs that facilitate deployment and removal of the mobile cart under the operating table. The wheel pairs can be selectively folded and / or retracted to allow navigation around and traversing obstacles, such as longitudinal bars found under spine operating tables. In one embodiment, the cart includes three wheel pairs, two of which are selectively retractable to allow the cart to be deployed under the spine operating table.

[0026] In an alternative embodiment, the mobile cart may optionally include two constituent mobile units that can be coupled to approach the operating table from either side when deployed underneath the operating table, thereby providing an alternative methodology for deployment underneath the operating table that does not require folding and / or retracting wheel pairs.

[0027] In this embodiment, with appropriate mechanical and electrical connections, the two component mobile units can be joined under the operating table to form one mobile cart with centralized control and communication. The connection and centralized control between the two component units allows the robotic arms to be based on a single chassis, thus enjoying the benefits of true centralized robotic control.

[0028] Each constituent mobile unit houses one or more robotic arms that can be deployed from the side or top of the unit. Furthermore, in this embodiment, one of the constituent mobile units houses a central control unit that, once the mobile units are coupled together, controls the deployment and movement of all of the robotic arms by means of mechanical and electrical connections between the constituent mobile units. In this manner, a single-enclosure mobile robotic surgical system is created from two components, centrally controlled by a single control unit. The robotic arms operate from a single origin, with all the benefits that come with the robotic system "knowing" where each of the arms is in three-dimensional space due to a common origin.

[0029] In various embodiments of the bilateral robotic surgical system of the current invention, there is no requirement that either the cart or the robotic surgical arms be secured to the operating table or floor. The wheels of the mobile cart may be locked to prevent movement. Optionally, an element of the cart may be deployed to press against the underside of the operating table when deployed underneath, thus allowing for patient movement and / or stabilizing the operating table in the event of external forces being applied to the patient or the table.

[0030] The cart serves as a common, rigid base for the robotic arms, so that their precise locations, trajectories, and relationships are known. Each robotic arm may have several degrees of freedom, including height adjustment (Z-axis) for its robotic base. The robotic bases may also have rigid, precision rails that provide two additional degrees of freedom (XY movement) for adjusting the robotic bases for each unique case. This allows the robotic bases to be optimally positioned close to the patient's body (e.g., approximately 10 cm from the patient's body).

[0031] One of the key novel features of the following robotic system is its ability to provide a very large operating volume (up to 360-degree trajectory coverage around a designated organ) while using only two relatively small and short robotic arms (e.g., arm lengths up to 1 meter), which is crucial in surgical fields such as spinal surgery. This is possible because each arm is required to cover only a portion of the patient's body on each side of the table—for example, the right robotic arm is responsible for covering only the right side / right portion of the patient, while the left robotic arm is only required to reach the trajectory of the left side / left portion of the patient. While each robotic arm alone is insufficient to cover the entire required operating volume, both arms working in concert with each other are sufficient to provide full coverage of the surgical volume. Furthermore, even if a single 1-meter-long arm can cover the required distance from one side of the table to the other for a given task, extending the arms to their maximum length would result in a significant loss of precision. It is well known in the art that robotic arms are much stiffer and therefore more precise in the folded position, and less stiff and precise in the extended / extended position. Other systems with independently operating (non-navigated) robotic arms require the deployment of larger, heavier, less precise robotic arms when wide surgical field coverage is desired.

[0032] Several positioning technologies can be incorporated into the robotic system, for example, to provide the robot controller with the required coordinates of the robot's location relative to the surgical target (e.g., a human spine). The incorporation of a navigation system into the proposed robotic system can either be independent of the robotic system as a third-party system or integrated into the system. Another option is to perform an X-ray or CT scan while the robot holds a marker or similar markers are fixed to the bony anatomy in the area of ​​interest, thereby obtaining the location of the robot's end effector relative to the designated organ.

[0033] In further embodiments, this bilateral robot design solves several challenges previously unsolved by other surgical systems, particularly in spinal surgery. First, the robotic arms are not attached to the rails of the table (as in some current systems known in the art), thereby preventing them from getting too close to the patient and bumping into the patient's body, potentially injuring the patient and / or restricting the robot's movement. On the other hand, the robotic arms are not positioned too far from the patient, as in existing robotic systems, where the robotic arms are assembled on a cart that sits next to the table, forcing the robotic arms to be long, heavy, and cumbersome in order to reach both sides of the patient (left and right sides of the body) from the same location.

