JP2008018257A - Medical instrument - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a medical instrument such as an endoscope which facilitates the guiding of a marker smoothly to a site such as an affected part where it is dwelled. <P>SOLUTION: A sensory coil unit 43 having sensory coils Cx, Cy and Cz built in for electromagnetically detecting the position of a dwelling marker to be dwelled in the affected part or the like is detachably mounted at a grip part 41 of a hard endoscope 21 having an objective lens 62 at the tip part 40a of a hard inserting part 40. Each hard endoscope 21 has an IC memory 69 built in, which carries written proper information such as the length of each inserting part 40. The position of the dwelling marker is detected with the sensory coils Cx, Cy and Cz utilizing the information to find a relative positional relationship between the position of the dwelling marker and the position P of the tip part 40a, thereby facilitating the guiding of the tip part 40a to the site such as the affected part where the dwelling marker is dwelled. <P>COPYRIGHT: (C)2008,JPO&INPIT

Description

  The present invention relates to a medical device such as an endoscope that is inserted into a body or the like to perform endoscopy or treatment.

In recent years, endoscopes have been widely adopted in the medical field. It is also used for treatment under the observation of a flexible endoscope for digestive organs. In this case, depending on the condition of the affected part, it may be easier to perform a surgical procedure under the observation of a rigid endoscope.
In such a case, conventionally, an operator of a digestive endoscopy has placed a marker serving as a mark on a target site such as an affected part in the digestive tract to be examined and treated by surgery. Since the position of this marker is intervened by the stomach wall, intestinal wall, etc., it cannot be recognized as an image in optical observation with a rigid endoscope. In conventional examples, such as tactile sensation from outside the body or X-ray fluoroscopy It was done by means.
JP 2002-131209 A

As described above, in the conventional endoscope, even if a marker is placed, the position of the marker cannot be easily recognized.
Also, if the position of the marker is recognized and the tip end side of the endoscope can be approached smoothly to the position of the marker, it becomes easier to perform endoscopy and treatment smoothly. It was not such a configuration.
Japanese Patent Laid-Open No. 2002-131009 discloses an endoscope apparatus configured to detect the shape of the insertion portion including the position of the distal end portion of the flexible endoscope. Nor does it make the approach easier.

(Object of invention)
The present invention has been made in view of the above-described points, and an object of the present invention is to provide a medical device such as an endoscope that facilitates smooth guide to a target site such as an affected part where a marker is placed.

  The present invention relates to a medical device provided with an insertion portion for insertion into a body cavity, the marker being disposed on the proximal end side of the insertion portion in the medical device and placed at a target site in the body cavity from a position outside the body cavity A sensor for electromagnetically detecting the position of the sensor, information on the first positional relationship between the position where the sensor is disposed and the position of the distal end of the insertion portion in the medical device, and an output signal of the sensor And a second positional relationship detecting means capable of detecting a relative second positional relationship between the position of the distal end portion of the insertion portion and the position of the marker.

  According to the present invention, by enabling detection of the relative positional relationship between the position of the distal end portion of a medical device such as an endoscope and a marker placed on a target site such as an affected part, The tip can be smoothly approached to the target site using information.

  Embodiments of the present invention will be described below with reference to the drawings.

  1 to 12 relate to the first embodiment of the present invention, FIG. 1 shows the entire configuration of the endoscope system including the first embodiment of the present invention, and FIG. 2 shows the entire configuration of the first endoscope apparatus. 3 shows the overall configuration of the second endoscope apparatus, FIG. 4 shows the internal configuration of the rigid endoscope, FIG. 5 shows the configuration of the indwelling marker, and FIG. 6 shows the sense coil and the indwelling marker. FIG. 7 shows an example in which an indwelling marker is set according to the shape of the target part (target region), and FIG. 8 and FIG. 9 show the driving waveform by the drive coil and the indwelling by the driving thereof. The timing of the signal waveform transmitted from the marker source coil, etc. are shown. FIG. 10 shows the contents of endoscopy and placement of the indwelling marker by the flexible endoscope for digestive organs, and FIG. 11 shows the flexible endoscope for digestive organs. Surgery with rigid endoscope after indwelling marker placement Indicates treat contents at the time of surgery, FIG. 12 shows a display example of such an endoscopic image on the monitor.

