# US 11,439,461 B2 · Automated surgical robot > Agents: this data is available as JSON from the patentgrep API and MCP server — see https://patentgrep.com/llms.txt - Number: US 11,439,461 B2 - Document ID: US11439461B2 - Status: Granted - Kind: B2 - Application number: 16/486,942 - Filed: 2018-02-20 - Published: 2021-05-06 - Granted: 2022-09-13 - Earliest claimed: 2017-02-20 - Assignees: Duke University - Applicants: Duke University - Inventors: Patrick Codd; Kimberly Hoang; David Britton; Westin Hill; Weston Ross - Web page: https://patentgrep.com/patent/US11439461B2 ## CPC - A61B 18/20: using laser - A61B 34/10: Computer-aided planning, simulation or modelling of surgical operations - A61B 18/203: {applying laser energy to the outside of the body} - A61B 34/25: {User interfaces for surgical systems} - A61B 34/30: Surgical robots - G16H 20/40: relating to mechanical, radiation or invasive therapies, e.g. surgery, laser therapy, dialysis or acupuncture - G16H 30/40: for processing medical images, e.g. editing - G16H 40/63: for local operation - G16H 50/50: for simulation or modelling of medical disorders - G16H 50/70: for mining of medical data, e.g. analysing previous cases of other patients - A61B 34/32: operating autonomously - A61B 2017/00057: {Light} - A61B 2018/00345: {Vascular system} - A61B 2018/00446: {Brain} - A61B 2018/00452: {Skin} - A61B 2018/00577: {Ablation} - A61B 2018/00642: {with feedback, i.e. closed loop control} - A61B 2018/00785: {Reflected power} - A61B 2018/2025: {with a pilot laser} - A61B 2018/20353: {Scanning in three dimensions [3D]} - A61B 2018/20359: {by movable mirrors, e.g. galvanometric} - A61B 2018/205547: {Controller with specific architecture or programmatic algorithm for directing scan path, spot size or shape, or spot intensity, fluence or irradiance} - A61B 2034/104: {Modelling the effect of the tool, e.g. the effect of an implanted prosthesis or for predicting the effect of ablation or burring} - A61B 2034/105: {Modelling of the patient, e.g. for ligaments or bones} - A61B 2034/107: {Visualisation of planned trajectories or target regions} - A61B 2090/373: {using light, e.g. by using optical scanners} - A61B: DIAGNOSIS; SURGERY; IDENTIFICATION (usefulness limited to only animals A61D) - G16H: HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA ## Abstract An automated laser-surgery system for performing a closed-loop surgical procedure is disclosed. The procedure includes forming a post-procedural goal based on a three-dimensional (3D) image of a surgical site, planning a path for a surgical laser signal based on the post-procedural goal, performing a procedural pass by steering the surgical laser signal along the path, measuring the surface of the surgical site after the procedural pass, updating a model based on the measured effect at the surgical site, and evaluating the success of the procedural pass based on the surface measurement and the post-procedural goal. If necessary, a new path is planned based on the post-procedural goal and the surface measurement a new pass based on that path is performed, and the surface is again measured to evaluate the success of the new pass. These operations are repeated as a closed-loop sequence as many times as necessary to achieve success. ## Claims ### Claim 1 A surgical system for manipulating tissue at a surgical site, the system comprising: a first laser operative for providing a first laser signal, the first laser signal being operative for manipulating tissue at the surgical site; a beam scanner that is configured to controllably direct the first laser signal to points within a first region of the surgical site; a surface profiler that is configured to measure a range for points within the first region; and a processing circuit that is configured to: (1) plan a first path for the first laser signal within the first region, wherein the first path is based on a post-procedural goal and a first estimate of at least one tissue parameter selected from the group consisting of threshold radiant exposure, tissue density, ablation enthalpy, absorption coefficient, optical scattering coefficient, reduced scattering coefficient, refractive index, and scattering anisotropy coefficient, and wherein the first estimate is based on a model of the reaction of the tissue to the laser signal derived from a topological map of a first feature formed at the surgical site using the first laser signal; (2) control the first laser signal along the first path while simultaneously controlling at least one characteristic of the first laser signal, the at least one characteristic being selected from the group consisting of beam shape, focus, focal depth, spot size, and orientation; (3) generate a first intra-procedural model of the surgical site based on a measured range for each of a first plurality of points within the first region, wherein the range for each point of the first plurality thereof is measured after the first laser signal has traversed the first path; and (4) perform a first comparison of the post-procedural goal and the first intra-procedural model. ### Claim 2 (depends on 1) The system of claim 1 wherein the processing circuit is further configured to: (5) plan a second path for the first laser signal within the first region based on the first comparison; (6) control the first laser signal along the second path; (7) generate a second intra-procedural model of the surgical site based on a measured range for each of a second plurality of points within the first region, wherein the range for each point of the second plurality thereof is measured after the first laser signal is controlled along the second path; and (8) perform a second comparison of the post-procedural goal and the second intra-procedural model. ### Claim 3 (depends on 2) The system of claim 2 wherein the processing circuit is further configured to: (9) generate a second estimate of the at least one tissue parameter based on a difference between the first intra-procedural model and a third intra-procedural model that is based on a measured range for each of a third plurality of points within the first region, wherein the range for each point of the third plurality thereof is measured before the first laser signal is controlled along the first path; and (10) plan the second path such that it is further based on the second estimate. ### Claim 4 (depends on 1) The system of claim 1 wherein the processing circuit is further configured to (5) generate the first estimate such that it is based on an interaction between the first laser signal and a first point within the first region. ### Claim 5 (depends on 1) The system of claim 1 wherein the post-procedural goal is based on a second intra-procedural model of the surgical site, wherein the second intra-procedural model is based on a measured range for each of a second plurality of points within the first region, the range for each point of the second plurality thereof being measured before the first laser signal is controlled along the first path. ### Claim 6 (depends on 1) The system of claim 1 wherein the post-procedural goal is based on a first image of the surgical site, wherein the first image is a three-dimensional (3D) image taken before the first laser signal is controlled along the first path. ### Claim 7 (depends on 1) The system of claim 1 further comprising a second laser operative for providing a second laser signal, wherein the beam scanner is configured to controllably direct the second laser signal to any point within the first region. ### Claim 8 (depends on 7) The system of claim 7 wherein the surface profiler includes the second laser. ### Claim 9 (depends on 8) The system of claim 8 wherein the surface profiler includes a laser triangulation sensor, the laser triangulation sensor including the second laser. ### Claim 10 (depends on 1) The system of claim 1 wherein the beam scanner comprises a two-axis galvanometer. ### Claim 11 (depends on 1) The system of claim 1 wherein the beam scanner comprises a two-axis MEMS mirror. ### Claim 12 (depends on 1) The system of claim 1 further comprising a graphical user interface (GUI) that enables a user to specify a classification for tissue in at least one region of the surgical site. ### Claim 13 A method for manipulating tissue at a surgical site, the method comprising: generating a model of the reaction of the tissue to the laser signal from a topological map of a first feature formed at the surgical site using the first laser signal; generating a first estimate of at least one tissue parameter based on the model, the at least one tissue parameter being selected from the group consisting of threshold radiant exposure, tissue density, ablation enthalpy, absorption coefficient, optical scattering coefficient, reduced scattering coefficient, refractive index, and scattering anisotropy coefficient; planning a first path for the first laser signal within a first region of a surgical site, wherein the first path is based on a post-procedural goal and the first estimate; controlling at least one characteristic of the first laser signal, the at least one characteristic being selected from the group consisting of beam shape, focus, focal depth, spot size, and orientation; generating a first intra-procedural model of the surgical site based on a measured range for each of a first plurality of points within the first region, wherein the range for each point of the first plurality thereof is measured after the first laser signal has traversed the first path; and performing a first comparison of the post-procedural goal and the first intra-procedural model. ### Claim 14 (depends on 13) The method of claim 13 further comprising: planning a second path for the first laser signal within the first region, wherein the second path is based on the first comparison; controlling the first laser signal along the second path; generating a second intra-procedural model of the surgical site based on a measured range for each of a second plurality of points within the first region, wherein the range for each point of the second plurality thereof is measured after the first laser signal is directed along the second path; and performing a second comparison of the post-procedural goal and the second intra-procedural model. ### Claim 15 (depends on 14) The method of claim 14 further comprising: generating a second estimate of the at least one tissue parameter based on a difference between the second intra-procedural model and a third intra-procedural model that is based on a measured range for each of a third plurality of points within the first region, wherein the range for each point of the third plurality thereof is measured before the first laser signal is directed along the first path; and planning the second path such that it is further based on the at least one tissue parameter and the second estimate. ### Claim 16 (depends on 13) The method of claim 13 further comprising: controlling the first laser signal to create the first feature; and generating the first estimate based on the first feature and a model of the first feature. ### Claim 17 (depends on 13) The method of claim 13 further comprising measuring the range for each of the first plurality of points, wherein the range is measured via a laser triangulation sensor. ### Claim 18 (depends on 13) The method of claim 13 wherein the first laser signal is controlled along the first path by a two-axis beam scanner. ### Claim 19 (depends on 18) The method of claim 18 wherein the beam scanner comprises a two-axis galvanometer. ### Claim 20 (depends on 18) The method of claim 18 wherein the beam scanner comprises a two-axis MEMS mirror. ### Claim 21 (depends on 13) The method of claim 13 wherein the post-procedural goal is generated by operations comprising: generating a first pre-procedural model based on a first image of the surgical site, the first pre-procedural model being a 3D model, and the first image being generated before the first laser signal is controlled along the first path; and specifying a first classification for at least one region within the first pre-procedural model. ### Claim 22 (depends on 21) The method of claim 21 wherein the post-procedural goal is generated by operations further comprising: generating a first surface scan of the first region, the first surface scan being based on a range for each of a second plurality of points measured before the first laser signal is controlled along the first path; and adapting the first pre-procedural model based on the first surface scan.