# US 9,510,852 B2 · Automated image-guided tissue resection and treatment

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- Number: US 9,510,852 B2
- Document ID: US9510852B2
- Status: Granted
- Kind: B2
- Application number: 14/540,331
- Filed: 2014-11-13
- Published: 2015-03-26
- Granted: 2016-12-06
- Earliest claimed: 2012-02-29
- Assignees: PROCEPT BioRobotics Corporation
- Applicants: PROCEPT BioRobotics Corporation
- Inventors: Nikolai Aljuri; Surag Mantri; Luis Baez; George Surjan; Michael W. Sasnett; Jonathan Foote
- Web page: https://patentgrep.com/patent/US9510852B2

## CPC

- A61B 17/3203: Fluid jet cutting instruments
- A61B 1/307: for the urinary organs, e.g. urethroscopes or cystoscopes
- A61B 17/00234: {for minimally invasive surgery (A61B17/0218, A61B17/0469, A61B17/12013, A61B17/1285, A61B17/29, A61B17/320016 take precedence)}
- A61B 17/32037: {for removing obstructions from inner organs or blood vessels, e.g. for atherectomy}
- A61B 18/04: by heating (by applying electromagnetic radiation A61B18/18)
- A61B 18/1485: {having a short rigid shaft for accessing the inner body through natural openings}
- A61B 34/25: {User interfaces for surgical systems}
- A61B 90/37: {Surgical systems with images on a monitor during operation}
- A61B 18/20: using laser
- A61B 34/30: Surgical robots
- A61B 2017/00199: {with a console, e.g. a control panel with a display}
- A61B 2017/00274: {Prostate operation, e.g. prostatectomy, turp, bhp treatment}
- A61B 2017/306: {holding by means of suction}
- A61B 2018/00279: {deployable}
- A61B 2018/00285: {Balloons}
- A61B 2018/00327: {Ear, nose or throat}
- A61B 2018/00351: {Heart}
- A61B 2018/00404: {Blood vessels other than those in or around the heart}
- A61B 2018/0044: {Spinal cord}
- A61B 2018/00446: {Brain}
- A61B 2018/00488: {Esophagus}
- A61B 2018/00494: {Stomach, intestines or bowel}
- A61B 2018/005: {Rectum}
- A61B 2018/00517: {Urinary bladder or urethra}
- A61B 2018/00529: {Liver}
- A61B 2018/00541: {Lung or bronchi}
- A61B 2018/00547: {Prostate}
- A61B 2018/00577: {Ablation}
- A61B 2018/00589: {Coagulation}
- A61B 2018/00595: {Cauterization}
- A61B 2018/00601: {Cutting}
- A61B 2018/00607: {Coagulation and cutting with the same instrument}
- A61B 2018/00642: {with feedback, i.e. closed loop control}
- A61B 2018/0066: {without feedback, i.e. open loop control}
- A61B 2018/00982: {combined with or comprising means for visual or photographic inspections inside the body, e.g. endoscopes}
- A61B 2018/00994: {combining two or more different kinds of non-mechanical energy or combining one or more non-mechanical energies with ultrasound}
- A61B 2018/046: {in liquid form}
- A61B 2018/1472: {for use with liquid electrolyte, e.g. virtual electrodes}
- A61B 2018/20351: {Scanning mechanisms}
- A61B 2018/205: {with electronic means, e.g. acousto-optic}
- A61B 2018/20554: {Arrangements for particular intensity distribution, e.g. tophat}
- A61B 2018/2211: {Plurality of fibres}
- A61B 2018/2272: {with reflective or refractive surfaces for deflecting the beam (A61B2018/2261, A61B2018/2266 take precedence)}
- A61B 2034/107: {Visualisation of planned trajectories or target regions}
- A61B 2034/2048: {using an accelerometer or inertia sensor}
- A61B 2034/254: {being adapted depending on the stage of the surgical procedure}
- A61B 2090/064: {for measuring force, pressure or mechanical tension}
- A61B 2090/306: {using optical fibres}
- A61B 2090/364: {Correlation of different images or relation of image positions in respect to the body}
- A61B 2090/378: {using ultrasound}
- A61B 2090/3782: {transmitter or receiver in catheter or minimal invasive instrument}
- A61B 2090/3784: {both receiver and transmitter being in the instrument or receiver being also transmitter}
- A61B 2090/508: {with releasable brake mechanisms}
- A61B 2217/005: with suction drainage system
- A61B 2217/007: with irrigation system
- A61B 2218/002: Irrigation
- A61B 2218/007: Aspiration
- A61M 25/04: in the body, e.g. expansible {(A61M25/10, A61M16/0488 take precedence)}
- A61B: DIAGNOSIS; SURGERY; IDENTIFICATION (usefulness limited to only animals A61D)
- A61M: DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY (introducing media into or onto the bodies of animals A61D7/00; means for inserting tampons A61F13/26; devices for administering food or medicines orally A61J; containers for collecting, storing or administering blood or medical fluids A61J1/05); DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY (surgery A61B; chemical aspects of surgical articles A61L); DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR {(Electrotherapy, e.g. producing anaesthesia by the use of alternating or intermittent currents A61N1/36021)}

## Abstract

A system to treat a patient comprises a user interface that allows a physician to view an image of tissue to be treated in order to develop a treatment plan to resect tissue with a predefined removal profile. The image may comprise a plurality of images, and the planned treatment is shown on the images. The treatment probe may comprise an anchor, and the image shown on the screen may have a reference image marker shown on the screen corresponding to the anchor. The planned tissue removal profile can be displayed and scaled to the image of the target tissue of an organ such as the prostate, and the physician can adjust the treatment profile based on the scaled images to provide a treatment profile in three dimensions. The images shown on the display may comprise segmented images of the patient with treatment plan overlaid on the images.

