Device and method for extending the working envelope of a surgery assistance robot, and surgery assistance robot

Abstract

The device (26) for extending the working envelope (22) of a surgery assistance robot (10) comprises a carriage (11), a robotic arm (14, 15) provided with a base (23), a calibration means (13) for calibrating between a medical image and a geometric frame of reference of the robot, and a tiltable base (28) positioned between the carriage and the base of the robotic arm, this base being configured to remain rigid while calibration is being carried out by the calibration means and during the movements of the robotic arm.

Description

[0001] DESCRIPTION

[0002] TITLE OF THE INVENTION: DEVICE AND METHOD FOR EXTENDING THE WORKING ENVELOPE OF A SURGICAL ASSISTANCE ROBOT AND SURGICAL ASSISTANCE ROBOT

[0003] TECHNICAL FIELD OF THE INVENTION

[0004] The present invention relates to a device and a method for extending the working envelope of a surgical robot and to a surgical robot implementing it. The present invention also relates to a device for securing a surgical robot carriage to a patient's head and to a robot carriage incorporating it. It is particularly applicable to the field of computer-assisted cranial surgery.

[0005] STATE OF THE ART

[0006] The approaches described in this section are approaches that could be pursued, but not necessarily approaches that have been previously conceived or pursued. Therefore, unless otherwise stated, it should not be assumed that any of the approaches described in this section constitutes prior art simply because of its inclusion in this section.

[0007] During robot-assisted surgery, a robotic arm is moved to position a guide that the surgeon uses to move surgical instruments. The mechanical configuration of the robotic arm is determined by the dimensions of its rigid links and joints, and the joint orientation capabilities. This configuration allows the robotic arm to position the guide at any point and in any orientation within a given volume, called the "working envelope." Beyond this working envelope, the position or orientation of the guide can no longer be guaranteed.

[0008] Current mobile surgical robots have a fixed working envelope defined by their mechanical architecture, which limits their ability to access certain anatomical areas during surgery. This work envelope constraint also limits the number of surgical procedures that can be performed by these robotic systems. Increasing this working envelope requires modifying the configuration of the robotic arm, which presents numerous challenges, particularly in terms of cost, ergonomics, weight, volume, regulatory approvals, and so on.

[0009] During robotic-assisted brain surgery, it is necessary to secure the patient's head to a trolley supporting a robotic arm. The goal is to create a rigid assembly that minimizes the patient's head movement relative to the robotic surgical unit, thus maintaining the accuracy required for aligning the robot, the patient, and the medical imaging. A mechanical assembly is commonly used to create a rigid link between the robotic unit and a headrest that restricts the patient's head movement. These mechanical systems can be complex to assemble. Errors in assembly and locking by users can lead to mechanical play, resulting in a loss of precision in the associated robotic system. Furthermore, these assemblies are bulky and difficult to move within the confined space of an operating room.

[0010] For example, some robot trolleys have a telescopic arm that extends to connect to a stereotaxic frame that is itself previously attached to the patient's head. This type of arm has several drawbacks. First, it occupies a significant amount of space inside the trolley, reducing the available room for other internal components and / or imposing large dimensions on the trolley, hindering ease of use and maneuverability. Second, it has limited axial rigidity, reducing the accuracy of positioning the patient's head within the trolley's geometric reference frame, or it requires a large vertical cross-section, which also complicates its integration into the trolley.

[0011] There is also a known attachment system for the "Neuromate®" surgical robot that is unique in that it is immobilized in the operating room, notably by means of a pillar anchored to the floor. This system has several drawbacks, primarily related to its floor immobilization: it takes up significant space in an operating room, it alters the room's layout, and consequently limits its specialization to neurosurgery. Furthermore, its rigid design (floor fixing) reduces the possibilities for adapting to the patient's positioning.

[0012] SUMMARY OF THE INVENTION

[0013] The present invention aims to overcome all or part of the aforementioned drawbacks by proposing a device and a method for extending the working envelope of a surgical assistance robot which includes a tiltable base for a robotic arm, this base remaining rigid once the registration has been carried out between the medical imaging and the geometric reference of the robot.

[0014] The tilt of the base moves the working envelope of the robotic arm and therefore extends it, in a particular direction, towards the intervention area on the patient's body.

[0015] In some embodiments, the device comprises:

[0016] - a trolley carrying an anthropomorphic or SCARA type robotic aiming arm itself carrying a surgical instrument guide, mobile after recalibration and - a tilting device located between the trolley and the aiming arm, immobile during and after recalibration.

[0017] Note that the acronym SCARA stands for "Selective Compliance Assembly Robot Arm".