[0034] Additionally, because the system has at least one robotic arm deployed on each side of the table, each arm only needs to perform tasks on one side of the table, allowing the system to have relatively small / short, rigid robotic arms, which is extremely important from a precision standpoint, and these rigid arms also enable additional tasks in spine surgery that require significant force (e.g., vertebral manipulation) to be performed—a topic that is discussed further in the following section.

[0035] In robotic surgery, to achieve and maintain high precision, it is crucial to keep the distance between the robot base, the robot's end effectors, and the organ being operated on as small as possible. The following design enables exactly that, not just on one side of the patient, but on both sides simultaneously. Thanks to this design, this crucial bilateral "triangle of accuracy" is significantly smaller than all other available systems.

[0036] In the proposed design, the short robotic arms positioned on the very low profile described above are less likely to physically obstruct the surgical team and do not block their view / field of vision. In this proposed design, even at the highest working position, the robotic arms hardly block the surgeon's line of sight.

[0037] The novel bilateral robotic surgical system, by its design, can also facilitate and enable the following robotic surgical activities, by way of example only: performing bilateral and parallel surgical tasks simultaneously and / or sequentially on both sides of a patient (e.g., drilling vertebrae, inserting implants, etc.). This parallel operation is of further critical importance from the standpoint of precision. It is well known in spinal surgery that, when working along the spine (for example) from one vertebra to the next, precision is difficult to maintain due to the relative motion between one vertebra and another. One reason for this is that precision decreases when moving away from the vertebra marked by the navigation marker (e.g., when using a navigation system to position the robot). Another reason is that when touching / drilling a vertebra, that vertebra physically rotates relative to itself and also moves relative to the other vertebrae in the spine. The proposed system can overcome this challenge as illustrated in the following exemplary sequence: One robotic arm drills and precisely places a pedicle screw in the first pedicle (the first vertebra selected as closest to the navigation system marker or image scan marker, or any other positioning method used in conjunction with the system). The robotic arm, still connected to the now well-secured drill / implant, is then used as a stabilizer for drilling the next vertebra / pedicle—either the same vertebra or the adjacent vertebra (above or below)—while rigidly connected to the vertebra. The system can then continue drilling and placing screws in a "zigzag" pattern, i.e., left-right / up-down, with the right grip stabilizing the left drill, and vice versa.

[0038] Due to the fact that the system's multiple robotic arms are short, strong, and rigidly connected to the same rigid platform (cart), they can manipulate vertebrae relative to one another, holding (for example) implants that are rigidly inserted into the pedicles of the vertebrae from both sides. This technique can be used to manipulate two vertebrae (e.g., indirect decompression, compression, distraction, etc.), several vertebrae together, or even the entire spine. By positioning these arms one behind the other, they can displace two vertebrae a few millimeters and then maintain this displacement consistently and safely while the surgeon performs delicate surgical tasks between them (e.g., disc removal, decompression, etc.).

[0039] In alternative embodiments, the system can add additional arms to each side, so that while the two opposing arms are engaged in retracting two vertebrae as described above, a third and fourth arm are available to perform additional surgical tasks, either guided / controlled by a human surgeon or robotically controlled with software and algorithm guidance. Furthermore, because the arms are short, strong, and share the same rigid base, they can optionally be attached to (for example) metal rods that are part of braces and connect screws, and manipulate them by bending the rods to achieve a desired spinal posture. This is not achievable with any other available surgical robotic system. In this surgical approach, the fact that the robotic arms are deployed on either side of the patient, have a relatively low profile, emanate from a common base that is separate from each other, and are controlled by a central controller that knows the position of each arm means that high forces and precision can be applied to safely bend rods and manipulate the vertebrae in vivo.

