Patent Application
20230033676
Tubular dilators as known in the art are generally inserted in telescopic fashion until the necessary surgical channel is created. There are also manual distractors which consist of manually adjustable number of blades for establishing the surgical channel. Both of these approaches are manual and do not provide the surgeon with any meaningful feedback other than retracting the tissue.
Described herein are various embodiments for a tissue dilator device, as well as systems and methods for using the same.
The robotic dilator described herein, is a multi-blade (e.g., two or more blades) support structure used to establish and maintain a surgical channel. The surgical channel may allow a surgeon, or a surgical robot, to have access to a point of interest on the spine. An electronic controller provides the capability to individually actuate/control each individual blade of the two or more blades, which are used to establish and form of a surgical channel. The dilator blades form a narrow diameter tube in one position, and while in the narrow diameter tube, the dilator blades can be inserted into the patient. The narrow diameter tube forms the minimum diameter/footprint of the robotic dilator. Once the robotic dilator is in place, the individual blades may then be actuated individually (one at a time) or simultaneously (2 or more at a time) to dilate the surrounding tissue. The surgical channel may be expanded using the blades, until the channel is large enough for surgical tools to pass through the surgical channel created by the dilator blades. Each dilator blade may be equipped with one or more force sensors, to measure any resistance force the tissue may apply to the blades as the working channel is created or maintained. The information from the force sensors may help guide the surgeon to avoid inducing unnecessary trauma to a patient’s surgical area. In some examples, one or more neurostimulator sensors may be implemented. Each dilator blade may also be equipped with neuromonitoring electrodes, for determining the proximity of each individual blade to a potential surrounding nerve route, thus providing the surgeon with information helping to avoid nerve damage or trauma.
In an embodiment there may be a tissue dilating apparatus for use with a robotic surgery system.
In an embodiment, there is a blade assembly apparatus. The blade assembly apparatus has a frame housing. The frame housing has a front plate and a back plate, and two or more support members between the front plate and the back plate. There is also a first screw mechanically engaged to the housing. The first screw passing through the back plate and is coupled to the front plate. The coupling may be facilitated mechanically. The first screw has a front end, a back end, and a first screw longitudinal axis. The first screw in some examples has a first gear along a first screw length, the first gear is near the back plate. The blade assembly apparatus also has a carriage mechanically engaged to the first screw, such that rotation of the first screw can displace the carriage along the first screw longitudinal axis of the first screw, or in some examples, at least a portion of a length of the first screw. There is also a blade attached or mechanically engaged to the carriage, the blade is positioned outside the housing. The blade assembly apparatus allows for rotation of the first screw, to cause the carriage to move within the housing, and the displacement of the blade outside of the housing. The first screw may include a first translation gear.
In some embodiments, the blade assembly may have additional components which may or may not be used. The design may be altered to fit a particular clinical need. The blade assembly may have a second screw generally parallel to the first screw. The second screw may also be supported between the back plate and the front plate. The second screw may have a second gear that is positioned along the length of the second screw so as to generally match the position of the gear on the first screw. The second screw may have a second translation gear in substantially orthogonal alignment with the first translation gear of the first screw. The second screw may have a second screw longitudinal axis. The gears (e.g., the first screw, the second screw, etc.) may mesh and one gear drive the other, or there may be a pinion gear between them. In the case where the gears directly drive each other, the first screw and the second screw may rotate in opposite directions. The pinion gear may be in rotational engagement with the first translation gear and the second translation gear such that the pinion gear is configured to provide force to drive the second translation gear when the first translation gear is rotated. A rotation of the first and second translation gears is configured to move the carriage along the first screw longitudinal axis and the second screw longitudinal axis. Where a pinion gear is used, the first and second screw may rotate in the same direction. In some embodiments, there may be a transverse screw to cause the carriage to move in a transverse direction relative to the first screw.
In some embodiments, there is a tissue dilating device for use with a robotic surgical system. In certain examples, the tissue dilating apparatus has a frame having an interior and an exterior. Two or more blade assemblies are mounted circumferentially around the exterior of the frame, each blade assembly has a housing, a first screw mechanically engaged to the housing, a carriage mechanically engaged to the first screw, such that rotation of the first screw can displace the carriage along at least a portion of a length of the first screw and a blade fixedly attached to the carriage, the blade positioned outside the housing, wherein the rotation of the first screw causes the carriage to move within the housing, and causes the displacement of the blade outside of the housing and in the interior of the frame. In some examples, the blade is made of at least one selected from a group consisting of a stainless steel, an aluminum, a titanium and a metal alloy. The tissue dilating apparatus may also have two or more mechanical actuators engaged to a like number of blade assemblies. Each of the mechanical actuators may be mechanically engaged or coupled to a respective one of the plurality of blade assemblies. In this way, the plurality of mechanical actuators move the plurality of blade assembly apparatus to create a working channel for a surgical instrument.
In some embodiments, when the elongate members are in a closed position, the elongate members may be spaced equidistant around the aperture created by the interior surface of the frame. Each elongate member may be moved in a radial direction moving in and out from the center. When the elongate members are pushed toward the center of the aperture and abut each other along their elongate length, they form a closed position, and the elongate members may not be “closed” any further. Each elongate member has a closed position, and a variety of open positions. There may be two, three or four elongate blades in some embodiments. There may be more than four elongate blades in some other embodiments. In some embodiments, the elongate members may come together when the elongate members are closed in around the axis of operation, and form a narrow working channel. In other embodiments, the elongate members may be moved away from the axis of operation, and moved toward the edges of the aperture defined by the inner surface of the frame. In some embodiments, when the elongate members are moved away from the axis of operation the elongate members may be moved in an irregular pattern or manner from each other. The elongate members may form any combination of positions as may be allowed using the motors and gears to power the elongate members, or any other sub component described herein.
In various embodiments, the elongate members may have a proximal end and a distal end. For purposes of discussion and orientation, the proximal end refers to the end of something that is closest to the user, while the distal end refers to the end farthest from the user, or closest to the surgical site. In various embodiments, the elongate members may not be connected to each other along their length, but may instead operate independently of each other.
In some embodiments, there may be a tissue dilating apparatus according to the previous aspect, wherein the plurality of elongate members are not connected to each other.
In some embodiments, there may be a tissue dilating apparatus wherein the plurality of elongate members further comprises a first elongate member, and a second elongate member. The first and second elongate members may be moveably attached to the frame. The first and second elongate members each have a proximal end in close proximity to the frame. The first and second elongate members each have a distal end. An expandable barrier may be mechanically engaged to the distal end of the first and second elongate members.
