Device for controlling two robotic arms for retinal surgery

Abstract

The invention relates to a device (1) for controlling a surgical robot (2) comprising a control interface (9) configured to allow an operator (7) to select a control mode from among a plurality of predetermined control modes; a control member (6) configured to be handled by the operator (7) so as to control a main robotic arm (21) from among two robotic arms (21, 22); and a processing unit (8) configured to determine a main setpoint from the movement of the control member (7); control the main robotic arm (21) according to the main setpoint, so as to move a main surgical instrument (3a) in accordance with the main setpoint; determine a secondary setpoint based on the main setpoint and the selected control mode; control the other robotic arm (22) according to the secondary setpoint, so as to move a secondary surgical instrument (3b) in accordance with the secondary setpoint.

Description

[0001] DESCRIPTION

[0002] TITLE: Control system for two robotic arms for retinal surgery TECHNICAL FIELD

[0003] This disclosure relates to the general field of telemanipulation of surgical robots, particularly those applied to eye surgery.

[0004] STATE OF THE ART

[0005] During a standard retinal surgery procedure, a surgeon typically uses two surgical instruments—one in each hand—to operate on a patient. These surgical procedures require extreme precision and exceptional dexterity. However, in most cases, only one instrument needs to be consciously positioned, as the position of the second instrument is either fixed or dependent on the position of the first.

[0006] Recent technological advances have enabled the integration of robotic systems to assist surgeons in these delicate procedures. During robot-assisted teleoperated surgeries, the surgeon remotely controls surgical instruments to perform various operations on a patient via a control console. Each hand independently controls a robotic arm that manipulates its respective surgical instrument based on position commands. An example of a robotic arm control device is described in document WO 2020 / 115249. Such a device includes a control station from which the surgeon can remotely control both robotic arms.

[0007] In retinal surgery, it frequently happens that only one of the surgical instruments needs to be consciously positioned. The available control interfaces are not always user-friendly and limit the surgeon's autonomy. Indeed, the surgeon must be fully focused on moving both surgical instruments simultaneously. Such systems therefore fail to fully exploit the potential offered by robotic arm control of surgical instruments.

[0008] DESCRIPTION OF THE INVENTION

[0009] One objective of this disclosure is to propose a control system for two robotic arms, each manipulating a surgical instrument for vitreoretinal surgery, that is simpler for an operator to use. This objective is achieved by a control system for a robot for eye surgery, the robot comprising a first robotic arm and a second robotic arm, the control system comprising:

[0010] a control interface configured to allow an operator to select a piloting mode from a plurality of predetermined piloting modes including a pointing mode;

[0011] a control unit configured to be manipulated by the operator to control one of the main robotic arms, either the first or the second robotic arm; and a processing unit configured to

[0012] determine a main instruction from the movement of the control element;

[0013] to control the main robotic arm according to the main instruction, so that a main surgical instrument extending along a main axis and carried by the main robotic arm is moved by the main robotic arm in accordance with the main instruction;

[0014] determine a secondary setpoint from the main setpoint and the selected control mode;

[0015] pilot the other robotic arm according to the secondary instruction, so that a secondary surgical instrument extending along a secondary axis and carried by the other robotic arm is moved by the other robotic arm in accordance with the secondary instruction, the secondary instruction being determined so that the secondary surgical instrument is oriented so that the primary axis and the secondary axis intersect at a predetermined point, and one end of the secondary surgical instrument is at a fixed distance from the predetermined point, when the selected piloting mode is the pointing mode.

[0016] Thanks to the proposed control system, the operator only needs to provide the position instructions for the primary instrument. The position instructions for the secondary instrument are determined by the processing unit, resulting in a predefined behavior for the secondary instrument based on the mode selected by the operator. This simplifies remote operation for the operator, as they can focus solely on moving the primary instrument, while the secondary instrument automatically adopts the appropriate behavior.

[0017] The invention is advantageously complemented by the following features, taken individually or in any of their technically possible combinations: - The first robotic arm is adapted to move a first surgical instrument, and the second robotic arm is adapted to move a second surgical instrument, and the control interface is configured to allow the operator to select the main robotic arm from among the first robotic arm and the second robotic arm, so as to define the main surgical instrument and the secondary surgical instrument from among the first surgical instrument and the second surgical instrument.

[0018] - The plurality of predetermined piloting modes includes an end anchoring mode, and, when the selected piloting mode is the end anchoring mode, the secondary setpoint is determined so that one end of the secondary surgical instrument follows one end of the primary surgical instrument.

