US-20260123990-A1 - ROBOTIC SURGERY

Abstract

A laser or ultrasonic instrument is used to remove tissue during a surgery, such as to form one or more pilot holes in a vertebra or a window in bone. Where a laser is used, interrogative laser pulses can be used to obtain information, such as detecting depth or tissue type.

Inventors

• Eric Finley
• Adrien Ponticorvo
• Michael Serra
• Christopher Nelsen
• Robert German
• Justin Doose
• Danielle RICHTERKESSING
• Antonio Ubach
• John C. Love

Assignees

• NUVASIVE, INC.

Dates

Publication Date

20260507

Application Date

20251231

Claims (20)

1. 1 . A method comprising: receiving a selection of a tissue type over a user interface; providing an interrogation laser pulse to tissue; receiving the interrogation laser pulse from the tissue; determining an interrogated tissue type based on the received interrogation laser pulse; and providing a removal laser pulse to the tissue responsive to the interrogated tissue type matching the selected tissue type.
2. 2 . The method of claim 1 , further comprising: determining an interrogated tissue thickness based on the received interrogation laser pulse; setting one or more parameters based on the determined interrogated tissue thickness; and generating the removal laser pulse according to the one or more parameters.
3. 3 . The method of claim 2 , wherein the tissue type is ligament tissue, disc tissue, tumor tissue, or bone tissue.
4. 4 . The method of claim 1 further comprising: a laser instrument configured to selectively emit: a first laser pulses at a wavelength selected to affect disc tissue or cartilage tissue without ablating bone; and a second laser pulses configured to interrogate a target region; a light detector configured to detect the second laser pulses;
5. 5 . The method of claim 4 , further comprising an irrigator configured to provide a fluid proximate tissue affected by the laser instrument to provide cooling and a medium to evacuate debris; and a suction generator configured to remove the fluid.
6. 6 . The method of claim 5 , further comprising: a computer coupled to the light detector and having one or more processors configured to perform topographical analysis or spectral analysis based on the detected second laser pulses.
7. 7 . The method of claim 6 , further comprising: a laser generator configured to generate the first laser pulses according to parameters, wherein the computer is further configured to modify the parameters based on the topographical analysis or spectral analysis.
8. 8 . The method of claim 5 , further comprising a reference array coupled to the laser instrument and configured to permit the tracking of a location of the laser instrument.
9. 9 . The method of claim 5 , wherein the reference array includes two or more tracking fiducials.
10. 10 . The method of claim 5 , further comprising a coupling configured to couple the laser instrument to a robot.
11. 11 . A method comprising: providing an interrogation laser pulse to tissue; receiving the interrogation laser pulse from the tissue; determining an interrogated tissue type based on the received interrogation laser pulse; and providing a removal laser pulse to the tissue responsive to the interrogated tissue type matching the selected tissue type.
12. 12 . The method of claim 1 , further comprising: determining an interrogated tissue thickness based on the received interrogation laser pulse; setting one or more parameters based on the determined interrogated tissue thickness; and generating the removal laser pulse according to the one or more parameters.
13. 13 . The method of claim 12 , wherein the tissue type is ligament tissue, disc tissue, tumor tissue, or bone tissue.
14. 14 . The method of claim 11 further comprising: a laser instrument configured to selectively emit: a first laser pulses at a wavelength selected to affect disc tissue or cartilage tissue without ablating bone; and a second laser pulses configured to interrogate a target region; a light detector configured to detect the second laser pulses;
15. 15 . The method of claim 14 , further comprising an irrigator configured to provide a fluid proximate tissue affected by the laser instrument to provide cooling and a medium to evacuate debris; and a suction generator configured to remove the fluid.
16. 16 . The method of claim 15 , further comprising: a computer coupled to the light detector and having one or more processors configured to perform topographical analysis or spectral analysis based on the detected second laser pulses.
17. 17 . The method of claim 16 , further comprising: a laser generator configured to generate the first laser pulses according to parameters, wherein the computer is further configured to modify the parameters based on the topographical analysis or spectral analysis.
18. 18 . The method of claim 15 , further comprising a reference array coupled to the laser instrument and configured to permit the tracking of a location of the laser instrument.
19. 19 . The method of claim 15 , wherein the reference array includes two or more tracking fiducials.
20. 20 . The method of claim 15 , further comprising a coupling configured to couple the laser instrument to a robot.