[0018] Thus, according to a first aspect, the present invention aims at a device for extending the working envelope of a surgical assistance robot which includes a trolley, a robotic arm equipped with a base, a means for registration between a medical image and a geometric reference of the robot, an inclinable base positioned between the trolley and the base of the robotic arm, this base being configured to remain rigid during a registration carried out by the registration means and during the movements of the robotic arm.

[0019] The tilting of the base moves the working envelope of the robotic arm and therefore extends it towards the intervention area on the patient's body.

[0020] In some embodiments, the tilting base includes a bracket with two arms connected by a hinge joint, one of the arms being fixed to the carriage, the other arm being fixed to the base of the robotic arm, to vary the angle between the axis perpendicular to the base and the vertical.

[0021] In some embodiments, the axis of the hinge joint is horizontal.

[0022] In some embodiments, the axis of the hinge joint is perpendicular to a vertical plane passing through a support arm of a headrest.

[0023] In some embodiments, the axis of the hinge joint is on the upper face of the carriage.

[0024] In some embodiments, the device also includes a means for manually locking the inclination of the base.

[0025] A manual tilting and / or locking mechanism offers advantages in terms of cost, ease of use, and independence from the robot's central processing unit. Therefore, the present invention can be deployed on existing robots without modifying their robotic arm calibration and movement software.

[0026] In some embodiments, the device of the invention further comprises a motorized tilting means for the tiltable base.

[0027] The motorized tilting of the base allows this tilting to be controlled by a central unit of the robot, for example according to the type of surgical procedure to be performed and / or the configuration of the operating room.

[0028] In some embodiments, the motorized tilting means includes at least one motorized cylinder.

[0029] In some embodiments, the motorized tilting mechanism includes a parallel robot. A parallel robot has the advantage of allowing tilting in all directions and a wide range of tilt angle values. Furthermore, a parallel robot typically includes position sensors that provide precise knowledge of the orientation of the robotic arm's base.

[0030] In some embodiments, the device of the invention further comprises a marker or sensor of the locked state of the tilting means.

[0031] The robot operator or the central unit controlling the robot can thus verify that the tilt mechanism is locked. If this lock is not engaged, the alignment between the medical imaging and the robot's geometric coordinate system and / or the movements of the robotic arm may be inhibited.

[0032] In some embodiments, the device that is the subject of the invention further comprises:

[0033] - a pivot joint on a wall of the carriage, the axis of rotation of said pivot joint being horizontal,

[0034] - an arm mounted on this pivot joint,

[0035] - a means of locking the angular position of the arm relative to the wall of the carriage, and

[0036] - a fixing attachment for the position and orientation of a headrest or stereotaxic frame in relation to the arm.

[0037] Thus, the pivot joint of the arm has two cumulative technical characteristics. Firstly, it is located on a wall of the carriage, and secondly, its axis of rotation is horizontal. Thanks to these arrangements, the patient head support arm does not obstruct the interior of the surgical robot carriage, and it increases the carriage's external dimensions very little, both when not in use and during surgical procedures.

[0038] According to a second aspect, the present invention relates to a surgical assistance robot, which includes a trolley, a robotic arm equipped with a base, a means of registration between a medical image and a geometric reference of the robot and an extension device which is the subject of the invention.

[0039] The advantages, purposes and special characteristics of this robot being similar to those of the device which is the subject of the invention, they are not recalled here.

[0040] In embodiments, this robot further includes a means for determining the locked state of the base tilt, the recalibration means being configured not to perform recalibration when this determination means indicates an unlocked state of the base and / or the robotic arm being configured not to perform movement when this determination means indicates an unlocked state of the base.

[0041] According to a third aspect, the present invention relates to a method for extending the working envelope of a surgical assistance robot comprising a trolley and a robotic arm equipped with a base, which comprises, successively: - a tilting step of a tiltable base positioned between the trolley and the base of the robotic arm,

[0042] - a step for locking the base's tilt, and

[0043] - a registration step between a medical image and a geometric reference of the robot.

[0044] In some embodiments, the tilting step of the tiltable base varies the angle between the axis perpendicular to the base and a vertical line.

[0045] The advantages, purposes and particular characteristics of this process being similar to those of the device which is the subject of the invention, they are not recalled here.

[0046] In embodiments, the method of the invention includes a step of determining the locked state of the inclination of the base, the recalibration step being inhibited when this inclination is not locked.

[0047] The present invention also relates to a surgical assistance robot coupled to a mobile chassis incorporating a rigid foldable arm whose distal end has a rigid attachment system to a headrest in order to facilitate its storage and minimize its bulk.

[0048] Thus, the arm remains outside the chassis of the trolley. It therefore does not impose any constraints on the internal components of this chassis or its overall volume.

[0049] The arm is connected to the trolley frame via a pivot joint. The system implementing this pivot joint, for example a hinge, includes a locking mechanism and, preferably, a means for indicating the locking status. The rigid attachment system to the headrest may also include a means for indicating the locking status of the system. Preferably, at least a portion of the arm is radio-transparent. Preferably, the folding arm may be telescopic.