[0040] Similar techniques for high-precision, robust robotic bone manipulation are relevant to additional surgical fields, such as hip / knee replacement surgery, where two strong robotically coordinated arms can hold and manipulate two bones (e.g., femur, tibia, etc.), while a robotically synchronized third arm provides imaging, navigation, etc. to enhance the surgery and / or assist the surgeon with multiple tasks while performing other surgical tasks in between. The third arm may hold some type of surgical instrument, and these three or four surgical arms can automatically cooperate with or without human supervision to robotically perform surgical tasks. Due primarily to the fact that all of these arms are robotically coordinated using a single, rigid housing, yet remain manageable under typical economic and human-machine interface (HMI) considerations, the following is achieved:

[0041] Anatomical objects and markers can be acquired through intraoperative imaging (e.g., intraoperative CT). In this example, a robotic navigation camera is used mounted on a robotic arm, which in turn is fixed to a single housing with a control unit. A single housing may have one or more robotic arms mounted thereon and used for surgical tasks. The control unit coordinates the movement of the multiple robotic arms, and thus the navigation cameras directed at the anatomical objects, to create a closed feedback loop. The use of navigation cameras provides both redundancy and diversity of information about anatomical objects of interest, which is essential for the accuracy and overall validity of the information. The cameras may employ different technologies, such as infrared and optical (RGB) modalities. The use of different modalities also provides diversity of information, thereby improving the overall accuracy and quality of the information provided.

[0042] In the same embodiment, additional robotic navigation cameras may be mounted on additional robotic arms mounted on the same single housing, with the additional cameras positioned at a conventional distance (e.g., 1-2 meters) from the surgical field to image the entire surgical field. The additional robotic arms may be mounted on the single housing and may carry markers or end effectors. Those skilled in the art will recognize that due to the fact that all of the robotic arms are mounted on the same housing and their movements are coordinated by a control unit housed in the housing, the movements of each of the various arms are related to the movements of the other robotic arms in a closed feedback loop. For example, if one of the robotic arms carries a navigation camera near an anatomical region of interest (e.g., a particular vertebra) based on the location of a marker, the navigation camera held at a conventional distance can visualize the entire surgical field and assist in positioning other nearby navigation cameras near the anatomical region of interest (e.g., an adjacent vertebra where a marker has already been placed). This closed feedback loop can then be used to guide the deployment of surgical instruments, which may be robotically brought to the surgical field as end effectors on a robotic arm mounted in a single housing, or manually brought to the surgical field by the surgeon. In either robotic or non-robotic scenarios, a robotic navigation camera held at a customary distance from the surgical field can assist in the deployment of surgical instruments thanks to its view of the entire surgical field at the optimal distance and angle for any particular scenario, and its inherent ability to robotically maneuver itself to overcome obstacles and interferences that obscure its path.

[0043] Those skilled in the art will understand that the optical navigation modality specifically disclosed herein is but one possibility for enhancing the navigation capabilities of the system of the current invention. Those skilled in the art will recognize that, by way of example only, other navigation modalities, such as EM navigation and ultrasound navigation, each could be similarly incorporated into the system of the current invention in accordance with techniques known in the art.

[0044] Although applicants have disclosed embodiments of the inventive system with two surgical arms (i.e., robotic arms that deploy surgical instruments) and one navigation arm (i.e., robotic arm that holds the navigation camera), it is also possible to have an embodiment of the inventive system with one surgical arm and one navigation arm. Such a two-arm embodiment may have the navigation arm and surgical arm located at opposite ends of the cart to provide a bilateral system, but it is also possible for the navigation arm and surgical arm to be located at the same end of the cart. In either arm placement scenario of this two-arm system, as described above, the mobile cart of the current inventive system would still be deployed under the operating table, providing the disclosed benefits of mobility and no interference with surgical workflow.

[0045] Specific reference will now be made to the accompanying drawings. Those skilled in the art will readily appreciate that the accompanying drawings are merely exemplary embodiments of the present invention. Those skilled in the art will understand that the described embodiments can be readily modified without departing from the spirit or intent thereof, and that such variations would still fall within the scope of the present disclosure. By way of example only, while many of the accompanying drawings show a mobile robotic system with three robotic arms, those skilled in the art will appreciate that more or fewer robotic arms may be deployed. As a further example, many of the accompanying drawings show a mobile robotic system with three sets of retractable wheels that facilitate deployment of the mobile robotic cart under an operating table. However, those skilled in the art will appreciate that any combination of wheels or similar features that enable a mobile cart to be deployed under an operating table, particularly a table for spinal surgery, falls within the scope of the current invention.

