Facilitating performance of saw cuts along curved cut paths

Abstract

Surgical robotic cutting is optimized through, in one example, determining a curved cut to be performed along a curved cut path and, based on this, determining intermediate cut(s) for performing prior to performing the curved cut, then setting, as part of a cutting plan, commands for execution by a surgical robot to perform a series of cuts to resect patient anatomy, where the intermediate cut(s) is / are performed prior to performing the curved cut. In another example, a process identifies a series of cuts for a surgical robot to perform using a sagittal saw to resect patient anatomy, and performs the series of cuts by executing commands of a cutting plan, where this includes performing intermediate cut(s) and, based on performing the intermediate cut(s), performing a curved cut along a curved cut path.

Description

FACILITATING PERFORMANCE OF SAW CUTS ALONG CURVED CUTPATHSCROSS-REFERENCE TO RELATED APPLICATION

[0001] This application claims the benefit of U.S. Provisional Application No.63 / 695,619, entitled OPTIMIZATION OF CURVED SAW-BASED CUT PATHS, filed September 17th, 2024, the contents of which are incorporated by reference herein.BACKGROUND

[0002] In clinical practice, cutting tools may be mounted to a robot to assist with execution of various cuts and / or resections of bone and / or tissue. Robotic devices and systems can vary in terms of their level of autonomy. Some may be fully autonomous, some semi-autonomous, and some completely manually operated. Some can rely on physical engagement by the user and haptic controls, i.e., user-initiated cutting, where the cutting tool is moved by the force of a surgeon or other user acting on the cutting tool. In contrast, some non-haptic systems may rely on a more autonomous (e.g., fully autonomous or semi-autonomous) approach in which the robot itself drives movement of the cutting tool with minimal or no direct force from the surgeon.SUMMARY

[0003] Shortcomings of the prior art are overcome and additional advantages are provided through the provision of, in a first embodiment, a computer-implemented method to facilitate surgical robotic cutting. The method incudes determining a curved cut to be performed along a curved cut path by the surgical robot using a sagittal saw to cut patient anatomy. The method further includes, based on the curved cut to be performed, determining at least one intermediate cut for performing prior to performing the curved cut to remove anatomic material and provide space for movement of a blade of the sagittal saw to follow along the curved cut path. The method further includes setting, as part of a cutting plan, commands for execution by the surgical robot to perform a series of cuts to resect the patient anatomy, wherein the setting plans the series of cuts with an order that performs the at least one intermediate cut prior to performing the curved cut.5247.034AWO Page 1 of 23

[0004] In embodiments, the method can optionally further include executing the cutting plan, where the executing causes the surgical robot to perform the series of cuts in the planned order in which the at least one intermediate cut is performed prior to performing the curved cut.

[0005] In embodiments, an intermediate cut of the at least one intermediate cut is a substantially straight intermediate cut along a substantially straight toolpath for the sagittal saw. Additionally, in embodiments, the at least one intermediate cut includes a plurality of intermediate cuts, where an intermediate cut of the plurality of intermediate cuts includes a curved intermediate cut to be performed along a curved intermediate cut path, and where the setting plans the series of cuts with the order to perform the substantially straight cut prior to performing the curved intermediate cut.

[0006] In embodiments, the curved cut path is determined based on positioning of at least one anatomic structure of the patient to avoid in resecting the patient anatomy.

[0007] In another embodiment, a computer-implemented method for surgical robotic cutting, includes identifying a series of cuts for a surgical robot to perform using a sagittal saw to resect patient anatomy, and performing, by the surgical robot, the series of cuts by executing commands of a cutting plan. Performing the series of cuts includes performing at least one intermediate cut to remove anatomic material and provide space for movement of a blade of the sagittal saw to follow along a curved cut path, and based on performing the at least one intermediate cut, performing a curved cut along the curved cut path by withdrawing, at least partially, the blade of the sagittal saw from the space provided by the at least one intermediate cut, and repositioning the at least partially withdrawn blade to being to begin cutting along the curved cut path.

[0008] In embodiments, an intermediate cut of the at least one intermediate cut is a substantially straight intermediate cut along a substantially straight toolpath for the sagittal saw. Additionally, in embodiments, the at least one intermediate cut includes a plurality of intermediate cuts, where an intermediate cut of the plurality of intermediate cuts includes a curved intermediate cut to be performed along a curved intermediate cut path, and where the performing the plurality of intermediate cuts performs the substantially straight cut prior to performing the curved intermediate cut.5247.034AWO Page 2 of 23

[0009] In embodiments, the curved cut path avoids at least one anatomic structure of the patient in resecting the patient anatomy.

[0010] In accordance with one or more aspects, each of the embodiments is separable and optional from one another. Further, embodiments may be combined with one another.

[0011] In one or more embodiments, a computer system is provided that includes a memory; and a processor in communication with the memory, where the computer system is configured to perform any of these and other embodiments disclosed herein. In other alternative embodiments, a computer program product is provided that includes a computer readable storage medium readable by a processing circuit and storing instructions for execution by the processing circuit for performing any of these and other embodiments disclosed herein.