[0050] In some embodiments, the pivot joint is mounted on the wall of the carriage via a sliding joint.

[0051] Preferably, the pivot joint is equipped with a pivot joint locking marker or sensor.

[0052] Thus, according to a fourth aspect, the present invention relates to a device for securing a surgical robot carriage and the head of a patient, which includes a pivot joint on a wall of the carriage, an arm mounted on this pivot joint, a means for locking the angular position of the arm relative to the wall of the carriage, and a locking attachment for the position and orientation of a headrest or stereotaxic frame relative to the arm.

[0053] Thanks to these arrangements, the patient head support arm does not clutter the inside of the surgical robot trolley.

[0054] In some embodiments, the axis of rotation of the pivot joint is horizontal. Thus, the pivot joint of the arm has two cumulative technical characteristics. First, it is located on a wall of the carriage, and second, its axis of rotation is horizontal. Thanks to these arrangements, the patient head support arm does not obstruct the interior of the surgical robot carriage, and it only minimally increases the carriage's external dimensions, both when not in use and during surgical procedures.

[0055] In some embodiments, the device which is the subject of the fourth aspect of the invention further comprises a marker or a locking sensor for the pivot joint.

[0056] Thus, visually, audibly or electrically, an operator and / or an electronic and computer circuit of the trolley can verify the locking of the pivot link.

[0057] In some embodiments, the arm is telescopic.

[0058] Thanks to these provisions, the position of the fixation attachment can be adapted to the respective position of the trolley and the head of the patient lying on the operating table, by simply deploying the telescopic arm.

[0059] In some embodiments, the device which is the subject of the fourth aspect of the invention further comprises a marker or a locking sensor for the deployment of the telescopic arm.

[0060] Thus, visually, audibly or electrically, an operator and / or an electronic and computer circuit of the truck can verify the locking of the telescopic arm extension.

[0061] In some embodiments, the device which is the subject of the fourth aspect of the invention further comprises a sliding connection of the pivot connection on the wall of the carriage.

[0062] The vertical position of the support arm can thus be easily modified by sliding the pivot joint on the sliding joint.

[0063] In some embodiments, the device which is the subject of the fourth aspect of the invention further comprises a marker or a locking sensor for the sliding link.

[0064] Thus, visually, audibly or electrically, an operator and / or an electronic and computer circuit of the trolley can check the locking of the sliding link and therefore the height of the headrest attachment or stereotaxic frame.

[0065] In embodiments, the device which is the subject of the fourth aspect of the invention further comprises a movable reinforcement connecting the wall of the carriage to the arm and configured to support the arm in a position away from the wall of the carriage on which the pivot joint is mounted.

[0066] The rigidity of the support arm is thus reinforced.

[0067] In some embodiments, the device which is the subject of the fourth aspect of the invention further comprises a marker or a locking sensor for the mobile reinforcement.

[0068] Thus, visually, audibly, or electrically, an operator and / or an electronic and computer circuit of the trolley can verify the locking of the mobile reinforcement. In some embodiments, at least part of the arm is radio-transparent.

[0069] In this way, a medical image can be obtained in the operating room with a scanner without artifacts caused by the support arm.

[0070] According to a fifth aspect, the present invention relates to a surgical robot cart, which includes a device described in the fourth aspect of the present invention. Since the advantages, purposes, and specific features of this cart are similar to those of the device described in the fourth aspect of the invention, they are not described here.

[0071] BRIEF DESCRIPTION OF THE FIGURES

[0072] Other advantages, purposes and specific features of the invention will become apparent from the following non-limiting description of at least one particular embodiment of the device and robot that are the subject of the present invention, with reference to the accompanying drawings, in which:

[0073] Figure 1 schematically represents, in side view, a first embodiment of a device for extending the working envelope of a surgical assistance robot, the subject of the invention, in its neutral configuration.

[0074] Figure 2 schematically represents, in side view, the device illustrated in Figure 1, in its envelope extension configuration.

[0075] Figure 3 schematically represents, in side view, a second embodiment of a device for extending the working envelope of a surgical assistance robot, the subject of the invention, in its extended configuration.

[0076] Figure 4 represents, in the form of a flowchart, the steps for implementing the device that is the subject of the invention,

[0077] Figure 5 schematically represents, in side view, a third embodiment of a trolley with a support arm in a folded position.

[0078] Figure 6 schematically represents, in side view, the trolley illustrated in Figure 5, with its support arm in the unfolded position.

[0079] Figure 7 schematically represents, in side view, the trolley illustrated in Figure 5, with its support arm in the unfolded position and a telescopic extension deployed.

