# US 2018/0021097 A1 · Surgical guidance system and method

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- Number: US 2018/0021097 A1
- Document ID: US20180021097A1
- Status: Published application
- Kind: A1
- Application number: 15/722,875
- Filed: 2017-10-02
- Published: 2018-01-25
- Earliest claimed: 2002-03-06
- Applicants: MAKO Surgical Corp.
- Inventors: Arthur Quaid; Hyosig Kang; Dennis Moses; Rony Abovitz; Scott Illsley
- Web page: https://patentgrep.com/patent/US20180021097A1

## CPC

- A61B 34/30: Surgical robots
- A61B 17/1675: {for the knee}
- A61B 17/1695: {Trepans or craniotomes, i.e. specially adapted for drilling thin bones such as the skull}
- A61B 17/1703: {using imaging means, e.g. by X-rays}
- A61B 17/1764: {for the knee}
- A61B 34/10: Computer-aided planning, simulation or modelling of surgical operations
- A61B 34/20: Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
- A61B 34/35: for telesurgery
- A61B 34/37: Leader-follower robots (A61B34/35 takes precedence)
- A61B 34/70: {Manipulators specially adapted for use in surgery}
- A61B 34/71: {Manipulators operated by drive cable mechanisms}
- A61B 34/74: {Manipulators with manual electric input means}
- A61B 34/76: {Manipulators having means for providing feel, e.g. force or tactile feedback}
- A61B 90/36: {Image-producing devices or illumination devices not otherwise provided for}
- A61B 90/361: {Image-producing devices, e.g. surgical cameras}
- A61B 90/37: {Surgical systems with images on a monitor during operation}
- A61F 2/30942: {for designing or making customized prostheses, e.g. using templates, CT or NMR scans, finite-element analysis or CAD-CAM techniques}
- A61N 1/0534: {Electrodes for deep brain stimulation}
- A61N 1/3605: {Implantable neurostimulators for stimulating central or peripheral nerve system}
- A61N 1/372: Arrangements in connection with the implantation of stimulators
- G06F 3/016: {Input arrangements with force or tactile feedback as computer generated output to the user}
- G16Z 99/00: Subject matter not provided for in other main groups of this subclass
- A61B 5/1127: {using markers}
- A61B 5/745: {using a holographic display}
- A61B 17/1677: {for the patella}
- A61B 17/17: Guides {or aligning means} for drills {, mills, pins or wires}
- A61B 17/1739: {specially adapted for particular parts of the body}
- A61B 17/1767: {for the patella}
- A61B 34/25: {User interfaces for surgical systems}
- A61B 90/14: Fixators for body parts, e.g. skull clamps; Constructional details of fixators, e.g. pins
- A61B 2017/00115: {with audible or visual output}
- A61B 2017/00119: {alarm; indicating an abnormal situation}
- A61B 2017/00725: {Calibration or performance testing}
- A61B 2034/102: {Modelling of surgical devices, implants or prosthesis}
- A61B 2034/105: {Modelling of the patient, e.g. for ligaments or bones}
- A61B 2034/107: {Visualisation of planned trajectories or target regions}
- A61B 2034/108: {Computer aided selection or customisation of medical implants or cutting guides}
- A61B 2034/2048: {using an accelerometer or inertia sensor}
- A61B 2034/2051: {Electromagnetic tracking systems}
- A61B 2034/2055: {Optical tracking systems}
- A61B 2034/2059: {Mechanical position encoders}
- A61B 2034/2068: {using pointers, e.g. pointers having reference marks for determining coordinates of body points}
- A61B 2034/207: {Divots for calibration}
- A61B 2034/252: {indicating steps of a surgical procedure}
- A61B 2034/254: {being adapted depending on the stage of the surgical procedure}
- A61B 2034/305: {Details of wrist mechanisms at distal ends of robotic arms}
- A61B 2090/08021: {of the patient or his organs}
- A61B 2090/365: {augmented reality, i.e. correlating a live optical image with another image}
- A61B 2090/3937: {Visible markers}
- A61B 2090/3983: {Reference marker arrangements for use with image guided surgery}
- A61F 2/38: for elbows or knees
- A61F 2002/4632: {using computer-controlled surgery, e.g. robotic surgery}
- A61F 2002/4633: {for selection of endoprosthetic joints or for pre-operative planning}
- G05B 2219/36432: By putting some constraints on some DOF, move within limited volumes, areas, planes, limits motion in x, y or z planes, virtual reality constraints
- G05B 2219/39196: Use of passive joint, no actuator but brake, brake on or off
- G05B 2219/40478: Graphic display of work area of robot, forbidden, permitted zone
- G05B 2219/45117: Medical, radio surgery manipulator
- G05B 2219/45171: Surgery drill
- G16H 20/40: relating to mechanical, radiation or invasive therapies, e.g. surgery, laser therapy, dialysis or acupuncture
- G16H 40/63: for local operation
- 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)
- A61N: ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY (measurement of bioelectric currents A61B; surgical instruments, devices or methods for transferring non-mechanical forms of energy to or from the body A61B18/00; anaesthetic apparatus in general A61M; incandescent lamps H01K; infrared radiators for heating H05B)
- G06F: ELECTRIC DIGITAL DATA PROCESSING (computer systems based on specific computational models G06N)
- G16Z: INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS, NOT OTHERWISE PROVIDED FOR
- G05B: CONTROL OR REGULATING SYSTEMS IN GENERAL; FUNCTIONAL ELEMENTS OF SUCH SYSTEMS; MONITORING OR TESTING ARRANGEMENTS FOR SUCH SYSTEMS OR ELEMENTS (systems for controlling or regulating non-electric variables G05D; systems for regulating electric or magnetic variables G05F; control devices or systems insofar as characterised by mechanical features only G05G)
- G16H: HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA

## Abstract

A method for controlling a surgical tool includes associating a joint of a patient with a representation of the joint, collecting data indicating at least one of a position and an orientation of a first bone and a second bone of the joint as the joint is moved through a range of motion, and creating a surgical plan based at least in part on the data collected. The method further includes establishing a virtual cutting boundary on the representation of the joint based on the surgical plan, superimposing a representation of the surgical tool on the representation of the joint, wherein the surgical tool is to be operated by a user to execute the surgical plan during a surgical procedure, and controlling the surgical tool to prevent the surgical tool from cutting a portion of the joint outside a boundary that corresponds to the virtual cutting boundary.

## Claims

### Claim 1

A method for controlling a surgical tool, comprising:
associating a joint of a patient with a representation of the joint;
collecting data indicating at least one of a position and an orientation of a first bone and a second bone of the joint as the joint is moved through a range of motion;
creating a surgical plan based at least in part on the data collected;
establishing a virtual cutting boundary on the representation of the joint based on the surgical plan;
superimposing a representation of the surgical tool on the representation of the joint, wherein the surgical tool is to be operated by a user to execute the surgical plan during a surgical procedure; and
controlling the surgical tool to prevent the surgical tool from cutting a portion of the joint outside a boundary that corresponds to the virtual cutting boundary.

### Claim 2 (depends on 1)

The method of claim 1, wherein creating a surgical plan comprises planning bone preparation for implanting a first implant on the first bone of the joint.

### Claim 3 (depends on 2)

The method of claim 2, wherein planning bone preparation for implanting the first implant includes associating a representation of the first implant with a representation of the first bone.

### Claim 4 (depends on 2)

The method of claim 2, further comprising preparing the first bone of the joint according to the surgical plan, wherein preparing the first bone comprises the steps of:
superimposing a representation of a portion of material to be removed from the first bone on a representation of the first bone; and
updating the representation of the portion of material to be removed from the first bone with a representation of a portion of material actually removed by the surgical tool.