In some embodiments, there may be a tissue dilating apparatus wherein one or more of the elongate members further comprises a carriage, the carriage bridging the distance of the frame. The carriage may be in mechanical engagement with at least one of the motor gears.
In some embodiments, the tissue dilating apparatus may have elongate members that may be movable about a fulcrum.
In some embodiments, the tissue dilating apparatus may have a fulcrum positioned in the aperture defined by the interior surface of the frame.
In some embodiments, the tissue dilating apparatus may have a plurality of elongate members wherein each of the elongate members may be independently movable.
In some embodiments, the tissue dilating apparatus may have a frame that is movable about the axis of operation.
In some embodiments, the tissue dilating apparatus may also have a plurality of motors in mechanical engagement with the set of motor gears.
In some embodiments, the tissue dilating apparatus may include an electronic controller for controlling the plurality of motors.
In some embodiments, there may be a tissue dilating apparatus as described herein that may include a force sensor operable with at least one of the elongate members.
In some embodiments, there may be a tissue dilating apparatus as described herein that further comprises at least one neuromonitoring sensor in mechanical engagement with at least one of the elongate members.
In some embodiments, there may be a tissue dilating apparatus as described herein wherein the frame may define a plane that may be substantially orthogonal to the axis of operation.
In some embodiments, there may be a tissue dilating apparatus as described herein, wherein the plurality of elongate members may be operable as a tissue retractor.
In some embodiments, there may be a robotic surgery system with a tissue dilating device. The system possesses a robotic arm and a tissue dilating apparatus positioned at the distal end of the robotic arm. The apparatus has a frame with an interior surface and an exterior surface. The interior surface of the frame defines an aperture. A plurality of elongate members with an atraumatic form are disposed in a generally orthogonal orientation with respect to the aperture. The plurality of elongate members define a working channel, and an axis of operation. A plurality of gears are in moveable mechanical engagement with the plurality of elongate members. The gears are mechanically engaged to the exterior surface of the frame. The plurality of gears move in response to a plurality of motors, the gears moving the elongate members to alter the shape of the working channel. A computer with a user interface is in electrical communication with robotic arm and the tissue dilating apparatus. There is an electronic controller directing the movement of the robotic arm and the tissue dilating apparatus, the electronic controller is operated through the user interface of the computer.
To easily identify the discussion of any particular element or act, the most significant digit or digits in a reference number refer to the figure number in which that element is first introduced.
In the various figure descriptions, part numbers are assigned to drawing elements without regard to importance. A lower part number does not signify greater or lesser importance. Part numbers are arbitrarily assigned during the drafting the patent application. No commonality exists or is intended between similar parts of different drawings.
As used herein, when an element, component, device or layer is described as being “on,” “connected to,” “coupled to” or “in contact with” another element, component, device or layer, it can be directly on, directly connected to, directly coupled with, in direct contact with, or intervening elements, components, devices or layers may be on, connected, coupled or in contact with the particular element, component or layer, for example. When an element, component, device or layer for example is referred to as being “directly on,” “directly connected to,” “directly coupled to,” or “directly in contact with” another element, component, device or layer, there are no intervening elements, components, devices or layers for example.
Described herein are various embodiments of a medical tool for use with a robotic surgery device or system. For discussion purposes only, a frame of reference is adopted to assist in the reading of the present disclosure. Reference is made to a surgical site, which is the location in a patient body where a medical procedure may occur. The physical elements of the various embodiments describe any portion of the element that is closest to the surgical site position as distal or distal end. Elements which have a portion that is toward the surgical site have a distal portion. If the element also has a portion that is further away from the surgical site, that further away portion is referred to as the proximal end.
In some embodiments, the use of “front” and “back” are used. The front is closest to generally facing toward the surgical site, or facing the working channel that connects to the surgical site. The back end is away from the surgical site, or the side opposite the front end.
To avoid any prolix description of the many embodiments, the use of “generally” or “substantially” are used herein and meant to refer to the written description of an object, plus or minus, an additional 15% of the particular measurement. If the reference is in degrees, such as an object that is “substantially orthogonal”, the relationship may be read as 90 degrees, +/- 15 degrees. If the measurement is “substantially 100 millimeters”, the measurement should be read as 100 mm, +/- 15 mm (15%).
In another embodiment, the two blades 122, 124 may be in a closed position, with no gap viewable between the blades 122, 124. The blade assemblies 126, 128 may be seen to abut each other, with no gap between them.
A top view of the frame 224, caps, and motor gear assembly 200 are shown in
In some embodiments, each blade assembly may have a separate translation gear. In an embodiment, a second translation gear 212 may engage a blade gear 214 to move a second blade 218. In an embodiment, a third motor gear 232 may drive a third translation gear 228, which in turn may drive a third blade gear 230 to move a third blade 220. A fourth motor gear 238 may drive a fourth translation gear 236, which may mechanically engage a fourth blade gear 234 to move a fourth blade 222.
The frame 224 may have an electrical connector 226 for a general purpose input/output device. This may be a quick connect electrical socket having multiple connectors for different components such as power, force sensing elements, neuromonitoring signals, stress and/or strain sensors, position sensors and so on. The various electrical components may be wired into a single adapter, or may maintain their separate identity with a variety of plugs in the electrical connector 226.
In some embodiments, the frame may be rotated, so the blade assemblies may rotate in a circular fashion. The rotation of the frame about the axis of operation may be conducted manually, or under motor control. The motor control may also function as a fully robotic motion, or a robot assisted motion. In the various embodiments, the frame may rotate through an arc measure that matches half the angle between the elongate members. For example, if there are three elongate members, the arc measure between the three elongate members may be 120 degrees. The frame may rotate ½ of the arc measure, or rotate up to 60 degrees. If there are four elongate members, the arc measure may be 90 degrees between the elongate members. In this example the frame may rotate about 45 degrees, or half the arc measure between the elongate members. In still other embodiments, the frame may rotate at least ½ the arc measure between the elongate members. In other embodiments, the frame may rotate freely.
A view of two embodiments of the dilator are now seen in
In an embodiment, the other features shown in
In another view, the blade assemblies 320 may be seen in an open configuration as shown in
A blade gear assembly 400 is now shown in
In an embodiment, motive force from a motor or motor gear connector may drive the drive gear 410. Torque, or force may be applied to the pinion gear 414 and to the upper drive gear 412. The force from the motor or motor gear connector drives the lower drive screw 420 and the upper drive screw 416 simultaneously. The carriage may move along the axis of the upper and lower drive screw, causing the blade to move in one axis. As may be appreciated by those skilled in the art, any one of the axles shown may be the drive gear, with torque being transferred to any of the other gears and axles.