As shown in FIG. 1, an endoscope system 1 provided with the present embodiment includes, for example, a first endoscope device 2 as an endoscopic device for digestive organs and a second endoscope device as a surgical endoscope device. N pieces composed of an endoscopic device 3 and particularly an RF-ID tag or the like placed in a target region (target site) 5 to be examined or treated on the affected part of the patient 4 by the first endoscopic device 3 side Indwelling markers Mi / n (i = 1, 2,..., N) are provided.
The first endoscope device 2 includes a flexible endoscope 11 that can be inserted along a bent body cavity, a light source device 12 that supplies illumination light to the flexible endoscope 11, and the flexible endoscope 11. A processor device 13 that performs signal processing on an image sensor incorporated in the image sensor, a monitor 14 that displays a video signal output from the processor device 13, and a processor device 13 that is connected to the indwelling marker Mi / n and the like. For example, it comprises a keyboard 15 for inputting, and a microphone (with a microphone set) 17 that is attached to the head of the operator 16 and can input information to the indwelling marker Mi / n or the like by voice. .

The second endoscope apparatus 2 includes a rigid endoscope 21 that is inserted into the abdomen 4a or the like of the patient 4 for surgery, and a light source apparatus 22 that supplies illumination light to the rigid endoscope 21. A processor device 23 for performing signal processing on an image sensor incorporated in the rigid endoscope 21, a monitor 24 for displaying a video signal output from the processor device 23, and a processor device 23 for inputting information. And a keyboard 25 for performing
The flexible endoscope 11 includes a soft and elongated insertion portion 30, a handle portion 31 provided at the proximal end of the insertion portion 30 and gripped by the operator 16, and a universal cable 32 extending from the handle portion 31. The end of the universal cable 32 is branched into, for example, a light guide cable 32a and a signal cable 32b, and connectors 32c and 32d provided at the ends are attached to and detached from the light source device 12 and the processor device 13, respectively. Connect freely.

  The flexible endoscope 11 can be inserted into the stomach 33 or the like, for example, through the bent esophagus or the like by inserting the insertion portion 30 from the mouth.

In addition, a treatment instrument insertion port 34 is provided near the proximal end of the insertion part 30, and a treatment instrument is inserted, and the distal end side of the treatment part is protruded through a channel provided in the insertion part 30 to perform treatment. The indwelling marker Mi / n can be indwelled using the grasping forceps 35 as an indwelling treatment tool.
The insertion portion 30 includes a hard distal end portion 30 a, a bendable bending portion 30 b, and a soft (flexible) soft portion 30 c, and the operator 16 is provided with a bending knob provided on the handle portion 31. By operating 36, the bending portion 30b can be bent in any direction, up and down, left and right.
The handle portion 31 is provided with a drive coil unit 37 for electromagnetically transmitting the surgeon 16 to write information to the indwelling marker Mi / n by voice or the like. Then, as will be described later, by transmitting information to be written from the drive coil in the drive coil unit 37 by electromagnetic waves, the information transmitted to the memory in the indwelling marker Mi / n can be written (stored). Yes.

On the other hand, the rigid endoscope 21 is provided with a rigid and elongated insertion portion 40, a handle portion 41 provided at the proximal end of the insertion portion 40, and gripped by the operator 16, and extends from the handle portion 41. The universal cable 42 includes a universal cable 42, and the distal end of the universal cable 42 is branched into, for example, a light guide cable 42a and a signal cable 42b. The connectors 42c and 42d provided at the distal ends are connected to the light source device 22 and the processor device 23. And is detachably connected.
Further, in the rigid endoscope 21, for example, the position of the indwelling marker 6 is detected near the proximal end of the insertion portion 40, or the position P of the distal end portion 40a of the insertion portion 40 in the rigid endoscope 21 is detected. (See FIG. 4) and a sense coil unit 43 (with a built-in sense coil) that can detect the visual field direction S is attached.

The sense coil unit 43 is also used for detecting the position of the indwelling marker Mi / n.
The rigid endoscope 21 has its insertion portion 40 inserted into the body from the abdominal portion 4a of the patient 4 via the trocar 44.