[0046] Those skilled in the art will also understand that any known and available surgical robotic arm could be deployed on a mobile robotic system in accordance with the present invention. The inventors make no proprietary claim to any particular robotic arm, but rather have invented a mobile surgical robotic system in which multiple robotic arms are deployed and controlled from a common base, which, as described herein, provides significant advantages over the current state of the art. Those skilled in the art will be able to recognize and select the types of robotic arms that could be used in conjunction with the present invention.

[0047] Additionally, one of ordinary skill in the art, once reviewing the present disclosure, will be able to recognize and select the types and dimensions of materials required to assemble the system of the present invention. One of ordinary skill in the art will know the types of materials that are commercially acceptable in surgical robotic systems, and will understand the control systems and associated software that would be required to assemble and operate the system of the presently disclosed invention.

[0048] 1a-1h display various side and top views of a multi-arm mobile surgical robotic system 100 according to various embodiments of the present invention. The mobile surgical robotic system 100 is shown embodied in a mobile cart 101. The cart 101 has three sets of wheels 102, 103, 104 that are selectively retractable to facilitate movement of the cart 101, for example, around an operating room. The retractable nature of the wheels 102, 103, 104 allows the cart 101 to navigate around obstacles, such as longitudinal rods found under spinal surgery tables.

[0049] 1a-1h has a pair of doors 105 at one end and a pair of doors 106 at the other end for storage and deployment of one or more robotic arms 107, 108, 109. As shown, cart 101 houses three robotic arms 107, 108, 109 that can optionally be folded into cart 101 or deployed from either end of cart 101 when the doors are open. As previously discussed herein, cart 101 forms a common base for robotic arms 107, 108, 109. Robotic arms 107, 108, 109 originate from the common base and their selective deployment is governed by a central control unit located within cart 101.

[0050] 2a-2b show two side views of the operation of the side doors of a multi-arm mobile surgical robotic system 200 according to various embodiments of the present invention. As shown in FIGS. 2a and 2b, the cart 201 of the mobile surgical robotic system 200 has a pair of doors 202, 203 located at each end of the cart 201. In the views provided here, one or more robotic arms 204 are folded into each end of the cart 201, and the doors 202, 203 are selectively openable to allow deployment of the robotic arms 204.

[0051] 3a-3c show alternate side views of the wheel deployment of a multi-arm mobile surgical robotic system 300 according to various embodiments of the present invention. In FIGS. 3a-3c, the cart 301 of the mobile surgical robotic system 300 has a first set of wheels 302 near one end of the cart 301, a second set of wheels 303 near the other end of the cart 301, and a third set of wheels 304 on the same side of the centerline as the first set of wheels 302. This design setup allows the mobile cart 301 of the current invention to be deployed under a surgical table 305 that may encounter obstacles in its way, such as a longitudinal bar 306 found on nearly all conventional spine surgical tables. As shown in FIG. 3a, when the cart 301 approaches the longitudinal bar 306 under the spine surgical table, the first set of wheels 302 can be retracted while the other two sets of wheels 303, 304 remain in contact with the floor. Next, as shown in Figure 3b, once the vertical surface of the first set of wheels 302 has cleared the bar 306, the first set of wheels 302 can be returned to contact the floor. Finally, as shown in Figure 3c, the third set of wheels 304 can be retracted so that the mobile cart 301 can be advanced and centered under the operating table 305. With two sets of wheels always in contact with the floor, the cart 301 remains mobile and stable.

[0052] 4a-4g display various top, side, and end views of the deployment of robotic arms of a multi-arm mobile surgical robotic system 400 according to various embodiments of the present invention. The various views in this series of figures illustrate partial and full deployment as multiple robotic arms are deployed through the open doors of a cart 401. For example, FIG. 4c shows an embodiment of a mobile surgical robotic system 400 of the present invention with three robotic arms 402, 403, and 404 deployed. Two robotic arms 403 and 404 hold surgical instruments 405, and the third robotic arm 402 holds a navigation camera 406. Additionally, FIG. 4c shows two screens 407 that provide various options for a user to interface with the system 400 of the present invention.

