Abstract: A robot-guided system to assist orthopedic surgeons in performing orthopedic surgical procedures on pre-positioned inserts, including for the fixation of bone fractures, and especially for use in long bone distal intramedullary locking procedures. The system provides a mechanical guide for drilling the holes for distal screws in intramedullary nailing surgery. The drill guide is automatically positioned by the robot relative to the distal locking nail holes, using data derived from only a small number of X-ray fluoroscopic images. The system allows the performance of the locking procedure without trial and error, thus enabling the procedure to be successfully performed by less experienced surgeons, reduces exposure of patient and operating room personnel to radiation, shortens the intra-operative time, and thus reduces post-operative complications.

Abstract: A robotic device for performing intracranial procedures, comprising a baseplate for mounting on the subject's skull and a rotatable base element rotating on the baseplate. The rotatable base element has a central opening through which a cannulated needle can protrude such that it can rotate around an axis perpendicular to the baseplate. This cannulated needle is robotically controlled to provide motion into and out of the subject's skull. A flexible needle is disposed coaxially within the cannulated needle, and it is controlled to move into and out of a non-axial aperture in the distal part of the cannulated needle. Coordinated control of the insertion motion of the cannulated and flexible needles, and rotation of the combined cannulated/flexible needle assembly enables access to be obtained to a volume of a region of the brain having lateral dimensions substantially larger than the width of the cannulated needle.

Abstract: A system for rod bending for use in robotic spinal surgery, enabling the correct bending of a fusion rod to match the shape required to accurately pass through the heads of the pedicle screws. The system uses data generated by information provided to the robot by the surgeon's preoperative plan, optionally augmented by feedback from the robot control system of deviations encountered intraoperatively. Such deviations could occur, for example, when the surgeon decides intraoperatively on a different trajectory or even to skip screws on one vertebra, in which case, the robot will be commanded to perform the alternative procedure, with commensurate instructions relayed to the control system of the rod-bending machine. The system is also able to thin down the rod at predetermined locations along its length, adapted to be at selected intervertebral locations, for maintaining limited flexibility between vertebrae, instead of fixating them.

Abstract: A robotic system for performing minimally invasive spinal stabilization, using two screws inserted in oblique trajectories from an inferior vertebra pedicle into the adjacent superior vertebra body. The procedure is less traumatic than such procedures performed using open back surgery, by virtue of the robot used to guide the surgeon along a safe trajectory, avoiding damage to nerves surrounding the vertebrae. The robot arm is advantageous since no access is provided in a minimally invasive procedure for direct viewing of the operation site, and the accuracy required for oblique entry can readily be achieved only using robotic control. This robotic system also obviates the need for a large number of fluoroscope images to check drill insertion position relative to the surrounding nerves. Disc cleaning tools with flexible wire heads are also described. The drilling trajectory is determined by comparing fluoroscope images to preoperative images showing the planned path.

Abstract: A robotic system for flexible needle steering under ultrasound imaging. A robot is used to steer the needle along a predetermined curved trajectory by maneuvering the needle base. The needle tip position is detected by an ultrasound sensor and the tracking error of the needle tip from a predetermined needle path is input to a controller which solves the inverse kinematic based on the needle position, and the needle and tissue properties. The control algorithm uses a novel method to detect the elastic properties of the tissue by analyzing tissue motion at the region in front of the needle tip. The inverse kinematic solution may be performed on a model of the needle as a flexible beam having laterally connected virtual springs to simulate lateral forces exerted by the tissue elasticity. The system is able to direct the needle to a target within the tissue while circumventing forbidden regions.

Abstract: A method and a kit for the prevention of venous stenosis associated with the use of hemodialysis AV shunts. The kit may use a bifurcated needle for providing access to the shunt or blood vessel. One of the arms is used for returning the blood to the subject after dialysis treatment, while the other arm is used for inserting a device for cleaning the vein, the device being either an autonomous crawling device, or a passive tethered device moved down the vein by the blood flow. The autonomous crawling device may be a series of sequentially inflatable chambers, the stenosis being cleared by pressure from the outer walls of the chambers when inflated and moved. The passive device may be an element having a flexible disc-like structure, whose flexible peripheral edge slides along the inner walls of the blood vessel, compressing or clearing the material attached thereto.

Abstract: A robotic surgical system incorporating a surgical robot attached to a patient's bone by an attachment member, such that motion of the bone induces corresponding motion of the robot, maintaining the robot/bone positional relationship. The robot is supported on a mechanical mounting member attached through a controlled joint to a bed-mounted base element. The controlled joint can alternatively enable the mechanical mounting member to move freely relative to the base element, or its position can be controlled by signal inputs adapted to prevent excessive force being applied in the system. Two modes of operation are available (i) free motion in which the control system is decoupled from the mounting member, which rides freely with patient bone motion, and (ii) servo-controlled motion, in which drive mechanisms control the joint motion to prevent application of excessive force on the patient bone or attachment member.