[0019] - When the selected piloting mode is end-anchoring mode, the secondary setpoint is determined so that the tip of the secondary surgical instrument is at a predetermined fixed distance from the tip of the primary surgical instrument. - The predetermined point is the intersection between the primary axis and an area of ​​interest of the eye, typically the retina.

[0020] - The fixed distance is zero, so the end of the secondary surgical instrument is on the main axis.

[0021] - The control interface is configured to allow the operator to select a distance between the predetermined point and one end of the main surgical instrument. - The predetermined point is one end of the main surgical instrument.

[0022] - The plurality of predetermined piloting modes includes a cleaning mode, and, when the selected piloting mode is the cleaning mode, the secondary setpoint is determined so that one end of the secondary surgical instrument is in contact with the primary surgical instrument so as to clean an external surface of the primary surgical instrument.

[0023] - The robot includes a third robotic arm, and the control system further includes an additional control element configured to be moved by the operator to control the third robotic arm; the processing unit is further configured to

[0024] determine an additional main instruction from the movement of the additional control element;

[0025] control the third robotic arm from the additional main command, so that an additional surgical instrument manipulated by the third robotic arm is moved in accordance with the movement of the additional control organ.

[0026] - The first robotic arm is suitable for moving a first surgical instrument, the second robotic arm is suitable for moving a second surgical instrument, and the third robotic arm is suitable for moving a third surgical instrument, and the control interface is configured to allow the operator to select the main robotic arm from among the first robotic arm and the third robotic arm, so as to define the main surgical instrument and the additional surgical instrument from among the first surgical instrument and the third surgical instrument.

[0027] DESCRIPTION OF THE FIGURES

[0028] Other features, purposes and advantages of the invention will become apparent from the following description, which is purely illustrative and not limiting, and which should be read in conjunction with the accompanying drawings on which:

[0029] Figure 1 schematically illustrates an operating scene with a surgical robot control device according to one embodiment of the invention.

[0030] Figure 2 illustrates geometric parameters of the eye used to estimate a position of the center of the eye.

[0031] Figure 3 schematically illustrates a method of controlling a secondary surgical instrument based on the position of a primary surgical instrument.

[0032] Figure 4 schematically illustrates another method of controlling the secondary surgical instrument depending on the position of the main surgical instrument.

[0033] Figure 5 schematically illustrates an operating scene with a surgical robot control device according to another embodiment of the invention.

[0034] Across all figures, similar elements bear identical references.

[0035] DETAILED DESCRIPTION OF THE INVENTION

[0036] Operating scene So

[0037] Referring to Figure 1, a surgical robot 2 comprises a first robotic arm 21 and a second robotic arm 22. It will be understood that the two robotic arms 21 and 22 can each be considered an independent robot. The robotic arms 21 and 22 are articulated to allow free movement at one end, on which a surgical instrument 3a, 3b is mounted.

[0038] The robotic arms 21,22 manipulate the surgical instruments 3a, 3b as part of surgical interventions in the eye of a patient 4 placed on an operating table 5. The patient 4 and the operating table 5, if applicable, constitute an operative scene So and the eye an interventional target or region of interest.

[0039] Generally, during such a procedure, the patient 4, lying on their back on the operating table 5, is under anesthesia. The patient's head is held still. In order to access the eye and insert the necessary instruments, a surgeon 7, typically an ophthalmologist or vitreoretinal surgeon, makes several micro-incisions in the wall of the eyeball and inserts a trocar into each micro-incision. A trocar is a tube that pierces the eyeball, forming a channel into which the surgical instrument 3a, 3b is to be inserted.

[0040] Each surgical instrument 3a, 3b or tool includes one end adapted to be inserted into an insertion point of the eye, the other end being held and manipulated by the respective robotic arm 21, 22. In the context where the robot 2 is used for eye surgery, and in particular for robotic bimanual vitreoretinal surgery, the surgical instruments 3a, 3b are notably chosen from a pair of forceps, a pair of scissors, a vitrectomy probe, a diathermy probe, a laser probe, an endolight or endo-illumination probe, an aspiration or injection cannula, etc.

[0041] In order to remotely control the robotic arms 21, 22, a control device 1 is proposed. The operator 7 is placed near the control device 1. The control device 1 can be arranged outside the operating scene So, or near the operating table 5.

[0042] The control device 1 includes a control interface 9, a control unit 6 and a processing unit 8.

