WO2002074500A2 - Dispositif pour afficher la position spatiale d'un instrument chirurgical pendant une operation - Google Patents

Dispositif pour afficher la position spatiale d'un instrument chirurgical pendant une operation Download PDF

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Publication number
WO2002074500A2
WO2002074500A2 PCT/EP2002/002279 EP0202279W WO02074500A2 WO 2002074500 A2 WO2002074500 A2 WO 2002074500A2 EP 0202279 W EP0202279 W EP 0202279W WO 02074500 A2 WO02074500 A2 WO 02074500A2
Authority
WO
WIPO (PCT)
Prior art keywords
instrument
receiver
actual position
central computer
display device
Prior art date
Application number
PCT/EP2002/002279
Other languages
German (de)
English (en)
Other versions
WO2002074500A3 (fr
Inventor
Jürgen WAHRBURG
Original Assignee
Wahrburg Juergen
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Wahrburg Juergen filed Critical Wahrburg Juergen
Priority to AU2002311027A priority Critical patent/AU2002311027A1/en
Publication of WO2002074500A2 publication Critical patent/WO2002074500A2/fr
Publication of WO2002074500A3 publication Critical patent/WO2002074500A3/fr

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/36—Image-producing devices or illumination devices not otherwise provided for
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/20—Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00017—Electrical control of surgical instruments
    • A61B2017/00115—Electrical control of surgical instruments with audible or visual output
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B2017/00017—Electrical control of surgical instruments
    • A61B2017/00199—Electrical control of surgical instruments with a console, e.g. a control panel with a display
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/10—Computer-aided planning, simulation or modelling of surgical operations
    • A61B2034/107—Visualisation of planned trajectories or target regions
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/20—Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
    • A61B2034/2046—Tracking techniques
    • A61B2034/2055—Optical tracking systems
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/36—Image-producing devices or illumination devices not otherwise provided for
    • A61B90/37—Surgical systems with images on a monitor during operation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/50—Supports for surgical instruments, e.g. articulated arms

