Arthroscopic surgery systems and methods

Abstract

An arthroscopic surgery system and method are provided that simplify arthroscopic surgery through the use of remotely operable instruments. The system includes a frame configurable to extend above or laterally of at least a portion of a patient undergoing surgery, and one or more surgical arms extending from the frame. Each of the multiple surgical arms has an arthroscopic instrument. The multiple surgical arms and associated arthroscopic instruments are remotely controllable from a user interface to perform arthroscopic surgery.

Description

[Technical Field]

[0001] The present invention relates to arthroscopic surgery, particularly but not exclusively to robotic arthroscopic surgery. [Background technology]

[0002] Arthroscopic surgery is a surgical procedure on joints, such as the ankle, knee, hip, spine, shoulder, elbow, or wrist, performed by making small incisions in the patient's skin through which a miniature camera and surgical instruments are inserted into the joint. Arthroscopic surgery is a type of "keyhole surgery," allowing the surgeon to view the joint area and operate on soft tissues such as ligaments, bony joint surfaces, and other structures from outside the joint. In contrast to traditional "open" surgery, recovery time and tissue damage are significantly reduced.

[0003] The problem with arthroscopic surgery is that it is a highly technical and difficult medical procedure. Most surgeons are apprehensive about performing arthroscopic surgery, and even among those that are performed, there are a significant number of cases where observable damage occurs due to the procedure itself.

[0004] Certain systems exist that utilize laparoscopic robots to assist surgeons in performing keyhole surgery on other parts of the body, such as the Da Vinci Surgical System from Intuitive Surgical, Inc., California, USA.

[0005] In these systems, the surgeon typically operates robotic arms from a console, which have instruments mounted on them to perform the laparoscopy. Laparoscopy is typically performed within a single large body cavity, such as the abdomen, and the surgeon gains access through a common approach. Because the body cavity is large and malleable, gas is used to expand the cavity, creating a large space between the entrance and the surgical site. This facilitates surgical visibility and access.

[0006] The problem with such systems is that they are not suitable for use in arthroscopic surgery, which, in contrast to laparoscopy, involves operating on joints that are small, resistant to expansion, often multi-compartmental, separated by anatomical structures, and / or difficult to access.

[0007] For example, laparoscopic instruments are typically too large to fit inside the knee. Even if laparoscopic instruments could be made smaller, they would not be able to create the large cavities and spaces used in laparoscopy because the joint is primarily composed of sensitive articular cartilage covering an inflexible bony surface. Furthermore, even when the joint is distended, the joint cavity is still narrow, tortuous, and lined with cartilage that must be avoided. Contact and rubbing against the cartilage causes wear and tear.

[0008] Therefore, laparoscopic robots such as the Da Vinci Surgical System are not suitable for use in arthroscopic surgery.

[0009] Thus, there is clearly a need for improved arthroscopic surgical systems and methods.

[0010] Where a prior art document is referred to in this specification, it will be expressly understood that such reference is not an admission that such document forms part of the public knowledge in the art in Australia or anywhere else. Summary of the Invention

[0011] The present invention is directed to arthroscopic surgery systems and methods that may at least partially overcome at least one of the above-mentioned drawbacks or provide consumers with a useful or commercial choice.

[0012] In view of the above, the present invention in one aspect broadly relates to an arthroscopic surgery system comprising a frame configurable to extend above or laterally of at least a portion of a patient to be operated on, and one or more surgical arms extending from the frame, each having an arthroscopic instrument, the one or more surgical arms and associated arthroscopic instruments being remotely controllable from a user interface to perform arthroscopic surgery.

[0013] Advantageously, the system simplifies arthroscopic surgery through the use of remotely controlled instruments, thereby reducing the potential for damage and injury during the procedure itself. Additionally, the system is easier to operate than traditional arthroscopic instruments, thereby lowering the barrier to entry for arthroscopic surgery.

[0014] The use of this frame allows the surgical arm and associated arthroscopic instrument to operate relative to a single origin (defined relative to the frame), thereby allowing simple Cartesian mapping of position.

[0015] Preferably, the frame is rigid. Preferably, the frame extends laterally in two dimensions.

[0016] Preferably, the frame is configurable to extend laterally above at least a portion of the patient. Preferably, the at least one surgical arm is reconfigurable to extend from different lateral locations on the frame. Preferably, the one or more surgical arms include a plurality of surgical arms extending from different lateral locations on the frame.

[0017] Because the frame extends laterally and the surgical arms extend downward from different lateral positions, multiple portal sites, such as on different sides of a joint, can be used while maintaining a common coordinate system between the surgical arms (unlike independent arms not connected by a frame).

[0018] In some embodiments, the frame is annular. The surgical arms may extend from the periphery of the frame.

[0019] In some embodiments, the frame is adjustable, which can be achieved by adding or removing portions of the frame.

[0020] Preferably, the one or more surgical arms include a plurality of surgical arms.

[0021] Preferably, the surgical arm is reconfigurable to extend from the frame to a plurality of different positions. In some embodiments, the surgical arm is configurable to extend from the frame to one or more predefined positions. The surgical arm may be removably coupled to the frame.

[0022] Alternatively, the surgical arm can be moved relative to the frame using an actuator, drive, or the like. The arm can be moved based on user input. One end of the surgical arm can be secured to the frame using a track. Preferably, a first end of the arm is configured to be driven along the track. In some embodiments, multiple tracks can be employed. In this case, it is envisioned that the ends of the surgical arms are stacked vertically, with a different arm positioned on each track.

[0023] The frame can have one or more roller assemblies for moving the surgical arm along the guide tracks. Preferably, the one or more roller assemblies can be received across and along the tracks. Each guide track can have at least one channel for guiding the passage of a roller assembly. As shown, it is contemplated that multiple guide tracks can be employed. In such cases, one of the one or more roller assemblies can be configured to engage one of the multiple guide tracks.

[0024] Preferably, the first end of at least one arm has a mounting portion for attachment to the frame. Preferably, the mounting portion is attached to the frame by a screw, pin, or similar fastener. In some embodiments, the mounting portion is configured to clamp or otherwise engage the frame.

[0025] The arms may be of different lengths to achieve different functions, for example, arms of different lengths may allow access to different parts of the patient or may be used to reach the patient in various surgical positions.

[0026] Preferably, the surgical arm is electrically and mechanically coupled to the frame.

[0027] Preferably, the surgical arm can then be articulated into a variety of different positions based on user input.

[0028] Preferably, the surgical arm is configured to bend about at least one pivot point. Preferably, the surgical arm is configured to bend about two or more pivot points.

[0029] Preferably, at least a portion of the surgical arm is configured to rotate.

[0030] Preferably, at least one of the surgical arms has at least six degrees of freedom, which may include one or more of: forward / backward, up / down, left / right, yaw, pitch, and roll.

[0031] In some embodiments, the surgical arm has eight degrees of freedom.

[0032] Preferably, the surgical arms are modularly addable or removable from the frame.

[0033] Preferably, the surgical arm has modular end plates and is configured to interface with a variety of different instruments.

[0034] Preferably, the modular endplate is provided with one or more buttons that can be used to control the surgical arm. In some embodiments, the buttons can be used to switch the arm into manual mode, allowing the user to physically reposition it. Similarly, the buttons can be used to save points to the runtime program.

[0035] The modular endplate includes a drive element configured to engage a corresponding drive element of the instrument, thereby mechanically driving one or more functional portions of the instrument.

[0036] The modular end plates may include electrical elements configured to electrically connect the instruments to the system. The electrical elements may be configured to provide power to the instruments and / or receive or transmit data to or from the system.

[0037] Each modular endplate can have a power drive element and electrical contacts in the same predetermined location to allow for modular use with a wide range of instruments. Arthroscopic instruments can use one or more of these power drive elements and / or electrical contacts as desired.

[0038] Preferably, a hand unit is associated with the surgical arms and / or the modular endplate. The hand unit is positioned in a user's hand for manually moving the one or more surgical arms. Preferably, the hand unit is configured to be operatively associated with the one or more surgical arms such that movement of the hand unit associated with one of the surgical arms and / or modular endplate causes movement of the remaining one or more surgical arms.