FIG. 2 shows a detailed configuration of the first endoscope apparatus 2.
As shown in FIG. 2, a light guide (see an enlarged view in FIG. 2) 45 that transmits illumination light is inserted into the insertion portion 30 of the flexible endoscope 11. 1 is detachably connected to the light source device 12 shown in FIG. Then, the illumination light supplied from the light source device 12 is transmitted and emitted from the emission surface at the tip of the light guide 45. The exit surface of the light guide 45 is attached to the illumination window of the tip portion 30a.
The distal end portion 30a is provided with an observation window adjacent to the illumination window, and an objective lens 46 is attached to the observation window. For example, a charge-coupled device (abbreviated as CCD) is used as an imaging device at the imaging position. 47) is arranged. The CCD 47 is electrically connected to the contact of the connector 32d by a signal line. Then, the user connects the connector 32 d to the processor device 13, thereby connecting to the drive & signal processing circuit 48 inside the processor device 13.
In addition, a channel 49 is provided in the insertion portion 30, and a treatment tool such as a grasping forceps 35 for placing the placement marker Mi / n can be inserted.

A drive coil 50 that transmits information to be written to the indwelling marker Mi / n by electromagnetic waves is housed in the drive coil unit 37 provided in the handle portion 31. The drive coil 50 is connected to the signal line inserted through the handle portion 31 and the universal cable 32, and is connected to the processor device 13 via the connector 32d.
The drive & signal processing circuit 48 incorporated in the processor device 13 includes a timing generator 51 that generates timing signals such as various clocks, and a CCD drive circuit that generates a CCD drive signal that drives the CCD 47 in synchronization with the timing signals. 52.
Also, an amplifier 53 for amplifying a CCD output signal output from the CCD 47 by application of a CCD drive signal, an A / D converter 54 for A / D converting the output signal of the amplifier 53, and the A / D converter 54. A video signal processing circuit 55 that performs video signal generation signal processing on the digital CCD output signal output from 54, and a D / A conversion that D / A converts the video signal output from this video signal processing circuit 55 And an amplifier 57 for amplifying the analog video signal output from the D / A converter 56.

The analog video signal amplified by the amplifier 57 is input to the monitor 14, and an endoscopic image corresponding to the video signal is displayed on the display surface of the monitor 14.
The timing generator 51 also supplies the timing signal to the A / D converter 54, the video signal processing circuit 55, and the D / A converter 56.
The processor device 13 includes a CPU 58 that performs control processing, a speech recognition circuit 59 that performs speech recognition, and a drive coil drive circuit 60 that generates a signal for driving the drive coil 50.
Data and the like are input to the CPU 58 by operating the keyboard 15 by the surgeon 16 or the like. A voice signal input by the surgeon 16 or the like through the microphone set 17 is voice-recognized by the voice recognition circuit 59, converted into corresponding character information, and input to the CPU 58.

  The CPU 58 outputs a signal corresponding to data and character information input from the keyboard 15 and the voice recognition circuit 59 to the drive coil drive circuit 60. The drive coil drive circuit 60 sends a signal corresponding to the input data and character information to the drive coil 50 in the handle portion 31. The drive coil 50 converts the input information from the CPU 58 side into a signal that is converted into an electromagnetic wave. Radiates as.

Here, for example, the handle 31 of the flexible endoscope 11 is provided with switches Sc and Sd for instruction operation. For example, when the switch Sc is pressed and turned on, the operation signal is input to the CPU 58 provided in the processor device 13. And CPU58 receives this instruction | indication signal, and performs the transmission operation | movement from the drive coil 50 to the indwelling marker Mi / n toward the indwelling marker Mi / n. Further, by operating the switch Sd, transmission from the drive coil 50 to the indwelling marker Mi / n is stopped. In this way, signals are not emitted unnecessarily.
The switches Sc and Sd may be provided in the drive coil unit 37. In this case, the signal is transmitted from the drive coil unit 37 to the CPU 58 via the flexible endoscope 11. Further, only the switch Sc may serve as a function of starting transmission and stopping transmission.

