Systems And Methods For Performing Lateral-Access Spine Surgery

Abstract

A retractor apparatus for a surgical robotic system includes a frame defining a central open region, a connecting member that connects the frame to a robotic arm, a plurality of coupling mechanisms for attaching a set of retractor blades within the central open region of the frame such that blades define a working channel interior of the blades, and a plurality of actuators extending between the frame and each of the coupling mechanisms and configured to move the blades with respect to the frame to vary a dimension of the working channel. Further embodiments include a surgical robotic system that includes a robotic arm and a retractor apparatus attached to the robotic arm, and methods for performing a robot-assisted surgical procedure using a retractor apparatus attached to a robotic arm.

What is claimed is: 
     
         1 . A surgical robotic system, comprising:
 a motion tracking system to track the position and orientation of one or more objects within a coordinate system;   an imaging device comprising an o-shaped gantry to obtain image data of a patient positioned therein;   a robotic arm defining an end movable relative to a support structure arranged adjacent to the o-shaped gantry of the imaging device, with the robotic arm configured to maintain alignment of the end relative to a target position of a patient's body defined within the coordinate system; and   a retractor apparatus attached to the robotic arm, the retractor apparatus comprising:
 a frame attached to the robotic arm, the frame defining a central open region; 
 a connecting member that connects the frame to the end of the robotic arm for concurrent movement relative to the support structure; 
 a plurality of retractor blades with at least one retractor blade configurable to provide intraoperative neurophysiological monitoring (IONM), with the at least one retractor blade comprising at least one electrode on at least one retractor blade and a conductive path extending within the at least one retractor blade for electrically coupling the electrode to a power source and a circuit for generating IONM stimulation signals; 
 a plurality of coupling mechanisms for attaching the plurality of retractor blades within the central open region of the frame such that the plurality of retractor blades define a working channel interior of the plurality of retractor blades; 
 a plurality of actuators extending between the frame and each of the coupling mechanisms and configured to move the retractor blades with respect to the frame to vary a dimension of the working channel; and 
 a marker device fixed to the frame that enables the retractor apparatus to be tracked using the motion tracking system to track the position and orientation of the retractor apparatus within the coordinate system. 
   
     
     
         2 . The surgical robotic system  claim 1 , wherein the at least one retractor blade comprising the electrode comprises one or more channels extending through the at least one retractor blade and the electrode is disposed within at least one of the channels. 
     
     
         3 . The surgical robotic system  claim 2 , wherein the at least one retractor blade comprising the electrode comprises a conductive lead located within at least one of the channels for providing the conductive path to transmit the IONM stimulation signals between the electrode, power source, and circuitry. 
     
     
         4 . The surgical robotic system  claim 2 , wherein the electrode is on the at least one retractor facing towards the working channel interior of the plurality of retractor blades. 
     
     
         5 . The surgical robotic system  claim 1 , wherein at least one of the coupling mechanism and the at least one retractor blade includes a port for electrically connecting the electrode on the at least one retractor blade to a separate IONM probe device. 
     
     
         6 . The surgical robotic system  claim 1 , wherein at least one of the power source and the circuit for generating IONM stimulation signals is located on the frame of the retractor apparatus. 
     
     
         7 . The surgical robotic system  claim 1 , at least one of electrical power and signals are transmitted from the robotic arm to the retractor apparatus. 
     
     
         8 . The surgical robotic system  claim 1 , wherein the electrode is configured to electrically stimulate surrounding tissue in response generation of the IONM stimulation signals to detect at least one of presence and proximity of a neural structure. 
     
     
         9 . The surgical robotic system  claim 8 , further comprising a nerve detection component operatively coupled to the electrode and the circuit, the nerve detection component configured to process data associated with the electrode and circuit. 
     
     
         10 . The surgical robotic system  claim 9 , wherein the nerve detection component is configured to control characteristics of the IONM stimulation signals. 
     
     
         11 . The surgical robotic system  claim 9 , wherein the nerve detection component is configured to measure a tissue response to the stimulation by the electrode and determine proximity of a neural structure relative to at least one of the plurality of retractor blades based on the tissue response. 
     
     
         12 . The surgical robotic system  claim 11 , wherein varying the dimension of the working channel is at least partially based on the determination of proximity of a neural structure relative to at least one of the plurality of retractor blades. 
     
     
         13 . The surgical robotic system  claim 11 , wherein at least one of electrical power and signals are transmitted from the nerve detection component to the retractor apparatus. 
     
     
         14 . The surgical robotic system  claim 13 , wherein based on the determination of proximity of a neural structure relative to the plurality of retractor blades, the nerve detection component is configured to control movement of the plurality of retractor blades. 
     
     
         15 . The surgical robotic system  claim 14 , wherein movement of the retractor blades are stopped in response to the determination of proximity of a neural structure via the nerve detection component. 
     
     
         16 . The surgical robotic system  claim 9 , wherein at least one of the retractor blades is moved away from a detected nerve in response to the determination of proximity of a neural structure via the nerve detection component. 
     
     
         17 . The surgical robotic system  claim 9 , wherein the nerve detection component is configured to a user feedback device to provide at least one of audio and visual feedback based on the determination of proximity of a neural structure relative to at least one of the plurality of retractor blades. 
     
     
         18 . The surgical robotic system  claim 1 , wherein the at least one retractor blade comprises a plurality of electrodes on the at least one retractor blade, the plurality of electrodes located along the at least one retractor blade for simulating different portions of surrounding tissue. 
     
     
         19 . The surgical robotic system  claim 1 , wherein the plurality of actuators are configured to move each retractor blade independently of movement of other retractor blades. 
     
     
         20 . The surgical robotic system of  claim 1 , wherein the support structure includes a curved rail operatively attached to the o-shaped gantry of the imaging device and with the robotic arm defining a second end operatively attached to the curved rail, with a position of the second end of the robotic arm being adjustable along the curved rail.