[0039] The hand unit is configured to fit within a user's hand for manual operation by the user. The hand unit can fit within a user's hand in a typical manner, such as in the palm of the user's hand or within the fingers.

[0040] In use, it is envisioned that the user will use the hand unit to position the surgical arm, which advantageously allows the user to manually direct the surgical arm to the appropriate location on the patient, which may help mitigate surgeon liability concerns.

[0041] The hand unit may further comprise a locking mechanism, preferably configured to lock the surgical arm for manipulation within a range relative to the patient.

[0042] Preferably, the hand unit is configured to generate tactile signals, which are generated based on data from the system and may correspond to the operation or lock status of the hand unit, or other suitable information.

[0043] In another embodiment, one or more of the arthroscopic instruments are permanently or semi-permanently attached to an associated surgical arm. The arthroscopic instruments may be attached to the arm by fasteners (e.g., nuts and bolts) or may form part of the surgical arm.

[0044] The system can include a drape covering each surgical arm. The drape can be sterile. The drape can have a rigid upper mount, a rigid lower mount, and a flexible sheath connecting them. The rigid upper mount and the rigid lower mount can have openings through which connectors of the arms and / or instruments can pass.

[0045] The rigid upper mount may be configured to be received between the frame and the surgical arm, and the rigid lower mount may be configured to be received between the arm and the arthroscopic instrument.

[0046] Preferably, the flexible sheath provides a continuous tube between the openings in the rigid upper mount and the rigid lower mount. In one embodiment, the flexible sheath includes a tube. The tube may be disposed inside the flexible sheath tube or may be disposed outside the flexible sheath tube. Preferably, the tube is connected to one or more pumps and valves for regulating fluid pressure and flow rate. The one or more pumps may comprise a series of pumps. The valve may comprise a compression valve.

[0047] The drape can have tubes connectable to a fluid inflow / outflow system, a suction system, data and power, and / or an RF energy system.

[0048] Those skilled in the art will appreciate that the drape is for single use. Preferably, the drape is packaged for use with the system. The packaging can be of any suitable type to maintain sterility.

[0049] Preferably, the drape is packaged in a tear-open sterile package so that the drape inside remains sterile when the package is torn open.

[0050] In embodiments in which the drape has rigid upper and lower mounts, the packaging can further include one or more packaging chambers configured to separately cover the rigid upper and lower mounts and the flexible sheath, thereby allowing the rigid upper and lower mounts to be removed separately from the packaging to reduce the risk of contamination.

[0051] Preferably, the instrument comprises a modular joint having a plurality of drive elements configured to engage corresponding drive elements on modular endplates of the arms, and the system can control the arthroscopic instrument through rotation of the drive elements on the modular endplates.

[0052] The modular coupling can have a plurality of electrical coupling elements configured to engage with corresponding electrical elements on the modular end plates of the arms, which can be used to power or communicate with (to and / or from) the appliance.

[0053] The instrument includes an internal cable connected to a gear and internal pulley of a drive element, which allows the instrument to bend and actuate.

[0054] The appliance may include an identifier that allows the system to identify the attachment. The identifier may comprise an RFID tag.

[0055] The instrument may include an arthroscopic camera.

[0056] The arthroscopic camera may be configured to take images. The arthroscopic camera may be configured to transmit electrical signals to the system in the form of live / streaming video images. The arthroscopic camera may include a light source powered by the robotic arm.

[0057] Preferably, the arthroscopic camera is configured to be inserted into the surgical site. In this regard, it is envisioned that the arthroscopic camera takes images of the surgical site from within the surgical site.

[0058] Preferably, the arthroscopic instrument has a diameter of less than about 5 mm at a portion thereof. Preferably, the arthroscopic instrument has a diameter of less than about 5 mm at the portion inserted into the surgical site. The diameter of the arthroscopic instrument may range from about 1.9 mm to 4.0 mm. Similarly, the length of the instrument may range from about 90 mm to 170 mm.

[0059] The arthroscopic instrument may be in electronic communication with the system's controller via one or more electrical cables, cords, etc. More preferably, the surgical effector and controller may be in wireless communication with the controller (e.g., via Bluetooth, near field communication (NFC), Wi-Fi, etc.).

[0060] The system can include a radio frequency (RF) energy generator configured to generate RF energy for use by one or more instruments.

[0061] Preferably, the system is configured to generate a depth map from images captured by the system, which depth map is preferably used to create 3D video from images captured by the monocular camera.

[0062] Preferably, the depth data associated with the depth map is overlaid on the image data.

[0063] Preferably, the contour lines are superimposed on the image data.

[0064] Preferably, the image is processed. The image may be processed to adjust or improve contrast, focus, white balance and / or resolution.

[0065] Additionally, the image may be flipped, rotated, and / or scaled with or without input from the surgeon user. For example, the image may be flipped, rotated, and / or scaled automatically. Alternatively, the surgeon may rotate the image to allow for a comfortable working position (e.g., upright position) regardless of the orientation of the surgical instruments.

[0066] In some embodiments, the image data is classified, and one or more labels may be displayed in association with the classification.

[0067] Preferably, the system is configured to automatically identify "abnormal anatomy" and label it, for example, using an image overlay.

[0068] In some embodiments, training data from past cases is used to create discriminative classifiers (e.g., via a Haar classifier or the like) that can then be used to automatically classify joint anatomy.

[0069] Preferably, the system includes a fluid management system configured to regulate the flow, pressure, or temperature of fluid to the joint, either via an instrument or directly, and the fluid may be saline.

[0070] The fluid may be configured to prevent heat dissipation to surrounding tissue, such as in the case of cauterizing or other heat-generating devices.

[0071] One or more sensors, such as a temperature sensor, may be provided on the instrument, and data from the sensors is provided to the system.

[0072] The fluid management system can adjust the flow rate according to data from the sensors.

[0073] The fluid management system may include a pump, a pressure sensor, and a control valve (e.g., a pinch valve) for regulating pressure and flow to the instrument. The fluid management system can have one or more lines. In the case of multiple lines, each line is independently adjustable.

[0074] The fluid management system may be configured to automatically maintain temperature and pressure within certain thresholds.

[0075] The system includes a suction system used for fluid evacuation and may be connected to an external suction system that manages fluid aspiration and handling.

[0076] The fluid management system may be configured to inflate the joint in which the arthroscopic procedure is performed.

[0077] Preferably, the expansion is achieved by adjusting the pressure and / or flow rate of fluid within the fluid management system. The pressure and / or flow rate may be adjusted at least in part according to sensor data. The sensor data may include inlet pressure and / or outlet pressure. The system may be configured to use a model of the joint and / or system to adjust the pressure and / or flow.

[0078] Preferably, the system is at least partially portable. The system may have a wheeled base. The wheeled base may be lockable in place.

[0079] Preferably, the frame is supported in the elevated position by articulated arms which extend upwardly from a wheeled base.

[0080] In some embodiments, the surgical system has storage areas for storing auxiliary items, wiring, and other infrastructure and / or consumables.

[0081] Preferably, the storage location is located at the base of the robot. The storage location may further include shelves, drawers, or similar compartments to aid in organization. The storage location may be lockable.

[0082] Preferably, the storage site houses a suction pump, a regulator, a fluid trap, etc. In this regard, the storage site may house part of a fluid management system.

[0083] In some embodiments, the base includes a locking mechanism for locking the base in place. The locking mechanism may be, for example, a foot pedal. It is envisioned that the base is first wheeled to the appropriate location and then locked into place using the locking mechanism. Advantageously, this prevents accidental movement of the base, and therefore the arthroscopic instrument, during surgery due to bumps by surgeons or other medical personnel or environmental factors such as earthquakes.

[0084] As shown, the consumable may be placed in a storage location. Preferably, the consumable has a readable identifier, such as a serial number, bar code, QR code, or the like. The readable identifier may be read by the system. Preferably, the readable identifier is read by a reader. Preferably, the reader is associated with a modular end plate on the arm of the robot.