## Claims

### Claim 1

An apparatus to treat tissue of a patient, comprising:
an arm coupled to a base, the arm comprising a first movable configuration and a second stiff configuration;
a treatment probe to treat a patient, the probe comprising an outer elongate tube having a working channel and an inner rapid exchange carrier rotatable and translatable within the working channel to position and orient a nozzle to release a pressurized stream of fluid toward the tissue, the inner rapid exchange carrier configured to be inserted and removed from a proximal end of the outer elongate tube;
a processor comprising instructions to rotate and translate the inner rapid exchange carrier to treat the patient; and
a linkage coupled to the processor and the treatment probe to rotate and translate the inner rapid exchange carrier in response to the instructions, the linkage comprising a first fixed portion comprising a housing, and a second moveable portion comprising an linkage tube to drive the inner rapid exchange carrier with rotation and translation, the linkage tube having an inner dimension sized to receive the inner rapid exchange carrier and a locking structure to couple the inner rapid exchange carrier with the linkage tube to move together during rotation and translation;
the first fixed portion of the linkage being coupled to a proximal portion of the outer elongate tube in order for the outer elongate tube to remain substantially fixed when the linkage tube and inner rapid exchange carrier rotate and translate together to treat the patient.

### Claim 2 (depends on 1)

An apparatus as in claim 1, further comprising a manifold and a plurality of channels, the manifold connected to a proximal end of the outer elongate tube, the plurality of channels extending along the outer elongate tube to couple a first port of the manifold to a balloon anchor with a first channel and to couple a second port of the manifold with an opening near a distal end of the outer elongate fluid to deliver fluid to a treatment site, wherein the manifold is connected to the linkage by a locking element when the balloon has been inflated.

### Claim 3 (depends on 1)

An apparatus as in claim 1, wherein the outer elongate tube comprises a spine coupled to an anchor, and wherein the spine extends between the anchor and the linkage to fix a distance from the first fixed portion of the linkage to the anchor when the inner rapid exchange carrier is rotated and translated with the second moveable portion of the linkage to position and orient the nozzle to treat a target location of the patient referenced to the anchor.

### Claim 4 (depends on 1)

An apparatus as in claim 1, wherein the outer elongate tube is coupled to an anchor, and wherein the outer elongate tube extends between the anchor and the linkage to fix a distance along the outer elongate tube from the first fixed portion of the linkage to the anchor when the inner rapid exchange carrier is rotated and translated with the second moveable portion of the linkage to position and orient the nozzle to treat the patient.

### Claim 5 (depends on 4)

An apparatus as in claim 4, wherein the outer elongate tube and the inner rapid exchange carrier are configured to deflect as the probe is inserted into the tissue and wherein the outer elongate tube maintains a substantially constant arc length between the first fixed portion of the linkage and the anchor in order to maintain placement of the nozzle in relation to the anchor when the nozzle is rotated and translated along an axis of the probe with the inner rapid exchange carrier to treat the patient.

### Claim 6 (depends on 1)

An apparatus as in claim 1, wherein the linkage comprises an outer hand piece portion graspable and positionable with a hand of a user when the arm is in the first movable configuration.

### Claim 7 (depends on 1)

An apparatus as in claim 1, wherein the first fixed portion of the linkage comprises a support coupled to the treatment probe and the arm to support the treatment probe and the linkage with the arm when the probe has been inserted into the patient.

### Claim 8 (depends on 7)

An apparatus as in claim 7, wherein the support comprises one or more of a rigid casing of the linkage, a frame of the linkage, or the housing of the linkage, and wherein the support remains substantially fixed with the arm when the patient is treated.

### Claim 9 (depends on 7)

An apparatus as in claim 7, wherein the support is coupled to the treatment probe to insert the probe in the patient and position the nozzle at a target location and orientation and wherein the support is coupled to the arm and the outer elongate tube in order to support the probe with the probe positioned and oriented within the patient when the arm is in the second stiff configuration.

### Claim 10 (depends on 7)

An apparatus as in claim 7, wherein the support and arm are capable of supporting the linkage and the treatment probe at an intended position and orientation when the arm is in the second stiff configuration in order to fix the location of the linkage when the patient is treated with the nozzle.

### Claim 11 (depends on 1)

An apparatus as in claim 1, wherein the linkage is coupled to the inner rapid exchange carrier to control a position of the nozzle along an axis of the outer elongate tube and a rotation of the nozzle around the axis of the outer elongate tube.

### Claim 12 (depends on 1)

An apparatus as in claim 1, wherein the apparatus is configured to remove living cells of the tissue in order to provide the living cells outside of the patient.