Definitions

  • the invention relates to a Norplatz for displaying the spatial position of a surgical instrument during an operation according to the preamble of claim 1 and "a Norcardi to support the orientation of a receiver.
  • Navigation systems include, as essential sub-components, a three-dimensional digitization system that records the spatial position and orientation of the surgical instruments during the operation through the interaction of movable transmitter elements and stationary receiver elements, and a central computer with a connected monitor, on which the current instrument position is displayed in the correct position a preoperative recording is displayed.
  • Navigation systems therefore offer the surgeon the essential advantage of being able to record at any time during the operation where the instrument being guided is located. This is particularly important if the surgical area is not fully visible, for example, when drilling in bones or using minimally invasive surgical techniques. In these cases, the navigation systems can be used to achieve more precise and documentable surgical results that are less dependent on the individual skill of the surgeon and limit the risk, particularly for younger, less experienced surgeons.
  • the surgeon In the case of surgical interventions that are carried out with the support of navigation systems, the surgeon usually specifies exactly which spatial positions the surgical instrument must assume during the operation during preoperative planning on the basis of preoperative recordings. These target positions are transmitted to the central computer of the navigation system, stored there and usually during operation together with the preoperative recording and the actual position of the instrument.
  • the target and actual positions of the surgical instruments are displayed exclusively on the screen of the central computer, in that corresponding graphical symbols are usually shown in the preoperative recording of the operating field.
  • the actual position is constantly updated on the screen in accordance with the movements carried out by the operator and recorded by the digitizing system. This requires extensive calculations in the central computer, which only allow a limited repetition frequency of the displayed image on the screen and can lead to a delayed display which is perceived as very annoying.
  • the surgeon In order to track the movement of the instrument position on the screen, the surgeon must continuously take his gaze away from the operating area for at least brief moments.
  • the invention is based on the object of designing a standard device of the type specified at the outset in such a way that the use of the navigation system is improved for the surgeon during the operation.
  • FIG. 1 shows a schematic representation of the structure of the device
  • FIG. 2 schematically shows the configuration of the guide device as a screen above an operating table
  • 3 shows an optical display device which can be attached to the instrument
  • FIG. 4 shows a schematic representation of the positioning of the receiver relative to the operating field.
  • FIG. 1 denotes a stationary receiver of a navigation device with receiving elements 2, which receive signals from a transmitter 4 attached to the surgical instrument 3 and pass them on to an central computer 5 via an electrical line 8.
  • the transmitter 4 on the surgical instrument 3 is connected for control via a line 9 to the central computer 5 or a supply unit arranged therein.
  • a screen 6 is connected to the central computer 5 via a line 10, on which a display of the surgical field generated in the central computer 5 is reproduced with the desired and actual position of the surgical instrument.
  • a memory device is provided in the central computer 5, in which the calculated image information of the operation field and the required target positions of the instrument are entered and stored in preparation for an operation. Furthermore, the central computer 5 displays the current actual position of the instrument 3 detected by the navigation device together with the target position and the operation field on the screen 6. This structure is known per se.
  • a separate, arbitrarily positionable guide device 7 is provided, which is connected via a line 11 to a comparison device in the central computer 5 in such a way that only the data of a comparison between the target and actual position of the instrument are taken and reproduced on the guide device 7.
  • the guide device 7 can, for. B. be designed as a small screen that can be positioned in the visual field of the surgeon and perceived by the surgeon so that he does not have to turn away from the operating field if he wants to read the position of the instrument on the control device.
  • FIG. 2 shows an exemplary embodiment of a guiding device in the form of a screen 20 above an operating table 12, to which a hinge 14 is attached via fastening rails 13. is brought, which holds the screen 20 above a patient 15 on the operating table, wherein the guide device in the form of the screen 20 can be adjusted into a position easily visible to the surgeon via the articulated arm 14.
  • a spatial coordinate system is reproduced on the screen 20, the surgical instrument 3 ′ being represented, for example, by a line that has to be moved to the zero point of the coordinate system that corresponds to the desired position, as shown by dashed lines Lines is indicated in Fig. 2.
  • the control device only takes over the data of the actual position of the instrument 3 from the central computer 5 for display in the form of a line, while the target position is represented by the zero point of the coordinate system.
  • crosshairs or similar markings reproduced in different colors or in different sizes can also be reproduced on the screen 20, which represent the desired position on the one hand and the actual position on the other hand.
  • the guide device can be designed as a display device which does not show the operator the absolute position of the surgical instrument as guide information, but only the deviation from the preoperatively determined target position.
  • the guide device can be made very small, so that it can be attached directly to the surgical instrument, as shown, for example, in FIG. 3.
  • a guide device in the form of an optical display device 21 is attached to the schematically represented surgical instrument 3 via a holder 16, on which illuminated directional arrows 17 are reproduced, which correspond to the coordinate directions of a spatial coordinate system and indicate to the operator the direction in which he does this Must move the instrument to reach the preoperatively determined target position.