[0080] Figure 8 schematically represents, in side view, an implementation of the trolley illustrated in Figure 5, during a surgical procedure with robotic assistance.

[0081] Figure 9 schematically represents, in side view, a fourth embodiment of the trolley that is the subject of the invention,

[0082] Figure 10 schematically represents, in side view, a fifth embodiment of the trolley that is the subject of the invention, and

[0083] Figure 11 represents, in the form of a flowchart, the steps for implementing the device that is the subject of the invention. DESCRIPTION OF THE IMPLEMENTATION METHODS

[0084] The present description is given by way of non-limiting attribution, each feature of an embodiment being able to be advantageously combined with any other feature of any other embodiment.

[0085] It should be noted from the outset that the figures are not to scale.

[0086] As can be understood from this description, various inventive concepts can be implemented by one or more of the methods or devices described below, several examples of which are provided herein. The actions or steps performed in implementing the method or device can be ordered in any appropriate manner. Consequently, it is possible to construct embodiments in which the actions or steps are performed in a different order than illustrated, which may include performing certain acts simultaneously, even if they are presented as sequential acts in the illustrated embodiments.

[0087] The indefinite articles "un" and "une", as used in the description, should be understood as meaning "at least one", unless clearly stated otherwise.

[0088] The expression "and / or," as used in this document, should be understood as meaning "either or both" of the elements thus joined, that is, elements that are present conjunctively in some cases and disjunctively in others. Multiple elements listed with "and / or" should be interpreted in the same way, that is, "one or more" of the elements thus joined. Other elements may also be present, besides those specifically identified by the "and / or" clause, whether or not they are related to those specifically identified elements.Thus, by way of non-limiting example, a reference to "A and / or B", when used in conjunction with an open language such as "including", may refer, in one embodiment, to A only (possibly including elements other than B); in another embodiment, to B only (possibly including elements other than A); in yet another embodiment, to A and B (possibly including other elements); etc.

[0089] As used here in the description, "or" should be understood inclusively.

[0090] As used in this description, the expression "at least one," when referring to a list of one or more items, should be understood as meaning at least one item chosen from one or more items in the list of items, but not necessarily including at least one of each item specifically listed in the list of items and not excluding any combination of items in the list of items. This definition also allows for the optional presence of items other than those specifically identified in the list of items to which the expression "at least one" refers, whether or not they are related to those specifically identified items.Thus, by way of non-limiting example, "at least one of A and B" (or, equivalently, "at least one of A or B", or, equivalently, "at least one of A and / or B") may refer, in one embodiment, to at least one, possibly including more than one, A, without B present (and possibly including elements other than B); in another embodiment, to at least one, possibly including more than one, B, without A present (and possibly including elements other than A); in yet another embodiment, to at least one, possibly including more than one, A, and at least one, possibly including more than one, B (and possibly including other elements); etc.

[0091] In the description below, all transitive expressions such as "comprising", "including", "carrying", "having", "containing", "implying", "holding", "composed of", and others, should be understood as open, that is, as meaning including but not limited to. Only the transitive expressions "consisting of" and "consisting essentially of" should be understood as closed or semi-closed transitive expressions, respectively.

[0092] Throughout this description, the terms "upper" and "top" refer to what is at the top when the device of the present invention is in its operational configuration. The terms "lower" and "bottom" refer to what is at the bottom when the device of the present invention is in its operational configuration. The term "inside" refers to what is inside the device. The term "outside" refers to what is outside the device.

[0093] The figures illustrate an application of the invention to a cranial surgery robot. Of course, the present invention is also applicable to any other type of surgery, for example, of the knee or spine.

[0094] The first embodiment is shown in Figures 1 and 2. A robot 10 comprises a carriage 11 mounted on casters 12 and a robotic arm with a base 23. The robotic arm is either anthropomorphic or SCARA type. In the figures, the robotic arm is anthropomorphic and has rigid links 14 and joints 15. On one side of the carriage 11 is a support arm 16 for a headrest or stereotaxic frame 17 that holds the head 18 of a patient 19 lying on an operating table 20 in position. In some variations, the support arm is independent of the carriage, for example, by being fixed to the floor. The robot 10 includes a central unit 13 configured to perform the registration between the medical imaging and the geometric coordinate system of the robotic arm, that is, to match the geometric coordinates in the robot's real space with the geometric coordinates in the medical imaging.This central unit 13 is shown in the trolley 11, but it can be located on another trolley, for example a navigation trolley, or remotely, for example on a server communicating with the trolley 11. The trolley 11 is equipped with jacks (not shown) actuating support feet on the ground, which fix the trolley 11 in position and stabilize it during the movements of the robotic arm 14 and 15.

[0095] The work envelope 22 of robot 10 is represented by dashed lines.