[0043] The control interface 9 allows the operator 7 to communicate with the processing unit 8 and supervise the surgical procedure. The control interface 9 is specifically configured to allow the selection of a piloting mode from among a plurality of predetermined piloting modes. The control interface 9 may include a touchscreen, or a screen and a cursor or buttons, so that the operator 7 can simply select the piloting mode by clicking on the touchscreen or moving the cursor on the screen.

[0044] The operating room can be equipped with an imaging system that allows the surgeon to view the eye and the instruments being manipulated in real time via a control unit with a user interface. An example of such an imaging system is an ophthalmic microscope. The surgeon typically inserts an endo-illumination probe through a trocar to illuminate the intraocular tissues deep within the eye, thus enabling the acquisition of sufficiently high-quality images.

[0045] Preferably, the imaging system control unit is coupled to the processing unit 8 so that the images acquired by the imaging system can be viewed by the operator 7 on the control interface 9. This allows the operator 7 to select a target directly on the image of the retina, after the processing unit 8 has obtained a geometric referencing between the image reference frame and that of the patient's eye 4.

[0046] The control unit 6 is configured to be manipulated by the operator 7 to control one of the robotic arms 21, 22, referred to as the main robotic arm. Hereafter, the main robotic arm will be assumed to be the first robotic arm 21. The control unit 6 is, for example, a joystick or a haptic device for remotely controlling the main robotic arm 21. The control unit 6 includes at least one motion sensor to measure the movements initiated by the operator 7 on the control unit 6. An example of a control unit 6 is described in FR 3109717 A1. The first surgical instrument 3a manipulated by the main robotic arm 21 is referred to as the main surgical instrument 3a. The second robotic arm 22, which is not directly controlled by the control unit 6, is called secondary robotic arm 22, and the second surgical instrument 3b, manipulated by the secondary robotic arm 22, is called secondary surgical instrument 3b.It should be understood that these names are used for purely illustrative purposes.

[0047] The processing unit 8 is configured to determine control instructions for the robotic arms 21, 22 from signals received from the control unit 6. The processing unit 8 typically includes a processor or microprocessor and its own memory to store data used for controlling the robot 2.

[0048] More specifically, the processing unit 8 is configured to determine a master setpoint from the movement of the control organ 6, and to control the main robotic arm 21 from the master setpoint, so that the main surgical instrument 3a is moved in accordance with the movement of the control organ 6. In other words, the master setpoint is determined so that the main surgical instrument 3a reproduces in the eye of the patient 4 the movements intended by the operator 7 manipulating the control organ 6.

[0049] The processing unit 8 is also configured to determine a secondary instruction from the main instruction and the control mode selected by the operator 7, and to control the other robotic arm 22 from the secondary instruction, so that the secondary surgical instrument 3b is moved by the other robotic arm 22. Thus, the control organ 6 and the processing unit 8 make it possible to translate the surgeon's commands into control instructions for each robotic arm 21, 22 so that each surgical instrument 3a, 3b, held by a respective robotic arm 21, 22, moves according to the respective instruction. The robotic arm 21, 22 is configured to position the surgical instrument 3a, 3b in space, and preferably includes at this end an instrument manipulator capable of rotating the surgical instrument 3a, 3b on itself, i.e. around the instrument's own axis, and / or of actuating the surgical instrument 3a, 3b.

[0050] Each robotic arm 21, 22 is equipped with actuators that allow the surgical instrument 3a, 3b to be moved in space along at least six degrees of freedom (three axes of translation and three axes of rotation) in order to comply with the control instructions determined by the processing unit 8. The actuators of each robotic arm 21, 22 allow the surgical instrument 3a, 3b to be moved so that it constantly passes through a predetermined point in space. This predetermined point can be defined in software at the exact location of the trocar T1, T2 through which the surgical instrument 3a, 3b passes, so that its movements do not create stress on the sclera of the eye 41. Alternatively or additionally, the predetermined point can be moved during surgery, for example, to follow the movements of the patient 4 as described in document WO 2022 / 106457A1.

[0051] Eye model for generating pilot commands

[0052] The control of robot 2 is based on a geometric model of the surgical scene So defined by the eye 41 of patient 4 and the robotic arms 21, 22. At the level of the eye 41, or more precisely the eyeball 41, two points Pa, Pb are defined as the insertion points for the respective surgical instruments 3a, 3b. The insertion points Pa, Pb correspond to the center of the circle formed by the intersection of the cannula of the trocar T1, T2 with the sclera of the eye 41, the surface of the eyeball.