[0012] Additional features and advantages are realized through the concepts described herein.BRIEF DESCRIPTION OF THE DRAWINGS

[0013] Aspects described herein are particularly pointed out and may be distinctly claimed, and objects, features, and advantages of the disclosure are apparent from the detailed description herein taken in conjunction with the accompanying drawings in which:

[0014] FIG. 1 depicts example resections of a total knee arthroplasty;

[0015] FIG. 2 illustrates oscillatory motion of a sagittal cutting blade;

[0016] FIG. 3 illustrates an example scenario of cutting to enable a curved sagittal blade trajectory, in accordance with aspects described herein;

[0017] FIGS. 4A-4E depict example cut path planning and execution with respect to multiple resections of a TKA procedure, in accordance with aspects described herein;

[0018] FIGS. 5 and 6 depict example processes to facilitate surgical robot cutting, in accordance with aspects described herein; and5247.034AWO Page 3 of 23

[0019] FIG. 7 depicts one example of a computer system and associated devices to incorporate and / or use aspects described herein.DETAILED DESCRIPTION

[0020] Example processes and approaches for facilitating performance of curved cut paths, for instance autonomous performance thereof by a robot during autonomous surgical procedures are described herein, though aspects herein may be used with other types of surgical procedures. For instance, processes can be carried out by a surgical robot, e.g., by way of a computer system controlling performance of the robot in carrying out a surgical plan to perform a surgical procedure. The surgical plan might dictate resections to be made to patient anatomy. Accordingly, a cutting plan can be determine / set to form commands to carry out the resections. Aspects described herein can help optimize performance of robotic cutting in surgical procedure.

[0021] Some aspects described herein are presented in the context of surgical procedures, and more specifically knee surgery. Total Knee Arthroplasty (“TKA”, sometimes referred to as a “knee replacement”) is a procedure of orthopedic surgery in which a knee joint (e.g., an arthritic knee joint) may be replaced with a prosthesis. In a knee replacement, a series of bone resections / cuts are made to accommodate the placement of one or more implant(s) and / or implant component(s). Though examples are described herein with reference to a TKA procedure, aspects described herein are generalizable to any application, including any of various surgical procedures.

[0022] FIG. 1 depicts example cuts of a TKA, which generally includes seven planar cuts: five femoral cuts to the patient femur, one tibial cut to the patient tibia, and one patella cut to the patient patella. These can all be achieved with a cutting instrument, for example a sagittal saw. The seven planar resections are identified in FIG. 1 as (i) a tibial resection 102 on a proximal portion of the tibia 101, (ii) a collection of cuts to the patient femur 103 that include a posterior femur resection 104, an anterior femur resection 106, a distal femur resection 108, two chamfer resections (a posterior chamfer resection 110 that provides a chamfer between the posterior femur resection 104 and the distal femur resection 108, and an anterior chamfer resection 112 that provides a chamfer between the anterior femur resection 106 and the distal femur resection 108), and a patella resection 114 to the patella 115.5247.034AWO Page 4 of 23

[0023] All of the cuts can be executed with a sagittal saw, as an example. A sagittal saw includes (at least) a planar saw blade and a drive mechanism. The planar saw blade extends distally from the drive mechanism, which moves the saw blade in an oscillatory, back-and-forth pattern (a cutting stroke) in the plane in which the blade is aligned, and generally in a motion / arc that is oriented perpendicular to the direction in which the saw is advanced forward to achieve the desired cut. FIG. 2 illustrates oscillatory motion of a sagittal cutting blade, specifically depicting an example sagittal cutting blade 202 that oscillates in an arced motion (left and right in this figure) and is coupled to / mounted in a base portion 204. The cutting blade 202 has teeth 206 that cut when the teeth, oscillating as the blade oscillates, move across the target material. The cutting tool, and more specifically the blade thereof when oscillating, is driven forward (indicated by the arrows in FIG. 2) into the material to be cut. Thus, cutting is performed by moving the saw blade toward and into (i.e., upward in the view of FIG. 2) the object to be cut. During cutting, the blade 202 may be intended to stay within a plane in which the blade 202 is aligned, rapidly oscillating back and forth to cut through material (e.g., bone and / or tissue) in that plane. During active and / or autonomous cutting as part of a surgical procedure (e.g., a TKA), a robot may hold the cutting tool (e.g., the body 204 of the sagittal saw) and position and / or direct the blade 202 during cutting.

[0024] Robot-assisted surgical procedures are becoming increasingly popular. This includes TKA surgeries performed with the use of a surgical robot / robotic system (also referred to herein as a robot control system or a surgical robot / robotic system). An active / fully autonomous robot is able to perform cuts without requiring direct force to be applied to the arm or cutting tool by the surgeon. Generally, there is some level of pre-programmed instruction(s) and real-time feedback to execute bone resections with minimal or no surgeon intervention. In contrast, haptic-based robots require a user to apply direct force to the arm or cutting tool. In these systems, the surgeon’s hand guides the tool within robot-enforced boundaries (e.g., with haptic feedback) to prevent the surgeon from cutting outside of the planned area. A key difference between an active robot and a haptic-based robot is that active robots work autonomously, while haptic robots assist the surgeon without taking full control.