  • by lighting up one or more directional arrows 17 the surgeon is shown the direction in which the instrument guided by him must be moved.
  • the luminosity of the directional arrows can be selected proportional to the extent of the deviation from the target position.
  • the directional arrows 17 are arranged approximately in a star shape around a light-emitting diode 18 which, for example, lights up green when the instrument 3 is in the correct target position. det. Instead of directional arrows, a sequence of light points or light-emitting diodes can be provided.
  • the guide device 7 can be designed as an acoustic guide device which outputs synthetically generated speech commands in order to indicate to the operator in which direction he has to move the surgical instrument in order to reach the desired position.
  • speech commands sound signals can also be used, wherein different sound frequencies can be used to differentiate the required correction direction and a volume proportional to the deviation.
  • sound signals can also be provided to support optical reproduction on the control device.
  • the guide device can be designed as a vibration transmitter, which is attached to the body of the surgeon in such a way that the surgeon recognizes in the vibrations emitted by the vibration transmitter in which direction the surgical instrument must be moved in order to reach the desired position.
  • a plurality of vibration transmitters can also be provided, which can be attached to the surgeon's body at various points.
  • the individual vibration transmitters can also convey the measure of the deviation from the desired position to the surgeon as information by means of the excitation frequency.
  • control device can also be controlled wirelessly by the central computer 5, so that no disruptive cables have to be laid. This is particularly advantageous when the guide device is attached to the instrument 3.
  • the guide device when the guide device is attached directly to the instrument 3, the guide device is designed to be sterilizable.
  • the intended use of navigation systems in the operating room requires the careful alignment of the stationary receiver 1 in such a way that its spatial measuring range encompasses the range of motion of the surgical instruments equipped with transmitting elements 4 in the operating area as completely as possible.
  • the alignment is usually carried out in two planes by rotating the receiver, which is attached to a holding arm or a tripod, about its horizontal and vertical axis.
  • the present invention teaches that the guide device 7, which can be positioned as desired, can also be used to provide the operating personnel with significantly improved support for achieving the precise, easily adjustable orientation of the receiver 1.
  • the control device 7 shows which axes and in which directions of rotation the operating personnel must move the receiver in order to adjust the center of its measuring range to the current position of the instrument equipped with transmitting elements 4.
  • a program is implemented in the central computer 5, the functionality of which, according to the invention, is to control the control device via the connecting line 11 in such a way that the required change in the receiver orientation is signaled to the operating personnel via the display device of the control device.
  • the navigation system is set up in detail in the following steps. The operating personnel first guides the instrument into a position that is in the measuring range of the receiver 1.
  • the software in the central computer 5 calculates from the measured spatial coordinates of the instrument 3 how the receiver orientation has to be changed in order to set the center of the measuring range to this instrument position. Based on this, the displays of the control device are controlled in such a way that they signal to the operating personnel the actions required to change the receiver orientation. The instrument is then slowly moved towards the center of the operating area, with the guide device 7 continuously signaling how the receiver alignment must be adjusted in order to follow the instrument movement and to keep the current instrument position in the center of the measuring range. Using this readjustment procedure, the instrument is guided to the center of the operating area so that the centers of the operating area and the measuring area coincide after completion of the readjustment. The area of operation is only covered in the best possible way by the measuring range of the receiver 1.
  • the use of the mobile guide device 7 according to the invention offers significant advantages over the prior art.
  • the alignment of the receiver 1 can take place in a targeted manner and therefore much faster instead of using a trial method, the best possible result of the receiver alignment is reproducibly achieved, and no additional hardware components, for example in the form of a laser pointer, are required.
  • FIG. 4 shows what the displays for signaling the required rotary movements of the receiver can look like on a guide device 7, which is designed in the form of a small screen 20.
  • the software in the central computer 5 is programmed according to the invention in such a way that it generates either a two-part image or two successive, in each case undivided images on the screen.
  • the images symbolically show in top view 22 and side view 23 the receiver 1, the spherically assumed measuring range 24 of the receiver, the current position 25 of the instrument in the measuring range, the vertical or horizontal axis of rotation 26, directional arrows 27 with a number of degrees 28, the direction and size of the Specify the required angle of rotation and the desired target position of the receiver orientation in dashed lines.
  • the illuminated directional arrows 17 indicate the movements required for the optimal alignment of the receiver.
  • the arrows marked “z” show the required rotation about the vertical axis of the receiver, the arrows marked “y” the rotation about the horizontal axis of the receiver and the arrows marked “x” the required linear movement of the tripod or support arm of the recipient.
  • the achievement of the optimal alignment is indicated by an additional signal such as the light-emitting diode 18.
  • the invention further teaches that the movements required for aligning the receiver are performed not only by the guide device 7 but also by a.
  • Display on the 'screen 6 of the central computer 5 can be displayed.
  • One exemplary embodiment represents the generation of one or two symbolic images, as explained above for a guide device with a small screen 20 with reference to FIG. 4.

