# US 10,368,953 B2 · Robotic system for fastening layers of body tissue together and method thereof > Agents: this data is available as JSON from the patentgrep API and MCP server — see https://patentgrep.com/llms.txt - Number: US 10,368,953 B2 - Document ID: US10368953B2 - Status: Granted - Kind: B2 - Application number: 16/132,159 - Filed: 2018-09-14 - Published: 2019-01-10 - Granted: 2019-08-06 - Earliest claimed: 2002-03-20 - Assignees: P Tech, LLC - Applicants: P Tech, LLC - Inventors: Peter M. Bonutti - Web page: https://patentgrep.com/patent/US10368953B2 ## CPC - A61B 34/30: Surgical robots - A61B 5/0071: {by measuring fluorescence emission} - A61B 6/032: {Transmission computed tomography [CT]} - A61B 17/025: {Joint distractors} - A61B 17/0401: {Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors (A61B17/0642 takes precedence; fixation devices for tendons or ligaments A61F2/0811)} - A61B 17/0644: {penetrating the tissue, deformable to closed position} - A61B 17/14: Surgical saws ({A61B17/1637 takes precedence;} dental saws for teeth A61C3/12) - A61B 17/1626: {Control means; Display units} - A61B 17/88: {Osteosynthesis instruments;} Methods or means for implanting or extracting internal {or external} fixation devices {(A61B17/7074 takes precedence)} - A61B 17/8802: {Equipment for handling bone cement or other fluid fillers} - A61B 17/8805: {for introducing fluid filler into bone or extracting it (A61B17/7097, A61B17/8833 take precedence)} - A61B 17/885: {Tools for expanding or compacting bones or discs or cavities therein (A61B17/8805, A61B17/7097 take precedence)} - A61B 17/8852: {capable of being assembled or enlarged, or changing shape, inside the bone or disc} - A61B 17/8855: {inflatable, e.g. kyphoplasty balloons} - A61B 17/8858: {laterally or radially expansible (inflatable A61B17/8855)} - A61B 34/10: Computer-aided planning, simulation or modelling of surgical operations - A61B 34/32: operating autonomously - A61B 34/77: {Manipulators with motion or force scaling} - A61B 90/03: {Automatic limiting or abutting means, e.g. for safety} - A61B 90/37: {Surgical systems with images on a monitor during operation} - A61B 90/39: {Markers, e.g. radio-opaque or breast lesions markers} - A61F 2/0063: {Implantable repair or support meshes, e.g. hernia meshes} - A61B 17/154: {for preparing bone for knee prosthesis} - A61B 17/8875: {Screwdrivers, spanners or wrenches} - A61B 2017/00557: {inflatable (A61B2017/22051 takes precedence)} - A61B 2017/0256: {for the spine} - A61B 2017/0648: {threaded, e.g. tacks with a screw thread} - A61B 2034/303: {specifically adapted for manipulations within body lumens, e.g. within lumen of gut, spine, or blood vessels} - A61B 2090/034: {abutting on parts of the device itself} - A61B 2090/065: {for measuring contact or contact pressure} - A61B 2090/3916: {Bone tissue} - A61F 2/389: {Tibial components (A61F2/3868 takes precedence)} - A61F 2002/30133: {kidney-shaped or bean-shaped} - A61B: DIAGNOSIS; SURGERY; IDENTIFICATION (usefulness limited to only animals A61D) - A61F: FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS (dental prosthetics A61C) ## Abstract A method of using a robotic guidance system for performing surgery on a spine is provided. The method includes utilizing a computerized tomographic scan image of a location on a spinal column of a patient, such that the computerized tomographic scan image is connected to a computer and visible on a monitor connected to the computer. The method also includes attaching a coupling component to the spinal column of the patient, coupling a marker to the coupling component, and imaging, with a fluoroscope, the view of the spinal column of the patient, wherein the fluoroscope image is transmitted to the computer and visible on the monitor and the at marker is clearly visible in the fluoroscope image. The method also includes positioning a cannula, with a robotic mechanism, to a first position relative to a vertebra in the spinal column of the patient, drilling a passage through the cannula into bone of the vertebra in the spinal column of the patient, inserting a guidewire through the cannula into the passage in the bone of the vertebra in the spinal column of the patient, and positioning a screw into the bone of the vertebra in the spinal column of the patient. ## Claims ### Claim 1 A method of fastening at least first and second portions of body tissue together, the method comprising: imparting, using an adaptive arm of a robotic mechanism, a clamping force to the first and second portions of body tissue suitable to press the first and second portions against one another; generating, using a force measurement system associated with the adaptive arm, a clamping force signal indicative of the clamping force imparted by the adaptive arm to the first and second portions of