The indwelling marker Mi / n receives this electromagnetic wave, uses a part thereof as a power source, demodulates it, and stores the transmitted information in the memory 88a (see FIG. 5).
Specifically, a signal radiated as an electromagnetic wave from the drive coil 50 includes the observation by the operator 16, the placement date and time (of the placement marker 6), and the serial number (ie, 1 / n, 2 / n) of the placement marker Mi / n. ,..., N / n) are superimposed. Then, the electromagnetic wave is received by the source coil Cmi that is also used for reception and transmission built in the indwelling marker Mi / n. Further, a part of the signal is used as a power source, the transmitted signal is demodulated, a signal corresponding to the input information is generated, and stored in the memory 88a of the IC chip 88 in the placement marker Mi / n.
In the present embodiment, in addition to the position information based on the signal transmitted from the source coil Cmi of the indwelling marker Mi / n, the information stored in the memory 88a of the indwelling marker Mi / n is read out, so that the subsequent rigidity The treatment by the endoscope 21 side can be performed more smoothly.

The position where the drive coil 50 is provided is not limited to the case where the drive coil 50 is provided in the handle portion 31 of the flexible endoscope 11, but is provided in another position or a position other than the flexible endoscope 11, for example, the processor device 13. You may do it.
FIG. 3 shows a detailed configuration of the second endoscope apparatus 3. FIG. 4 shows details of the rigid endoscope 21 constituting the second endoscope apparatus 3.
As shown in FIG. 4, a light guide 61 is inserted into the rigid insertion portion 40 of the rigid endoscope 21, and this light guide 61 is further inserted into the universal cable 42 extending from the handle portion 41. Is inserted.
Then, as shown in FIG. 1, the user transmits illumination light supplied from the light source device 22 by connecting the connector 42 a to the light source device 22. The emission surface at the tip of the light guide 61 is attached to the illumination window at the tip 40a of the insertion portion 40, and the illumination light is emitted forward from the illumination window.

In addition, an objective lens 62 is attached to an observation window provided adjacent to the illumination window, and a CCD 63 is disposed at the imaging position. The CCD 63 is connected to a drive & signal processing circuit 64 built in the processor device 23 as shown in FIG. 3 through a signal line inserted into the insertion section 40 or the like.
As shown in FIG. 4, a sense coil unit 43 is detachably attached to the handle portion 41 of the rigid endoscope 21.
For example, a connector receiver 65 is provided at one place on the outer peripheral surface of the handle portion 41 and is detachably connected to the connector 66 on the sense coil unit 43 side. The sense coil unit 43 includes sense coils Cx, Cy, Cz and a drive coil Cd. The sense coils Cx, Cy, Cz and the drive coil Cd are connected to the contacts of the connector 66 by lead wires. ing.

The sense coils Cx, Cy, Cz and the drive coil Cd are connected to the sense coil processing circuit 67 and the drive coil in the processor device 23 shown in FIG. 3 via signal lines connected to the contacts of the connector receiver 65. Each is connected to a signal processing circuit 68.
The drive coil Cd may be shared by one of the sense coils Cx, Cy, and Cz. In that case, the drive coil Cd can be omitted.
In the present embodiment, the sense coil unit 43 is detachable from the rigid endoscope 21, so that the sense coil unit 43 can be used in a state suitable for the rigid endoscope 21 to which the sense coil unit 43 is actually attached. In addition, each rigid endoscope 21 incorporates, for example, a memory IC 69 in which a scope ID unique to the rigid endoscope 21 is written.
The information in the memory IC 69 is read by the CPU 70 provided in the processor device 23, and the information makes the distal end portion 40a of the rigid endoscope 21 approach the portion where the placement marker Mi / n is placed. It is used when treating.

When the sense coil unit 43 is detachable as described above, the position of the sense coils Cx, Cy, Cz and the insertion portion are different if the mechanical dimensions such as the length of the insertion portion 40 of the rigid endoscope 21 are different. The relative position with respect to the position P of the front end portion 40a of the 40 is different, and in order to determine the positional relationship between them, information that can uniquely determine it is necessary.
In this way, when the sense coil unit 43 is detachable and compatible and is detachably combined with various rigid endoscopes, the above information in each rigid endoscope is required. Become. In order to achieve this, in the present embodiment, information unique to each rigid endoscope is stored in the memory IC 69 in each rigid endoscope 21 together with the scope ID, and the information is stored on the processor device 23 side. Is used for detecting the position by the sense coil unit 43 and also used for detecting the position of the distal end portion 40a.