[0085] It is envisioned that the reader will detect whether the consumable is a genuine consumable associated with the system, and if an inauthentic consumable is detected, the system can restrict usage.

[0086] Preferably, consumable use is recorded. This use may be recorded by operation of the system, i.e., use may be recorded as the system is operating. Alternatively, or in addition, use may be recorded when the consumable is read by a reader associated with a modular end plate.

[0087] Advantageously, recording consumable usage may enable the system to identify consumable inventory levels. The system may be configured to access the internet to automatically place consumable orders.

[0088] The ordering interface may display the consumable order and require the user and / or hospital procurement department to confirm the consumable order before the consumable order is placed, but preferably the ordering interface is separate from the user interface for remotely operating the arthroscopic surgical robot.

[0089] In another embodiment, the system may be configured to generate reports outlining consumable inventory levels for review by users and / or hospital procurement departments.

[0090] Preferably the system is configured to generate a map showing the relative position of the instrument. Preferably the map includes the relative position of the patient.

[0091] Preferably, the system includes a headset. Preferably, the system includes one or more controllers with which a surgeon can interact to control instruments and thereby perform surgery.

[0092] Preferably, image data from the arthroscopic camera is displayed on the headset.

[0093] Preferably, the controller is configured to control the operation and movement of the camera and the instrument.

[0094] In some embodiments, the system may be configured to generate a haptic signal via the controller.

[0095] The tactile signal may be generated according to data from the system and may correspond to a warning, a confirmation, or any other suitable information.

[0096] Preferably, the system includes a console having a display and one or more user input devices to allow a user to interact with the system, which may be in the form of a joystick controller and / or a keyboard.

[0097] The system may have a central controller for controlling various aspects of the system, the central controller including one or more processors and a memory coupled to the processors, the memory having various instruction codes for carrying out the functions of the system.

[0098] In another aspect, the present invention broadly relates to a surgical system having one or more surgical arms each having a surgical instrument, and an intraoperative fluid management system associated with at least one of the one or more surgical arms and / or surgical instruments, wherein the one or more surgical arms and associated surgical instruments are remotely operable to perform arthroscopic surgery.

[0099] The fluid management system can have one or more pumps and valves for regulating the pressure and / or flow rate of the fluid. The one or more pumps may consist of a series of pumps. The valves may consist of compression valves.

[0100] The fluid management system may be configured to regulate the flow, pressure, or temperature of a fluid to the body, either via an appliance or directly. The fluid may comprise saline.

[0101] The fluid may be configured to prevent heat dissipation to surrounding tissue, for example, in the case of a cauterizing or other heat-generating device.

[0102] One or more sensors, such as a temperature sensor, may be provided on the device, and data from the sensors is provided to the fluid management system.

[0103] The fluid management system can adjust the flow rate according to data from the sensors.

[0104] The fluid management system can regulate pressure and flow to the instrument. The fluid management system can have one or more lines, where each line is independently regulated.

[0105] The fluid management system may be configured to automatically ensure that temperatures and pressures are maintained within certain thresholds.

[0106] In yet another aspect, the present invention generally relates to a surgical drape for application to a subject during surgery, the drape comprising a sheath configured to at least partially cover the subject and at least one tube for transporting fluids to or from a patient during surgery.

[0107] Preferably, the drape is configured to attach to a remotely operable surgical arm of the surgical system. The drape may extend over the surgical arm.

[0108] Preferably, the sheath is flexible.

[0109] The drape can further have rigid upper and lower mounts, with the sheath extending therebetween. The rigid upper and lower mounts can have openings through which the arms and / or instrument connectors extend.

[0110] Preferably, the flexible sheath provides a continuous tube between the openings in the rigid upper mount and the rigid lower mount.

[0111] The rigid upper mount may be adapted to be received intermediate the frame and the surgical arm, and the rigid lower mount may be adapted to be received intermediate the arm and the surgical instrument.

[0112] Preferably, one of the at least one tube is configured to carry an intraoperative fluid, which may comprise saline.

[0113] In yet another aspect, the present invention broadly relates to an arthroscopic instrument comprising a shaft including a distal end configured to enter a joint during surgery, and an articulation section disposed at the distal end adjacent a tip of the shaft, the articulation section configured to allow the tip of the shaft to change position.

[0114] Preferably, the articulation part comprises a pivot joint. Preferably, the articulation part comprises a swivel joint. The articulation part may comprise a pivot joint and a swivel joint.

[0115] Preferably, the rotary joint is a ball and socket joint. The ball is at least partially received in the end of the surgical arm. Preferably, the ball is rotatably fixed in place by an end cap extending partially over the ball at the end opposite the surgical arm. A support may extend between the end cap and the surgical arm to hold the ball in place. Preferably, the support is substantially elongated.

[0116] Preferably, the support is resilient so as to be able to move to allow movement of the ball contained therein. In this regard, the support may be made of an elastomeric polymer.

[0117] In some embodiments, the support is comprised of two or more support members, hi some such embodiments, a first support member may be associated with a second support member by respective ends.

[0118] The arthroscopic instrument can have one or more cables configured to induce movement of the joint. The cables may be coupled to one or more pulleys.

[0119] Preferably, the cable extends along the length of the shaft. Preferably, the cable extends inside the shaft.

[0120] The arthroscopic instrument can have one or more drive elements coupled to one or more cables. Preferably, rotation of the one or more drive elements can cause translation of the one or more cables within the shaft. Preferably, the drive elements are located at or adjacent to the proximal end of the shaft.

[0121] Preferably, the device comprises a modular coupling portion, which may comprise a plurality of drive elements, and which may comprise a plurality of electrical coupling elements.

[0122] The device may have a marker that allows identification of the device. The marker may consist of an RFID marker.

[0123] In yet another aspect, the present invention broadly relates to a surgical camera including a reusable base portion having an interface for providing an image from the camera, and a disposable distal portion removably coupled to and extending outwardly from the reusable base portion.

[0124] Preferably, the disposable distal portion is at least partially configured to enter a patient's body during surgery. In one embodiment, the camera is an arthroscopic camera. At least a portion of the distal portion is configured to enter a joint during surgery.

[0125] Preferably, the disposable distal portion comprises an image sensor. Preferably, the disposable distal portion comprises one or more articulating parts.

[0126] Preferably, the reusable base portion and the disposable distal portion are electrically coupled. Preferably, the reusable base portion and the disposable distal portion are mechanically coupled. The reusable base portion and the disposable distal portion may be mechanically coupled by one or more drive members, such as cogs or gears.

[0127] The disposable distal portion may be single use. The disposable distal portion may be multi-use.

[0128] In other embodiments, the camera can have a disposable cover on at least its distal portion.

[0129] In another aspect, the present invention generally relates to a surgical system comprising a camera configured to capture images during surgery and a processor configured to generate depth data according to the captured images.

[0130] The camera may be configured to be a monocular camera. The camera may be configured to be inside the patient's body during use, i.e., surgery.

[0131] Preferably, the system is further configured to overlay the depth data, or a derivative thereof, onto one or more captured images for display. The system may be configured to overlay depth cues, such as contour lines, onto the images.

[0132] The system may be configured to overlay surgical and / or device information. By way of example, the system may be configured to overlay pre-operative planning information, runtime data such as distances or angles, system performance information such as instrument loads, usability information, or any other appropriate and relevant information.

[0133] The system can have a display on which the captured image with the overlaid depth data, or a derivative thereof, is displayed, and the display can be configured to display the overlaid image in real time or near real time.

[0134] The system may include a surgical instrument equipped with a camera, which may comprise an arthroscopic camera.

[0135] The camera may be configured to capture video as the camera moves relative to the patient, and the depth data is generated at least in part according to differences between images captured by the camera at different times.

[0136] The system may have a dedicated camera control unit (CCU) to manage the camera signals and control the camera sensor. Various image processing functions may be performed using the CCU.

[0137] The camera may have an LED light source associated with it to illuminate the area being imaged. The LED light source may be adjustable and may be associated with the tip of the camera.