In some embodiments, there may be a blade assembly apparatus. The blade assembly apparatus may have a carriage housing. In some embodiments, the carriage housing has a front plate and a back plate. There may be two or more support members connecting the front plate to the back plate. In some embodiments, the support members may connect the corners or edges of the front and back plate, forming a cube or other three dimensional frame like structure. A first screw may be coupled to the carriage housing, with the first screw passing through the back plate and coupled to the front plate. In some embodiments, the first screw may be received by an aperture in the front plate. In some embodiments, the front plate may have a port attached to the front plate, wherein the port may receive the tip or front end of the first screw. The first screw may be directly coupled to the front plate either in direct contact with the front plate, or coupled to the front plate through one or more intermediate elements. In an embodiment, the tip or front end of the first screw may be axially secured by the connection to the front plate to reduce wobbling or lateral oscillation. The first screw may have a drive gear positioned outside the carriage housing, and a first gear positioned adjacent the back plate, either inside or outside the back plate. A carriage may be mechanically engaged with the first screw, which may be a lead screw, ball screw or similar device. The first screw may rotate and drive the carriage forward or backward along the length of the screw. In some embodiments, a blade may be attached to, or part of the carriage. The blade may be positioned outside the carriage housing. A cap or bridge component may connect the blade and the carriage. The cap or bridge may provide sufficient space between the carriage and the blade so the carriage housing may be attached to a frame of a dilating device. The gap space may be sufficient to permit the carriage to be moved along the length of the first screw, and have the blade move a corresponding distance, with the blade inside the frame of a dilating device.
In some embodiments, there may be a second screw generally parallel to the first screw. The second screw may have the same configuration with respect to the front plate and the back plate, with a translation gear on the second screw. In some embodiments, the second screw may be received by an aperture in the front plate. In some embodiments, the front plate may have a port attached to the front plate, wherein the port may receive the tip or front end of the first screw. The first screw may be directly coupled to the front plate either in direct contact with the front plate, or coupled to the front plate through one or more intermediate elements. In an embodiment, the tip or front end of the first screw may be axially secured by the connection to the front plate to reduce wobbling or lateral oscillation. The translation gear of the second screw may be on the same position as the translation gear on the first screw, so the translation gears may directly or indirectly mesh together. In an embodiment where an indirect mesh of gears may be used, a pinion gear may be positioned between the first translation gear and the second translation gear. Then the first screw rotates, the first translation gear may rotate as well, and the pinion gear may transfer mechanical energy to the second translation gear, and cause the carriage to move in response to the rotation of the two screws.
The first screw, second screw and transverse screw discussed may be a standard screw, with each receiving part being threaded. In some embodiments, the screw may be a lead screw or a ball screw or similar component suited for causing the carriage to move along the length of the screw while the screw rotates. Other components that may be functionally equal to a lead screw may also be used.
A blade assembly 500a is now shown in
In an embodiment, the carriage may move along the path defined by the first and second screws. The carriage 514a may move on the first and second screws with both screws turning in unison, or the movement of the carriage 514a on the second screw 520a and first screw 522a may be asymmetric, with one lead screw translating the carriage a greater distance than the other lead screw. The first and second screws may be in a generally stationary position relative to the carriage housing 512a. In some embodiments, there may be a transverse screw and transverse gear 530a which may provide a motive force to move the carriage in a transverse direction.
In various embodiments, the carriage housing may be an open frame structure, as shown, or it may be more enclosed. The blade assembly mount may be sterilized, and a partially open or mostly open structure may facilitate removal of biological waste, and allow for easier cleaning of the parts and assembly. In some embodiments, the design may be suitable for autoclaving. In some embodiments, the carriage housing may be part of a unibody design, where the front and back plates, and the support members may be a single unit, which may be machined, printed, assembled, stamped or manufactured by other means.
In an embodiment, a drive gear 510a may be coaxially engaged to either the second screw 520a or the first screw 522a. The drive gear 510a may be in mechanical communication with a motor or a translation gear, both of which are described herein. The carriage 514a may be driven by a single lead screw. In some embodiments, the individual lead screws may have a rotational gear on each lead screw, with a pinion gear in between the rotational gears. In this manner, one of the screws may serves as the drive axle with a driving rotational gear 508a, and torque may be distributed evenly to the other, non-drive axle screw through the pinion gear. The carriage housing 512a may be attached to, or mechanically engaged to the frame. The cap 506a may connect to a carriage 514a, and the carriage 514a may translate up and down on the axis defined by the first screw and also move the blade with the carriage. While some embodiments may use lead screws, other embodiments may use ball screws or any other screw-driven actuator. Equivalent mechanical actuators for moving the carriage may include linear actuators, rail and piston slides, cam shaft and so on. In various embodiments, the cap 506a, carriage 514a and blade 504a may be made as a single part, or multiple parts assembled together. In various embodiments, the dilator device may be made of various forms of stainless steel. In some embodiments the blades may be made from carbon fiber. In some embodiments the blades may be made of various alloys, including but not limited to titanium alloys, tungsten alloys or other steel alloys. In some embodiments the dilator device may be made of ceramic composite materials. In some embodiments various components of the dilator device may be made of polymers, such as poly carbonate, polyether ether ketone (PEEK) or polymer composites. It may be understood by those skilled in the art that various components of the dilator device may be made of different materials. In various embodiments, the dilator device may be reusable, so the materials selected for manufacturing the dilator device may be sterilizable, washable or cleaned.
In some embodiments, there may be a transverse screw that may be oriented in an orthogonal position relative to the first screw. The transverse screw may cause the carriage to move in a transverse axis, which may cause the blade portion to move in a transverse direction. In some embodiments, there may be more than one transverse screws, which may cause the blade to move in a variety of different directions.
In another embodiment, as shown in
In an embodiment, the housing 512b may have an open architecture, which may promote cleaning the blade assembly after use. The open architecture may permit the parts within the housing to be washed or cleaned. In some embodiments, the blade assembly may have a second screw (not shown), which may also be mechanically engaged to the carriage housing 512b and the carriage 514b. In some embodiments, the second screw may intersect the carriage 514b at a substantially orthogonal angle to the first screw, so the carriage may be moved in a second direction different from the first. In various embodiments, the blade, housing, bridge and other components of the blade assembly may be made of stainless steel, aluminum, titanium or any metal alloy, polymer or ceramic composite. In some embodiments, a transverse screw and gear 530b may be provided to permit the carriage 514b to move in a transverse direction.