[0096] Between the carriage 11 and the robotic arm 14 and 15 is a steerable base. It should be noted here that the term "steerable" means the ability to change the tilt, that is, the angle formed between the axis perpendicular to the base 23 and a vertical line and, possibly, the ability to change the angle formed between this axis and a fixed vertical plane. In other words, steerable means at least one degree of freedom corresponding to the variation of the tilt.

[0097] In the first embodiment, this swiveling base includes a motorized tilting means. For example, the motorized tilting means includes at least one motorized cylinder 24.

[0098] In the first embodiment, this steerable base consists of a parallel robot 25. A parallel robot is a mechanism whose architecture gives it remarkable properties. The technical definition of such a robot is: a closed kinematic chain mechanism whose end effector is connected to the base by several independent kinematic chains. Such a parallel robot 25 consists of extendable "parallel" links 24 connected to a common base. These links 24 are not geometrically parallel, to reduce the risk of twisting of the robot 25, but their kinematics are independent, which is why they are described as parallel to the robot 25. These links 24 include, for example, electric actuators, for example, six of them.It should be noted that, for the implementation of the first three aspects of the present invention, a single link 24 is sufficient, for example, in the case where the base 23 of the robotic arm 14 and 15 is connected to the carriage 11 by a hinge link. By analogy with the case where more than one link 24 is provided, in this document, a robot having only one link 24 is also called a "parallel robot".

[0099] As illustrated in figure 2, by orienting the base 23 of the robotic arm 14 and 15, by implementing the parallel robot 25, the working envelope 22 of the robotic arm 14 and 15 is moved towards the surgical intervention area, here the head 18 of the patient 19.

[0100] It is important to note that the parallel robot 25 does not operate in conjunction with the robotic arms 14 and 15. Indeed, once oriented, the parallel robot 25 remains rigid during and after the registration process. In contrast, the robotic arms 14 and 15 are mobile during and after registration to position a guide near or in contact with the surgical intervention area.

[0101] In other words, the robotic arm 14 and 15 does not include the parallel robot 25 and the central unit 13, which controls the operation of the electrical components of the robotic arm 14 and 15, in particular the motors located in the joints and at the distal end of the robotic arm 14 and 15, independently controls, in two successive phases of operation, the movements of the parallel robot 25 and the robotic arm 14 and 15. Thus, the implementation of the first three aspects of the present invention only very slightly modifies the operation of a robot 10 not having a steerable base.A simple control of the robot 25's orientation, which can be implemented by elements other than the central unit 13, for example via a touchscreen user interface and / or a button (in the case of a parallel robot with only one linkage 24) or two buttons (one to control the tilt angle and the other to control the tilt direction) operated by a user, is sufficient to implement the first three aspects of the invention. The tilt control of this user interface and / or each such button is deactivated by the central unit 13 as soon as the recalibration begins, so that this tilt cannot be changed without altering the recalibration.

[0102] In the second embodiment, illustrated in Figure 3, the orientable base of the robotic arm 14 and 15 is a tilting base 28, having only one degree of freedom to vary the angle between the axis perpendicular to the base 23 and a vertical line. An adjustable bracket 26 includes a hinge joint 30 and a means for locking the angle between the arms of the bracket, one of these arms being fixed to the carriage 11 and the other to the base 28 of the base 23 of the robotic arm 14 and 15.

[0103] As shown in Figure 3, the axis of the hinge joint 30, perpendicular to the plane of Figure 3, is horizontal and perpendicular to the vertical plane passing through the support arm 16. Preferably, this axis 30 is located on the upper face of the carriage 11. Preferably, the locking mechanism is manually operated, requiring no motorization. Preferably, and as shown in Figure 3, the robotic arm 14 is an anthropomorphic robot.

[0104] In embodiments such as that illustrated in Figure 3, this adjustable bracket 26 has an arc of a circle whose center is on the axis of the hinge joint, equipped with mechanical markers 27, for example circular holes, on which a mechanical part, for example a sliding lock, mounted under the base 23, can be manually locked. These markers denote preferred inclinations, for example in five-degree increments up to thirty or forty degrees.

[0105] In some embodiments, the inclination of the base 28 can only be locked in two extreme positions.

[0106] A marker or sensor 29 of the locked state of the base 28's tilt provides a signal representing this state. With a marker, this signal can be visual, for example, the locking mechanism causing a colored surface to appear at the end of the lock when it is engaged, or audible, with the locking mechanism producing a recognizable sound. With a sensor 29, this signal can also be electrical, for example, via a dry contact in an electronic circuit that is closed when the locking mechanism is engaged, or via a magnetic sensor. With such a sensor 29, this signal can be processed by an electronic and / or computer circuit so that an indicator light on a user interface changes to indicate to the operator that the base 28's tilt is locked in the operating position.This signal can also be processed by the central unit 13 of the robot 10 to prohibit all or part of the functions of the robot 10, for example the recalibration and / or the movements of the robotic arm 14 and 15, when the tilting base 28 is not in a locked state.