[0138] The light source can be located within the camera. Preferably, the light source is located adjacent to the camera. Most preferably, the light source is located adjacent to the camera and may be associated with the surgical arm to which the camera is attached.

[0139] In another embodiment, the light source is mounted separately from the camera. Preferably, the light source is mounted on a movable member associated with the surgical arm to which the camera is attached. Advantageously, this may allow the camera to be separately oriented to illuminate the camera's field of view without casting shadows or obstructing the surgical site.

[0140] In yet another aspect, the present invention generally relates to an arthroscopic surgery system that includes an arthroscopic camera configured to capture images during surgery and a headset configured to display the captured images.

[0141] The headset may be configured to display three-dimensional images, which may include stereoscopic images, which may be generated from monoscopic images from an arthroscopic camera.

[0142] The arthroscopic surgery system may have a controller that allows interaction with the surgeon.

[0143] In yet another aspect, the present invention generally relates to an arthroscopic surgery system comprising one or more surgical arms each having an associated arthroscopic instrument and a handheld controller having more than three degrees of freedom, wherein the one or more surgical arms and associated arthroscopic instruments are remotely controllable by the handheld controller to perform arthroscopic surgery.

[0144] The handheld controller may have one or more joysticks.

[0145] Any of the features described herein may be combined in any combination with any one or more of the other features described herein within the scope of the present invention.

[0146] The reference herein to prior art is not an acknowledgement or suggestion that the prior art forms part of the general general knowledge. [Brief explanation of the drawings]

[0147] Various embodiments of the present invention will now be described with reference to the following drawings. [Figure 1] FIG. 1 shows an arthroscopic surgery system according to one embodiment of the present invention. [Figure 2] 2 is a side view of an arthroscopic instrument of the system of FIG. 1 in the form of an arthroscopic grasper according to an embodiment of the present invention. [Figure 3a] FIG. 3a shows a side view of an arthroscopic instrument of the system of FIG. 1 in the form of an arthroscopic camera according to an embodiment of the present invention. [Figure 3b] FIG. 3b is a side view of the arthroscopic instrument of FIG. 3a in a separated configuration according to an embodiment of the present invention. [Figure 4] FIG. 4 shows a side view of the articulating portion of the system of FIG. 1 according to an embodiment of the present invention. [Figure 5a] FIG. 5a shows a perspective view of a sterile drape of the system of FIG. 1 according to an embodiment of the present invention. [Figure 5b] FIG. 5b is a simplified side view of the sterile drape of FIG. 5a according to an embodiment of the present invention. [Figure 6] FIG. 6 shows a simplified diagram of an end plate of the system of FIG. 1 according to an embodiment of the present invention. [Figure 7a] FIG. 7a shows a perspective view of an endplate for an arthroscopic instrument of the system of FIG. 1 according to an embodiment of the present invention. [Figure 7b] FIG. 7b shows a perspective view of a mounting portion for an arthroscopic instrument of the system of FIG. 1 according to an embodiment of the present invention. [Figure 7c] FIG. 7c shows an exploded view of the end plate and mounting portion of FIGS. 7a and 7b according to an embodiment of the present invention. [Figure 8a] Figure 8a shows a screen shot of a camera image from the system in Figure 1 without image overlay. [Figure 8b] Figure 8b shows a screen shot of a camera image from the system in Figure 1, with contour lines overlaid on the image. [Figure 9] FIG. 9 shows screen shots of four different image views (i.e., images the surgeon sees during surgery) of the system of FIG. 1 according to an embodiment of the present invention. [Figure 10] FIG. 10 is a perspective view of a portion of an arthroscopic surgery system according to an alternative embodiment of the present invention. [Figure 11] FIG. 11 is a diagram showing a screen shot of a surgery screen of an arthroscopic surgery system according to an embodiment of the present invention. [Figure 12] FIG. 12 is a top perspective view of an attachment portion of the system of FIG. 1 according to an embodiment of the present invention. [Figure 13] 13 illustrates a rear view of an arthroscopic instrument of the system of FIG. 1 in the form of a hand grip for connecting with the mounting portion of FIG. 12 according to an embodiment of the present invention. [Figure 14]FIG. 14 illustrates a side view of an arm of an arthroscopic instrument of the system of FIG. 1 according to an embodiment of the present invention. [Figure 15] FIG. 15 is a side view of a frame of the arthroscopic surgery system of FIG. 1 according to an embodiment of the present invention. [Figure 16] FIG. 16 is an enlarged side view of a portion of the frame of FIG. 15 according to an embodiment of the present invention.

[0148] Preferred features, embodiments, and variations of the present invention can be discerned from the following detailed description, which provides sufficient information for those skilled in the art to practice the invention, and which is not to be construed as limiting the scope of the foregoing summary in any way. DETAILED DESCRIPTION OF THE INVENTION

[0149] Embodiments of arthroscopic surgery methods and systems are described below that simplify arthroscopic surgery, thereby reducing the potential for damage or injury resulting from the surgery itself. Additionally, the methods and systems are easier to use than conventional arthroscopic instruments, thereby lowering the barrier to entry for arthroscopic surgery.

[0150] FIG. 1 illustrates an arthroscopic surgery system 100 according to one embodiment of the present invention.

[0151] Arthroscopic surgery system 100 is portable and includes a wheeled base 105 that can be moved to a desired location in the operating room and locked into place. In use, wheeled base 105 is moved to a position adjacent to patient 110 on operating table 115 in preparation for surgery and locked in that position prior to and during surgery performed using system 100.

[0152] System 100 includes a rigid frame 120 supported in an elevated position by articulating arms 125 extending upwardly from a base 105. Frame 120 includes a plurality of surgical arms 130, each carrying a plurality of teleoperable arthroscopic instruments 135, as outlined in further detail below.

[0153] System 100 is intended for arthroscopic surgery, i.e., surgery on joints such as the ankle, knee, hip, spine, shoulder, elbow, wrist, etc. In use, after wheeled base 105 is locked into place, frame 120 is positioned above the joint to be operated on in patient 110. Because frame 120 extends laterally above the patient, surgical arms 130 and arthroscopic instruments 135 can operate on different sides of the joint while maintaining a common point of reference through rigid frame 120.

[0154] The system 100 includes a headset 140 and a controller 145 operable by a surgeon 150 to remotely control the surgical arm 130 and the arthroscopic instrument 135. In particular, the arthroscopic instrument 135 includes an arthroscopic camera and instruments such as cutters and graspers.

[0155] The controller 145 has more than three degrees of freedom (e.g., up / down, left / right, front / back). In a preferred embodiment, the controller 145 has at least six degrees of freedom. The degrees of freedom may be provided by the movement of the controller itself and / or by interaction with its components.

[0156] Image data from the arthroscopic camera is processed and displayed to the surgeon 150 on the headset 140, and the controller 145 controls the operation and movement of the camera and instrument 135. In this way, the headset 140 and controller 145 can function like a virtual reality (VR) system.

[0157] Headset 140 may be configured to display three-dimensional images, such as stereoscopic images, generated according to depth data estimated from the images.

[0158] System 100 may be configured to generate tactile signals via controller 145 to assist surgeon 150. The tactile signals may be generated according to data from system 100 and may correspond to warnings, confirmations, or any other suitable information.

[0159] Similarly, the system 100 may be configured to generate and display on the headset 140 a position map showing the relative positions of the instruments 135 and the patient 110. The system 100 may allow the surgeon 150 to zoom in and out and rotate the model to allow the surgeon 150 to operate from various angles while in a common (e.g., upright) position.

[0160] System 100 further includes a console 155 having a display 160 and user input devices in the form of a joystick controller 165 and a keyboard 170. Console 155 can be used to perform the procedure or in a more limited form used to adjust system 100 parameters pre-operatively, to input patient details, and / or to assist surgeon 150 during surgery. Headset 140 and console 155 are preferably configured for simultaneous operation.

[0161] However, those skilled in the art will readily appreciate that any number and type of suitable user interfaces may be used. By way of example, rather than a headset 140 and controller 145, a console 155 may be used by the surgeon 150.