[0053] The insertion points Pa and Pb are fixed relative to the sclera and therefore relative to the eyeball. Each eyeball is mobile within an orbit of eye 41, which is assumed to be fixed in the surgical scene frame So, as anesthesia induces akinesis. Furthermore, eye 41 has a center O that is both the center of the orbit and the center of the eyeball. The position of the center O of eye 41 in the surgical scene frame So is known and determined prior to the operation, by configuring the eye model described below.

[0054] We consider a frame of reference R^A 1 RO.B 1in which are expressed the piloting commands of the surgical instruments 3a, 3b, as retrieved from the surgeon via the piloting device 1. Its origin is the insertion point Pa, Pb of the surgical instrument 3a, 3b in the eyeball. With reference to Figure 2, the center O of the eye 41 can be theoretically estimated in a model of the eye 41, comprising the following quantities:

[0055] 1. Axial length AL equals the distance between the apex of the cornea and the fovea of ​​the eye 41. This is a common biometric measurement that can be obtained during a preoperative examination. In the absence of a measurement, an average estimate of 23.8 mm can be used, an estimate that can be made more precise by taking into account the patient's gender, age, origin, and any eye pathologies 4;

[0056] 2. The anterior chamber depth (ACD) is equal to the distance between the apex of the cornea and the apex of the lens. This is a common biometric measurement that can be obtained during a preoperative examination. In its absence, an average estimate of 3.17 mm can be used, a value that can be refined according to the patient's characteristics.4

[0057] 3. The white-to-white distance WW represents the horizontal diameter of the cornea.

[0058] This is a common biometric measurement that can be obtained during a preoperative examination. In its absence, an average estimate of 11.80mm can be used, or, as before, refined according to the patient's characteristics 4;

[0059] 4. The limbus-trocar distance LT: this is the distance separating the limbus (edge ​​of the iris) from the insertion point of the trocar T1, T2, measured radially with respect to the iris. Vitreoretinal surgery trocars are supplied with a gauge allowing for precise adherence to a predefined distance, which, depending on the supplier, can vary between 3mm and 4mm;

[0060] 5. The trocar opening angle (a): This is the angle formed by the line (0T1) and the patient's longitudinal axis 4 (from head to toe), projected onto the plane of the eye's reference frame. This angle depends primarily on the surgeon's usual practice. It can be easily measured once the trocars are inserted, either directly by the surgeon or by processing images acquired with an ophthalmic microscope. If no measurement is possible, the common value of 60 degrees can be used.

[0061] The following assumptions or approximations are also made:

[0062] - the diameter of the eyeball is equal to the difference between the axial length and the depth of the anterior chamber, and therefore its radius R is R = OT = (AL - ACD);

[0063]

[0064] - the limbus belongs to the surface of the eyeball, therefore its distance to 0 is equal to R; - the two reference points of the distance LT and the vertical axis are coplanar.

[0065] These five quantities and three hypotheses allow us to determine, using known geometric tools, the position of point 0 in the R^A coordinate system. 1 and R?, B 1 -x = —R sin 0 sin a Rsin 0 since

[0066] y = Rsin 0 cos a Rsin 0 cos a

[0067]

[0068] z = Rcos 0 Rcos 0

[0069] Reeve

[0070] 0,A

[0071]

[0072]

[0073] The processing unit 8 can store in memory the parameters of the eye model 41 for patient 4. The eye model described above can be used to determine geometric transformations within the surgical scene So, in order to locate any point in one of the coordinate systems associated with each element of the scene, for example in a moving coordinate system linked to the surgical tool, a moving coordinate system corresponding to an articulated arm 21, 22, or the eye orbit coordinate system Rg rblt If the robotic arms 21,22 are mounted on a mobile base, a reference frame is also associated with each mobile base of the robotic arm 21,22. Otherwise, the base of the robotic arm forms a fixed reference frame in the operating scene So.

[0074] Thus, it is possible to position the secondary surgical instrument 3b in relation to the main surgical instrument 3a.

[0075] Before the surgical instruments 3a, 3b are piloted, the processing unit 8 receives the position of the insertion points Pa, Pb. Typically, during a model initialization step, the surgical instruments 3a, 3b are placed by the operator 7 at the entrance of their respective insertion point Pa, Pb, and the positions are sent to the processing unit 8.