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  • Health & Medical Sciences (AREA)
  • Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Engineering & Computer Science (AREA)
  • Medical Informatics (AREA)
  • General Health & Medical Sciences (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • Veterinary Medicine (AREA)
  • Public Health (AREA)
  • Robotics (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Pathology (AREA)
  • Surgical Instruments (AREA)
  • Apparatus For Radiation Diagnosis (AREA)

Abstract

L'invention concerne un dispositif pour afficher la position spatiale d'un instrument chirurgical pendant une opération. Ce dispositif comprend, outre le système de navigation classique pour l'instrument guidé par le chirurgien, un système de guidage séparé, qui transmet immédiatement au chirurgien des informations relatives à la position dudit instrument et peut être placé dans le champ de vision du chirurgien ou dans le voisinage immédiat du champ d'opération.
PCT/EP2002/002279 2001-03-02 2002-03-01 Dispositif pour afficher la position spatiale d'un instrument chirurgical pendant une operation WO2002074500A2 (fr)

Priority Applications (1)

Application Number Priority Date Filing Date Title
AU2002311027A AU2002311027A1 (en) 2001-03-02 2002-03-01 Device for display of the spatial position of a surgical instrument during an operation

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
DE10110093.0 2001-03-02
DE10110093A DE10110093A1 (de) 2001-03-02 2001-03-02 Vorrichtung zum Anzeigen der räumlichen Position eines chirurgischen Instruments während einer Operation

Publications (2)

Publication Number Publication Date
WO2002074500A2 true WO2002074500A2 (fr) 2002-09-26
WO2002074500A3 WO2002074500A3 (fr) 2003-09-18

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AU (1) AU2002311027A1 (fr)
DE (1) DE10110093A1 (fr)
WO (1) WO2002074500A2 (fr)

Cited By (9)

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US9119655B2 (en) 2012-08-03 2015-09-01 Stryker Corporation Surgical manipulator capable of controlling a surgical instrument in multiple modes
US9226796B2 (en) 2012-08-03 2016-01-05 Stryker Corporation Method for detecting a disturbance as an energy applicator of a surgical instrument traverses a cutting path
US9480534B2 (en) 2012-08-03 2016-11-01 Stryker Corporation Navigation system and method for removing a volume of tissue from a patient
US9603665B2 (en) 2013-03-13 2017-03-28 Stryker Corporation Systems and methods for establishing virtual constraint boundaries
US9652591B2 (en) 2013-03-13 2017-05-16 Stryker Corporation System and method for arranging objects in an operating room in preparation for surgical procedures
US9820818B2 (en) 2012-08-03 2017-11-21 Stryker Corporation System and method for controlling a surgical manipulator based on implant parameters
US9921712B2 (en) 2010-12-29 2018-03-20 Mako Surgical Corp. System and method for providing substantially stable control of a surgical tool
US11103315B2 (en) 2015-12-31 2021-08-31 Stryker Corporation Systems and methods of merging localization and vision data for object avoidance
US11202682B2 (en) 2016-12-16 2021-12-21 Mako Surgical Corp. Techniques for modifying tool operation in a surgical robotic system based on comparing actual and commanded states of the tool relative to a surgical site

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DE10259250A1 (de) * 2002-12-17 2004-07-01 "Stiftung Caesar" (Center Of Advanced European Studies And Research) Chirurgisches Instrument mit integrierter Navigationskontrolle
DE102006045100B4 (de) * 2006-09-21 2014-11-06 Universität Oldenburg Navigationseinrichtung für ein medizinisches Instrument
DE102011012460A1 (de) 2011-02-25 2012-08-30 Hicat Gmbh Chirurgisches Instrument mit integrierter Navigationskontrolle
DE102015001575A1 (de) 2015-02-07 2016-08-11 Audi Ag Verfahren und Vorrichtung zur Visualisierung der Bewegung eines Roboters

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GB9405299D0 (en) * 1994-03-17 1994-04-27 Roke Manor Research Improvements in or relating to video-based systems for computer assisted surgery and localisation
WO1999038449A1 (fr) * 1998-01-28 1999-08-05 Cosman Eric R Systeme de suivi d'objets optiques

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DE19728788A1 (de) * 1997-07-05 1999-01-07 Nis Peter Boysen Verfahren zur Patienten-Positionierung relativ zum Behandlungsgerät
DE19807884A1 (de) * 1998-02-25 1999-09-09 Schweikard Verfahren und Vorrichtung zur intraoperativen rechnergestützten Bestimmung von räumlichen Koordinaten anatomischer Zielobjekte

