Robotic system for minimally invasive surgery

Patent metadata

Field	Value
Publication number	US-12201386-B2
Application number	US-201816644553-A
Country	US
Kind code	B2
Filing date	Sep 6, 2018
Priority date	Sep 6, 2017
Publication date	Jan 21, 2025
Grant date	Jan 21, 2025

Abstract

Systems and methods for performing minimally invasive surgical procedures, especially for removal of tumors, and especially for brain tumors, using a robotically inserted therapeutic probe, which first detects tumorous tissue on a pre-planned path through the patient's tissue, before performing therapeutic procedures on the tissue, such as ablation. This pre-treatment detection procedure is thus able to avoid the destruction of healthy tissue. This also ensures that the therapeutic process indicated in a preoperative surgical plan is only performed on tumorous tissue, without sole reliance on preoperative image indications. This is important for neurosurgical operations performed on the brain, since preoperative images may not be accurate due to brain shift occurring during the procedure. Detection can be performed optically or ultrasonically, and treatment by laser or RF ablation. The probe insertion can be performed at 90° to the insertion axis of the device, thus minimizing passage through healthy tissue.

First claim

The invention claimed is:

1. A system for detection and therapeutic ablation of a diseased region in brain tissue of a subject by clearance of a segment of the diseased region along a sequence of successive paths of an ablation tip, the paths being sequenced to incrementally scan the ablation tip throughout the segment, and the system comprising:
a rigid cannula needle having a laterally directed distal orifice and a flexible inner probe capable of deployment laterally from said rigid cannula needle through said orifice, said flexible inner probe having at its distal end the ablation tip, and the ablation tip comprising a sensor element configured to detect a state of said brain tissue in the region of said ablation tip as a diseased state or a healthy state;
a robotic device configured to move said probe within the brain tissue of the subject; and
a controller adapted to instruct the robotic device with commands to move the ablation tip along one or more of said successive paths while ablating, each sequence of said successive paths beginning with an initial path, and each path of said sequence, after the initial path, is incrementally adjusted relative to a respective sequentially preceding path of said sequence, wherein the commands of at least one of the sequences of successive paths comprising:
(i) commands which insert the ablation tip into the tissue along an initial path of said sequence leading from the orifice toward a target position,
(ii) commands generated in response to a sensed state of said tissue in the region of said target position, wherein when said sensor element detects said healthy-state then the commands move said rigid cannula needle and said flexible inner probe within said tissue to at least withdraw outward the flexible inner probe, extracting it along same said path, and
(iii) commands which re-insert the ablation tip into the tissue along said successive paths in the sequence, each said successive path being incrementally adjusted relative to a respective sequentially preceding path to target a new target position within the diseased region; and
wherein the ablation tip operates during movement along the sequences of paths to perform therapeutic ablation which clears diseased tissue from the segment, and the increments of adjustment between paths of each sequence of paths are sized to move the ablation tip to clear by ablation a portion of a volume including the segment, the segment extending between the initial path in which said sensor element detects said diseased state and a last path of the successive paths in which said sensor element detects said diseased state.

2. A system according to claim 1 , wherein said sensor element comprises any one or more of the group consisting of an ultrasound imaging probe, a direct optical detection probe, and an electrical impedance measurement probe.

3. A system according to claim 1 , wherein said flexible inner probe comprises self-reassembling elements.

4. A system according to claim 1 , further comprising a set of markers adapted to be mounted on the body of said subject for rendering in a preoperative image set, and wherein said robotic device is adapted to be mounted on the body of said subject in a known position relative to said markers, such that the robotic device is registered to said preoperative image set.

5. A method of detection and therapeutic ablation of a diseased region in brain tissue of a subject by clearance of a segment of the diseased region along a sequence of successive paths of an ablation tip, the paths being sequenced to incrementally scan the ablation tip throughout the segment, and the method comprising:
(i) inserting into said brain tissue a rigid cannula needle having a laterally directed orifice and a flexible inner probe capable of deployment laterally from said rigid cannula needle through said orifice, said flexible inner probe having at its distal end the ablation tip, and the ablation tip comprising detection and ablation elements;
(ii) deploying said flexible inner probe from said laterally directed orifice in incremental steps along a first path, the incremental steps being performed according to physician-marked limits for a range of robotic motion, and under the instruction of a robotic controller;
(iii) between the incremental steps, receiving, at the robotic controller, sensing data from the detection element indicative of whether tissue in the region of said ablation tip is diseased;
(iv) actuating the ablation, the actuating comprising the robotic controller generating a command actuating ablation, and instructing the robotic device with the command, wherein the controller is configured to perform the generating contingent on the sensing data indicating that tissue in the region of said ablation tip is diseased;
(v) withdrawing the ablation tip in response to the sensing data indicating that tissue in the region of said ablation tip is healthy; and
(vi) repeating said deploying of said flexible inner probe after performing successive incremental deployment steps of said rigid cannula needle in longitudinal and rotational directions;
wherein the ablation tip operates during the incremental steps of the first path and the successive incremental deployment steps to perform therapeutic ablation to clear diseased tissue from the diseased region within the segment, the segment being smaller than the physician-marked limits in a direction extending radially from the laterally directed orifice, and said being smaller is due to the withdrawing the ablation tip in response to the sensing data indicating that tissue in the region of said ablation tip is healthy; and
wherein the sequence of successive paths are paths along which the successive incremental deployment steps occur, and are incrementally adjusted in response to a sensed state of said tissue in the region of said ablation tip in one or more of the longitudinal and rotational directions by a distance sized to move the ablation tip to clear the segment, the segment extending between the first path and a last path of the sequence of successive paths along which the successive incremental deployment steps occur.

6. A method according to claim 5 , wherein said tissue comprises brain tissue of the subject.

7. A method according to claim 5 , wherein said detection element comprises a fiber optical fluorescence probe, and said ablation element comprises a tip of a fiber delivering an ablative laser beam.

8. A method according to claim 5 , wherein said detection element comprises an ultrasound imaging probe.

9. A method according to claim 5 , wherein said ablation element comprises at least one of the group consisting of a set of radio frequency ablation electrodes and a cryo-ablation ablation tip.

10. A method according to claim 5 , wherein said flexible inner probe comprises self-reassembling elements.

11. A method according to claim 5 , wherein said orifice is directed at right angles to the axis of said rigid cannula needle.

12. A method of surgical treatment of a subject by therapeutic ablation of brain tissue of a subject, the method comprising:
(i) delineating a region to be treated of the subject's brain tissue on a preoperative image set;
(ii) mounting on the subject's body in proximity to said region a robotic system comprising a cannula needle having a laterally directed orifice at its distal end;
(iii) inserting said cannula needle into the subject's tissue until said orifice reaches a selected lateral level of said region to be treated;
(iv) inserting into said cannula needle a flexible probe such that its distal end exits said laterally directed orifice, said flexible probe having an ablation tip at it

Assignees

• Technion Res & Dev Foundation

Inventors

• Ziso Hadas
• Zarrouk David
• Shoham Moshe
• Zaaroor Menashe

Classifications

• A61B2018/2005

  with beam delivery through an interstitially insertable device, e.g. needle · CPC title

• A61B2018/0293

  using an instrument interstitially inserted into the body, e.g. needle · CPC title

• A61B2018/00875

  Resistance or impedance · CPC title

• A61B2018/00577

  Ablation · CPC title

• A61B2018/00446

  Brain · CPC title