[0076] Next, the corresponding geometric model of the operational scene So is configured taking into account the received positions. This initialization allows us to know the transformation between the eye frame R° e11 and that of the base of the robotic arm 21, 22, from the current position of the surgical robot 2. The processing unit 8 can receive a position command for the surgical instrument 3a, 3b in the patient's eye 4 from the control organ 6. The processing unit 8 can calculate a new transformation j'roboti j'robotz, p Oursatisfy this positioning instruction and correctly position the surgical instrument 3a, 3b in relation to the trocar.

[0077] Preferably, the control interface 9 is configured to allow operator 7 to select the primary robotic arm from among the first robotic arm 21 and the second robotic arm 22. This allows the primary surgical instrument to be defined as either the first surgical instrument 3a or the second surgical instrument 3b, depending on the selected primary robotic arm. The secondary surgical instrument is the tool manipulated by the robotic arm that has not been selected by operator 7. This allows operator 7 to switch hands at will and to remotely manipulate the surgical instruments 3a and 3b held by robot 2 with their most dexterous hand. This also allows operator 7 to use their preferred hand in situations that would not be humanly feasible in conventional surgery.This also allows access to all areas of the eye, and in particular to use an instrument on the nasal side to operate on the temporal side, and vice versa.

[0078] For example, during a vitrectomy on patient 4's right eye, as described later, the operator 7, if right-handed, can select the robotic arm 22 located to the patient's left as the primary robotic arm to manipulate the surgical instrument 3b, which enters through the left side of patient 4's nose, by operating the control unit 6 with their right hand. Operator 7's left hand is then free, as the first surgical instrument 3a, in this case the endo-illumination probe, is automatically manipulated by the other robotic arm 21 located to the patient's right.

[0079] The processing unit 8 calculates the main setpoint from the movement performed by the operator 7 on the control element 6, and from the transformation robotlcalculated for the main robotic arm 21. The main instruction is a positioning instruction for the end of the main robotic arm 21 to which the main surgical instrument 3a is attached.

[0080] Alternatively, the main instruction can be determined not by a dedicated interaction measurement from a telemanipulation system such as the control unit 7, but by trajectory planning. This allows for a fully automated surgical procedure. The main instruction can also be determined by selecting a target from retinal images taken by the ophthalmic microscope and transmitted to the operator via the control interface 9. This allows for a semi-automated procedure.

[0081] The control device 1 then allows the secondary robotic arm 22 to be controlled automatically, so that the surgical instrument 3b inserted into the eye 41 of patient 4 makes a movement synchronized with that of the main surgical instrument 3a.

[0082] Presentation of piloting modes

[0083] Different piloting modes are illustrated in Figures 3 and 4. As before, we consider the main surgical instrument 3a moved by the first robotic arm 21 and the secondary surgical instrument 3b moved by the second robotic arm 22. The main surgical instrument 3a extends along a main axis Xa, and the secondary surgical instrument 3b extends along a secondary axis Xb.

[0084] The surgical instruments 3a, 3b are inserted into the eye 41 of the patient 4 at their respective insertion points Pa, Pb, so that during the surgical procedure, the end 31 of the main surgical instrument 3a is disposed inside the eye 41, and the end 32 of the secondary surgical instrument 3b is disposed inside the eye 41.

[0085] The primary surgical instrument 3a is precisely moved within the eye 41, according to the primary instruction determined by the processing unit 8. The secondary surgical instrument 3b is moved synchronously with the primary surgical instrument 3a. In other words, the movement of the secondary surgical instrument 3b depends on the movement of the primary surgical instrument 3a; that is, the secondary instruction is determined so that the secondary surgical instrument 3b automatically follows the primary surgical instrument 3a. The secondary surgical instrument 3b is typically an endo-illumination probe, as detailed below.

[0086] The plurality of predetermined piloting modes may include an end anchoring mode, as illustrated in Figure 3.

[0087] When the piloting mode selected by operator 7 is the end anchoring mode, the secondary setpoint is determined by the processing unit 8 so that the end 32 of the secondary surgical instrument 3b follows the end 31 of the primary surgical instrument 3a, when the secondary robotic arm 22 is piloted.

[0088] The term "following the tip" means that the relative position of tip 32 and tip 31 remains constant when the two robotic arms 21 and 22 are controlled by the processing unit 8. In other words, the secondary command is determined so that tip 32 of the secondary surgical instrument 3b follows the same path as tip 31 of the primary surgical instrument 3a and secondary surgical instrument 3b within the eye 41, separated from tip 31 by a predetermined vector. This ensures a safe distance between the two tips 31 and 32 and prevents collisions. Furthermore, if the secondary surgical instrument 3b is an endo-illumination probe, it maintains a constant illumination intensity in the area of ​​interest throughout the procedure. This results in higher-quality images acquired by the imaging system.