[0025] Executing surgical cuts actively (i.e., by a robot autonomously following a cut path) may be more efficient and safer than manual surgical procedures, allowing5247.034AWO Page 5 of 23the surgeon to use both hands for other tasks and potentially freeing up space in the operating room. It therefore follows that there is a present need for active robotic surgical systems (including associated instrumentality) and methods for generating surgical plans, under control of which the active robotic surgical systems are to perform in actively, autonomously (including semi -autonomously), and safely executing cutting along toolpaths during various procedures, an example of which is surgery, such as a TKA, as one example.

[0026] One problem / drawback with the use of sagittal saws (e.g., a sagittal saw of FIG. 2), also referred to as sagittal cutters, is that cuts are only possible by lateral movement of the toothed edge across and against the material to be cut (a sagittal oscillating blade can only cut along the teeth, which shear the surfaces it contacts), and then moving the saw forward (i.e., upward in the view of FIG. 2) to plunge the blade into the object to cut. In the case TKA cuts, this material includes bone. The sides of an oscillating sagittal blade are generally non-cutting surfaces (i.e., sides, of saw blades, that are not configured to cut will not do so). Thus, a sagittal cutting blade can cut only when and where the oscillating teeth move across the material (side-to- side) within this range of oscillation, or cutting stroke, and cutting with the side of the blade is not possible. Further, the body of the blade can move into regions only that are within the cutting stroke of the blade and along its axis of travel.

[0027] Robots and / or other computer integrated systems and / or equipment are increasingly utilized in surgical procedures. Such devices can include a mounted cutting tool to perform cuts / incisions, which may be use-initiated and controlled - that is, a human operator of the robot dynamically directs, typically via physical input devices, the movement and other actions of the cutting tool by directing the robot to perform such actions (i.e., the robot is not actively executing the cuts / incisions).

[0028] As noted, however, active robots perform activities, including cutting, autonomously or semi-autonomously. To perform a function like cutting, an active robot is to move through a series of ordered coordinates, collectedly referred to as a toolpath, which, in the case of a cutting blade, is a cut path. Generally, the tool executes its intended task with the tool at or around each ordered coordinate on the toolpath. A sequence of cuts encompassed in a toolpath may be represented as a sequence of planes. Commanding the robot to execute or assist with surgical cuts may5247.034AWO Page 6 of 23thus require generating toolpath(s) for a robot with a mounted cutting instrument (e.g., a scalpel, sagittal saw, or other cutting tool) to follow.

[0029] For TKA using a sagittal saw, generating toolpaths that facilitate and / or rely on side-cutting is not trivial or obvious. Aspects described herein provide for specific cut ordering to execute curved cuts. Meanwhile, an advantage of cutting with a sagittal saw versus other tools such as a rotary tool is primarily speed of cutting, and advantages of an active robot verses, e.g., a haptic robot, may include speed, more freedom for the user / surgeon to focus on other surgical tasks (for example having two hands to manipulate retractors), generally less demands on the user, and in some cases better execution of challenging cuts (for example milling a hip cavity).

[0030] In accordance with aspects described herein, systems and methods to facilitate active surgical cutting are provided. For instance, aspects provide optimized cut paths to facilitate cutting using a sagittal saw and robot, for instance to guide active robotic execution of cuts using a robot-mounted sagittal cutting instrument. In accordance with some aspects described herein, a series of cut paths are planned that help facilitate robotic execution of cuts, such as TKA cuts, with a sagittal cutter mounted to a robot. Additionally, aspects enable curved cutting, for instance execution of curved cut paths. One reason it may be desired to provide curved cut paths is to mitigate the risk of cutting or damaging soft tissue structures.

[0031] In accordance with some aspects described herein, a curved trajectory (“side cut”) is enabled / provided by first creating space for lateral movement of the blade to follow the curved trajectory. FIG. 3 illustrates an example scenario of cutting to enable a curved sagittal blade trajectory, in accordance with aspects described herein. Referring to FIG. 3, interface 300 depicts a proximal-distal view of the proximal end of a patient tibia, showing the tibial cut from ‘above’. Blade 302 of a sagittal saw is shown executing the tibial cut in a sequence of planar cuts to resect portion 304. To accomplish this, two toolpaths 306 and 308 are shown. The substantially straight toolpath 306 may be followed first to perform a first cut (extending generally upward in FIG. 3). By ‘substantially straight’ is meant that curvature of the toolpath is less than a threshold curvature, which may be preconfigured or determined dynamically, for instance as a parameter of processing. This clears a space corresponding to the blade 302. The space provides space for the5247.034AWO Page 7 of 23blade to, after being withdrawn from the space, then follow the curved toolpath 308. The blade 302 is able to follow path 308 because the side 308 of blade 302 (right side in FIG. 3) does not need to cut through bone material in order for the curve to be followed, which is on account of the first cut along path 306 having already been made. In other words, bone material that would otherwise be there has already been removed. If the robot had attempted to cut along the curved path 308 first, the body of the blade (specifically the right side 310) would push into / against uncut material, and the curved trajectory of the cut along path 308 would not be achieved.