[0107] In embodiments (not shown), the orientable base of the robotic arm 14 and 15 is a combination of two tiltable bases, each having only one degree of freedom, made up, for example, of two adjustable brackets whose axes of rotation are not parallel.

[0108] In both embodiments of the robot 10 described above, the robot 10 includes a means for determining the locked state of the orientation of the base 25 or 28. This means may be:

[0109] - in the control software of the parallel robot 25, which transmits to the central unit 13 a message indicating that the orientation of the parallel robot 25 is locked,

[0110] - on a user interface communicating with the central unit 13, through which an operator confirms the locking of the base orientation, where

[0111] - a sensor 29 of a locked state of the tilting means of the tiltable base.

[0112] The recalibration means 13 is configured not to perform recalibration when this determination means indicates an unlocked state of the tilting base and the robotic arm 14 and 15 is configured not to perform movement when this determination means indicates an unlocked state of the tilting base.

[0113] In other embodiments (not shown), the robot 10 and the device, 25 or 26, do not include a means for determining the locked state of the orientation of the tiltable base.

[0114] Figure 4 shows steps of process 40 for implementing the device and the robot that are the subject of the invention.

[0115] During step 41, an operator positions the trolley 11 and immobilizes it by deploying its feet via their jacks.

[0116] During step 42, the operator controls the orientation of the robotic arm's tilting base. For example, this orientation depends on the surgical procedure to be performed and / or the operating room configuration. For instance, surgery on the patient's spine may require a greater tilt of the base than surgery on the patient's skull. As another example, positioning the carriage near a long side of the operating table requires a smaller tilt of the base than positioning it near a short side.

[0117] In step 43, the operator locks the orientation of the tilting base. In step 44, the locked state of the base's tilt is determined; the realignment step 45 is inhibited when this tilt is not locked.

[0118] As explained above, for this determination step, the operator, the circuits, or the software of the carriage 11 checks that the orientation of the tilting base is locked. Preferably, during step 44, the locked state of the base's tilt is captured via a sensor 29, and the transition to step 45 is inhibited until this tilt is locked. Also preferably, during step 44, the deployed state of the carriage 11's feet is captured via another sensor (not shown), and the transition to step 45 is inhibited until the carriage 11's feet are deployed.

[0119] During step 45, the operator performs the registration of the position and orientation of the intervention area, the medical imaging, and the robot's geometric reference frame. Registration involves, for example, a robot probe or a navigation camera and a pointer equipped with a handheld navigation reference, attached to the patient's head, or fixed to the headrest or stereotaxic frame. A navigation reference 21, illustrated in Figures 1 to 3, is a set of at least four markers pre-mounted on a rigid support in non-coplanar and asymmetrical positions. An image of this navigation reference thus allows the position (three coordinates in an orthonormal coordinate system) and orientation (three angular coordinates in this system) of this navigation reference 21 to be determined. The robotic arm is then configured for performing a surgical procedure.

[0120] After the end of the surgical operation, the robot removal steps are the reverse of steps 44 to 41.

[0121] The implementation of the first three aspects of the present invention has the following advantages:

[0122] - it increases the workspace of a surgical aiming assistance robot,

[0123] - It provides increased accessibility to the patient's different anatomical areas,

[0124] - It increases the number of surgical procedures that can be performed by a targeting robot.

[0125] - it allows maintaining the precision of the spatial positioning of an instrument guide at the end of the robotic arm of the surgical aiming assistance robot.

[0126] Advantageously, the particular technical characteristics of the first three aspects of the invention combine with those of the last two aspects, described opposite Figures 5 to 11, to form a robot and a trolley that can jointly shift the working envelope of the robotic arm towards the operating table and support a part of the patient's body without cluttering the internal volume of the trolley.

[0127] The third embodiment is shown in Figures 5 to 8. A robot 50 includes a carriage 51 mounted on casters 54 and a robotic arm 52 having joints 53. On one of the walls of the carriage 51, there is a pivot joint 55, for example a hinge, on which a support arm 56 is mounted. The support arm 56 can thus perform a rotation (illustrated by an arrow in Figure 6) around the pivot joint 55, so that its distal end 57 moves away from the chassis of the carriage 51 and extends towards the head of a patient to be operated on.

[0128] The robotic arm 52 is an anthropomorphic industrial robotic arm. The carriage 51 is equipped with a ground stabilization system (not shown), for example, jacks (not shown) actuating support feet on the ground. This stabilization system fixes the carriage 51 in position and prevents its movement during the movements of the robotic arm 52. The support arm 56 has a base (not shown) perpendicular to its main axis. This base is connected to the pivot joint 55 so as to pivot about the horizontal axis of rotation of this pivot joint 55.