[0089] According to another example, the secondary instruction is determined so that the end 32 of the secondary surgical instrument 3b makes a displacement symmetric to that of the end 31 of the main surgical instrument 3a with respect to an axis corresponding to the perpendicular bisector of the triangle formed by the insertion points Pa,Pb and the center O, and passing through the center O of the eye 41.

[0090] Preferably, the secondary instruction is determined by the processing unit 8 so that the secondary axis Xb passes through the end 31 of the primary surgical instrument 3a when the secondary robotic arm 22 is driven. Thus, the secondary surgical instrument 3b is always oriented towards the end 31 of the primary surgical instrument 3a when the latter is moved according to the primary instruction. In other words, in this driving mode, the ends 31, 32 and the insertion point Pb of the secondary surgical instrument 3b are aligned throughout the movement of the surgical instruments 3a and 3b.Preferably, when the selected piloting mode is the end anchoring mode, the secondary setpoint is determined by the processing unit 8 so that the end 32 of the secondary surgical instrument 3b is at a predetermined fixed distance from the end 31 of the primary surgical instrument 3a, when the other robotic arm 22 is piloted.

[0091] With reference to the previous example, the secondary instruction can be determined by the processing unit 8 so that a vector defined between the end 32 of the secondary surgical instrument 3b and the end 31 of the main surgical instrument 3a is of constant magnitude, or is identical, when the secondary robotic arm 22 is driven.

[0092] If the secondary surgical instrument 3b is an endo-illumination probe, this allows, in particular, the tip of the secondary surgical instrument 3a to be illuminated inside the eye 41.

[0093] The plurality of predetermined piloting modes includes a pointing mode, as illustrated in Figure 4. Here, the main surgical instrument 3a is oriented by the operator 7 manipulating the control organ 6 towards a zone of interest 40 of the eye 41. The zone of interest 40 is, for example, a point on the retina of the eye 41 on which the operator 7 wants to intervene.

[0094] When the piloting mode selected by operator 7 is the pointing mode, the secondary command is determined by the processing unit 8 so that the secondary surgical instrument 3b is oriented so that the primary axis Xa and the secondary axis Xb intersect at a predetermined point Px when the secondary robotic arm 22 is piloted. The distance between the end 31 and the predetermined point can be set by operator 7 prior to the surgical procedure. Preferably, the control interface 9 is configured to allow operator 7 to select the distance between the predetermined point Px and the end 31 of the primary surgical instrument 3a.

[0095] The predetermined point Px can be the intersection between the principal axis Xa and the area of ​​interest of the eye 41. The area of ​​interest 40 is the region of the eye 41 on which the operator 7 wishes to operate. It is a target for the tip 31 of the main surgical instrument 3a, typically an area of ​​the retina. The predetermined point Px thus lies within the area of ​​interest 40. The distance is then equal to the distance between the tip 31 and the area of ​​interest 40. The distance can be calculated by the processing unit 8 from the parameters defining the model of the eye 41 described previously.

[0096] The secondary instruction can be determined by the processing unit 8 so that the tip 32 of the secondary surgical instrument 3b is at a fixed distance from the predetermined point Px when the other robotic arm 22 is being operated. Thus, only one orientation of the secondary surgical instrument 3b is possible, with point Px, tip 32, and insertion point Pb aligned. Tip 32 is the only point on the virtual sphere with a radius equal to the fixed distance and centered on the predetermined point Px that satisfies this constraint. This prevents collisions between the surgical instruments 3a and 3b during the procedure.

[0097] The fixed distance can be small or even zero, so that the end 32 of the secondary surgical instrument 3b is very close to or even on the main axis Xa when the secondary robotic arm 22 is driven by the processing unit 8. This can allow the surface of the main surgical instrument 3a to be scraped, to clean it.

[0098] The predetermined point can be the end 31 of the main surgical instrument 3a. In this case, the secondary surgical instrument 3b is oriented towards the end 31 of the main surgical instrument 3a, as in the end anchoring mode.

