# US 11,304,686 B2 · System and method for guided injection during endoscopic surgery

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- Number: US 11,304,686 B2
- Document ID: US11304686B2
- Status: Granted
- Kind: B2
- Application number: 14/123,547
- Filed: 2012-06-11
- Published: 2014-05-22
- Granted: 2022-04-19
- Earliest claimed: 2011-06-17
- Assignees: Koninklijke Philips N.V.
- Applicants: Robert Manzke; Raymond Chan; Haytham Elhawary; Aleksandra Popovic
- Inventors: Robert Manzke; Raymond Chan; Haytham Elhawary; Aleksandra Popovic
- Web page: https://patentgrep.com/patent/US11304686B2

## CPC

- A61B 34/20: Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
- A61B 1/00149: {using articulated arms}
- A61B 1/044: {for absorption imaging}
- A61B 5/061: {Determining position of a probe within the body employing means separate from the probe, e.g. sensing internal probe position employing impedance electrodes on the surface of the body (A61B1/00158 takes precedence)}
- A61B 5/4839: {combined with drug delivery}
- A61B 8/0841: {for locating instruments}
- A61B 8/0883: {for diagnosis of the heart}
- A61B 8/12: in body cavities or body tracts, e.g. by using catheters
- A61B 17/00234: {for minimally invasive surgery (A61B17/0218, A61B17/0469, A61B17/12013, A61B17/1285, A61B17/29, A61B17/320016 take precedence)}
- A61B 17/3478: {Endoscopic needles, e.g. for infusion (biopsy needles A61B10/0233; catheters with injection needles A61M25/0067)}
- A61B 34/10: Computer-aided planning, simulation or modelling of surgical operations
- A61B 34/30: Surgical robots
- A61B 90/361: {Image-producing devices, e.g. surgical cameras}
- A61B 2017/00119: {alarm; indicating an abnormal situation}
- A61B 2017/00243: {cardiac}
- A61B 2017/00247: {Making holes in the wall of the heart, e.g. laser Myocardial revascularization}
- A61B 2034/107: {Visualisation of planned trajectories or target regions}
- A61B 2034/2048: {using an accelerometer or inertia sensor}
- A61B 2034/2059: {Mechanical position encoders}
- A61B 2090/062: {penetration depth}
- A61B 2090/065: {for measuring contact or contact pressure}
- A61B 2090/363: {Use of fiducial points}
- A61B 2090/365: {augmented reality, i.e. correlating a live optical image with another image}
- A61B: DIAGNOSIS; SURGERY; IDENTIFICATION (usefulness limited to only animals A61D)

## Abstract

A guidance system and method include a real-time imaging device (121) configured to intra-operatively collect image data of a target region to provide a real-time image. A target determination module (108) is configured to generate an overlay map (111) registered to the real-time image to project morphological feature information on corresponding features in the real-time image of the target region. A medical instrument (122) is provided to perform a procedure on the target region such that the at least one medical instrument is guided to a region suitable for performing an operative task based upon the overlay map.

## Claims

### Claim 1

A guidance system, comprising:
a real-time imaging device configured to pre-operatively or intra-operatively collect image data of a target region to provide a pre-operative or real-time image;
a target determination module configured to convert the pre-operative or real-time image data of the target region including a heart into a morphological map registered to the pre-operative or real-time image to project morphological feature information including wall thickness of the heart, or scar tissue on the heart, or both, on corresponding features in the real-time image of the target region, the morphological map comprising a danger zone denoting a high risk area where critical anatomy is located; and
at least one medical instrument configured to perform a procedure on the target region such that the at least one medical instrument is guided to a region suitable for performing an operative task based upon the morphological map, the at least one medical instrument being configured to perform the operative task based on the morphological feature information.

### Claim 2 (depends on 1)

The guidance system as recited in claim 1, wherein the real-time imaging device includes an endoscope with a camera.

### Claim 3 (depends on 1)

The guidance system as recited in claim 1, wherein the morphological map includes one of color and texture variations to indicate variation in the wall thickness, or scar tissue, or both, on the heart.

### Claim 4 (depends on 1)

The guidance system as recited in claim 1, wherein the at least one medical instrument includes a needle and the morphological map shows acceptable injection sites.

### Claim 5 (depends on 1)

The guidance system as recited in claim 1, wherein the at least one medical instrument is guided using a robot and the robot is controlled based upon the morphological map.

### Claim 6 (depends on 5)

The guidance system as recited in claim 5, wherein the robot inserts the at least one medical instrument into an organ.

### Claim 7 (depends on 5)

The guidance system as recited in claim 5, wherein the robot measures an insertion depth of a needle of the at least one medical instrument, and a display indicates a current insertion depth in real-time.