In some embodiments, the blade assembly may have one or more sensors. The sensor maybe any described herein, such as a force sensor, a strain sensor, a neurosensory, a magnetic sensor, electromagnetic sensor, and so on. In some embodiments, the blade assembly may have one or more markers. The markers may include a fiducial for optical detection, electromagnetic detection, or conductance. The marker may include a bar code, or a QR (Quick Response) code. The various sensor(s) and marker(s) may be placed anywhere on the blade assembly. In some embodiments, the sensor or marker may be positioned at the top or proximal end of the blade (near or on the bridge). In some embodiments, the sensor or marker may be placed along the length of the blade, or the distal end.
A cross section of the blade assembly mount 600 is now shown in
In various embodiments, the upper lead screw 612, the lower lead screw 614 may be supported by the back end 628 of the blade mount 630. In some embodiments, the blade mount 630 may be fastened to the frame 610. In some embodiments, the upper lead screw 612 and/or lower lead screw 614 may be in rotational engagement with the frame 610. In other embodiments, the upper and lower lead screws may be anchored to the frame. In still other embodiments, the upper and lower lead screws may terminate in the blade mount 630 without penetrating or touching the frame 610.
In some embodiments, the carriage of the blade assembly may be moved equally with both the upper and lower lead screws. In some embodiments, the displacement of the carriage on the upper and lower lead screw may not be equal, as shown in
In some embodiments, the carriage may be tilted in a side to side motion, causing the blade to move in an additional degree of freedom. The carriage may have a horizontal lead screw (not shown) that allows the carriage to be moved from side to side, in addition to back and forth. In some embodiments, the use of a horizontal lead screw in substantially an orthogonal relationship to the upper lead screw and the lower lead screw, may allow the carriage to move on an axis substantially orthogonal to the plane of the drawing page. In some embodiments, use of the different lead screws to control position of the carriage (and blade) may produce two axis of movement with four degrees of freedom (DOF). Use of a third axis parallel to the blade may produce a third axis and six DOF. In many embodiments, the dilator may be attached to a robotic arm, offering additional DOF with the use of the robotic arm.
An angle view of a blade assembly is now shown in
In some embodiments, the blade 804 may be connected to a carriage 820. A force sensor 808 may be mounted on the blade to measure the force or strain exerted on the blade during use. An upper lead screw 810 may connect the carriage to an upper blade gear 812, and a lower lead screw 818 may connect the carriage 820 to a lower blade gear 816. A portion of the back end 814 of the blade mount (the rest omitted for clarity) may support the upper lead screw 810 and the lower lead screw 818. The blade mount back end 814 may be mechanically engaged to the frame 822 via a set of attachment points (not shown).
In operation, each of the upper blade gear 812 and the lower blade gear 816 may be rotated using a transition gear connected to a motor. The upper and lower gear may be rotated in synch or rotated individually. As the gears are rotated, the lead screws rotate and drive the carriage along the length of the lead screws forward or backward. If the two lead screws are rotated in unison, the carriage may maintain the same orientation from start to finish. In some embodiments the carriage may be orthogonal to the lead screws. In some embodiments the carriage may be tilted with respect to the lead screws. In other embodiments, the rotation of the upper and lower lead screws may cause the carriage to change its orientation. A higher linear displacement in the upper screw may cause the carriage to tilt forward (toward the frame), while a lower linear displacement of the upper lead screw compared to the lower lead screw may result in the carriage being tilted backward (away from the frame). In some embodiments, the blade 804 may be mechanically engaged to the carriage in a fixed orientation, with the carriage and blade in a substantially parallel alignment. In some embodiments, the frame 822 may be solid. In some embodiments, the frame 822 may have one or more openings along its perimeter.
In various embodiments, the blade 804 may have a tapered breadth. In some embodiments, the length of the elongate members/blades may be selected for the type of surgical procedure the dilator device may be used for. In some embodiments the length of the blade may be 40 millimeters (mm). In some embodiments the length may be 80 mm. In still other embodiments the length may exceed 120 mm. As the blade length becomes greater, there may be additional material used in the blade shape to provide structural integrity. In some embodiments, the proximal end of the blade (the end away from the surgical site) may be larger while the distal end (the end at or in closer proximity to the surgical site) may be narrower. In various embodiments, the blade may be tapered, or have a step down form with more material used in the proximal end. In some embodiments, the proximal end may be reinforced with stronger materials. In some embodiments, the blade may have structural support along its length, or portions of its length to provide enhanced structural rigidity and reduce the amount of flex the blade experiences under load.
An example of a tilted blade is now shown in
In an embodiment, the set of elongate members may come together to form a tapered dilator 1000 as shown in
In various embodiments, the closed position of the blades 1004 may be opened by actuation of a set of motors for driving the displacement of the carriage of each blade.
Examples of a parallel and non-parallel motion of the blades are now shown in
In an alternative embodiment, the closed working channel may have a first foot print 1120, and then a second open foot print 1122. The individual blade members 1118a-n may open in a tilted manner with the distal ends angled outward as shown. There is no limit to the variety and positions of the individual blade members and shapes of working channel footprints as is described herein.
A variety of blade cross sections 1202 are now shown in
In an embodiment, the cross section of the blades may be circular (like round chopsticks), and placed as two members 1204, three members 1206, four members 1208, five members 1210 or more. In another embodiment, the elongate members may be formed to generally take the shape of sections of a circle (in cross section) like hemisphere 1212, triangle 1214, quarter 1216 or fifth 1218 pieces or more.
In an embodiment, there may be four blades that may be moved via their respective carriages to different positions 1300 as shown in
In some embodiments, the individual blades may be moved using a motor controller. Each blade assembly may have a force sensor, to measure the amount of force each blade is experiencing when moving against tissue. The motor controller may have force limits assigned to each blade, and these force limits may be uniform, or unique for each blade. When the motors drive each blade, the blades may not move in a uniform manner. The controller may deviate the motive force of each blade to “wiggle” the blades to create an opening that may also be a path of less resistance. The result is the first blade 1308, second blade 1310, third blade 1312 and fourth blade 1314 may produce an asymmetric pattern and pathway for a working channel. So long as the working channel is sufficiently sized to allow another surgical tool down the surgical channel, the tissue dilator may function as intended.