[0162] As outlined above, arthroscopic surgery generally requires the use of multiple portal sites. The surgical arm 130, and therefore the arthroscopic instruments 135, are positionable on the frame 120 so that they may be positioned on different sides of the joint being operated on.

[0163] The frame 120 is generally wide and extends laterally in two dimensions. In one embodiment, outlined in more detail below, the frame 120 is circular, and the surgical arm 130 is positionable around the frame.

[0164] In some embodiments, the surgical arm 130 is positionable at multiple predefined positions around the frame 120. In other embodiments, the surgical arm 130 can be moved relative to the frame, e.g., based on user input, using, e.g., an actuator, a drive assembly, etc.

[0165] The surgical arm 130 itself can then articulate to a variety of different positions based on user input. In some embodiments, the arm 130 includes a robotic wrist with at least one horizontal pivot and two vertical pivots, thereby providing eight degrees of freedom. The arm 130 may also be configured to bend at its end to allow the "pose" of the end of the instrument to be changed.

[0166] Such a configuration allows the arthroscopic instrument 135 to move in all orthogonal directions and rotate about all planes to access the joint from any desired angle.

[0167] 1 shows three surgical arms 130, additional surgical arms 130 may be added or removed as needed, and one skilled in the art will readily appreciate that any suitable number of arms may be used.

[0168] The arthroscopic instrument 135 is coupled to the arm 130 using a modular endplate that has multiple motors (e.g., three motors) for driving various portions of the arthroscopic instrument 135 and multiple electrical contacts for powering, controlling, and / or communicating with the arthroscopic instrument 135. This configuration allows a modular approach that allows a wide range of arthroscopic instruments 135 to be used with the system 100 without the need to modify the arm 130.

[0169] Although motors (mechanical control) and electrical contacts (electrical control) have been described, one skilled in the art will readily appreciate that some components may be entirely mechanical and / or electrical.

[0170] 2 is a side view of an arthroscopic instrument 200 in the form of an arthroscope grasper according to an embodiment of the present invention. Instrument 200 may be similar to or identical to one of arthroscopic instruments 135 of FIG.

[0171] The arthroscopic instrument 200 includes a plurality of drive elements 205 configured to engage with corresponding drive elements on the modular end plates of the arms 130, allowing the system 100 to control the arthroscopic instrument 200 through rotation of the drive elements on the modular end plates.

[0172] Instrument 200 includes internal cabling coupled to gears and internal pulleys of drive elements 205 to bend and actuate instrument 200. Two of the drive elements 205 / cables are used to control the bending of instrument 200 (i.e., the relative movement of components 210 around the joint), and the third drive element cable is used to control grasper 215 at the tip of instrument 200. Although not shown, the cables can be used with internal pulleys or the like to cause instrument 200 to bend.

[0173] The joint is located at the distal end of the instrument 200, allowing the instrument to change "pose" within the joint and work in new approaches, thereby allowing the instrument 200 to work in areas that would otherwise be inaccessible.

[0174] The joint can have a pivot joint and a rotary joint, allowing the tip to bend in any direction with just two cables.

[0175] 3a is a side view of an arthroscopic instrument 300 in the form of an arthroscopic camera according to an embodiment of the present invention. Instrument 300 may be similar to or identical to one of arthroscopic instruments 135 of FIG.

[0176] The instrument 300 similarly includes an internal cable coupled to the gears and internal pulleys of the drive element 205 to bend and actuate the instrument 300. However, instead of a punch, it has a camera 315 at its tip.

[0177] The camera 315 is coupled to a number of electrical contacts 320 such that, in use, the camera 315 is electrically coupled to the system to provide power to the camera 315 and transmit electrical signals back to the system in the form of a live / streaming video image.

[0178] The device 300 consists of a reusable portion and a base portion.

[0179] 3b is a side view of an arthroscopic instrument 300 in a separated configuration according to an embodiment of the present invention. In particular, the instrument comprises a reusable base portion 300a having an interface for providing an image from a camera, and a discard distal portion 300b removably coupled to and extending outwardly from the reusable base portion 300a.

[0180] The disposable distal portion 300b is configured to be at least partially inserted into a patient's body and is preferably provided in a sterile state (e.g., in a sterile package), while the reusable base portion 300a does not need to be sterilized because it does not enter the patient's body and can be covered with a drape.

[0181] When connected, the disposable distal portion 300b and the reusable base portion 300a are electrically and mechanically coupled, with a mechanical and electrical interface 325 provided therebetween, which may include electrical contacts and mechanical drive members such as cogs or gears for moving the cables therethrough.

[0182] The reusable base 300a includes a camera control unit in addition to an interface, which may include a Bluetooth or similar interface.

[0183] Such a configuration would be cheaper than a fully disposable surgical camera, as the relatively expensive CCU and data interface may be reused, but like a fully reusable surgical camera, it could reduce the need for cleaning and sterilization of parts.

[0184] The modular endplates have power drive elements and electrical contacts in the same predefined locations. The arthroscopic instrument 135 can then use any one or more of these power drive elements and / or electrical contacts based on need. As an example, a fixed camera used simply to determine the patient's approximate position may not be coupled to a drive element at all. Similarly, the modular endplates can have fluid inflow / outflow, suction, and RF power connections.

[0185] While the above instruments are shown, one skilled in the art will readily appreciate that the system 100 is modular and may be used with a variety of instruments. However, arthroscopic instruments 135 generally have a diameter of less than about 5 mm and are more typically smaller (e.g., between 1.9 mm and 4.0 mm in diameter). Similarly, the length of the instruments may be between about 90 mm and 170 mm.

[0186] The device 135 is curved or bendable, either passively or by active bending as outlined above.

[0187] Similarly, the instrument 135 may include internal functionality such as a processor, gearbox, etc. to support its operation. As an example, an arthroscopic shaver may be coupled to a modular endplate by an intermediate gearbox. Similarly, the instrument may have an identifier, such as an RFID identifier, that allows for identification of the instrument.

[0188] The instrument 135 may be coupled to a fluid management system to provide irrigation, regulate pressure, flow rate, and prevent heat loss to surrounding tissue, for example in the case of a cauterizing or other heat-generating instrument.

[0189] In some embodiments, the arthroscopic instrument 135, in addition to performing a function in surgery, includes sensors, such as temperature sensors, and provides data from the sensors to the system 100 via the modular endplates. This data can then be used to control systems, such as fluid management systems, as outlined below.

[0190] The instruments 135 are typically sterile and are either single-use instruments or sterile reusable instruments. It is not practical to sterilize the arm 130, so a single-use sterile drape is placed over the arm.

[0191] FIG. 4 is a side view of articulating portion 400 of the arthroscopic instrument of system 100.

[0192] The articulating section 400 is associated with the moving part 210 and forms the end of the surgical arm 130 to which the arthroscopic instrument 135 is attached.

[0193] Articulating unit 400 has a sheath 410 with a first end that fits around the end of moving part 210 and a second end that receives a ball 420. The ball engages an end cap 405, allowing rotational movement of the end cap 405 relative to the moving part 210. Various elements can be attached to the end cap 405 to perform various functions.

[0194] End cap 401 is secured in position over a portion of ball 420 by supports 425. Supports 425 are spaced apart from ball 420 so as not to impair the rotational movement of ball 420. Articulating unit 400 provides motion to the instrument in other ways than the pulley / cable system described above.

[0195] As outlined above, the system 100 may include a sterile drape over the arm 130 .

[0196] FIG. 5a is a perspective view of a sterile drape 500a of system 100 according to an embodiment of the present invention.

[0197] Drape 500a has a rigid upper mount 505 and a rigid lower mount 510 with a flexible sheath 515 extending therebetween.

[0198] Rigid upper mount 505 is adapted to be received intermediate frame 120 and arm 130 (i.e., the arm mount on frame 120). Rigid lower mount 510 is adapted to be received intermediate arm 130 and arthroscopic instrument 135 (i.e., the modular end plate).

[0199] In particular, the rigid upper and lower mounts 505, 510 have openings 510a therein through which the connectors of the arm 130 and instrument 135 extend. A flexible sheath 515 provides a continuous tube between the openings 510a of the rigid upper and lower mounts 505, 510, thereby enclosing the entire arm 130 and thus providing a sterile outer surface thereof.