[0099] Preferably, regardless of the selected control mode, the tip 32 of the secondary surgical instrument 3b is moved within a predetermined zone around the tip 31 of the primary surgical instrument 3a. For example, a virtual zone is constructed by the processing unit 8 from a geometric model of the primary surgical instrument stored in memory, and a maximum distance is determined by the operator 7, typically prior to the operation or adapted during the operation via the control interface 9. The virtual zone constrains the movement of the secondary robotic arm 22, so that the tip 32 of the secondary surgical instrument 3b is confined within the virtual zone in close proximity to the primary surgical instrument 3a, when the two robotic arms 21, 22 are controlled by their respective commands.Preferably, the control unit 6 is equipped with a haptic feedback system, allowing it to signal to the operator 7 when the determined secondary instruction would have caused the robot to move outside the predetermined zone. This primarily maintains consistency between the position of the control unit 6 and the position of the main surgical instrument 3a. It can also allow the operator 7 to take corrective action or regain manual control of the two robotic arms, for example.

[0100] Alternatively or in addition, the plurality of predetermined piloting modes may include a cleaning mode. When the selected piloting mode is the cleaning mode, the secondary instruction is determined by the processing unit 8 so that the end 32 of the secondary surgical instrument 3b is in contact with the main surgical instrument 3a in order to clean an external surface of the main surgical instrument 3a, when the other robotic arm 22 is piloted.

[0101] The main surgical instrument 3a can be stationary when the cleaning mode is selected by the operator 7, or it can follow the trajectory defined by the main instruction. For example, the end 32 of the secondary surgical instrument 3b moves back and forth along the external surface of the main surgical instrument 3a.

[0102] Alternative embodiment

[0103] With reference to Figure 5, robot 2 may include a third robotic arm 23, configured to move a third surgical tool 3c.

[0104] Preferably, the control device 1 comprises a first control element 61 and a second control element 62. Typically, the first control element 61 is located to the left of the operator 7 and the second control element 62 is located to the right of the operator 7. In particular, the operator 7 actuates the first and second control elements 61, 62, which then send control signals to the processing unit 8 of the piloting device 1 for piloting the robotic arms 21, 23 of the robot 2 in the operating scene So. In other words, the additional control element 62 is configured to be moved by the operator 7 so as to pilot the third robotic arm 23.

[0105] The processing unit 8 is further configured to determine an additional master setpoint from the movement of the additional control unit 62, and to control the third robotic arm 23 from the additional master setpoint, so that the additional surgical instrument 3c manipulated by the third robotic arm 23 is moved in accordance with the movement of the additional control unit 7.

[0106] Preferably, the control interface 9 allows the operator 7 to select which robotic arm between the first robotic arm 21 and the third robotic arm 23 is the main robotic arm, so as to define the main surgical instrument 3a and the additional surgical instrument 3c among the two surgical instruments controlled by the control organs 61, 62. Thus, the secondary robotic arm 22 is controlled according to the movement of the selected robotic arm, which therefore makes it possible to define which surgical instrument 3a or 3c is followed by the surgical instrument 3b which is controlled automatically.

[0107] Application of the piloting device to a vitrectomy

[0108] A specific example of the use of the control device 1 is described for illustrative purposes. Vitrectomy consists of the removal of the vitreous humor, that is, the transparent gel that fills the eye. Such an operation may be necessary in cases of vitreous opacity or vitreous hemorrhage. More generally, vitrectomy may be performed during complex intraocular retinal surgeries, such as for epiretinal membrane surgery or macular hole surgery. It is common in the management of retinal detachments when the surgical procedure is intraocular. In this context, the vitreous humor is partially or completely removed to allow internal access to the retina, which lies behind it.

[0109] To achieve this, the surgeon uses a vitreotome as the primary instrument. This device is configured to aspirate the vitreous humor from the eye and simultaneously replace it with a fluid, such as saline solution, while carefully controlling the infusion and aspiration pressures throughout the surgical procedure. Mastering these parameters ensures the least traumatic surgery possible for the patient.

[0110] To facilitate the procedure, the surgeon uses a secondary instrument. This secondary instrument is, for example, a lighting device such as an endo-illumination probe. The secondary instrument is configured to illuminate the area the surgeon wishes to aspirate.

[0111] Prior to the operation, guides or trocars are inserted into the eye to restrict the movement of the surgical instruments. In this context, the surgeon must precisely position the vitreotome inside the eye, while the illuminating instrument must illuminate the area targeted by the vitreotome. The movement of the illuminating instrument can therefore be advantageously controlled by the proposed guidance system. Indeed, since the position of the secondary instrument can be accurately deduced from the position of the primary instrument, it is possible to synchronize the two instruments to automatically position the secondary instrument based on the movement of the primary instrument.

[0112] This allows the surgeon to focus on moving the main instrument, particularly during delicate operations. The surgeon can also use their free hand for other functions, such as accessing other interface controls, thus gaining greater autonomy during the surgical procedure.