An end view of sample elongate member positions 1400 is now shown in
A dilator and motor 1500 are shown in
A profile view motor and dilator 1600 is now shown in
In some embodiments, a user may use a combination of visual guidance and robotic controls as a dilator controller 1700. In various embodiments, visual guidance 1702 may take a wide variety of forms. The visual guidance component may take images of the tissue to be operated on (including surrounding tissues used to access the desired surgical site, and tissues that may affect the surgery, as well as tissues the surgery may have an effect on). The scope of the visualization may be determined by preprogrammed parameters of the surgical system, the control system for the surgical dilator, the physician, by health care workers or even by insurance companies or policies.
In an embodiment, the visual guidance device may be a fluoroscopy device, with the fluoro images provided in electronic format to a computer. The visual guidance may also include a static or dynamic operation coordinate location system (a mapping system). The mapping system may use fixed positions external to the patient in combination with movable (dynamic) positions that are in or on the patient to create a three dimensional map of the surgical site, and track the position of the surgical tool, surgical site, and any objective tissues within the surgical site to be influenced by the surgical tool, or to be protected from influence of the surgical tool.
The fluoroscopic image (fluoro) may be combined with real time images using ultrasound, with the ultrasound images being integrated into the master imagery, which may be the fluoro image, or a computer interpolated (composite) image of the fluoro and ultrasound. In some other embodiments, nuclear magnetic resonance (NMR) images, positron emission topography (PET) scan images, or computer tomography (CT) scan images may be used with or instead of any other imaging modality described herein. Any future imaging modality which may provide guidance may also be used. The various imaging modalities may be used to produce a real time, or near real time display of the surgical site, and actual or representative images showing the penetration of surgical tools into the patient tissues. In some embodiments, the representation may not be a visual representation, but may be an audible signal, such as a change in frequency, amplitude, volume or elimination of sounds. A tactile feedback may also be used to alert or warn when the surgical tools are either approaching tissue that should not be interacted with, or target tissue that should be removed/altered.
In various embodiments, the visual images may be coordinated to produce an image map of the surgical area. Placement of the surgical tools into the image may be done using a registration system. The resulting image may form a user image visual 1704. The user may then interact with the surgical site by guiding the surgical tools, registered to the image of the surgical site, using one or more input controls for the user 1706. In various embodiments, the visual guidance system may be incorporated into a surgical robot and robot controller.
Several examples for the use of the dilator are now shown in
The introducer 1802 may be pressed to a desired depth, with the tip of the introducer positioned at a depth of an operation site or surgical side 1808. The force arrows 1806 designate the direction of force used to apply the introducer. The introducer may be inserted manually, using robotic guidance, using full robotic control, or any combination of automated robotics and human guidance, as well as robotic forces and human forces, as may be appropriate for the procedure.
In an embodiment, once the introducer may be positioned, a dilator 1820 as described herein, may be slidably advanced over the introducer 1802 as shown in
The dilator 1820 may be advanced over the introducer 1802 as shown in
In another example use case, the elongate members may remain in a parallel configuration when used as shown in
In another embodiment, the elongate members may be connected together on the distal ends using a flexible or expandable structure as shown in
In various embodiments, the expandable material may be a stretchable material such as an elastic polymer, natural rubber, latex or similar material. In certain embodiments, the expandable material may be a mesh or netting material that may be porous, but of sufficiently fine mesh to prevent or reduce the intrusion of solid tissue into the working channel. In other embodiments, the exterior surface of the expandable material may be treated with a hydrophobic coating, to assist in repelling fluids from the working channel. A wide variety of materials may be used for the expandable material, including, but not limited to, polymers, ceramics, fabrics, metals, alloys or any combination of useful materials. The expandable material may be reusable or disposable.
In some embodiments, the material may form a helically wound braid (HWB) which may tighten as the braid expands. The initial form of the helically wound braid may be relatively loose fitting. The helically wound braid may be attached, or may be engaged by, the elongate members. In an embodiment, the helically wound braid may be woven around the elongate members, so the HWB may be long and thin during deployment. Then as the elongate members expand, the HWB may shorten and the braid may compress, forming a barrier against tissue or fluid intrusion into the working channel. In some embodiments, the HWB may have engagement loops which may be engaged by the elongate members. The HWB may be inserted into a surgical site over an introducer, and the tissue dilator may be inserted over the introducer following the HWB. The elongate members of the tissue dilator may engage with the HWB and deploy the HWB as the elongate members expand.
In some embodiments, a control system or control method may be used to control the tissue dilating apparatus. In some embodiments, the control system may take advantage of various sensing and actuation capabilities of the dilator system to realize different control strategies. On a high level, the control system may engage the actuation force and/or control the position of each blade. The system may monitor the blade position, the forces exerted on each blade, as well as measure positions of relevant structure in the surgical environment (such as neuro-monitoring signals to determine the location of nerves). The measuring of forces on each blade, and the measurement of the environment around each blade may be done continuously, or with a sufficient sampling rate to promote safety, with all data fed back to the control system.
In an embodiment, there may be a control method that uses position control. A user may specify the desired center axis and diameter of a planned working channel. The control system may convert these parameters from a user coordinate system into the dilator coordinate system, and then use a position based feedback control loop to servo each blade to the desired position to establish the desired working channel. Furthermore, the user may also adjust the individual position of each blade, for a more customized shape and size of the working channel.
In an embodiment, the position control method may be used together with force sensing and neuro monitoring. For example, if the tissue interaction force is below a specified threshold and/or neuro-monitoring signal indicates no critical neural structures are in the vicinity, the blade may be moved with a standard speed; when the force increases above a first threshold, or neuromonitoring shows the blade may be close to a nerve root, the blade speed may be reduced and warning signals (visual, auditory, haptic, etc.) may be used to alert the user. In some embodiments, if the force exceeds a second threshold that may be deemed unsafe, or neuromonitoring measures the blade may be too close to a critical structure, the blade motion may be stopped or even deflected, and the user may be informed with these warning signals.
In another embodiment, a force control system may be used. In an embodiment, each blade may be moved to reach a target force value or to follow a prescribed force profile (e.g., a force-time curve). Compared to the position control embodiment, the force control system may allow the maximum opening given a force threshold. This method may also be used together with position and neuromonitoring feedback. For example, if there are additional position-based constraints, such as a forbidden region predefined with a given preoperative image position, or with real-time surgical navigation, or with neuromonitoring, these constraints may be simulated as opposing forces to prevent the blade from violating them. Similar to the position control scheme, various warning signals may be used to alert the user.