Abstract: A method and a kit for the prevention of venous stenosis associated with the use of hemodialysis AV shunts. The kit may use a bifurcated needle for providing access to the shunt or blood vessel. One of the arms is used for returning the blood to the subject after dialysis treatment, while the other arm is used for inserting a device for cleaning the vein, the device being either an autonomous crawling device, or a passive tethered device moved down the vein by the blood flow. The autonomous crawling device may be a series of sequentially inflatable chambers, the stenosis being cleared by pressure from the outer walls of the chambers when inflated and moved. The passive device may be an element having a flexible disc-like structure, whose flexible peripheral edge slides along the inner walls of the blood vessel, compressing or clearing the material attached thereto.

Abstract: A system and method for performing spinal fusion using vertebral connecting rods constructed of a shape memory material, such as shape memory alloy. The connecting rod is cooled below its phase transition temperature, which is chosen to be just below body temperature, and is inserted through a curved guide tube previously inserted into the back of the patient. The guide tube is located so as to deliver the connecting rod at its desired location between the preinserted pedicle screw heads. The rod, being in its flexible state below the transition temperature, negotiates the curve and exits the guide tube in a straight form and parallel to the patient's spine. As it heats up to body temperature, it regains its original straight shape and its original rigidity, and is ready for connecting its associated vertebrae to each other.

Abstract: A robotic system for performing minimally invasive spinal stabilization, using two screws inserted in oblique trajectories from an inferior vertebra pedicle into the adjacent superior vertebra body. The procedure is less traumatic than such procedures performed using open back surgery, by virtue of the robot used to guide the surgeon along a safe trajectory, avoiding damage to nerves surrounding the vertebrae. The robot arm is advantageous since no access is provided in a minimally invasive procedure for direct viewing of the operation site, and the accuracy required for oblique entry can readily be achieved only using robotic control. This robotic system also obviates the need for a large number of fluoroscope images to check drill insertion position relative to the surrounding nerves. Disc cleaning tools with flexible wire heads are also described. The drilling trajectory is determined by comparing fluoroscope images to preoperative images showing the planned path.

Abstract: A system for insertion of a surgical tool along a trajectory to a target region in a patient's tissues, under the guidance of ultrasound imaging. The system includes a hand-held robot to whose base the probe of an ultrasound system is rigidly connected. The activated platform of the hand held robot carries a surgical tool guide. The alignment of the tool guide defines the trajectory which the tool takes within the subject's body. The position of the target region seen on the ultrasound display, can be recorded, and the robot coordinate frame of reference registered thereto. The system aligns the pose of the robot such that the surgical tool is aimed directly at the target region, independently of motion of the ultrasound probe and its associated robot. An inertial measurement unit can be incorporated to provide back-up positional information if the image of the lesion is lost.

Abstract: A robotic system for flexible needle steering under ultrasound imaging. A robot is used to steer the needle along a predetermined curved trajectory by maneuvering the needle base. The needle tip position is detected by an ultrasound sensor and the tracking error of the needle tip from a predetermined needle path is input to a controller which solves the inverse kinematic based on the needle position, and the needle and tissue properties. The control algorithm uses a novel method to detect the elastic properties of the tissue by analyzing tissue motion at the region in front of the needle tip. The inverse kinematic solution may be performed on a model of the needle as a flexible beam having laterally connected virtual springs to simulate lateral forces exerted by the tissue elasticity. The system is able to direct the needle to a target within the tissue while circumventing forbidden regions.

Abstract: A method verifying the position of a surgically inserted orthopedic insert. A preoperative three dimensional image data set of the surgical site is generated, showing the bone into which the insert is to be inserted. During the insertion procedure, a series of intraoperative two-dimensional fluoroscope images are generated, each at a known pose relative to the bone, showing the insert during or after insertion into the bone. The 3-D position of the insert is determined in an intraoperative three dimensional image data set reconstructed from the series of intraoperative 2-D fluoroscope images. The reconstructed intraoperative 3-D image data set is registered with the preoperative three dimensional image data set, such as by comparison of imaged anatomical features. Once this registration is achieved, the determined 3-D position of the insert is used to implant a virtual image of the insert into the preoperative three dimensional image data set.