FIG. 6 described later shows a state in which the position P of the tip 40a is displayed in the coordinate system for detecting the position of the indwelling marker Mi / n by the sense coils Cx, Cy, Cz.
In this case, the information unique to the rigid endoscope includes the positions of the sense coils Cx, Cy, Cz by the attachment of the sense coil unit 43, the mechanical dimensions of the rigid endoscope 21 (the length of the insertion portion 40, the sense coil). In addition to the Cx, Cy, and Cz positions to the objective lens 62 at the distal end portion 40a and the spatial coordinate position), the lens magnification of the objective lens 62, the lens viewing angle, and the perspective direction (straight angle) in the direct-view type and the perspective type. ) And the like.

All the information may be stored in the memory IC 69, or only the model number and the manufacturing number of the rigid endoscope 21 are stored in the memory IC 69, and the processor device 23 side is based on the information. It is also possible to use the LUT (Look Up Table) memory (not shown) provided in FIG. The rigid endoscope 21 can be identified not only by the memory IC 69 storing the scope ID but also by an optical reading means such as a barcode.
Further, for example, the handle 41 of the rigid endoscope 21 is provided with switches Sa and Sb for instruction operation. For example, when the switch Sa is pressed and turned on, the operation signal is input to the CPU 70 provided in the processor device 23. Then, the CPU 70 receives this instruction signal and starts a transmission operation from the drive coil Cd toward the indwelling marker Mi / n toward the indwelling marker Mi / n. Further, by operating the switch Sb, transmission from the drive coil Cd to the indwelling marker Mi / n is stopped. In this way, unnecessary signal emission may be avoided.

The switches Sa and Sb may be provided in the sense coil unit 43. In this case, the signal is transmitted to the CPU 70 via the connector 66 and the connector receiver 65. Further, only the switch Sa may serve as a function of starting transmission and stopping transmission.
The drive & signal processing circuit 64 in the processor device 23 shown in FIG. 3 has the same configuration as the drive & signal processing circuit 48 shown in FIG.
That is, the drive & signal processing circuit 64 includes a timing generator 71 that generates various timing signals, and a CCD drive circuit 72 that generates a CCD drive signal that drives the CCD 63 in synchronization with the timing signals.

Also, an amplifier 73 that amplifies the CCD output signal output from the CCD 63 by application of the CCD drive signal, an A / D converter 74 that A / D converts the output signal of the amplifier 73, and the A / D converter. A video signal processing circuit 75 that performs video signal generation signal processing on the digital CCD output signal output from 74, and a D / A conversion that D / A converts the video signal output from the video signal processing circuit 75 And an amplifier 77 that amplifies the analog video signal output from the D / A converter 76.
The analog video signal amplified by the amplifier 77 is input to the monitor 24, and an endoscopic image corresponding to the video signal is displayed on the display surface of the monitor 24.
The timing generator 71 also supplies the timing signal to the A / D converter 74, the video signal processing circuit 75, and the D / A converter 76.

The drive coil signal processing circuit 68 includes a timing generator (clock generator) 78 that generates clocks of various timings, a filter 79 using a BPF that is set to pass the clocks from the timing generator 78, and the filter. And an amplifier 80 for amplifying the clock signal that has passed through 79.
The clock output from the timing generator 78 to the filter 79 side is controlled by the CPU 70. That is, in response to the switch Sa being turned on, the CPU 70 outputs a clock from the timing generator 78 to the filter 79 side.
A clock having a predetermined frequency amplified through the amplifier 80 is applied to the drive coil Cd. The drive coil Cd radiates an applied clock signal as an electromagnetic wave, which is received by the source coil Cmi of the placement marker Mi / n and used as a power source. Further, a signal used for position detection or the like is transmitted by the supply of the power.