[0032] Following are nonlimiting examples of regions where a curved cut could be helpful for clinical reasons, such as avoiding cutting or damaging soft tissue structures. It is noted that the order of removing bone material as between the medial or lateral side of the anatomy in these situations is less important than the concept of removing intermediate bone material (bone material in between the medial bone material and lateral bone material) first. It is also noted that curved cuts could also be desired in regions of intermediate bone material, and in these cases, the same principles described herein would apply. An example of a curved intermediate cut is provided on the tibial cut example below (FIG. 4E), where the curved intermediate cut (denoted by 462) could be desired for a cruciate-sparing surgical approach (e.g., if it is desired to leave a bone island in the posterior portion of the tibia). The below are for illustrative examples only.

[0033] In many surgical procedures, there are a plurality of surgical tasks and / or resections to be made. In a TKA procedure, as noted above, there are several such resections as described above. Although each is referred to as a resection or cut, in practice it may take several passes / cuts with the cutting tool to complete the resection. For instance, the proximal tibial “cut” might actually be completed in several discrete cuts through bone.

[0034] FIGS. 4A-4E depict example cut path planning and execution with respect to multiple resections of a TKA procedure, in accordance with aspects described herein. In the examples below, cut paths are to guide a robot through robotic execution of the desired cuts, in which the robot performs the cuts by moving the blade through the ordered coordinates of the cut path. Various cut paths represent curved cut paths that a blade is to follow. Reference to the execution or performance5247.034AWO Page 8 of 23of a cut path herein is to mean performance of a cut along the cut path as described above. To execute a curved cut path, intermediate bone is removed by way of one or more corresponding intermediate cut path(s), which would be performed prior to performing the curved cut path. Thus, the corresponding intermediate cut path(s) would necessarily precede the curved cut path.

[0035] FIG. 4A - Anterior femoral cut: The primary critical structures at risk during the anterior femur resection include the Quadriceps Tendon, medial collateral ligament (MCL) and lateral collateral ligament (LCL). To execute any curved cut path on the medial or lateral side, intermediate bone material is to be first removed. FIG. 4A shows an example anatomical environment and surgical region for the anterior femur cut to the femur 402. Shaded portion 404 represents the bone material to be resected by the anterior femoral resection. L and M in FIG. 4A represent the lateral and medial sides, respectively, of the femur. Referring to FIG. 4A, to execute the medial-side (M) curved cut path 406, at least the adjacent intermediate cut path 408 (and potentially also the other intermediate cut path 410, depending on factors such as blade size) is / are to be performed prior to performing the cut path 406. This would remove bone material intermediate (between) the medial (M) and lateral (L) sides, resulting in a planar void where the removal of the bone material resulting from executing the intermediate cut path(s) would allow the blade (not pictured) when executing the M-side curved cut path 406 to traverse in the curved / arced path shown by 406. Similarly, to execute the L-side curved cut path 412, at least the adjacent intermediate cut path 410 (and potentially also the other intermediate cut path 408, depending on factors such as blade size) is / are would be performed prior to performing the cut path 412. This would remove bone material intermediate (between) the medial and lateral sides, resulting in a planar void where the removal of the bone material resulting from executing the intermediate cut path(s) would allow the blade when executing the L-side curved cut path 412 to traverse in the curved / arced path shown by 412.

[0036] FIG. 4B - Distal femoral cut: The primary critical structures at risk during the distal femur resection include the Quadriceps Tendon, MCL and LCL. To execute any curved cut path on the medial or lateral side, intermediate bone material is to be first removed. FIG. 4B shows an example anatomical environment and surgical region for the distal femoral cut to the femur 402. Shaded portion 420 represents the bone5247.034AWO Page 9 of 23material to be resected by the distal femoral resection. L and M in FIG. 4B represent the lateral and medial sides, respectively, of the femur. Referring to FIG. 4B, to execute the lateral-side (L) curved cut path 422, the adjacent intermediate cut path 424 is to be performed prior to performing the cut path 422. This would remove bone material intermediate (between) the medial (M) and lateral (L) sides, resulting in a planar void where the removal of the bone material resulting from executing the intermediate cut path 424 would allow the blade when executing the L-side curved cut path 422 to traverse in the curved / arced path shown by 422.

[0037] FIG. 4C - Femoral anterior chamfer cut: The primary critical structures at risk during the anterior chamfer resection include the Quadriceps Tendon, MCL and LCL. To execute any curved cut path on the medial or lateral side, intermediate bone material is to be first removed. FIG. 4C shows an example anatomical environment and surgical region for the femoral anterior chamfer cut to the femur 402. Shaded portion 430 represents the bone material to be resected by the femoral anterior chamfer resection. L and M in FIG. 4C represent the lateral and medial sides, respectively, of the femur. Referring to FIG. 4C, to execute the medial-side (M) curved cut path 432, the adjacent intermediate cut path 434 is to be performed prior to performing the cut path 432. This would remove bone material intermediate (between) the medial (M) and lateral (L) sides, providing a space that would allow the blade when executing the M-side curved cut path 432 to traverse in the curved / arced path shown. Similarly, to execute the L-side curved cut path 438, the adjacent intermediate cut path 436 is to be performed prior to performing the cut path 438. This would remove bone material intermediate (between) the medial and lateral sides, providing a space that would allow the blade when executing the L-side curved cut path 438 to traverse in the curved / arced path shown by 438.