[0200] In some embodiments, the drape can have tubes that can be connected to a fluid inflow / outflow system, a suction system, and / or an RF energy system, as described below.

[0201] 5b is a simplified side view of a sterile drape 500b according to an embodiment of the present invention. Drape 500b may be similar to drape 500a, but has an inner tube 520.

[0202] The inner tubing 520 is for transferring fluids to and from the patient during surgery. The fluids may include saline or other intraoperative fluids. However, one skilled in the art will readily appreciate that multiple tubing may be provided for various purposes, including tubing that is not necessarily for fluid transport, such as suction tubing or tubing containing electrical wiring.

[0203] An inner tube 520 extends between the rigid upper and lower mounts 505, 510, and interfaces of the tube 520 are provided to the rigid upper and lower mounts 505, 510. In some embodiments, the rigid upper and lower mounts 505, 510 are provided to align with corresponding ports on the system 100 to facilitate easy attachment of the tube. By way of example, the upper and lower mounts 505, 510 can have a locking mechanism configured to lock the upper and lower mounts in place.

[0204] As mentioned above, the surgical arm 130 includes a modular endplate to which the arthroscopic instrument 135 is coupled.

[0205] FIG. 6 shows a simplified diagram of a modular end plate 600 of the system 100 according to an embodiment of the present invention.

[0206] The modular endplate 600 is coupled to the surgical arm 130 by an attachment portion 605 having a variety of attachment interfaces. The modular endplate 600 forms the distal end of the surgical arm 130.

[0207] Modular endplate 600 has a plurality of drive elements 610 configured to engage and drive corresponding drive elements of arthroscopic instrument 135. Although three drive elements 610 are shown, one skilled in the art will readily appreciate that any number of drive elements may be used.

[0208] Similarly, modular endplate 600 has an electrical connector 615 configured to mate with a corresponding electrical connector on arthroscopic instrument 135 .

[0209] A drape connection 620 is provided adjacent the drive element 610 and the electrical connector 615 to allow a drape to be coupled to the end of the surgical arm, thereby covering the surgical arm 130 .

[0210] Next, a number of interface buttons are provided to allow a person to interact with the modular endplate, as outlined below.

[0211] First, a manual override button 625 is provided to allow a user to manually override the movement of the surgical arm 130. Second, a plurality of manual control buttons 630 are provided, including an up button, a down button, a pitch up button, and a pitch down button, which are particularly useful for coarse arm movement.

[0212] A "Save Position" button 635 is provided to allow the system to save the position of the arm 130. This position can be reused later or saved for record-keeping purposes.

[0213] A "primary action" button 640 is provided to allow one or more primary action functions to be performed.

[0214] Finally, a nine-dimensional cross key 645 is provided to enable fine movement of the arm. The nine-dimensional cross key 645 has forward, backward, left, and right directions, as well as diagonal directions therebetween. Pressing the center of the cross key 645 can provide functions alternative to the above functions. This function not only moves the arm left, right, forward, and backward, but also allows left yaw, right yaw, left roll, and right roll. Additionally, up, down, pitch up, and pitch down may be provided.

[0215] However, those skilled in the art will readily appreciate that any suitable interface may be used to provide such functionality.

[0216] Returning to Figure 1, the system 100 includes a fluid management system 175 that regulates the flow of fluid (e.g., saline) directly to and within the joint via the device 135. The fluid management system 175 includes a pump, pressure sensors, and control valves (e.g., pinch valves) to regulate the pressure and flow to the device. The fluid management system 175 can have one or more lines, and if there are multiple lines, each line is independently controlled.

[0217] Joints are generally susceptible to thermal changes and fluid pressure during the course of a procedure. For example, the use of cautery wands and rotary cutters / shavers almost always alters the temperature, flow, and pressure within the joint. Temperatures above 50°C are associated with cartilage cell death, and high fluid pressures are associated with swelling, compartment syndrome, and risk to the limb. Similarly, changes in flow can disrupt the joint and cause impingement of instruments with the articular surfaces.

[0218] In this way, the fluid management system can be configured to ensure that temperatures and pressures remain within certain thresholds.

[0219] The system 100 further includes a suction system 180 used for fluid evacuation and may be coupled to an external suction system that manages the aspiration and handling of fluids.

[0220] As mentioned above, the instrument 135 has sensors. In some embodiments, the fluid management system 175 utilizes data from the sensors to regulate the temperature, pressure, and visibility of the joint by adjusting the operating pressure and / or flow rate.

[0221] In a preferred embodiment, the fluid management system 175 includes one or more peristaltic pumps. A sterile saline bag is connected to the fluid management system 175, and the system is primed before use. A suction line operates in a similar manner, but drains into a suction reservoir or is connected to a waste port, such as a wall suction port in the operating room.

[0222] The fluid management system 175 and suction system 180 are provided within the articulating arm 125 to avoid or reduce the number of external hoses.

[0223] Finally, the system 100 includes a radio frequency (RF) energy generator 185 that regulates and controls the generation of RF energy used by one or more instruments 135 .

[0224] The RF energy generator 185 is a modular component of the system 100, so that it can be installed when needed and replaced with a similar or different system.

[0225] The RF energy generator serves to generate an RF signal for radio frequency ablation (RFA) purposes to the device 135. The RF signal is coupled to the device 135 through internal wiring in the arm 125.

[0226] System 100 may have various other modules coupled to it, as desired.

[0227] Although not shown, system 100 includes a central controller that controls various aspects of the system. The central controller may include one or more processors and memory coupled to the processors, where the memory stores various instruction codes for carrying out the functions of the system.

[0228] The central controller can thereby control the movement and operation of the instrument 135, receive data related to the procedure (e.g., joint temperature and pressure), system data (e.g., pump pressure, flow rate), and provide coordinated control of the various components.

[0229] As an example, if an RF wand is being used, the system can control fluid irrigation rates and RF energy generation based on temperature data associated with the joint to avoid tissue damage.

[0230] As mentioned above, the system 100 includes a camera for capturing image data inside the joint. Due to the limited size of the instrument 135, the camera is a monocular camera.

[0231] One problem with conventional monocular camera systems is that such systems have difficulty perceiving depth, which can result in misinterpretation of image data, which is clearly undesirable.

[0232] In some embodiments, image data from the camera is used to create a depth map from which 3D footage from a 2D source, as well as contour and / or depth data (or derivatives thereof) are overlaid onto the image.

[0233] In one embodiment, multiple images of an area from different points are processed together to create a depth map. Because the instrument 135 moves slowly and clearly, images of the joint may be taken from slightly different angles as the instrument moves through it. Because the patient / joint is generally stationary, these images can be used together to create a depth map, even if they were captured at slightly different times.

[0234] Several different algorithms can be used for this purpose, but generally they are based on geometry and the differences between images taken from slightly different angles: essentially, common points between the images are identified, and the relative translation of these points between the images is used to estimate depth.

[0235] As mentioned above, the arthroscopic instrument 135 is coupled to the surgical arm 130 by a modular endplate. Figure 7a illustrates an endplate 700 for the arthroscopic system 100. Figure 7b shows the mounting portion of the modular endplate 700 for the arthroscopic instrument of the system 100. Figure 7c shows an exploded view of the endplate 700 and mounting portion of Figures 7a and 7b.

[0236] End plate 700 has a receiving portion 705 for receiving mounting portion 705a. Three motors 710a are housed in corresponding motor couplings 710. As best shown in FIG. 7c, a retaining plate 715 is placed over the three motors 710a and corresponding motor couplings 710 to secure the motors 710 in place. Connection means 720 are configured to be received in connection means 720a, thereby connecting the end plate and mounting portion. As best shown in FIG. 7b, the mounting portion has struts 725 that provide support.

[0237] As best seen in Figure 7c, a retaining clip 730 is secured over the mounting portion and is configured to hold a portion of flexible sheath 515 over the mounting portion so as to maintain the sterility of arthroscopic instrument 135 and the surgical site.