[0129] The pivot joint 55 is equipped with locking means (not shown) configured so that once the base of the support arm 56 reaches the end of its upward rotation, these locking means secure the base in position. These locking means may be similar to those used for locking tilt or casement doors or windows. They may also include hinged flaps or handles rotating about an axis perpendicular to the support plane of the base in the locked position, bolts, magnets, or electromagnets, for example.

[0130] A pivot joint locking marker or sensor 59 provides a signal indicating that the pivot joint 55 is locked. With a marker, this signal can be visual, for example, by displaying a colored surface when the locking is complete, or audible, with the locking producing a recognizable sound. With a sensor, the signal can also be electrical, for example, via a dry contact in an electronic circuit that is closed when the locking is complete. In this latter case, the signal can be processed by an electronic and / or computer circuit so that an indicator light on a user interface displays an appearance that signifies to the operator that the support arm 56 is locked in the operating position. Alternatively, the signal can be processed by the robot's central processing unit to disable all or part of the robot's functions until the support arm 56 is locked in the operating position.

[0131] When the support arm 56 is locked in the operating position, it adopts the configuration shown in figure 6.

[0132] At least part, and preferably all, of the support arm 56 is radio-transparent to allow medical imaging by scanning in the operating room, for example to perform the registration of the geometric reference points of the robot, the patient and the medical imaging, at the beginning of surgery or if a movement of the patient has caused a shift of his head in the geometric reference point of the robot or the medical imaging or to perform a control imaging of the positioning of the implants (electrodes).

[0133] The telescopic support arm 56 is then extended as shown in Figure 7 to move its distal end 57 away from the chassis of the carriage 51. This movement brings a fastener positioned at this distal end 57 into alignment with a lower arm of a headrest or stereotaxic frame 60, as shown in Figure 8. Preferably, the support arm 56 includes a locking mechanism for its telescopic extension. Preferably, a marker or sensor (not shown) provides a visual, audible, or electrical signal indicating that this extension is locked, similar to the sensor 59 described above.

[0134] This headrest or frame is fixed to the head 65 of a patient 64 lying on an operating table 66. Once the lower arm of the headrest or frame 60 is positioned on this distal attachment, this attachment is locked to block the position and orientation of the stereotaxic headrest or frame 60.

[0135] Preferably, a marker or sensor (not shown) provides a signal, visual, audible or electrical, representative of the locking of this attachment of the headrest or stereotaxic frame on the support arm, in a manner similar to sensor 59 described above.

[0136] The fourth embodiment of the device of the invention, illustrated in Figure 9, contains the same elements as the third embodiment, except that the pivot joint 61 is mounted on a sliding joint 62 that extends vertically along a wall of the carriage 51. The pivot joint, and consequently the arm 56 and the distal attachment 57, can thus be moved vertically, notably to facilitate the connection of the distal attachment 57 to the headrest or stereotaxic frame 60 and to adapt to the size and positioning (seated or standing) of the surgeon and the patient (the table height being adjustable). This increases ergonomic comfort for the surgeon, as this type of surgery can last several hours. Naturally, the sliding joint 62 can be locked in position.Preferably, a marker or sensor (not shown) provides a visual, audible or electrical signal representative of the locking of this slide link 62, in a manner similar to the sensor 59 described above.

[0137] In the fifth embodiment of the device which is the subject of the invention illustrated in figure 10, we find the same elements as in the third embodiment, except that the pivot joint 55 is supplemented by a movable lateral reinforcement 63.

[0138] Therefore, the arm 56 and the distal attachment 57 can be moved vertically by rotating them around the axis of the pivot joint 55, particularly to facilitate joining the distal attachment 57 to the headrest or stereotaxic frame 60. The configuration of the lateral reinforcement 63 can, of course, be locked. Preferably, a marker or sensor (not shown) provides a visual, audible, or electrical signal indicating that the lateral reinforcement 63 is locked, similarly to the sensor 59 described above.

[0139] The present invention relates, according to its fourth aspect, to the device extending from the chassis wall of the trolley 51 to the arm of the headrest or stereotaxic frame 60. The present invention also relates to the surgical robot trolley 51, which includes this device which is the subject of the present invention.

[0140] Figure 11 represents, in the form of a logic diagram 70, the implementation steps of a cart that is the subject of the invention.

[0141] During step 71, an operator positions the trolley 51 and it is immobilized by deploying its cylinders.

[0142] During step 72, the operator rotates the support arm.

[0143] During step 73, the operator locks the pivot joint which is located at the base of the support arm.

[0144] During step 74, the operator or the circuits of the trolley 51 check the locking of the pivot link.

[0145] During step 75, the operator causes the extension and locking of the extension of the support arm.