In another embodiment, there may be a position and force hybrid control method. In some embodiments, when the dilator blades may move in an open or close translation direction, a position control may be used to reach a predefined opening. In another embodiment, such as tilting the blade, force control may be used to create a conical, cylindrical or asymmetric workspace while maintaining pressure force on tissue below a safe limit. Besides hybrid control for each blade, hybrid control may be employed across different blades, i.e., some blades may be controlled with a primary position feedback loop, while other blades may be controlled with a primary force feedback loop. In some embodiments, the shape and size of the working channel may be restricted by the patient anatomy, and the control system may adapt to limitations resulting from those restrictions.
An example of a control method is now shown in
The process of controlling a second blade 2050b may follow the same control and feedback pathways, with a motor torque 2006b and position control 2028b provided to a motor to produce actuation 2008b. The actuation reports back the torque provided 2020b and the position 2022b. The second blade 2050b may also experience resistance force 2016b caused by the patient anatomy 2018. The blade may report data back to the controller 2004 in the form of resistance forces 2024b and any neural signal 2026b detected.
The process may be duplicated for each blade used to make up the dilator, as shown, up to N number of blades.
In another embodiment, there may be a method of controlling a tissue dilating apparatus having two or more independently operable blades. The method may comprise providing a reference command to a controller. The method may include determining, by the controller, a position and an amount of motor torque to relay to a motor, where the position may be determined from the reference command. The method may include actuating a motor, to create the amount of motor torque to move a blade to the position. The method may include registering, from a sensor, the resistance force on the blade, and then compensating using the controller, for the resistance force on the blade, by further actuating the motor. The compensating may be continuous and done in real time, as the blade may have a force sensor to determine the resistance of the tissue, as well as a location sensor, to determine the blade location in the surgical space.
The method may be used to control each blade individually, with an overall control program to monitor each blade’s movement relative to the reference command. The overall control program may determine alternative motions for each blade as a potential compensation to one or more blades that may encounter strong resistance to their initial movement instructions. The alternative motion may be executed by the overall control program automatically, or recommended to the surgeon for approval. In various embodiments, the overall control program may monitor the position of all blades and provide either direct changes or recommendations to change, the movement path of any blade, based on the medical procedure or other parameters available to, or programmed into, the overall control program.
In an embodiment, the reference command may be input by a surgeon during a medical procedure. The surgeon may be physically present with the patient, or may be remote (not in the same room as the patient or the dilator/surgical robot). The reference command may be continuously updated, as when a surgeon may be engaged in a surgery or medical procedure, and need to move the dilator continuously, or during certain periods of time. The reference command may be a pre-programmed maneuver of the control software for the dilator, or for a robotic surgical system used to control the dilator.
Example blade movement using the different control methods are now shown in
In an embodiment, the dilator blades may open to a second diameter 2104 using the position control method. An instrument 2110 may then be positioned in the dilator. The initial dilator diameter is shown with a first diameter 2106. The second, expanded dilator diameter is shown with a second diameter 2104. The individual blade tips 2108 are positioned about the first diameter with the medical tool 2110 disposed within the first diameter 2106. In an embodiment, the force control method may be adopted. The surgical instrument may be moved toward the top right blade 2112, and the blade may be “pushed” by a virtual force 2130 rendered from the proximity between the surgical instrument 2114 and the blade 2112, causing the blade 2112 to “open up” (move further to the top right) to allow additional workspace for the instrument. As the blade moves toward the limit of the second diameter, the blade 2116 may reach a “hard stop” of the second diameter limit 2126. The surgical tool 2118 may move as close to the blade 2116 as may be physically possible, or delineated by a control limit of the dilator control method. In some embodiments, the lower left blade 2120 may shift 2132 toward the center, to a new position 2122, as shown. In this manner, the lower left blade 2120 may reduce force on the opposing side such that the likelihood of tissue injury may be reduced. This may be done in either force or position control methods.
Additional embodiments of differing numbers of blades for the dilator are illustrated in
The cross section views of additional embodiments of differing numbers of blades for the dilator are illustrated in
Various blades (e.g., blades illustrated in
The opening of the various blades (e.g., blades illustrated in
In an embodiment, a view of a closed set of blades 2600a is shown in
In an embodiment, a view of four blades in different positions are now shown in
In some embodiments, there may be a tissue dilating apparatus for use with a robotic surgical system as shown in
In an embodiment, the first screw may pass through the frame, and engage the blade directly. The screw may control the radial motion of the blade (toward and away from the center). This may be done by having the screw terminate in or on the blade, and the blade move as the screw is rotated. In some embodiments, the screw may be replaced by a piston, slider or other linear movement device. In some embodiments the screw may be an arm attached to a cam, converting rotational movement to linear movement.
In some embodiments, the tissue dilating apparatus may have two or more blades that may come together to form a tube. The blades may be individually moveable. The dilator may also have a group of motors in removable mechanical engagement to the mechanical actuators. Generally, there may be one motor to drive one mechanical actuator, and in turn drive one blade assembly. In some embodiments, the motor drive may be directly engaged with the blade assembly. The tissue dilating apparatus may be made of stainless steel, aluminum, or medical grade metal alloys.
The shape of the blades may depend on the number of blades used to create the working channel of the dilator. Referring to
In some embodiments, the tissue dilating apparatus has a plurality of independently operable blades. In process 2902, a controller provides a reference command. In process 2904, the controller determines a position and an amount of motor torque relay to a motor, wherein the position is determined based at least in part upon the reference command. In process 2906, a command is transmitted to the motor to create the amount of motor torque to move a blade to the position. In process 2908, the controller receives the sensor signal (e.g., one or more sensor signals, a plurality of sensor signals), for example, from one or more sensors, where the sensor signal indicates or can be used to determine a resistance force on the blade. In process 2910, the controller determines a compensation motion (e.g., actuation, expansion, rotation, etc.) based at least in part on the sensor signal.
In some examples, the controller moves the plurality of independently operable blades to create a working channel for a surgical instrument. In some examples, the plurality of independently operable blades form a tube. In some examples, the sensor is a force sensor configured to measure the resistance force applied by tissues to the blades as the working channel is created. In some examples, the compensation motion may be determined continuously and in real-time (e.g., less than 1 second) by the controller.