[0038] FIG. 4D - Femoral posterior chamfer cut: The primary critical structures at risk during the posterior chamfer resection include the Quadriceps Tendon, popliteal tendon MCL and LCL. To execute any curved cut path on the medial or lateral side, intermediate bone material is to be first removed. FIG. 4D shows an example anatomical environment and surgical region for the femoral posterior chamfer cut to the femur 402. Shaded portion 440 represents the bone material to be resected by the femoral posterior chamfer resection. L and M in FIG. 4D represent the lateral and medial sides, respectively, of the femur. Referring to FIG. 4D, to execute the medial-5247.034AWO Page 10 of 23side (M) curved cut path 442, the adjacent intermediate cut path 444 is to be performed prior to performing the cut path 442. This would remove bone material intermediate (between) the medial (M) and lateral (L) sides, providing a space that would allow the blade when executing the M-side curved cut path 442 to traverse in the curved / arced path shown. Similarly, to execute the L-side curved cut path 448, the adjacent intermediate cut path 446 is to be performed prior to performing the cut path 448. This would remove bone material intermediate (between) the medial and lateral sides, providing a space that would allow the blade when executing the L-side curved cut path 448 to traverse in the curved / arced path shown by 448.

[0039] FIG. 4E - Proximal tibia cut: The primary critical structures at risk during the tibial resection include the patellar tendon, MCL, LCL, and posterior cruciate ligament (PCL). To execute any curved cut path on the medial or lateral side, intermediate bone material is to be first removed, and to execute a curved intermediate cut to avoid cutting posterior bone for cruciate retaining approaches, intermediate bone material is to be first removed. FIG. 4E shows an example anatomical environment and surgical region for the proximal tibia cut to the tibia 450. Shaded portion 452 represents the bone material to be resected by the proximal tibia resection. L and M in FIG. 4E represent the lateral and medial sides, respectively, of the tibia. Referring to FIG. 4E, to execute the medial-side (M) curved cut path 454, at least the adjacent intermediate cut path 456 (and potentially also the intermediate cut path 458, depending on factors such as blade size) is / are to be performed prior to performing the cut path 454. This would remove bone material intermediate (between) the (M) and lateral (L) sides, resulting in a planar void where the removal of the bone material resulting from executing the intermediate cut path(s) would allow the blade when executing the M-side curved cut path 454 to traverse in the curved / arced path shown by 454. Similarly, to execute the L-side curved cut path 460, at least the adjacent intermediate cut path 458 (and potentially also the other intermediate cut path 456, depending on factors such as blade size) would be performed prior to performing the cut path 460. This would remove bone material intermediate (between) the medial and lateral sides, resulting in a planar void where the removal of the bone material resulting from executing the intermediate cut path(s) would allow the blade when executing the L-side curved cut path 460 to traverse in the curved / arced path shown by 460. In addition, another discrete intermediate cut5247.034AWO Page 11 of 23path 462 is shown corresponding to a curved intermediate cut to execute to avoid cutting posterior bone for cruciate retaining / sparing (i.e., to leave a bone island in the posterior portion of the tibia 450). With respect to this curved intermediate cut represented by path 462, it may be that at least one of the intermediate cut paths 456, 458 is to be performed first.

[0040] Aspects could be integrated into robotic surgical systems, for example. Additionally, aspects can be provided as software that can be integrated into target systems. There may be applications outside of surgery.

[0041] Active robot systems operate, in part, by executing commands to perform actions. Some actions require that robot movement follow toolpaths for manipulating / moving a tool. Example actions performed by active orthopedic surgical robot systems include cutting actions performed using a cutting tool and by, in part, following cut paths to execute cuts. The cutting actions are performed based on the definition / specification of cut paths for the robot to follow. Software can define parameters of cutting actions such as the cut paths to follow and the order in which to follow them. Further, software can be used to control a robot to perform defined cut paths and with the defined parameters, including ordering of the cuts. Further, software can perform aspects described herein to establish an order for the execution of cut paths relative to each other to facilitate cutting actions, including performance of curved cutting.

[0042] FIG. 5 depicts an example process to facilitate surgical robotic cutting. For instance, the process can be carried out by a surgical robot (e.g., a computer system of or in communication with the robot) in carrying out a surgical plan to perform a surgical procedure. The process of FIG. 5 can optimize performance of robotic cutting in such a procedure.

[0043] Referring to FIG. 5, the process determines (502) a curved cut to be performed along a curved cut path by the surgical robot using a sagittal saw to resect patient anatomy. In some examples, the curved cut path is determined based on positioning of at least one anatomic structure of the patient to avoid in resecting the patient anatomy. Then, based on the curved cut to be performed, the process determines (504) at least one intermediate cut for performing prior to performing the curved cut to remove anatomic material and provide space for movement of a blade of5247.034AWO Page 12 of 23the sagittal saw to follow along the curved cut path. The process continues by setting (506), as part of a cutting plan, commands for execution by the surgical robot to perform a series of cuts to resect the patient anatomy, and the setting plans the series of cuts with an order that performs the at least one intermediate cut prior to performing the curved cut.