A signal transmitted from the indwelling marker Mi / n side is received by the sense coils Cx, Cy, Cz, and input to the amplifier 81 of the sense coil processing circuit 67 in the processor device 23. After being amplified by the amplifier 81, a signal within a predetermined band is taken out by the filter 82, and further A / D converted by the A / D converter 83 to be converted into a digital signal.
This digital signal is input to the Fourier transform circuit 84 and also to the CPU 70.
The Fourier transform circuit 84 performs frequency analysis for extracting the input signal, specifically, the frequency component of the signal transmitted from the source coil of the indwelling marker Mi / n, and the frequency of the signal from the frequency analysis result. Extract ingredients. The extracted signal is output to the amplitude / phase detection circuit 85, and the amplitude / phase detection circuit 85 detects the amplitude and phase value (deviation from the reference phase) of the signal and outputs the detected signal to the marker coordinate detection circuit 86. . The marker coordinate detection circuit 86 detects (calculates) the three-dimensional coordinates of each indwelling marker Mi / n from the amplitude and phase value of the signals detected by the three sense coils Cx, Cy, Cz.

The calculated information is output to the video signal processing circuit 75 via the CPU 70 and superimposed on the video signal of the endoscopic image generated by the video signal processing circuit 75, so that the endoscope is displayed on the display surface of the monitor 24. The position of the indwelling marker Mi / n can be displayed together with the image.
The CPU 70 to which the output signal from the A / D converter 83 is input decodes the information modulated (superimposed) on the position detection signal, and the information written in the memory 88 a of the IC chip 88. Get. Then, the CPU 70 outputs to the video signal processing circuit 75 and performs control processing so that information such as the written findings can be displayed on the display surface of the monitor 24 together with the position of the indwelling marker Mi / n.

FIG. 5 shows the configuration of the indwelling marker Mi / n.
The indwelling marker Mi / n includes, for example, a source coil Cmi / n used for transmission and reception in an outer case such as a capsule shape, a modulation / demodulation circuit 87 connected to the source coil Cmi / n and performing modulation / demodulation, and transmitted information And a modulation / demodulation circuit 87 and an IC chip 88 that controls writing to and reading from the memory 88a.
In this embodiment, the flexible endoscope 11 transmits information for later treatment and writes (stores) it in the memory 88a. Then, when performing treatment with the rigid endoscope 21, it is driven to transmit for position detection, and information stored in the memory 88a is read, and treatment is performed by referring to, for example, findings in the information. Use it to make it easier or smoother.
FIG. 6 shows how the indwelling marker Mi / n is detected by the sense coils Cx, Cy, Cz.

The sense coils Cx, Cy, Cz are arranged so as to have sensitivity (that is, have directivity) in the three orthogonal axes x, y, z, and electromagnetic fields from the source coil Cmi / n of the placement marker Mi / n. It is used to detect the intensity and the phase shift, and the three-dimensional coordinate position of the source coil Cmi / n is calculated from the detection information.
Further, the position of the distal end portion 40a of the insertion portion 40 (or the objective lens 62 in the distal end portion 40a), which is a predetermined three-dimensional coordinate position with the sense coils Cx, Cy, Cz as the origin, is calculated from information from the IC memory 69. can do.
In FIG. 6, the coordinates of the position P of the tip end portion 40a are indicated by (xo, yo, zo) with the sense coils Cx, Cy, Cz as the origin. In the present embodiment, for example, the position of the three-dimensional coordinates of the source coil Cmi / 3 can be displayed with the position of the tip 40a as the origin. In this case, as shown in FIG. 6, for example, a coordinate system having the pupil position of the objective lens 62 as the position P of the distal end portion 40 a and the position P as the origin is shown as (x ′, y ′, z ′).

Further, in this embodiment, the sense coil Cx is arranged so as to have directivity in the axial direction of the insertion portion 40, and the visual field direction S of the objective lens 62 is a coordinate system having the sense coils Cx, Cy, Cz as the origin. It is set so as to be parallel to the x-axis direction at (x, y, z) and also in the x ′ direction in the coordinate system (x ′, y ′, z ′) with the position P of the tip 40a as the origin. ing. For this reason, mutual conversion between the coordinate system having the sense coils Cx, Cy, Cz as the origin and the coordinate system having the position P of the tip 40a as the origin is facilitated. In this embodiment, the direct view type is shown.
FIG. 7 shows a state in which the placement marker Mi / n is placed on the target region 5 to be noted such as an affected part.
Depending on the shape of the target region 5 such as the affected area, the placement marker Mi / n may be placed as shown in FIG. 7A or 7B.
As shown in FIG. 7A, in the case where the target area 5 has a shape close to a triangle, three placement markers M1 / 3, M2 / 3, and M3 / 3 may be placed at positions near the vertices.