### Claim 5 (depends on 4)

The method of claim 4, wherein the portion of material to be removed corresponds to the virtual cutting boundary associated with the representation of the joint.

### Claim 6 (depends on 2)

The method of claim 2, wherein creating a surgical plan further comprises planning bone preparation for implanting a second implant on the second bone of the joint.

### Claim 7 (depends on 6)

The method of claim 6, wherein planning bone preparation for implanting the second implant includes associating a representation of the second implant on a representation of the second bone.

### Claim 8 (depends on 6)

The method of claim 6, further comprising preparing the second bone of the joint according to the surgical plan, wherein preparing the second bone includes:
superimposing a representation of a portion of material to be removed from the second bone on a representation of the second bone; and
updating the representation of the portion of material to be removed from the second bone with a representation of a portion of material actually removed by the surgical tool.

### Claim 9 (depends on 8)

The method of claim 8, wherein the portion of material to be removed corresponds to the virtual cutting boundary associated with the representation of the second bone.

### Claim 10 (depends on 1)

The method of claim 1, further comprising monitoring movement of the first bone, the second bone, and the surgical tool, and updating the representation of the joint and the virtual cutting boundary in response to movement of the first bone and/or the second bone.

### Claim 11 (depends on 1)

The method of claim 1, wherein controlling the surgical tool to prevent the surgical tool from cutting a portion of the joint outside the boundary that corresponds to the virtual cutting boundary comprises controlling the surgical tool so that a tip of the surgical tool is prevented against penetrating the boundary while cutting.

### Claim 12

A surgical system, comprising:
a surgical tool configured to be manipulated by a user to execute a surgical plan during a surgical procedure;
a computer system configured to:
associate a joint of a patient with a representation of the joint;
collect data indicating at least one of a position and an orientation of a first bone and a second bone of the joint as the joint is moved through a range of motion;
create a surgical plan based at least in part on the data collected;
establish a virtual cutting boundary on the representation of the joint based on the surgical plan;
superimpose a representation of the surgical tool on the representation of the joint; and
control the surgical tool to prevent the surgical tool from cutting a portion of the joint outside a boundary that corresponds to the virtual cutting boundary.

### Claim 13 (depends on 12)

The surgical system of claim 12, further comprising a display for displaying at least one of the representation of the joint and the virtual cutting boundary.

### Claim 14 (depends on 12)

The surgical system of claim 12, further comprising a tracking system for monitoring movement of the first bone, the second bone, and the surgical tool, and wherein the computer system is further configured to update the representation of the joint and the virtual cutting boundary in response to movement of the first bone and/or the second bone.

### Claim 15 (depends on 12)

The surgical system of claim 12, wherein creating a surgical plan comprises planning bone preparation for implanting a first implant on the first bone of the joint.

### Claim 16 (depends on 15)

The surgical system of claim 15, wherein the computer system is further configured to:
superimpose a representation of a portion of material to be removed from the first bone on a representation of the first bone; and
update the representation of the portion of material to be removed from the first bone with a representation of a portion of material actually removed by the surgical tool.

### Claim 17 (depends on 16)

The surgical system of claim 16, wherein the portion of material to be removed corresponds to the virtual cutting boundary associated with the representation of the joint.

### Claim 18 (depends on 15)

The surgical system of claim 15, wherein creating a surgical plan further comprises planning bone preparation for implanting a second implant on the second bone of the joint.

### Claim 19 (depends on 18)

The surgical system of claim 18, wherein the computer system is further configured to:
superimpose a representation of a portion of material to be removed from the second bone on a representation of the second bone; and
update the representation of the portion of material to be removed from the second bone with a representation of a portion of material actually removed by the surgical tool.

### Claim 20 (depends on 12)

The surgical system of claim 12, wherein controlling the surgical tool to prevent the surgical tool from cutting a portion of the joint outside the boundary that corresponds to the virtual cutting boundary comprises controlling the surgical tool so that a tip of the surgical tool is prevented against penetrating the boundary while cutting.