Robotic guided endoscope

A method of guiding an endoscope to an orthopedic surgical site, comprising:

• generating preoperative images of the orthopedic surgical site, and determining a planned trajectory of the endoscope according to the preoperative images;
• mounting a surgical robot such that it has a fixed location relative to the orthopedic surgical site;
• attaching a three dimensional target to the robot or to an attaching structure providing the robot with its fixed location relative to the orthopedic surgical site;
• generating at least two intraoperative fluoroscope images of the orthopedic surgical site, said at least two intraoperative fluoroscope images including at least a major part of said three dimensional target, such that the orientation of the target in the co-ordinate system of said fluoroscope images can be calculated from the three dimensional target;
• from the position and orientation of the target, determining the position and orientation of the robot or of its attaching structure in the co-ordinate system of said fluoroscope images;
• relating the fluoroscope image co-ordinate system to the preoperative images by comparison of anatomic features on said at least two intraoperative fluoroscope images, such that the planned trajectory is also defined in the co-ordinate system of the robot;
• providing instructions to the robot to adopt a pose such that a guidance tube held in its operating arm is aligned along the planned trajectory;
• preparing an incision along the planned trajectory using a scalpel inserted along said guidance tube and enlarging the incision to a size suitable to accommodate said endoscope;
• using said robot pose to insert a guiding element along said planned trajectory, and removing said robot and any of its support structures;
• and
• using said guiding element to insert the endoscope along the planned trajectory.