System for determining proximity of a surgical tool to key anatomical features

Patent metadata

Field	Value
Publication number	US-12201374-B2
Application number	US-201716328648-A
Country	US
Kind code	B2
Filing date	Sep 4, 2017
Priority date	Sep 4, 2016
Publication date	Jan 21, 2025
Grant date	Jan 21, 2025

Abstract

Multi-component systems and methods for determining the proximity of surgical tools to key anatomical features are provided. The inventive systems and methods can be applied in any surgical procedure requiring precision to avoid damage to key anatomical features such as nerves, with a particular example being the robotic cochlear implantation minimally invasive approach to cochlear implantation. Use of purpose built surgical robots, electromyography and tissue impedance, stereotactic tracking and drilling force/bone density measurements are all key components, with inputs from these various modalities being dynamically weighted. In the example of robotic cochlear implantation, the inventive concepts are used to provide key surgical guidance so as to avoid damage to the facial nerve and the chorda tympani, among other anatomical features.

First claim

What is claimed is:

1. A facial nerve proximity detection system comprising:
a surgical robot comprising at least one surgical tool operably connected to the surgical robot, the robot being configured to operate near the facial nerve;
an electromyography system comprising a pulse generator and a stimulation probe connected to the pulse generator functioning to emit pulses from the pulse generator into tissue, and a monitoring unit configured to receive pulse responses from nerves;
a tissue impedance measurement system comprising a measurement probe and a processing unit to measure tissue impedance near the measurement probe;
a first pose measurement system comprising a stereotactic surgical tracking system configured to track the surgical robot, the at least one surgical tool, the stimulation probe and the measurement probe relative to a patient;
a second pose measurement system operating independently of the first pose measurement system configured to track the pose of the at least one surgical tool relative to the patient through non-stereotactic means; and
a control unit comprising a graphical user interface, configured to acquire inputs from the electromyography and tissue impedance system, the first pose measurement system and the second pose measurement system and produce a weighted facial nerve proximity score based on the inputs from the electromyography system, the tissue impedance measurement system, the first pose measurement system, and the second pose measurement system, to track the robot, the at least one surgical tool, the stimulation probe and the measurement probe relative to the patient, and configured to provide command inputs to a control system of the surgical robot based on the weighted facial nerve proximity score and tracking information so as to avoid the facial nerve.

2. The system of claim 1 , wherein the stimulation probe can be either operably connected to the robotic system or operated independently of the robotic system by a human user.

3. The system of claim 1 wherein the stimulation probe is tracked in space through a multitude of pose measurement systems, including an internal mechanical tracking system of the surgical robot and the first pose measurement system and the second pose measurement system.

4. The system of claim 1 , wherein the tissue impedance measurement system is externally controllable and programmable such that the electrical impedance of the tissue surrounding the stimulation probe can be measured.

5. The system of claim 1 , wherein the pulse generator is externally controllable and programmable such that sequences of pulses varying in amplitude, frequency and pulse width can be generated and emitted through the stimulation probe and wherein the pulse sequences can be dynamically adjusted based on assessment of a feedback signal coming from the monitoring unit.

6. The system of claim 1 , wherein the production of the weighted facial nerve proximity score comprises computing a most likely pose of the at least one surgical tool by dynamically weighting the inputs from the electromyography and tissue impedance system, the first pose measurement system and the second pose measurement system.

7. The system of claim 6 , wherein the weighted facial nerve proximity score is computed and represented in a number of discrete steps or as a continuous value.

8. The system of claim 1 , wherein the control unit provides the command inputs to the control system of the robot in order to prevent the robot from operating at an unsafe distance from the facial nerve.

9. A method of facial nerve proximity detection comprising:
providing a facial nerve proximity detection system comprising:
a surgical robot comprising at least one surgical tool operably connected to the surgical robot, the robot being configured to operate near the facial nerve;
an electromyography system comprising a pulse generator and a stimulation probe connected to the pulse generator functioning to emit pulses from the pulse generator into tissue, and a monitoring unit configured to receive pulse responses from nerves;
a tissue impedance measurement system comprising a measurement probe and a processing unit to measure tissue impedance near the measurement probe;
a first pose measurement system comprising a stereotactic surgical tracking system configured to track the surgical robot, the at least one surgical tool, the stimulation probe and the measurement probe relative to a patient;
a second pose measurement system operating independently of the first pose measurement system configured to track the pose of the at least one surgical tool relative to the patient through non-stereotactic means; and
a control unit comprising a graphical user interface, configured to acquire inputs from the electromyography and tissue impedance system, the first pose measurement system and the second pose measurement system and produce a weighted facial nerve proximity score based on the inputs from the electromyography system, the tissue impedance measurement system, the first pose measurement system and the second pose measurement system, and configured to provide command inputs to a control system of the surgical robot and to track the robot, the at least one surgical tool, the stimulation probe and the measurement probe relative to the patient;
receiving the outputs from the electromyography and tissue impedance systems, the first pose measurement system and the second pose measurement system;
producing the weighted facial nerve proximity score;
tracking the robot, the at least one surgical tool, the stimulation probe and the measurement probe to obtain tracking information pertaining to the robot, the at least one surgical tool and the measurement probe and the stimulation probe; and
providing the command inputs to the control system of the surgical robot according to the weighted facial nerve proximity score and the tracking information so as to avoid the facial nerve.

10. The method of claim 9 wherein the stimulation probe is tracked in space through a multitude of pose measurement systems, including an internal mechanical tracking system of the surgical robot and the first pose measurement system and the second pose measurement system.

11. The method of claim 9 , wherein the pulse generator is externally controllable and programmable such that sequences of pulses varying in amplitude, frequency and pulse width can be generated and emitted through the stimulation probe and wherein the pulse sequences can be dynamically adjusted based on assessment of a feedback signal coming from the monitoring unit.

12. The method of claim 9 , wherein the production of the weighted facial nerve proximity score comprises computing a most likely pose of the probe or tool by dynamically weighting the inputs from the electromyography and tissue impedance system, the first pose measurement system and the second pose measurement system.

13. The method of claim 12 , wherein the weighted facial nerve proximity score is computed and represented in a number of discrete steps or as a continuous value.

14. The method of claim 12 , wherein the dynamic weighting of inputs changes according to the stage of a robotic cochlear implantation procedure.

Assignees

• Univ Bern

Inventors

• Gerber Kate
• Gerber Nicolas
• Weber Stefan
• Anso Juan
• Williamson Tom

Classifications

• A61B5/395

  Details of stimulation, e.g. nerve stimulation to elicit EMG response · CPC title

• A61B5/0538

  invasively, e.g. using a catheter · CPC title

• A61B5/4893

  Nerves · CPC title

• A61B2090/0818

  Redundant systems, e.g. using two independent measuring systems and comparing the signals · CPC title

• A61B90/10

  for stereotaxic surgery, e.g. frame-based stereotaxis · CPC title