Process for percutaneous operations

Abstract

A method is described for performing a percutaneous operation on a patient to remove an object from a cavity within the patient. The method includes advancing a first alignment sensor into the cavity through a patient lumen. The first alignment sensor provides its position and orientation in free space in real time. The alignment sensor is manipulated until it is located in proximity to the object. A percutaneous opening is made in the patient with a surgical tool, where the surgical tool includes a second alignment sensor that provides the position and orientation of the surgical tool in free space in real time. The surgical tool is directed towards the object using data provided by both the first and the second alignment sensors.

What is claimed is: 
     
         1 . A method for performing a percutaneous operation on a patient, comprising:
 advancing a first alignment sensor into a cavity through a patient lumen, the first alignment sensor providing the position and orientation of the alignment sensor in free space in real time;   manipulating the first alignment sensor until the first alignment sensor is located in proximity to an object to be removed from the cavity   making a percutaneous opening in the patient with a surgical tool comprising a second alignment sensor that provides the position and orientation of the surgical tool in free space in real time; and   directing the surgical tool towards the object using data provided by both the first and the second alignment sensors.   
     
     
         2 . The method of  claim 1  wherein advancing the first alignment sensor into the cavity comprises:
 advancing a distal tip of an endoscope into the cavity, the distal tip comprising a camera to capture images of a field of view of the distal tipand the first alignment sensor. 
 
     
     
         3 . The method of  claim 2  wherein manipulating the first alignment sensor until the first alignment sensor is located in proximity to the object comprises:
 manipulating the distal tip of the endoscope until die object appears in the field of view of the camera. 
 
     
     
         4 . The method of  claim 1  wherein advancing the first alignment sensor into the cavity comprises:
 advancing a guide wire into the cavity, the guide wire comprising the first alignment sensor. 
 
     
     
         5 . The method of  claim 4  wherein manipulating the first alignment sensor until the first alignment sensor is located in proximity to the object comprises:
 performing fluoroscopy on the patient to generate fluoroscopic data including a location of the guide wire and first alignment sensor in the patient; and 
 manipulating the guide wire until the first alignment sensor is in proximity with the object based on the fiuoroscopic data. 
 
     
     
         6 . The method of  claim 1  wherein advancing a guide wire into the cavity comprises 
 advancing a ureteroscope into the cavity, the ureteroscope comprising a working channel; and 
 advancing the guide wire past the distal tip of the ureteroscope. 
 
     
     
         7 . The method of  claim 1  wherein the first and second alignment sensors are electromagneric (EM) sensors that receive EM fields emitted by a plurality of EM field generators placed in proximity to the patient. 
     
     
         8 . The method of  claim 7  wherein each of the EM sensors comprises at least one coil of conductive material. 
     
     
         9 . The method of  claim 7  further comprising:
 obtaining a three dimensional (3D) representation of an internal structure of the patient; and 
 registering data received from the first alignment sensor to the 3D representation to determine a frame of reference for the data that aligns with a position and orientation of the patient in free space. 
 
     
     
         10 . The method of  claim 9  wherein the 3D representation is a CT scan. 
     
     
         11 . The method of  claim 9  further comprising:
 segmenting the 3D representation to identify landmarks; and 
 registering locations of the landmarks with one or more alignment sensors to determine the frame of reference. 
 
     
     
         12 . The method of  claim 9 :
 wherein registering the data comprises   aggregating the locations of the landmarks into at least one point set; and   determining, based on point set, a homogeneous transformation composing a rotation matrix and a translation vector.   
     
     
         13 . The method of  claim 12 :
 wherein at least one of the landmarks is identifiable on an outside of the patient; and   wherein the first alignment sensor used to register locations of the landmarks is navigated outside the patient to register the locations.   
     
     
         14 . The method of  claim 13 :
 wherein the first alignment sensor used to register locations of the landmarks is coupled to a hand-held implement.   
     
     
         15 . The method of  claim 12 :
 wherein at least one of the landmarks is identifiable intra-operatively and   wherein the first alignment sensor used to register locations of the landmarks is navigated inside the patient to register the locations.   
     
     
         16 . The method of  claim 7  further comprising:
 obtaining a three dimensional (3D) representation of an internal structure of the patient, and 
 navigating the first alignment sensor outside the patient to identify a first point set comprising locations of landmarks identifiable outside the patient; 
 navigating a second alignment sensor inside the patient to identify a second point set comprising locations of landmarks identifiable inside the patient, 
 registering the first and second point sets to the 3D representation to determine a frame of reference for the data that aligns with a position and orientation of the patient in free space. 
 
     
     
         17 . The method of  claim 1  wherein each alignment sensor is electrically coupled to a conductive wire which transmits sensor data to a computing system for processing. 
     
     
         18 . The method of  claim 17 , further comprising:
 receiving, at the computer system, data from the first and second alignment sensors in real time;   providing, via a display device, a graphical interface displaying
 a first graphical element representing the position and orientation of the distal tip, and 
 a second graphical element representing the position and orientation of the surgical tool. 
   
     
     
         19 . The method of  claim 18 , wherein directing the surgical tool towards the object using data provided by both the first and the second alignment sensors comprises:
 updating the display of the first graphical element in the graphical interface in response to motion of the distal tip of the endoscope within the patient.   
     
     
         20 . The method of  claim 18 , wherein directing the surgical tool towards the object using data provided by both the first and the second alignment sensors comprises:
 updating the display of the second graphical element in the graphic interface in response to motion of the surgical tool within the patient.