body tissue; receiving, using a computer in communication with the force measurement system and the robotic mechanism, the clamping force signal from the force measurement system; determining, using the computer and the received clamping force signal, that the clamping force imparted by the adaptive arm to the first and second portions of body tissue has a predetermined magnitude; and fastening, after said determining and simultaneously with the clamping force imparted by the adaptive arm to the first and second portions of body tissue having the predetermined magnitude, the first and second portions of body tissue together using the adaptive arm. ### Claim 2 (depends on 1) The method of fastening at least first and second portions of body tissue together as set forth in claim 1, wherein said fastening comprises inserting at least one fastener into the first and second portions using the adaptive arm. ### Claim 3 (depends on 2) The method of fastening at least first and second portions of body tissue together as set forth in claim 2, wherein the at least one fastener comprises at least one staple. ### Claim 4 (depends on 1) The method of fastening at least first and second portions of body tissue together as set forth in claim 1, wherein said fastening comprises applying at least one fastener to the first and second portions of body tissue. ### Claim 5 (depends on 4) The method of fastening at least first and second portions of body tissue together as set forth in claim 4, wherein the at least one fastener is formed from a polymer. ### Claim 6 A method of fastening at least first and second portions of body tissue together, the method comprising: applying, using a robotic mechanism, a force to the first and second portions of body tissue suitable to press the first and second portions against one another; generating, using a sensor associated with the robotic mechanism, a fastening signal indicative of the first and second portions being suitable for being fastened to one another during said applying a force to the first and second portions of body tissue; receiving, using a computer in communication with the sensor and the robotic mechanism, the fastening signal from the sensor; determining, using the computer and the received fastening signal, that the first and second portions of body tissue are suitable for being fastened to one another; and fastening, after said determining, the first and second portions of body tissue together using a fastener applied by the robotic mechanism. ### Claim 7 (depends on 6) The method of fastening at least first and second portions of body tissue together as set forth in claim 6, wherein the fastener comprises at least one staple. ### Claim 8 (depends on 6) The method of fastening at least first and second portions of body tissue together as set forth in claim 6, wherein said applying a force to the first and second portions of body tissue comprises applying, using the robotic mechanism, a compressive force to the first and second portions of body tissue. ### Claim 9 (depends on 6) The method of fastening at least first and second portions of body tissue together as set forth in claim 6, wherein said fastening comprises inserting, using the robotic mechanism, the fastener through each of the first and second portions of body tissue. ### Claim 10 (depends on 6) The method of fastening at least first and second portions of body tissue together as set forth in claim 6, wherein said fastening includes engaging, using the robotic mechanism, an outer surface of the first portion of body tissue with a first part of the fastener, and engaging, using the robotic mechanism, an outer surface of the second portion of body tissue with a second part of the fastener. ### Claim 11 (depends on 10) The method of fastening at least first and second portions of body tissue together as set forth in claim 10, wherein said engaging, using the robotic mechanism, an outer surface of the second portion of body tissue with a second part of the fastener comprises deforming, using the robotic mechanism, the second part of the fastener. ### Claim 12 (depends on 6) The method of fastening at least first and second portions of body tissue together as set forth in claim 6, wherein said fastening, after said determining, the first and second portions of body tissue together comprises deforming, using the robotic mechanism, a part of the fastener. ### Claim 13 (depends on 12) The method of fastening at least first and second portions of body tissue together as set forth in claim 12, wherein the deformed part of the fastener engages an outer surface of the second portion of body tissue. ### Claim 14 (depends on 6) The method of fastening at least first and second portions of body tissue together as set forth in claim 6, wherein said applying a force to the