[0238] Figure 8a shows a screen shot 800a of a camera image from system 100, without any image overlay. As can be seen from this image, it is very difficult to perceive depth, especially in relation to relatively smooth surfaces.

[0239] FIG. 8b shows a screen shot 800b of a camera image from the system 100 with a contour line 805 overlaid on the image.

[0240] The contour line 805 is overlaid on the image using a series of color-coded dots, however the use of dots is only one example of how the contour line may be displayed, and one skilled in the art will readily appreciate that a solid line may be used instead.

[0241] In other embodiments, shading, coloring, etc. may be used to represent depth and / or distance in the image. Alternatively, the image may be labeled with depth cues in a wide variety of ways.

[0242] In addition to creating a depth map, the image may be processed in various ways before being presented to the user.

[0243] By way of example, images may be flipped and / or scaled to provide a more intuitive user experience. In such cases, images can be flipped and / or scaled to provide a consistent working environment for the surgeon instead of operating based on a flipped view.

[0244] Similarly, image processing can be used to improve image quality, for example by improving contrast, focus, white balance, and resolution. Carefully controlled camera motion simplifies the application of super-resolution techniques, allowing multiple images to be interpolated to produce a higher resolution image than the camera itself.

[0245] In some embodiments, image data may be classified during use. This classification can be performed manually and / or automatically using artificial intelligence (AI).

[0246] In one embodiment, training data from past cases is used to create discriminative classifiers (e.g., via a Haar classifier or similar technique), which are then used to automatically classify the anatomy of the joint.

[0247] In one embodiment, the system is configured to use a classifier to automatically identify "abnormal anatomy" and label it using an image overlay or the like.

[0248] FIG. 9 shows a screen shot 900 of four different image views (i.e., images viewed by a surgeon during surgery) of the system 100 according to an embodiment of the present invention.

[0249] The top left image has an area marked with a bounding box 905 and an associated label indicating "degenerative changes." As outlined above, the system can automatically identify such anatomical structures using discriminative classifiers.

[0250] The image on the top right shows a situation where no boxes or labels are included and therefore no "abnormal anatomy" is identified.

[0251] The bottom left image contains multiple bounding box elements 905, each with a different label.

[0252] Finally, the bottom right image has a single bounding box element 905 with an associated label.

[0253] Those skilled in the art will readily appreciate that such a classifier can be used to identify anything, including not only normal anatomy but also non-anatomical aspects (e.g., devices).

[0254] In addition to the manual control of the instruments described above, the system 100 can have one or more automated features to assist the surgeon in performing the procedure.

[0255] As an example, the system 100 may perform automatic tracking of a first instrument 135 by a second instrument 135. In such a case, the first and second devices operate in a "master-slave" fashion, with the slave following the movements of the master.

[0256] Similarly, the system 100 can automatically move one or more of the instruments 135 according to a desired target or path. The instruments 135 can move according to a desired location using image recognition-based object avoidance. Alternatively, the instruments 135 can simply follow paths taken by other instruments 135.

[0257] Similarly, the system 100 may perform autonomous execution of one or more programs, such as milling. By way of example, the surgeon may select one or more areas where a task or function is to be performed. Parameters may also be defined for the task or function.

[0258] In one embodiment, a user interface can be used to select an area by defining a bounding box, and then milling is selected for that area and performed automatically.

[0259] A task or function can have a repeating task (loop) or multiple subtask operations, which can be performed without further interaction from the surgeon.

[0260] A task or function can be performed by sending motion data to the arm in a particular sequence or by setting parameters in the system to initiate a function.

[0261] The system 100 may be further configured to monitor tasks performed by a surgeon and perform the tasks at a later time, in which case the system may monitor positional, visual, environmental, and operational data to train an AI program to perform such tasks autonomously.

[0262] Additionally, the system 100 can monitor surgical and instrument data to make inventory adjustments, generate purchase orders, and assist with logistics.

[0263] As mentioned above, the frame allows for accurate relative positioning of instruments 135 even when different portals are used. In some embodiments, the surgeon may use a graphical user interface to view the relative positions of the instruments in reference to one another.

[0264] The graphical user interface can depict portions of the patient and show the positions of the instruments relative to each other and to the patient, allowing the surgeon to quickly get an overview of the positions of the various instruments during surgery.

[0265] In some embodiments, image data of the patient's external anatomy is captured. This can be done using a camera associated with the frame. This image data can then be used to identify the patient's position relative to the system 100.

[0266] In some embodiments, markers or markings are placed on the patient that are used as reference points by the system. As an illustrative example, the portal site may be identified on the patient using a marker that is identified by the system.

[0267] The movement of the arm 130 may be controlled and coordinated in any suitable manner. In some embodiments, control of the arm is performed using forward kinematics and / or inverse kinematics.

[0268] As mentioned above, system 100 is modular, allowing for the use of a variety of different arms and instruments as needed. In some embodiments, the arms and / or instruments are registered with system 100 using, for example, a serial number, a QR code, or an RFID.

[0269] Once registered, the system is configured for the arm or instrument, for example, by retrieving parameters from a data store associated with the arm or instrument. Similarly, a command interface can be defined between the arm or instrument and the system's controller.

[0270] Although three arms 130 and instruments 135 are shown in FIG. 1, one skilled in the art will readily appreciate that any suitable number of arms and instruments may be used.

[0271] In addition to the controls and features described above, the system can be configured and reconfigured in many different ways. For example, the system may allow (e.g., using a console) adjustment of the strength of the system, the speed of the system, or even allow parts of the system (e.g., the arms) to be manually repositioned.

[0272] In addition to assisting the surgeon in performing the procedure, the system 100 may be configured to capture surgical data and record the procedure. Such surgical data may include image data captured during the procedure, as well as system and instrument time series data.

[0273] In some embodiments, the system may be configured to capture additional data directly from the surgeon, such as a microphone configured to record the surgeon's voice and / or a data entry form, allowing the surgeon to document the procedure (e.g., clinical recording and note-taking).

[0274] The system can then share this data with one or more applications or third-party systems. For example, clinical notes may be automatically uploaded to a clinical record system.

[0275] In some embodiments, QR code-based pairing can be used to associate a procedure with a specific surgeon. In such cases, the surgeon has an application installed on their smart device that is configured to scan a QR code associated with that system. The QR code is displayed on the screen and updates over time, providing data security.

[0276] Alternatively, the account may be directly associated with the system 100 .

[0277] As will be readily appreciated by those skilled in the art, embodiments of the system 100 may have a variety of forms and / or functions without departing from the scope of the present invention.

[0278] FIG. 10 is a perspective view of a portion of an arthroscopic surgery system 1000 according to an alternative embodiment of the present invention.

[0279] Arthroscopic surgery system 1000 is similar to system 100 and includes a frame 1020 having a wheeled base 1005, an articulating arm 1025 extending upwardly therefrom, and a plurality of surgical arms 1030 extending therefrom.

[0280] The arthroscopic instrument 135 is not shown in the system 1000, but instead includes a modular mounting plate 1030a at the end of the arm 1030 to allow for different instruments to be attached as needed.

[0281] The frame 1020 is annular and rotatable.

[0282] As mentioned above, a user interface is provided to allow the surgeon to remotely control the arthroscopic instrument, which may be provided by a headset or a display screen as outlined above.

[0283] FIG. 11 is a diagram showing a screen shot of a surgery screen of an arthroscopic surgery system according to an embodiment of the present invention.

[0284] The surgical screen has a live image element 1105 for displaying images from the arthroscopic camera. The image element 1105 updates in real time or near real time and has various settings elements for adjusting the image, such as white balance, contrast, brightness, focus, adding depth cues / contours, or automatically generating and displaying a 3D image from 2D image data and depth information.

[0285] The surgery screen also includes an Instrument Settings element 1110 through which instruments can be configured, including setting one instrument as a master instrument and other instruments as slave instruments that follow the master instrument.

[0286] A fluid / electrical control element 1115 is provided to display temperature and electrical data and to allow alarms to be set based thereon. By way of example, this element 1115 allows alarms to be set if the temperature or pressure of the fluid exceeds a certain threshold.