### Claim 8 (depends on 5)

The guidance system as recited in claim 5, wherein the robot measures an insertion force of a needle of the at least one medical instrument using a force sensor, and a display indicates a current insertion force in real-time.

### Claim 9 (depends on 8)

The guidance system as recited in claim 8, wherein information on the insertion force is employed in a closed loop control system to control insertion depth.

### Claim 10 (depends on 1)

The guidance system as recited in claim 1, wherein the morphological feature information is collected from the target region pre-operatively or intra-operatively using an imaging system.

### Claim 11

A workstation, comprising:
a processor;
memory coupled to the processor;
a real-time imaging device configured to intra-operatively collect image data of a target region including a heart to provide a real-time image;
a target determination module stored in the memory and configured to generate: a morphological map registered to the real-time image on a display to project morphological feature information including wall thickness of the heart, or scar tissue on the heart, or both, on corresponding features in the real-time image of the target region, the morphological map comprises a danger zone denoting a high risk areas where critical anatomy is located; and
at least one medical instrument manually or automatically controlled to perform a procedure on the target region such that the at least one medical instrument is guided to a region suitable for performing an operative task based upon the morphological map.

### Claim 12 (depends on 11)

The workstation as recited in claim 11, wherein the real-time imaging device includes an endoscope with a camera.

### Claim 13 (depends on 11)

The workstation as recited in claim 11, wherein the morphological map includes one of color and texture variations to indicate variations in the wall thickness, or scar tissue, or both, on the heart.

### Claim 14 (depends on 11)

The workstation as recited in claim 11, wherein the at least one medical instrument includes a needle and the morphological map shows acceptable injection sites.

### Claim 15 (depends on 11)

The workstation as recited in claim 11, wherein the at least one medical instrument is guided using a robot and the robot is controlled based upon the morphological map.

### Claim 16 (depends on 15)

The workstation as recited in claim 15, wherein the robot inserts a needle of the at least one medical instrument into an organ and measures at least one of an insertion depth and insertion force of the needle.

### Claim 17 (depends on 16)

The workstation as recited in claim 16, wherein a display indicates the at least one of insertion depth and insertion force in real-time.

### Claim 18 (depends on 16)

The workstation as recited in claim 16, wherein information on the insertion force is employed in a closed loop control system to control insertion depth.

### Claim 19 (depends on 11)

The workstation as recited in claim 11, wherein the morphological feature information is collected from the target region pre-operatively or intra-operatively using an imaging system.

### Claim 20 (depends on 11)

The workstation as recited in claim 11, wherein the target determination module generates a cross-hair in the real-time image for aiming the at least one medical instrument.

### Claim 21 (depends on 20)

The workstation as recited in claim 20, further comprising a warning mechanism configured to provide an alert when the cross-hair is aimed at a risk area as indicated by the morphological map.

### Claim 22

A method, comprising:
determining characteristics of interest for a target region of a patient;
real-time imaging the target region including a heart to provide a real-time image;
generating a morphological map registered to the real-time image on a display to project morphological feature information including wall thickness of the heart, or scar tissue on the heart, or both, on corresponding features in the real-time image of the target region, the morphological map comprising a danger zone denoting a high risk area where critical anatomy is located; and
performing a procedure on the target region such that at least one medical instrument is guided to a region suitable for performing an operative task based upon the morphological map.

### Claim 23 (depends on 22)

The method as recited in claim 22, wherein the step of performing a procedure comprises:
steering a needle to the target region; and
deploying the needle into the target region in accordance with the morphological map.

### Claim 24 (depends on 22)

The method as recited in claim 22, wherein generating a morphological map includes generating the morphological map to include one of color and texture variations to indicate variations in morphological feature information.

### Claim 25 (depends on 22)

The method as recited in claim 22, wherein generating a morphological map includes displaying acceptable injection sites.

### Claim 26 (depends on 22)

The method as recited in claim 22, wherein performing a procedure includes robotically guiding the at least one medical instrument to the target region using the morphological map to control guidance to an operable site.

### Claim 27 (depends on 22)

The method as recited in claim 22, wherein the morphological feature information is collected from the target region pre-operatively or intra-operatively using an imaging system.

### Claim 28 (depends on 22)

The method as recited in claim 22, further comprising generating a cross-hair in the real-time image for aiming the at least one medical instrument, and alerting when the cross-hair is aimed at a risk area as indicated by the morphological map.

### Claim 29 (depends on 22)

The method as recited in claim 22, wherein real-time imaging includes imaging at least one of insertion depth and an insertion force achieved by the at least one medical instrument.

### Claim 30 (depends on 29)

The method as recited in claim 29, wherein information on the insertion force is employed in a closed loop control system to control insertion depth.