Claims

DEMANDS 1. Control device (1) for a robot (2) for eye surgery, the robot (2) comprising a first robotic arm (21) and a second robotic arm (22), the control device (1) comprising a control interface (9) configured to allow an operator (7) to select a control mode from among a plurality of predetermined control modes including a pointing mode; a control unit (6) configured to be manipulated by the operator (7) so as to control a main robotic arm (21) from among the first robotic arm (21) and the second robotic arm (22); and a processing unit (8) configured for determine a main instruction from the movement of the control element (7); to control the main robotic arm (21) according to the main instruction, so that a main surgical instrument (3a) extending along a main axis (Xa) and carried by the main robotic arm (21) is moved by the main robotic arm (21) in accordance with the main instruction; determine a secondary setpoint from the main setpoint and the selected control mode; pilot the other robotic arm (22) according to the secondary instruction, so that a secondary surgical instrument (3b) extending along a secondary axis (Xb) and carried by the other robotic arm is moved by the other robotic arm (22) in accordance with the secondary instruction, the secondary instruction being determined so that the secondary surgical instrument (3b) is oriented so that the main axis (Xa) and the secondary axis (Xb) intersect at a predetermined point (Px), and that one end (32) of the secondary surgical instrument (3b) is at a fixed distance from the predetermined point (Px), when the selected piloting mode is the pointing mode.

2. Control device according to claim 1, wherein the first robotic arm (21) is adapted to move a first surgical instrument (3a), and the second robotic arm (22) is adapted to move a second surgical instrument (3b), and wherein the control interface (9) is configured to allow selection, by the operator (7), of the main robotic arm from among the first robotic arm (21) and the second robotic arm (22), so as to define the main surgical instrument (3a) and the secondary surgical instrument (3b) from among the first surgical instrument (3a) and the second surgical instrument (3b).

3. Pilot device according to any one of claims 1 and 2, wherein the plurality of predetermined pilot modes includes an end anchoring mode, and wherein, when the selected pilot mode is the end anchoring mode, the secondary setpoint is determined so that one end (32) of the secondary surgical instrument (3b) follows one end (31) of the primary surgical instrument (3a).

4. Piloting device according to claim 3, wherein, when the selected piloting mode is the end anchoring mode, the secondary setpoint is determined so that the end (32) of the secondary surgical instrument (3b) is at a predetermined fixed distance from the end (31) of the primary surgical instrument (3a).

5. Control device according to any one of claims 1 to 4, wherein the predetermined point (Px) is the intersection between the principal axis (Xa) and an area of ​​interest of the eye (41), typically the retina.

6. Piloting device according to any one of claims 1 to 5, wherein the fixed distance is zero, so that the end (32) of the secondary surgical instrument (3b) is on the main axis (Xa).

7. Control device according to any one of claims 1 to 6, wherein the control interface (9) is configured to allow selection of a distance between the predetermined point (Px) and an end (31) of the main surgical instrument (3a) by the operator (7).

8. Piloting device according to any one of claims 1 to 7, wherein the predetermined point (Px) is an end (31) of the main surgical instrument (3a).

9. A control device according to any one of claims 1 to 8, wherein the plurality of predetermined control modes further includes a cleaning mode, and wherein, when the selected control mode is the cleaning mode, the secondary setpoint is determined such that one end (32) of the secondary surgical instrument (3b) is in contact with the primary surgical instrument (3a) in order to clean an external surface of the primary surgical instrument (3a).19 10. A control device according to any one of claims 1 to 9, wherein the robot (2) comprises a third robotic arm (23) and wherein the control device further comprises an additional control element configured to be moved by the operator so as to control the third robotic arm (23), and wherein the processing unit (8) is further configured to determine an additional main instruction from the displacement of the additional control element (62); control the third robotic arm (23) from the additional main command, so that an additional surgical instrument (3c) manipulated by the third robotic arm (23) is moved in accordance with the movement of the additional control organ (62).

11. Control device according to claim 10, wherein the first robotic arm (21) is adapted to move a first surgical instrument (3a), the second robotic arm (22) is adapted to move a second surgical instrument (3b), and the third robotic arm (23) is adapted to move a third surgical instrument (3c), and wherein the control interface (9) is configured to allow selection, by the operator (7), of the main robotic arm from among the first robotic arm (21) and the third robotic arm (23), so as to define the main surgical instrument (3a) and the additional surgical instrument (3c) from among the first surgical instrument (3a) and the third surgical instrument (3c).

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