first and second portions of body tissue and said fastening are performed using a single adaptive arm of the robotic mechanism, wherein said single adaptive arm is received in a cannula in a patient's body. ### Claim 15 (depends on 6) The method of fastening at least first and second portions of body tissue together as set forth in claim 6, wherein said fastening is performed during said applying a force to the first and second portions of body tissue. ### Claim 16 (depends on 6) The method of fastening at least first and second portions of body tissue together as set forth in claim 6, wherein said applying a force to the first and second portions of body tissue and said fastening are performed using a single adaptive arm of the robotic mechanism. ### Claim 17 (depends on 16) The method of fastening at least first and second portions of body tissue together as set forth in claim 16, wherein said applying a force to the first and second portions of body tissue is performed using a first drive mechanism of the robotic mechanism, wherein said fastening is performed using a second drive mechanism of the robotic mechanism. ### Claim 18 (depends on 17) The method of fastening at least first and second portions of body tissue together as set forth in claim 17, wherein the first drive mechanism and the second drive mechanism are operated independently of one another. ### Claim 19 (depends on 17) The method of fastening at least first and second portions of body tissue together as set forth in claim 17, wherein the first drive mechanism is actuated independently of and before the second drive mechanism so that the first and second portions of body tissue are suitably pressed against one another before and during said fastening. ### Claim 20 (depends on 6) The method of fastening at least first and second portions of body tissue together as set forth in claim 6, wherein said applying a force to the first and second portions of body tissue is performed using a first drive mechanism of the robotic mechanism, wherein said fastening is performed using a second drive mechanism of the robotic mechanism. ### Claim 21 (depends on 20) The method of fastening at least first and second portions of body tissue together as set forth in claim 20, wherein said first drive mechanism applies a predetermined force to the first and second portions of body tissue. ### Claim 22 (depends on 20) The method of fastening at least first and second portions of body tissue together as set forth in claim 20, wherein the first drive mechanism is actuated independently of and before the second drive mechanism so that the first and second portions of body tissue are suitably pressed against one another before and during said fastening. ### Claim 23 (depends on 6) The method of fastening at least first and second portions of body tissue together as set forth in claim 6, wherein the first and second portions of body tissue are fastened together in linear apposition. ### Claim 24 (depends on 6) The method of fastening at least first and second portions of body tissue together as set forth in claim 6, wherein the first and second portions of body tissue are fastened together in linear apposition using a plurality of linearly aligned fasteners applied by the robotic mechanism. ### Claim 25 (depends on 6) The method of fastening at least first and second portions of body tissue together as set forth in claim 6, wherein said fastening comprises applying a fastening force to the fastener. ### Claim 26 (depends on 6) The method of fastening at least first and second portions of body tissue together as set forth in claim 6, wherein said fastening comprises applying a predetermined fastening force to the fastener. ### Claim 27 (depends on 6) The method of fastening at least first and second portions of body tissue together as set forth in claim 6, wherein said applying a force to the first and second portions of body tissue comprises applying a predetermined force to the first and second portions of body tissue. ### Claim 28 (depends on 6) The method of fastening at least first and second portions of body tissue together as set forth in claim 6, wherein said predetermined force is maintained by the robotic mechanism. ### Claim 29 (depends on 6) The method of fastening at least first and second portions of body tissue together as set forth in claim 6, wherein the first and second portions of body tissue include one or more of a colon and a stomach. ### Claim 30 (depends on 6) The method of fastening at least first and second portions of body tissue together as set forth in claim 6, wherein said applying a force to the first and second portions of body tissue and said fastening are performed using a single adaptive arm of the robotic mechanism, wherein the single adaptive arm is inserted in an abdomen of a patient.