[0044] In some examples, an intermediate cut of the at least one intermediate cut is a substantially straight intermediate cut along a substantially straight toolpath for the sagittal saw. Additionally, in some examples, the at least one intermediate cut includes a plurality of intermediate cuts, where an intermediate cut of the plurality of intermediate cuts includes a curved intermediate cut (different from the curved cut) to be performed along a curved intermediate cut path. The setting in these examples plans the series of cuts with the order to perform the substantially straight cut prior to performing the curved intermediate cut.

[0045] Further, in some embodiments, the process executes the cutting plan, for instance as part of carrying out a surgical plan to perform a surgical procedure. The executing in this case causes the surgical robot to perform the series of cuts in the planned order in which the at least one intermediate cut is performed prior to performing the curved cut.

[0046] FIG. 6 depicts another example process to facilitate surgical robotic cutting. For instance, the process can be carried out by a surgical robot (e.g., a computer system of or in communication with the robot) in carrying out a surgical plan to perform a surgical procedure. The process of FIG. 6 can optimize performance of robotic cutting in such a procedure.

[0047] Referring to FIG. 6, the process identifies (602) a series of cuts for a surgical robot to perform using a sagittal saw to resect patient anatomy. The process then performs (604), by the surgical robot, the series of cuts by executing commands of a cutting plan, where the performing of the series of cuts includes performing (606) at least one intermediate cut to remove anatomic material and provide space for movement of a blade of the sagittal saw to follow along a curved cut path, and, based on performing the at least one intermediate cut, performing (608) a curved cut along the curved cut path by withdrawing, at least partially, the blade of the sagittal saw5247.034AWO Page 13 of 23from the space provided by the at least one intermediate cut, and repositioning the at least partially withdrawn blade to begin cutting along the curved cut path.

[0048] In some examples, the curved cut path avoids at least one anatomic structure of the patient in resecting the patient anatomy.

[0049] It is noted that part of the processing can also include, based on identifying the series of cuts and identifying that a curved cut is planned, automatically identifying, on the basis of the curved cut, that intermediate cut(s) will be needed, whether or not they are already planned as part of the series of cuts. On the basis of the series of cuts including the curved cut, the process can automatically determine the intermediate cut(s) to perform in order to perform the curved cut, and plan those as part of a cutting plan that executed the series of cuts.

[0050] In examples, an intermediate cut of the at least one intermediate cut is a substantially straight intermediate cut along a substantially straight toolpath for the sagittal saw. Additionally, in some examples, the at least one intermediate cut includes a plurality of intermediate cuts, where an intermediate cut of the plurality of intermediate cuts includes a curved intermediate cut (different from the curved cut) to be performed along a curved intermediate cut path. The performing the plurality of intermediate cuts in this case perform the substantially straight cut prior to performing the curved intermediate cut.

[0051] One or more embodiments described herein may be incorporated in, performed by, and / or used by one or more computer systems, such as one or more systems that are a part of, or are in communication with, an orthopedic surgical robot, as an example. Processes described herein may be performed singly or collectively by one or more computer systems. A computer system may also be referred to herein as a data processing device / system, computing device / system / node, or simply a computer. The computer system may be based on one or more of various system architectures and / or instruction set architectures.

[0052] FIG. 7 depicts an example computer system to incorporate, use, and / or facilitate aspects described herein. Computer system 700 may be provided as part of a robotic / robot control system, for example, referring to a system that controls a robot in performance of actions. Computer system 700 is in communication with one or5247.034AWO Page 14 of 23more external device(s) 702 (such as one or multiple robot(s), tracking camera(s), rigid robot tracking array(s), foot pedal(s), monitor(s), Deadman switch(es), etc.). Computer system 700 may be provided as part of a surgical navigation technology / system, for example. Computer system 700 is in communication with one or more external device(s) 702 (such as one or multiple robot(s), tracking camera(s), rigid robot tracking array(s), foot pedal(s), monitor(s), Deadman switch(es), etc.). Computer system 700 includes one or more processor(s) 702, for instance central processing unit(s) (CPUs). A processor can include functional components used in the execution of instructions, such as functional components to fetch program instructions from locations such as cache or main memory, decode program instructions, and execute program instructions, access memory for instruction execution, and write results of the executed instructions. A processor of processor(s) 702 can also include register(s) to be used by one or more of the functional components. Computer system 700 also includes memory 704, input / output (I / O) devices 708, and I / O interfaces 710, which may be coupled to the processor(s) 702 and each other via one or more buses and / or other connections. Bus connections represent one or more of any of several types of bus structures, including a memory bus or memory controller, a peripheral bus, an accelerated graphics port, and a processor or local bus using any of a variety of bus architectures. By way of example, and not limitation, such architectures include the Industry Standard Architecture (ISA), the Micro Channel Architecture (MCA), the Enhances ISA (EISA), the Video Electronics Standards Association (VESA) local bus, and the Peripheral Component Interconnect (PCI).

[0053] Memory 704 can be or include main or system memory (e.g., Random Access Memory) used in the execution of program instructions, storage device(s) such as hard drive(s), flash media, or optical media as examples, and / or cache memory, as examples. Memory 704 can include, for instance, a cache, such as a shared cache, which may be coupled to local caches (examples include LI cache, L2 cache, etc.) of processor(s) 702. Additionally, memory 704 may be or include at least one computer program product having a set (e.g., at least one) of program modules, instructions, code or the like that is / are configured to carry out functions of embodiments described herein when executed by one or more processors.