[0287] The surgical screen has a map element 1120 that shows the relative position and configuration of the system according to a coordinate system.

[0288] Those skilled in the art will readily appreciate that the coordinate system may have a variety of other functions, such as configuration functions, menus, settings, documentation elements, status elements, and the like.

[0289] FIG. 12 shows the attachment end of the arthroscopic instrument with the hand grip of the system 100.

[0290] The mounting end 1200 has a mounting plate 1205 configured to engage with a hand grip 1300 as shown in Figure 13. The hand grip has a rotary joystick 1305 and a motor 1310.

[0291] In use, it is envisioned that hand grip 1300 is attached to surgical arm 130 along with mounting end 1200. Hand grip 1300 is then grasped by the surgeon and moved into position. Hand grip 1300 is coupled to one or more of surgical arms 130 such that movement in hand grip 1300 causes corresponding movement of the remaining surgical arms 130. Those skilled in the art will appreciate that such a configuration is useful for initially positioning surgical arm 130 at the surgical site.

[0292] 14 is a side view of a surgical arm 1400 of arthroscopic system 100. As shown, surgical arm 1400 has a mounting plate configured to engage hand grip 1300. Those skilled in the art will appreciate that surgical arm 1400 may include any suitable arthroscopic instrument.

[0293] The surgical arm 1400 has two handgrips 1405 to assist in movement of the surgical arm 1400. The handgrips are used to position the surgical arm 1400 in an appropriate location, such as at the surgical site or adjacent to the articulating arm 125 of the system 100 when the system 100 is not in use.

[0294] The surgical arm 1400 has a mounting end 1200 and a mounting plate 1205. The mounting plate 1205 is capable of engaging with a hand grip 1300.

[0295] 15 shows a side view of an alternative embodiment of an articulating arm 1500. The articulating arm 1500 is similar to the articulating arm 125 and frame 120 of the system 100. The articulating arm 1500 has pivot openings and pivot pins that allow the arm segments 1510a, 1510b, 1510c to pivot.

[0296] The ring frame 1515 has two extrusions 1520 extending perpendicularly from a centrally located location of the ring frame 1515 and extending diametrically about the ring frame 1515. A movement assembly 1525 is attached to the bottom of the ring frame 1515 for connecting the surgical arm 130 to the ring frame 1515 for movement thereabout.

[0297] Figure 16 shows an enlarged side view of the annular frame 1515 and translation assembly 1525 of Figure 15. The translation assembly 1525 has four rollers 1535 configured to engage tracks 1530 defined in the annular frame 1515.

[0298] Advantageously, arthroscopic surgery methods and systems have been described above that simplify arthroscopic surgery, thereby reducing the potential for damage or injury resulting from the surgery itself. Furthermore, the methods and systems are easier to use than conventional arthroscopic instruments, thereby reducing the barrier to entry for arthroscopic surgery.

[0299] Unlike laparoscopic robots, which are large and bulky and cannot be effectively used for arthroscopic surgery, the arthroscopic surgery method and system described above is not only sized appropriately for arthroscopic surgery, but also allows for access to the joint from multiple portals while the instruments remain precisely positioned at a common reference point.

[0300] Additionally, regulation of flow, pressure or temperature is provided rather than a system that encourages energy dissipation into adjacent tissue, which can damage the cartilage.

[0301] In this specification and claims (if any), the words "comprises" and "comprising" and their derivatives with "comprise" include each of the integers listed but do not exclude the inclusion of one or more further integers.

[0302] Throughout this specification, a reference to "one embodiment" or "an embodiment" means that a particular feature, structure, or characteristic described in connection with the embodiment is included in at least one embodiment of the present invention. Thus, the appearances of the phrase "in one embodiment" or "in an embodiment" in various places throughout this specification do not necessarily all refer to the same embodiment. Furthermore, the particular features, structures, or characteristics may be combined in any suitable manner in one or more combinations.

[0303] In accordance with the statute, the invention has been described in terms more or less specific to structural or methodical features. It is to be understood that the invention is not limited to the specific features shown or described, since the means described herein comprise preferred forms for carrying out the invention. The invention is therefore claimed in any of its forms or modifications within the proper scope of the appended claims, if any, as appropriately interpreted by those skilled in the art.

Claims

1. a frame configurable to extend above or laterally of at least a portion of a patient being operated on; one or more surgical arms extending from the frame, each having an arthroscopic instrument; An arthroscopic surgery system, wherein the one or more surgical arms and associated arthroscopic instruments are remotely controllable from a user interface to perform arthroscopic surgery.

2. The arthroscopic surgery system of claim 1 , wherein the frame is annular.

3. The arthroscopic surgery system of claim 1 , wherein the one or more surgical arms include a plurality of surgical arms extending from the frame at a plurality of different positions.

4. The arthroscopic surgery system of claim 1 , wherein the one or more surgical arms are removably coupled to the frame.

5. The arthroscopic surgery system of claim 1 , wherein at least one of the one or more surgical arms is secured to the frame using a track.

6. 10. The arthroscopic surgery system of claim 1, wherein at least one of the one or more surgical arms includes a modular endplate configured to engage with various arthroscopic instruments, the modular endplate having one or more electronic, sensing and / or drive elements configured to engage with corresponding elements of the arthroscopic instrument.

7. 10. The arthroscopic surgery system of claim 1, wherein the instrument includes an arthroscopic camera configured to capture images during surgery, the system further comprising a headset configured to display the captured images.

8. The arthroscopic surgery system of claim 1 , wherein at least one of the one or more arthroscopic instruments has an articulating portion configured to enter the patient's joint during surgery.

9. The arthroscopic surgery system according to claim 8 , wherein the articulation section has a rotary joint configured to allow a tip of the articulation section to change position.

10. 10. The arthroscopic surgery system of claim 1, further comprising a handheld controller having more than three degrees of freedom, wherein the one or more surgical arms and associated arthroscopic instruments are remotely controllable by the handheld controller to perform arthroscopic surgery.

11. at least one drape configured to extend over at least one of the one or more surgical arms, each of the at least one drape comprising: one or both of: 1) a rigid upper mount configured to be received intermediate the frame and one of the one or more surgical arms; and 2) a rigid lower mount configured to be received intermediate one of the one or more surgical arms and the arthroscopic instrument; The arthroscopic surgery system of claim 1 , further comprising: a sheath extending from one or both of the rigid upper mount and the rigid lower mount.

12. At least one of the arthroscopic instruments comprises a surgical camera, the surgical camera comprising: a reusable base having an interface for providing an image from the camera; The arthroscopic surgery system of claim 1 , further comprising: a disposable distal portion removably coupled to the reusable base portion and extending outwardly from the reusable base portion.

13. 10. The arthroscopic surgery system of claim 1, comprising a fluid management system having one or more pumps and valves for regulating fluid pressure and flow at a surgical site, the one or more pumps and valves being connected to the surgical site by tubing.

14. The arthroscopic surgery system of claim 13 , wherein the tube is associated with one or more drapes configured to extend over at least one of the one or more surgical arms.

15. The arthroscopic surgery system of claim 1 , wherein at least one arthroscopic instrument includes a camera, the camera configured to be inserted into the surgical site.

16. 16. The arthroscopic surgery system of claim 15, wherein the image generated by the camera is processed and presented to the surgeon, the processing comprising one or more of changing the color, contrast resolution, or exposure of the image, flipping and / or scaling the image, or converting the image to a three-dimensional image.

17. The arthroscopic surgery system of claim 15 , wherein the images generated by the camera are presented to the surgeon with overlays such as contour lines and / or depth indicators, surgical information, or device information.

18. The arthroscopic surgery system of claim 1 , wherein at least one of the arthroscopic instruments includes one or more sensors, such as a temperature sensor, a load sensor, or a position sensor, and data from the sensors is provided to the system.

19. The arthroscopic surgery system of claim 1 , wherein at least one of the one or more surgical arms is in wireless communication with a controller of the system.

20. The arthroscopic surgery system of claim 1 , comprising a console having a display and one or more user input devices for enabling a user to interact with the system.

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