[0146] During step 76, the operator positions the headrest or stereotaxic frame arm onto the distal attachment of the support arm.

[0147] During step 77, the operator locks the position and orientation of the stereotaxic headrest or frame onto the distal attachment of the support arm.

[0148] During step 78, the operator performs the registration of the position and orientation of the patient's head, or of the headrest or stereotaxic frame, on the one hand, of the medical imaging, on the other hand, and of the robot's geometric reference frame, on the other. This latter registration involves, for example, a robot probe or a navigation camera and a pointer equipped with a handheld navigation reference, attached to the patient's head or to the headrest or stereotaxic frame. A navigation reference 67, illustrated in Figure 8, is a set of at least four markers pre-mounted on a rigid support, in non-coplanar and asymmetrical positions. An image of this navigation reference thus makes it possible to identify the position (three coordinates in an orthonormal coordinate system) and the orientation (three angular coordinates in this coordinate system) of this navigation reference.

[0149] The robot is thus configured for performing a surgical procedure. The steps for folding the support arm are the reverse of steps 77 to 72 described above.

[0150] The implementation of the fourth and fifth aspects of the present invention has the following advantages:

[0151] - It prevents locking errors thanks to markers and / or sensors,

[0152] - it ensures rigid support between the carriage and the headrest or stereotaxic frame, Y1

[0153] - It provides flexibility in positioning within the operating room,

[0154] - It minimizes imaging artifacts thanks to the radio-transparency of the support arm.

Claims

DEMANDS 1. Device (25, 26) for extending the working envelope (22) of a surgical assistance robot (10) comprising a carriage (11), a robotic arm (14, 15) equipped with a base (23) and a means (13) for registration between a medical image and a geometric reference of the robot, characterized in that it comprises an inclinable base (25, 28) positioned between the carriage and the base (23) of the robotic arm, this base being configured to remain rigid during registration carried out by the registration means and during the movements of the robotic arm.

2. Device (26) according to claim 1, which includes a bracket (26) having two arms connected by a hinge joint (30), one of the arms being fixed to the carriage (11), the other arm being fixed to the base (28) of the base (23) of the robotic arm (14, 15), to vary the angle between the axis perpendicular to the base (23) and the vertical.

3. Device (26) according to claim 2, wherein the axis of the hinge joint (30) is horizontal.

4. Device (26) according to any one of claims 2 or 3, wherein the axis of the hinge joint (30) is perpendicular to a vertical plane passing through a support arm (16) of a headrest (17).

5. Device (26) according to any one of claims 2 to 4, wherein the axis of the hinge joint (30) is on the upper face of the carriage (11).

6. Device (26) according to any one of claims 2 to 5, which further comprises a means for manually locking the tilt of the tiltable base (28).

7. Device (25) according to claim 1, which further comprises a motorized tilting means (24) for the tiltable base (28).

8. Device (25) according to claim 7, wherein the motorized tilting means comprises at least one motorized cylinder (24).

9. Device (25) according to claim 8, wherein the motorized tilting means comprises a parallel robot.

10. Device (25, 26) according to any one of claims 7 to 9, further comprising a marker or sensor (29) of a locked state of the tilting means.

11. A device according to any one of claims 1 to 10, further comprising: - a pivot joint (55, 61) on a wall of the carriage, the axis of rotation of said pivot joint being horizontal, - an arm (56, 58) mounted on this pivot joint, - a means of locking the angular position of the arm relative to the wall of the carriage, and - a fastener (57) for fixing the position and orientation of a headrest or stereotaxic frame (60) in relation to the arm.

12. Surgical assistance robot (10), comprising a trolley (11), a robotic arm (14, 15) equipped with a base (23), a means (13) for registration between a medical image and a geometric reference of the robot and a device (25, 26) according to any one of claims 1 to 11.

13. Robot (10) according to claim 12, which further comprises a means (29) for determining the locked state of the tilt of the base (25, 28), the recalibration means (13) being configured not to perform recalibration when this determination means indicates an unlocked state of the base and / or the robotic arm (14, 15) being configured not to perform movement when this determination means indicates an unlocked state of the base.

14. Method (40) for extending the working envelope (22) of a surgical assistance robot (10) comprising a trolley (11) and a robotic arm (14, 15) equipped with a base (23), characterized in that it comprises, successively: - a tilting step (42) of a tiltable base (25, 28) positioned between the carriage and the base of the robotic arm, - a step (43) for locking the tilt of the base, and - a step (45) of registration between a medical image and a geometric reference of the robot.

15. Method according to claim 14, wherein the tilting step (42) varies the angle between the axis perpendicular to the base and a vertical line.

16. Method (40) according to any one of claims 14 or 15, further comprising a step (44) of determining the locked state of the inclination of the base (25, 28), the recalibration step (45) being inhibited when this inclination is not locked.

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