[0054] Memory 704 can store an operating system 705 and other computer programs 706, such as one or more computer programs / applications that execute to5247.034AWO Page 15 of 23perform aspects described herein. Specifically, programs / applications can include computer readable program instructions that may be configured to carry out functions of embodiments of aspects described herein.

[0055] Examples of VO devices 708 include but are not limited to microphones, speakers, Global Positioning System (GPS) devices, RGB, IR, and / or spectral cameras, lights, accelerometers, gyroscopes, magnetometers, sensor devices configured to sense light, proximity, heart rate, body and / or ambient temperature, blood pressure, and / or skin resistance, registration probes and activity monitors. An I / O device may be incorporated into the computer system as shown, though in some embodiments an VO device may be regarded as an external device (712) coupled to the computer system through one or more I / O interfaces 710.

[0056] Computer system 700 may communicate with one or more external devices 712 via one or more VO interfaces 710. Example external devices include a keyboard, a pointing device, a display, and / or any other devices that enable a user to interact with computer system 700. Other example external devices include any device that enables computer system 700 to communicate with one or more other computing systems or peripheral devices such as a printer. A network interface / adapter is an example I / O interface that enables computer system 700 to communicate with one or more networks, such as a local area network (LAN), a general wide area network (WAN), and / or a public network (e.g., the Internet), providing communication with other computing devices or systems, storage devices, or the like. Ethernet-based (such as Wi-Fi) interfaces and Bluetooth® adapters are just examples of the currently available types of network adapters used in computer systems (BLUETOOTH is a registered trademark of Bluetooth SIG, Inc., Kirkland, Washington, U.S.A.).

[0057] The communication between I / O interfaces 710 and external devices 712 can occur across wired and / or wireless communications link(s) 711, such as Ethernet-based wired or wireless connections. Example wireless connections include cellular, Wi-Fi, Bluetooth®, proximity -based, near-field, or other types of wireless connections. More generally, communications link(s) 711 may be any appropriate wireless and / or wired communication link(s) for communicating data.5247.034AWO Page 16 of 23

[0058] Particular external device(s) 712 may include one or more data storage devices, which may store one or more programs, one or more computer readable program instructions, and / or data, etc. Computer system 700 may include and / or be coupled to and in communication with (e.g., as an external device of the computer system) removable / non-removable, volatile / non-volatile computer system storage media. For example, it may include and / or be coupled to a non-removable, nonvolatile magnetic media (typically called a “hard drive”), a magnetic disk drive for reading from and writing to a removable, non-volatile magnetic disk (e.g., a “floppy disk”), and / or an optical disk drive for reading from or writing to a removable, nonvolatile optical disk, such as a CD-ROM, DVD-ROM or other optical media.

[0059] Aspects of the present invention may be a system, a method, and / or a computer program product, any of which may be configured to perform or facilitate aspects described herein. Computer system configured to perform these and other methods, and computer program products that include a computer readable storage medium storing instructions for execution to perform these and other methods are also provided.

[0060] Computer system 700 may be operational with numerous other general purpose or special purpose computing system environments or configurations.Computer system 700 may take any of various forms, well-known examples of which include, but are not limited to, personal computer (PC) system(s), server computer system(s), such as messaging server(s), thin client(s), thick client(s), workstation(s), laptop(s), handheld device(s), mobile device(s) / computer(s) such as smartphone(s), tablet(s), and wearable device(s), multiprocessor system(s), microprocessor-based system(s), telephony device(s), network appliance(s) (such as edge appliance(s)), virtualization device(s), storage controller(s), set top box(es), programmable consumer electronic(s), network PC(s), minicomputer system(s), mainframe computer system(s), and distributed cloud computing environment(s) that include any of the above systems or devices, and the like.

[0061] In some embodiments, aspects of the present invention may take the form of a computer program product, which may be embodied as computer readable medium(s). A computer readable medium may be a tangible storage device / medium having computer readable program code / instructions stored thereon. Example5247.034AWO Page 17 of 23computer readable medium(s) include, but are not limited to, electronic, magnetic, optical, or semiconductor storage devices or systems, or any combination of the foregoing. Example embodiments of a computer readable medium include a hard drive or other mass-storage device, an electrical connection having wires, random access memory (RAM), read-only memory (ROM), erasable-programmable read-only memory such as EPROM or flash memory, an optical fiber, a portable computer disk / diskette, such as a compact disc read-only memory (CD-ROM) or Digital Versatile Disc (DVD), an optical storage device, a magnetic storage device, or any combination of the foregoing. The computer readable medium may be readable by a processor, processing unit, or the like, to obtain data (e.g., instructions) from the medium for execution. In a particular example, a computer program product is or includes one or more computer readable media that includes / stores computer readable program code to provide and facilitate one or more aspects described herein.

[0062] As noted, program instruction contained or stored in / on a computer readable medium can be obtained and executed by any of various suitable components such as a processor of a computer system to cause the computer system to behave and function in a particular manner. Such program instructions for carrying out operations to perform, achieve, or facilitate aspects described herein may be written in, or compiled from code written in, any desired programming language. In some embodiments, such programming language includes object-oriented and / or procedural programming languages such as C, C++, C#, Java, etc.