Abstract: A device for use in reducing or preventing the occurrence of restenosis following procedures such as PTCA, in which a stent is used to hold a bodily lumen open. The device comprises a two layered stent, one lying within the other. Both stent layers have an open weave structure, such that they can expand to the correct dimensions after implantation. The outer stent layer is static and grips the inner wall of the lumen in which it is deployed in the usual manner. The inner layer stent is constructed such that it can be vibrated relative to the outer static stent layer. The inner layer stent may be made of a material which can be vibrated from an external source, such as a ferromagnetic material. This vibration prevents restenosis of the treated lumen. Alternatively, a vibrator, such as a piezoelectric device, can be installed on the inner stent layer.

Abstract: A self-propelled device for locomotion through a lumen, comprising a set of serially arranged inflatable chambers, adjacent chambers being fluidly connected, and a fluid source attached to one end of the set, such that the chambers inflate sequentially. The chambers are constructed of an elastic material and have a wall thickness and dimensions such that they have a characteristic with a non-monotonous relationship between the inflation pressure within the chamber and the chamber's inflated size. The characteristic is such that after an initial inflation pressure peak, the non-monotonous relationship adopts a negative slope, such that the volume of the chamber increases more rapidly than the volume of fluid flowing into it, and the inflation pressure of the chamber falls. This effect causes the chamber to inflate and anchor rapidly, while essentially slowing down the inflation of the succeeding chamber until inflation of the first is complete.

Abstract: A novel image-guided system for precise automatic targeting in minimally invasive keyhole neurosurgery. The system consists of a miniature robot fitted with a mechanical guide for needle, probe, or catheter insertion. Intraoperative, the robot is directly affixed to a head clamp or to the patient skull. It automatically positions itself with respect to predefined entry points and targets in a preoperative CT/MRI image following an anatomical registration with an intraoperative 3D surface scan of the patient facial features and a registration jig. The registration procedure is a novel three-way scheme, in which the intraoperative surface scan including the registration jig is matched to a model generated from the preoperative CT/MRI image, the robot position is known in relation to the registration jig, and the entry and target points are known from the preoperative CT/MRI image, such that the robot position can be related to the entry and target points.

Abstract: A self cleaning inlet head for use on a shunt. The head has a tube with openings disposed in predetermined positions in its wall, and a cleaning element installed inside the tube. The cleaning element may comprise a central shaft with a number of bristles protruding therefrom, preferably in locations substantially identical to the positions of the openings in the wall of the tube. Mutual vibratory motion between the cleaning element and the tube causes at least some of the bristles to enter the openings, thereby keeping them clear, and preventing tissue growth into them. The vibratory motion may be generated by the action of an external field on a responsive part of the cleaning element, such as an external magnetic field operating on a magnetic or magnetized part of the cleaning element or the bristles. Alternatively, the external field may be an ultrasound field operating on the bristles.

Abstract: A method and apparatus for steering of a flexible needle into tissue using a steering robotic platform for manipulation of the needle shaft, and by use of a semi-active arm for locating and orienting of the steering robot on the patient's body. As opposed to other steering methods, the robot does not hold the base of the needle, which is its proximal region, but rather grips the shaft of the needle by means of a manipulatable needle gripping device, near its distal end. The needle gripper attached to the robotic platform may be equipped with a traction assembly to provide motion to the needle in its longitudinal direction, such that it co-ordinates the entry of the needle with the desired entry angle. The gripping of the needle at its distal end, close to its insertion point, provides the needle manipulator with a low profile, with concomitant advantages.

Abstract: A system and method for ensuring safe and tolerable insertion of a needle into a subject's body according to a preplanned or continuously monitored sequence of insertion steps. The system comprises a gripping device for gripping the needle in order to perform robotic insertion steps, yet for releasing the grip between such insertion steps, until the next insertion step is initiated. Thereby, the robot has full control of the needle during insertion steps, but does not constrain the needle between insertions, such that movement of the subject can cause neither damage nor discomfort. The gripping and insertion steps may be coordinated to keep in synchronization with the subject's breathing cycles, such that the insertion steps may be performed in the same segment of each cycle of motion of the subject's chest. The gripper can either fully disconnect from the needle, or can partially disconnect but constrain motion within limits.

Abstract: A self-propelled device for locomotion through a lumen, comprising a set of serially arranged inflatable chambers, adjacent chambers being fluidly connected, and a fluid source attached to one end of the set, such that the chambers inflate sequentially. The chambers are constructed of an elastic material and have a wall thickness and dimensions such that they have a characteristic with a non-monotonous relationship between the inflation pressure within the chamber and the chamber's inflated size. The characteristic is such that after an initial inflation pressure peak, the non-monotonous relationship adopts a negative slope, such that the volume of the chamber increases more rapidly than the volume of fluid flowing into it, and the inflation pressure of the chamber falls. This effect causes the chamber to inflate and anchor rapidly, while essentially slowing down the inflation of the succeeding chamber until inflation of the first is complete.