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US9921712B2 (en) 2010-12-29 2018-03-20 Mako Surgical Corp. System and method for providing substantially stable control of a surgical tool
US10420619B2 (en) 2012-08-03 2019-09-24 Stryker Corporation Surgical manipulator and method for transitioning between operating modes
US9566122B2 (en) 2012-08-03 2017-02-14 Stryker Corporation Robotic system and method for transitioning between operating modes
US10463440B2 (en) 2012-08-03 2019-11-05 Stryker Corporation Surgical manipulator and method for resuming semi-autonomous tool path position
US9566125B2 (en) 2012-08-03 2017-02-14 Stryker Corporation Surgical manipulator having a feed rate calculator
US10426560B2 (en) 2012-08-03 2019-10-01 Stryker Corporation Robotic system and method for reorienting a surgical instrument moving along a tool path
US11672620B2 (en) 2012-08-03 2023-06-13 Stryker Corporation Robotic system and method for removing a volume of material from a patient
US9681920B2 (en) 2012-08-03 2017-06-20 Stryker Corporation Robotic system and method for reorienting a surgical instrument moving along a tool path
US9795445B2 (en) 2012-08-03 2017-10-24 Stryker Corporation System and method for controlling a manipulator in response to backdrive forces
US9820818B2 (en) 2012-08-03 2017-11-21 Stryker Corporation System and method for controlling a surgical manipulator based on implant parameters
US9226796B2 (en) 2012-08-03 2016-01-05 Stryker Corporation Method for detecting a disturbance as an energy applicator of a surgical instrument traverses a cutting path
US10314661B2 (en) 2012-08-03 2019-06-11 Stryker Corporation Surgical robotic system and method for controlling an instrument feed rate
US10350017B2 (en) 2012-08-03 2019-07-16 Stryker Corporation Manipulator and method for controlling the manipulator based on joint limits
US11639001B2 (en) 2012-08-03 2023-05-02 Stryker Corporation Robotic system and method for reorienting a surgical instrument
US9119655B2 (en) 2012-08-03 2015-09-01 Stryker Corporation Surgical manipulator capable of controlling a surgical instrument in multiple modes
US12004836B2 (en) 2012-08-03 2024-06-11 Stryker Corporation Surgical manipulator and method of operating the same using virtual rigid body modeling preliminary
US9480534B2 (en) 2012-08-03 2016-11-01 Stryker Corporation Navigation system and method for removing a volume of tissue from a patient
US11471232B2 (en) 2012-08-03 2022-10-18 Stryker Corporation Surgical system and method utilizing impulse modeling for controlling an instrument
US11045958B2 (en) 2012-08-03 2021-06-29 Stryker Corporation Surgical robotic system and method for commanding instrument position based on iterative boundary evaluation
US11179210B2 (en) 2012-08-03 2021-11-23 Stryker Corporation Surgical manipulator and method for controlling pose of an instrument based on virtual rigid body modelling
US11183297B2 (en) 2013-03-13 2021-11-23 Stryker Corporation System and method for arranging objects in an operating room in preparation for surgical procedures
US11464579B2 (en) 2013-03-13 2022-10-11 Stryker Corporation Systems and methods for establishing virtual constraint boundaries
US10512509B2 (en) 2013-03-13 2019-12-24 Stryker Corporation Systems and methods for establishing virtual constraint boundaries
US10410746B2 (en) 2013-03-13 2019-09-10 Stryker Corporation System and method for arranging objects in an operating room in preparation for surgical procedures
US9652591B2 (en) 2013-03-13 2017-05-16 Stryker Corporation System and method for arranging objects in an operating room in preparation for surgical procedures
US11918305B2 (en) 2013-03-13 2024-03-05 Stryker Corporation Systems and methods for establishing virtual constraint boundaries
US9603665B2 (en) 2013-03-13 2017-03-28 Stryker Corporation Systems and methods for establishing virtual constraint boundaries
US11103315B2 (en) 2015-12-31 2021-08-31 Stryker Corporation Systems and methods of merging localization and vision data for object avoidance
US11806089B2 (en) 2015-12-31 2023-11-07 Stryker Corporation Merging localization and vision data for robotic control
US11202682B2 (en) 2016-12-16 2021-12-21 Mako Surgical Corp. Techniques for modifying tool operation in a surgical robotic system based on comparing actual and commanded states of the tool relative to a surgical site
US11850011B2 (en) 2016-12-16 2023-12-26 Mako Surgical Corp. Techniques for modifying tool operation in a surgical robotic system based on comparing actual and commanded states of the tool relative to a surgical site

Also Published As

Publication number Publication date
AU2002311027A1 (en) 2002-10-03
WO2002074500A3 (fr) 2003-09-18
DE10110093A1 (de) 2002-09-26

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