[0063] Program code can include one or more program instructions obtained for execution by one or more processors. Computer program instructions may be provided to one or more processors of, e.g., one or more computer systems, to produce a machine, such that the program instructions, when executed by the one or more processors, perform, achieve, or facilitate aspects of the present invention, such as actions or functions described in flowcharts and / or block diagrams described herein. Thus, each block, or combinations of blocks, of the flowchart illustrations and / or block diagrams depicted and described herein can be implemented, in some embodiments, by computer program instructions.

[0064] While several aspects of the present invention have been described and depicted herein, these are only examples, and alternative aspects may be affected by5247.034AWO Page 18 of 23those skilled in the art to accomplish the same objectives. Accordingly, it is intended by the appended claims to cover all such alternative aspects as fall within the true spirit and scope of the invention.

[0065] The terminology used herein is for the purpose of describing particular embodiments only and is not intended to be limiting. As used herein, the singular forms “a”, “an” and “the” are intended to include the plural forms as well, unless the context clearly indicates otherwise. It will be further understood that the terms “comprises” and / or “comprising”, when used in this specification, specify the presence of stated features, integers, steps, operations, elements, and / or components, but do not preclude the presence or addition of one or more other features, integers, steps, operations, elements, components and / or groups thereof.

[0066] The corresponding structures, materials, acts, and equivalents of all means or step plus function elements in the claims below, if any, are intended to include any structure, material, or act for performing the function in combination with other claimed elements as specifically claimed. The description of one or more embodiments has been presented for purposes of illustration and description, but is not intended to be exhaustive or limited to in the form disclosed. Many modifications and variations will be apparent to those of ordinary skill in the art. The embodiment was chosen and described in order to best explain various aspects and the practical application, and to enable others of ordinary skill in the art to understand various embodiments with various modifications as are suited to the particular use contemplated.5247.034AWO Page 19 of 23

Claims

CLAIMSWhat is claimed is:

1. A computer-implemented method to facilitate surgical robotic cutting, the method including: determining a curved cut to be performed along a curved cut path by the surgical robot using a sagittal saw to cut patient anatomy; based on the curved cut to be performed, determining at least one intermediate cut for performing prior to performing the curved cut to remove anatomic material and provide space for movement of a blade of the sagittal saw to follow along the curved cut path; and setting, as part of a cutting plan, commands for execution by the surgical robot to perform a series of cuts to resect the patient anatomy, wherein the setting plans the series of cuts with an order that performs the at least one intermediate cut prior to performing the curved cut.

2. The method of claim 1, further including executing the cutting plan, wherein the executing causes the surgical robot to perform the series of cuts in the planned order in which the at least one intermediate cut is performed prior to performing the curved cut.

3. The method of claim 1, wherein an intermediate cut of the at least one intermediate cut is a substantially straight intermediate cut along a substantially straight toolpath for the sagittal saw.

4. The method of claim 3, wherein the at least one intermediate cut includes a plurality of intermediate cuts, wherein an intermediate cut of the plurality of intermediate cuts includes a curved intermediate cut to be performed along a curved intermediate cut path, and wherein the setting plans the series of cuts with the order to perform the substantially straight cut prior to performing the curved intermediate cut.5247.034AWO Page 20 of 235. The method of claim 1, wherein the curved cut path is determined based on positioning of at least one anatomic structure of the patient to avoid in resecting the patient anatomy.

6. A computer-implemented method for surgical robotic cutting, the method including: identifying a series of cuts for a surgical robot to perform using a sagittal saw to resect patient anatomy; and performing, by the surgical robot, the series of cuts by executing commands of a cutting plan, wherein the performing the series of cuts includes: performing at least one intermediate cut to remove anatomic material and provide space for movement of a blade of the sagittal saw to follow along a curved cut path; and based on performing the at least one intermediate cut, performing a curved cut along the curved cut path by withdrawing, at least partially, the blade of the sagittal saw from the space provided by the at least one intermediate cut, and repositioning the at least partially withdrawn blade to being to begin cutting along the curved cut path.

7. The method of claim 6, wherein an intermediate cut of the at least one intermediate cut is a substantially straight intermediate cut along a substantially straight toolpath for the sagittal saw.

8. The method of claim 7, wherein the at least one intermediate cut includes a plurality of intermediate cuts, wherein an intermediate cut of the plurality of intermediate cuts includes a curved intermediate cut to be performed along a curved intermediate cut path, and wherein the performing the plurality of intermediate cuts performs the substantially straight cut prior to performing the curved intermediate cut.

9. The method of claim 6, wherein the curved cut path avoids at least one anatomic structure of the patient in resecting the patient anatomy.5247.034AWO Page 21 of 2310. A computer system including: a memory; and a processing circuit in communication with the memory, wherein the computer system is configured to perform a method of any of claims 1-9.

11. A computer program product including: a computer readable storage medium readable by a processing circuit and storing instructions for execution by the processing circuit for performing a method of any of claims 1-9.5247.034AWO Page 22 of 23

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