US-20260123991-A1 - ROBOTIC SURGERY

US20260123991A1US 20260123991 A1US20260123991 A1US 20260123991A1US-20260123991-A1

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 (10)

1 . A method comprising: disposing a distal portion of a laser instrument proximate a target region of bone of a patient where a pilot hole is to be created; and forming a pilot hole in the target region, wherein the forming includes applying laser energy from the laser instrument to the target region.
2 . The method of claim 1 , wherein applying the laser energy includes applying the laser energy in a sub-ablative manner with respect to the bone.
3 . The method of claim 1 , further comprising: planning a procedure, wherein planning the procedure includes: receiving an indication of the location of the target region; receiving one or more characteristics of a screw to be disposed in the pilot hole; determining a characteristic of the pilot hole based on the one or more characteristics of the screw; and receiving confirmation of the determined characteristic of the pilot hole.
4 . The method of claim 1 , wherein the target region is a region of a vertebra; and wherein the method further comprises: removing tissue proximate the target region such that a screwdriver can reach a starting point of the screw and a posterior cortex of a spinal vertebra.
5 . The method of claim 1 , further comprising: obtaining a screw defining a screw cannula and a screw distal end; obtaining a screwdriver defining a driver cannula; placing the laser instrument through the driver cannula; and placing the laser instrument into the screw cannula such that the distal portion of the laser instrument is proximate the screw distal end.
6 . The method of claim 5 , further comprising: inserting the screwdriver through the guide of a robot arm; and with a robot arm, disposing the guide proximate the target region.
7 . The method of claim 6 , further comprising: after forming the pilot hole in the target region, driving the screw into the pilot hole using the screwdriver.
8 . The method of claim 9 , further comprising: while forming a pilot hole in the target region, moving a robot arm under a surgeon's control or automatically according to a plan.
9 . The method of claim 1 , wherein the forming includes calculating a depth of the pilot hole using the laser instrument.
10 . The method of claim 1 , wherein the laser energy is in a spectrum associated with Er:YAG; wherein the method further comprises applying cooling using a cooling lumen; wherein the method further comprises applying suction with a suction lumen; or wherein the method further comprises tracking a location with a navigation lumen.

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 generate