[0053] Figures 4d-4g show a closer-up top view of the deployment of the robotic arms from the mobile cart of the mobile surgical robotic system 400 of the present invention. These figures provide a more general view of the various stages of arm and screen deployment when using the present invention. Figures 4d-4g show three robotic arms 402, 403, 404 deployed along with two screens 407 for a user to interact with the system; two of the arms 403, 404 hold surgical instruments 405, and one of the arms 402 holds a navigation camera 406. Those skilled in the art will understand that the number of robotic arms and screens can be varied without departing from the spirit and substance of the present disclosure.

[0054] 5a-5d show various top and side views of surgical instrument deployment for a multi-arm mobile surgical robotic system 500 according to various embodiments of the present invention. Two robotic arms 501, 502 are shown holding surgical instruments 504, and one robotic arm 503 is shown holding a navigation camera 505. Two screens 506 for interacting with the system 500 are also shown. These figures illustrate that relatively short, robust robotic arms can be deployed, one on each side of the patient, and each robotic arm can independently advance a surgical instrument toward the patient's target anatomy. As discussed herein, this provides significant advantages in terms of robotic arm reach, stability, and precision, enabling a much wider range of surgical procedures to be performed. Because the robotic arms all originate from the same origin on the cart, the mobile surgical robotic system of the present invention allows the robotic arms to always know their positions relative to one another in space. Therefore, additional navigation functionality is not strictly required.

[0055] 5a-5d also show a single surgical marker 507 attached to the patient's anatomy. A navigation camera 505 mounted on one of the robotic arms 503 can visualize the marker 507. Because the navigation camera 505 is mounted on the robotic arm 503 that emanate from the same common point (cart) as the other robotic arms 501, 502, the mobile surgical robotic system 500 of the present invention can incorporate information from the navigation camera 505 into guiding the surgical robotic arms 501, 502 holding the surgical instrument 504. As discussed herein, coordination of all three robotic arms by a central control unit in the system of the present invention provides unified robotic coordination, which in turn provides improved accuracy and usability.

[0056] Figure 6 illustrates the deployment of a navigation modality for a multi-arm mobile surgical robotic system 600 according to various embodiments of the present invention. In Figure 6, a radiopaque surgical marker 601 is attached to a patient's bony anatomy. One of the robotic arms 602 of the mobile surgical robotic system 600 holds an additional marker 603 above the target bony anatomy of the patient, and an intraoperative CT system 604 is deployed to acquire images of the surgical field including the markers 601, 603. In this regard, the spatial location of the patient's bony anatomy is acquired along with the position of the end effector of the robotic arm 602 holding the marker 603. As described herein, because all of the robotic arms of the system originate from the same common origin on the system's cart, the mobile surgical robotic system of the present invention is then aligned with the patient's target anatomy, and the central control unit can guide the movement of the robotic arms (along with their attached instruments and end effectors) to the target anatomy during the performance of a surgical procedure, additionally using information obtained from navigation cameras (which are also aligned with the robotic arms because they are mounted on the same common base on the cart). The alignment step can be repeated as desired during a surgical procedure, for example, when the target anatomy is moved or when the surgeon desires to operate on a different region of the anatomy.

[0057] 7a-7b show side views of an alternative methodology for deploying the robotic arms of a multi-arm mobile surgical robot system 700 according to various embodiments of the present invention. FIG. 7a shows the robotic arms 702 folded within a mobile cart 701 of the mobile surgical robot system of the present invention. The robotic arms 702 on each side of the cart 701 are deployed on platforms 703, 704 that are selectively movable in a vertical plane and are optionally deployed on the inside or outside of the cart 701. FIG. 7b shows the platforms 703, 704 elevated from the cart 701 and the robotic arms 702 thereby deployed outside of the cart 701. Those skilled in the art will appreciate that this deployment strategy may offer advantages in some use cases. Deploying the robotic arms 702 in this manner may be simpler from a mechanical standpoint because it does not require multiple side doors. Deploying the arms 702 in this manner may also allow the top door to be more easily closed after the robotic arms are deployed to protect the interior of the cart from liquids and debris that may be generated during a surgical procedure.

[0058] Those skilled in the art will appreciate that numerous modifications can be made to the disclosed embodiments while remaining within the boundaries of the current invention. By way of example only, variations in the number of navigation cameras, robotic arms, markers, and end effectors can be used without departing from the invention. As another example, markers of various sizes can be used. The provided embodiments are representative in nature.

Claims

[Claim 1] The invention described in this specification.

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