Description

CROSS-REFERENCE TO RELATED APPLICATIONS The present application is a continuation of U.S. patent application Ser. No. 18/635,764, filed Apr. 15, 2024, which is a continuation of U.S. patent application Ser. No. 17/537,651 filed on Nov. 30, 2021, which claims benefit of U.S. provisional application 63/124,627 filed on Dec. 11, 2020, the contents of which are hereby incorporated herein in their entirety. BACKGROUND A wide variety of medical assemblies and systems have been developed. Some of these assemblies and systems include instruments used in surgeries. These assemblies and systems are manufactured by any one of a variety of different manufacturing methods and may be used according to any one of a variety of methods. Of the known medical assemblies, systems, and methods, each has certain advantages and disadvantages. Among the medical assemblies and systems include laser assemblies and systems used to modify tissue. For example, carbon dioxide (CO2) lasers are used in skin-resurfacing. When applied to bone, because CO2 lasers hit a wavelength where bone has a higher absorption rate than water, the bone is superheated and vaporized. Holmium: Yttrium-Aluminum-Garnet (Ho:YAG) lasers are used to remove kidney stones. Since the absorption of Ho:YAG energy by the kidney stones relative to water is low, relatively high amounts of energy is needed to treat kidney stones. Erbium-doped: Yttrium-Aluminum-Garnet (Er:YAG) lasers have been used in bone removal in the jaw area. Saline has been used to cool a bone removal area. SUMMARY In a first example, there is a first example method for performing spinal surgery. The first method can include: exposing a vertebra of a patient; disposing a distal end of a laser instrument proximate the vertebra; conducting a laser-based topographical analysis of the vertebra using the laser instrument; registering a patient's anatomy using the laser-based topographical analysis; and creating a pilot hole in the vertebra with the laser instrument. The first example can further include: determining that the patient's spine shifted since a prior non-laser-based registration. The registering of the patient's anatomy can include updating an existing non-laser-based registration using the laser-based topographical analysis. Creating a pilot hole in the vertebra with the laser instrument can include creating a multi-diameter pilot hole. Creating the multi-diameter pilot hole can include creating a multiple diameter pilot hole having a countersink diameter and a minor dimeter interference. The first method can further include: placing a navigated instrument or an implant engaged with the navigated instrument into the pilot hole. The first method can further include: conducting a spectral analysis of laser reflection received through the laser instrument to determine laser characteristics to be used to complete a surgical plan. The first method can further include: registering a patient's anatomy using a non-laser registration technique to produce a non-laser registration; conducting a laser-based topographical analysis of the vertebra; and calculating a registration confidence value for the registration using the laser-based topographical analysis. In a second example, there is a second example method including: removing a portion of facet joint tissue of a vertebra using laser energy transmitted from a distal end of a laser instrument, wherein the removing includes starting a laser cut on an outside of the facet and angling the transmission of the laser energy back into bone. The laser instrument can include an elongate shaft that defines a longitudinal axis. The laser instrument can define a laser pulse axis along which the laser instrument is configured to direct laser pulses. The laser pulse axis can be non-parallel with respect to the longitudinal axis. The second example can further include using a tissue dilator to expose spine tissue. The second example method can further include using laser topography, laser reflection, laser refraction, time of flight measurements, or optical coherence tomography to confirm when a cut is complete. Starting the laser cut on an outside of the facet and angling the transmission of laser energy back into bone can include using a mirror or angled laser fiber to perform the angling. Starting the laser cut on an outside of the facet and angling the transmission of laser energy back into bone can include angling the transmission of laser energy in a direction other than toward a disc or nerve. The second example method can further include extending the laser cut to undermine a spinous process proximate the facet joint and continuing the laser cut along a contralateral foraminal recess. The second example method can further include checking for range of motion limits that may dictate a patient re-orientation or a different tip with more angulation. The second example method can further include tuning a laser generator of the laser instrument such that genera