In the many embodiments, the blades may define a portion of the working channel for a surgical procedure. The blades (which are atraumatic) may be used to push tissue out of the way, and clear a path for a working channel. If the tissue may be pushed aside using the blades, the working channel may be created without any additional device or effort. In some embodiments, the tissue may be spongy, wet or bleeding, which may spill into the working channel. In embodiments where the blades may not be sufficient to define a working channel by themselves, additional elements may be introduced into the surgery, such as a dam, a flexible wall, such as made of medical grade rubber or polymer, or a helical wound cuff or collar of medical grade material. This additional dam or barrier may be stretched over a portion of the blades (such as near the distal tips), or may be erected around the blades before, during or after creation of the working channel.
The disclosure of the tissue dilating apparatus is now presented in a series of non-limiting aspects:
1. A blade assembly comprising:
2. The blade assembly of any described herein, wherein the first screw comprises a first translation gear, the blade assembly further comprising:
3. The blade assembly of any described herein, further comprising a second drive screw in parallel arrangement to the first screw, the second drive screw being rotated by a motor separate from the first screw.
4. The blade assembly of any described herein, further comprising a transverse screw mechanically engaged to the carriage housing and the carriage, the transverse screw being substantially orthogonal to the first screw.
5. The blade assembly of any described herein, where in the blade is made of at least one selected from a group consisting of a stainless steel, an aluminum, a titanium and a metal alloy.
6. The blade assembly of any described herein, further comprising a bridge portion configured to connect the blade and the carriage.
7. The blade assembly of any described herein, wherein the front plate has an aperture configured to receive at least one of the first screw or the second screw.
8. The blade assembly of any described herein, further comprising one or more sensors.
9. The blade assembly of any described herein, wherein the one or more sensors comprise at least one selected from a group consisting of a force sensor and a neurostimulator sensor.
10. The blade assembly of any described herein, wherein the first screw is directly coupled to the front plate.
11. A tissue dilating apparatus for use with a robotic surgical system, the apparatus comprising:
12. The tissue dilating apparatus of any described herein, wherein the plurality of mechanical actuators are configured to move the plurality of blade assembly apparatus to create a working channel for a surgical instrument.
13. The tissue dilating apparatus of any described herein, wherein each of the plurality of mechanical actuators is coupled to a respective one of the plurality of blade assembly apparatus.
14. The tissue dilating apparatus of any described herein, wherein the plurality of blades form a tube.
15. The tissue dilating apparatus of any described herein, wherein the plurality of blades are individually moveable.
16. The tissue dilating apparatus of any described herein, further comprising:
a plurality of motors in removable mechanical engagement to the plurality of mechanical actuators.
17. The tissue dilating apparatus of any described herein, wherein each blade of the plurality of blades is connected to a corresponding carriage by a bridge, wherein the bridge extends outside the carriage housing and the frame.
18. The tissue dilating apparatus of any described herein, wherein the plurality of blade assembly apparatus are made of at least one selected from a group consisting of stainless steel, aluminum, and medical grade metal alloys.
19. The tissue dilating apparatus of any described herein, wherein the plurality of blades are configured to form a barrier.
20. The tissue dilating apparatus of any described herein, further comprising:
a helical braid mesh woven around at least a portion of the plurality of blades, the helical braid mesh configured to expand and contract with the plurality of blades and form a substantially contiguous barrier between the plurality of blades.
21. The tissue dilating apparatus of any described herein, wherein a respective distal end of each blade of the plurality of blades is configured to form the barrier.
22. The tissue dilating apparatus of any described herein, wherein the plurality of blades are individually movable in pairs.
23. The tissue dilating apparatus of any described herein, wherein a first pair of blades are movable such that proximal ends of the first pair are positioned closer together when distal ends of the first pair are spaced farther apart.
24. The tissue dilating apparatus of any described herein, wherein a second pair of blades are movable such that proximal ends of the second pair are spaced farther apart when distal ends of the second pair are positioned closer together.
25. The tissue dilating apparatus of any described herein, wherein the plurality of blades are configured to retain a substantially parallel configuration with respect to each other when moving.
26. A method of controlling a tissue dilating apparatus having a plurality of independently operable blades, the method comprising:
27. The method of any described herein, further comprising moving, by the controller, the plurality of independently operable blades to create a working channel for a surgical instrument.
28. The method of any described herein, wherein the plurality of independently operable blades form a tube.
29. The method of any described herein, wherein the sensor is a force sensor configured to measure the resistance force applied by tissues to the blades as the working channel is created.
30. The method of any described herein, wherein the compensation motion is determined continuously and in real-time.
Embodiments of the subject matter and the operations described in this specification may be implemented in digital electronic circuitry, or in computer software, firmware, or hardware, including the structures disclosed in this specification and their structural equivalents, or in combinations of one or more of them. Embodiments of the subject matter described in this specification may be implemented as one or more computer programs, i.e., one or more modules of computer program instructions, encoded on one or more computer storage medium for execution by, or to control the operation of, data processing apparatus, such as a processing circuit. A controller or processing circuit such as CPU may comprise any digital and/or analog circuit components configured to perform the functions described herein, such as a microprocessor, microcontroller, application-specific integrated circuit, programmable logic, etc. Alternatively, or in addition, the program instructions may be encoded on an artificially generated propagated signal, e.g., a machine-generated electrical, optical, or electromagnetic signal, that is generated to encode information for transmission to suitable receiver apparatus for execution by a data processing apparatus.
A computer storage medium may be, or be included in, a computer-readable storage device, a computer-readable storage substrate, a random or serial access memory array or device, or a combination of one or more of them. Moreover, while a computer storage medium is not a propagated signal, a computer storage medium may be a source or destination of computer program instructions encoded in an artificially generated propagated signal. The computer storage medium may also be, or be included in, one or more separate components or media (e.g., multiple CDs, disks, or other storage devices). Accordingly, the computer storage medium is both tangible and non-transitory.
The operations described in this specification may be implemented as operations performed by a data processing apparatus on data stored on one or more computer-readable storage devices or received from other sources. The term “data processing apparatus” or “computing device” encompasses all kinds of apparatus, devices, and machines for processing data, including by way of example a programmable processor, a computer, a system on a chip, or multiple ones, or combinations, of the foregoing The apparatus may include special purpose logic circuitry, e.g., an FPGA (field programmable gate array) or an ASIC (application specific integrated circuit). The apparatus may also include, in addition to hardware, code that creates an execution environment for the computer program in question, e.g., code that constitutes processor firmware, a protocol stack, a database management system, an operating system, a cross-platform runtime environment, a virtual machine, or a combination of one or more of them. The apparatus and execution environment may realize various different computing model infrastructures, such as web services, distributed computing and grid computing infrastructures.
A computer program (also known as a program, software, software application, script, or code) may be written in any form of programming language, including compiled or interpreted languages, declarative or procedural languages, and it may be deployed in any form, including as a standalone program or as a module, component, subroutine, object, or other unit suitable for use in a computing environment. A computer program may, but need not, correspond to a file in a file system. A program may be stored in a portion of a file that holds other programs or data (e.g., one or more scripts stored in a markup language document), in a single file dedicated to the program in question, or in multiple coordinated files (e.g., files that store one or more modules, sub programs, or portions of code). A computer program may be deployed to be executed on one computer or on multiple computers that are located at one site or distributed across multiple sites and interconnected by a communication network.
The processes and logic flows described in this specification may be performed by one or more programmable processors executing one or more computer programs to perform actions by operating on input data and generating output. The processes and logic flows may also be performed by, and apparatus may also be implemented as, special purpose logic circuitry, e.g., an FPGA (field programmable gate array) or an ASIC (application specific integrated circuit).
Processors suitable for the execution of a computer program include, by way of example, both general and special purpose microprocessors, and any one or more processors of any kind of digital computer. Generally, a processor will receive instructions and data from a read only memory or a random access memory or both. The essential elements of a computer are a processor for performing actions in accordance with instructions and one or more memory devices for storing instructions and data. Generally, a computer will also include, or be operatively coupled to receive data from or transfer data to, or both, one or more mass storage devices for storing data, e.g., magnetic, magneto optical disks, or optical disks. However, a computer need not have such devices. Moreover, a computer may be embedded in another device, e.g., a mobile telephone, a personal digital assistant (PDA), a mobile audio or video player, a game console, a Global Positioning System (GPS) receiver, or a portable storage device (e.g., a universal serial bus (USB) flash drive), to name just a few. Devices suitable for storing computer program instructions and data include all forms of non-volatile memory, media and memory devices, including by way of example semiconductor memory devices, e.g., EPROM, EEPROM, and flash memory devices; magnetic disks, e.g., internal hard disks or removable disks; magneto optical disks; and CD ROM and DVD-ROM disks. The processor and the memory may be supplemented by, or incorporated in, special purpose logic circuitry.
To provide for interaction with a user, embodiments of the subject matter described in this specification may be implemented on a computer having a display device, e.g., a CRT (cathode ray tube) or LCD (liquid crystal display) monitor, OLED (organic light emitting diode) monitor or other form of display for displaying information to the user and a keyboard and/or a pointing device, e.g., a mouse or a trackball, by which the user may provide input to the computer. Other kinds of devices may be used to provide for interaction with a user as well; for example, feedback provided to the user may be any form of sensory feedback, e.g., visual feedback, auditory feedback, or tactile feedback; and input from the user may be received in any form, including acoustic, speech, or tactile input. In addition, a computer may interact with a user by sending documents to and receiving documents from a device that is used by the user; for example, by sending web pages to a web browser on a user’s client device in response to requests received from the web browser.
While this specification contains many specific embodiment details, these should not be construed as limitations on the scope of any embodiments or of what may be claimed, but rather as descriptions of features specific to particular embodiments. Certain features described in this specification in the context of separate embodiments can also be implemented in combination in a single embodiment. Conversely, various features described in the context of a single embodiment can also be implemented in multiple embodiments separately or in any suitable subcombination. Moreover, although features may be described above as acting in certain combinations and even initially claimed as such, one or more features from a claimed combination can in some cases be excised from the combination, and the claimed combination may be directed to a subcombination or variation of a subcombination.
Similarly, while operations are depicted in the drawings in a particular order, this should not be understood as requiring that such operations be performed in the particular order shown or in sequential order, or that all illustrated operations be performed, to achieve desirable results. In certain circumstances, multitasking and parallel processing may be advantageous. Moreover, the separation of various system components in the embodiments described above should not be understood as requiring such separation in all embodiments, and it should be understood that the described program components and systems can generally be integrated in a single software product or packaged into multiple software products.
References to “or” may be construed as inclusive so that any terms described using “or” may indicate any of a single, more than one, and all of the described terms.
Thus, particular embodiments of the subject matter have been described. Other embodiments are within the scope of the following claims. In some cases, the actions recited in the claims can be performed in a different order and still achieve desirable results. In addition, the processes depicted in the accompanying figures do not necessarily require the particular order shown, or sequential order, to achieve desirable results. In certain embodiments, multitasking and parallel processing may be advantageous.
Having described certain embodiments of the methods and systems, it will now become apparent to one of skill in the art that other embodiments incorporating the concepts may be used. It should be understood that the systems described above may provide multiple ones of any or each of those components and these components may be provided on either a standalone machine or, in some embodiments, on multiple machines in a distributed system. The systems and methods described above may be implemented as a method, apparatus or article of manufacture using programming and/or engineering techniques to produce software, firmware, hardware, or any combination thereof. In addition, the systems and methods described above may be provided as one or more computer-readable programs embodied on or in one or more articles of manufacture. The term “article of manufacture” as used herein is intended to encompass code or logic accessible from and embedded in one or more computer-readable devices, firmware, programmable logic, memory devices (e.g., EEPROMs, ROMs, PROMs, RAMs, SRAMs, etc.), hardware (e.g., integrated circuit chip, Field Programmable Gate Array (FPGA), Application Specific Integrated Circuit (ASIC), etc.), electronic devices, a computer readable non-volatile storage unit (e.g., CD-ROM, floppy disk, hard disk drive, etc.). The article of manufacture may be accessible from a file server providing access to the computer-readable programs via a network transmission line, wireless transmission media, signals propagating through space, radio waves, infrared signals, etc. The article of manufacture may be a flash memory card or a magnetic tape. The article of manufacture includes hardware logic as well as software or programmable code embedded in a computer readable medium that is executed by a processor. In general, the computer-readable programs may be implemented in any programming language, such as LISP, PERL, C, C++, C#, PROLOG, or in any byte code language such as JAVA. The software programs may be stored on or in one or more articles of manufacture as object code.
The various descriptions and figures of the robotic dilator may be taken as generally informative and provide guidance on the use, manufacture and operation of the present disclosure. However, the description and figures should not be taken as limiting in any sense, as the description may be defined by the appended claims.
This application claims priority in part from U.S. Provisional Application 63/226,992, entitled “Robotic Dilator” and filed on Jul. 29, 2021, the contents of which are herein incorporated by reference in its entirety.
| Number | Date | Country | |
|---|---|---|---|
| 63226992 | Jul 2021 | US |