In addition, when the target area 5 has a substantially square shape as shown in FIG. 7B, four indwelling markers M1 / 4, M2 / 4, M3 / 4, and M4 / 4 are placed at positions near each vertex. It is good to detain.
When the target region 5 is circular or elliptical, three or more placement markers Mi / n may be placed along the outer shape.
It is important to be able to recognize the total number n of indwelling markers Mi / n and the serial number i / n in order to eliminate the leaving of indwelling markers at the time of surgery.
FIG. 8 is transmitted for position detection and the like by the source coil Cmi on the placement marker Mi / 3 side by transmitting to the three placement markers Mi / 3 placed from the drive coil Cd of the rigid endoscope 21. Signal timing is shown.

As shown in FIG. 8A, the drive coil Cd outputs a burst wave having an oscillation frequency of, for example, 10 KHz as a signal having a predetermined period.
By receiving this, power is supplied to indwelling markers M1 / 3 to M3 / 3, and output signals shown in FIGS. 8B to 8D are transmitted.
8B to 8D show the fundamental wave (carrier wave) of the output signal. On this fundamental wave, information such as unique information and findings recorded in the memory 88a in each indwelling marker M1 / 3 to M3 / 3 is superimposed.
In this embodiment, it is necessary to recognize the position information of the three placement markers M1 / 3 to M3 / 3. The output signals of the three placement markers M1 / 3 to M3 / 3 are shown in FIG. As shown in FIG. 8 (D), by transmitting the burst wave of the drive coil Cd with a predetermined amplitude at the time t1, t2, and t3 from the burst wave transmission timing, When receiving with the sense coils Cx, Cy, Cz provided in the endoscope 21, it is possible to recognize which signal corresponds to which source coil Cmi / 3.

Further, by detecting the time delay from the time t1, t2, t3 as the phase shift of the signal waveform from the source coil Cmi / 3, between the sense coils Cx, Cy, Cz and each source coil Cmi / 3. The distance can be detected. Further, from the distance, the directivity by the sense coils Cx, Cy, Cz and the amplitude value of the detected signal waveform, for example, the three-dimensional source coil Cmi / 3 with the coordinate system of the sense coils Cx, Cy, Cz as the origin. The coordinate position can be calculated.
Further, with the sense coils Cx, Cy, Cz as the origin, the position of the distal end portion 40a of the insertion portion 40 (or the objective lens 62 in the distal end portion 40a), which is a predetermined three-dimensional coordinate position, is the origin, and the source coil Cmi / 3 The position of the three-dimensional coordinate can also be calculated.

  In the present embodiment, the position of the three-dimensional coordinates of the source coil Cmi / 3 is used to facilitate visual approach of the distal end portion 40a of the rigid endoscope 21 to the target region 5 where the placement marker Mi / 3 is placed. When the calculation result is displayed, the distal end portion 40a of the insertion portion 40 is displayed as the origin of the three-dimensional coordinate system.

When indwelling the indwelling markers M1 / 3 to M3 / 3 during endoscopy, when inputting predetermined information to each indwelling marker Mi / 3 from the endoscopic device 2 side for digestive organs, the serial number Since data is also input, this can be achieved by programming together the information that “After receiving the burst wave from the drive coil Cd, a transmission signal is output after time t1, t2, t3, respectively”.
FIG. 9 shows a method different from the method of FIG.
As shown in FIG. 9A, the transmission frequency of the drive coil Cd is a burst wave of 10 kHz, for example.

In response, power is supplied to the source coils Cm1 / 3 to Cm3 / 3 built in the placement markers M1 / 3 to 3/3, and the output signals shown in FIGS. 9B to 9D are respectively output. send.
The transmission signals from these source coils Cm1 / 3 to Cm3 / 3 are all uniform in terms of start timing, but instead, the transmission frequencies are set to be different from 10 kHz, 12 kHz, and 14 kHz, respectively.

Also in this case, it is necessary to recognize the position information of the three indwelling markers M1 / 3 to M3 / 3, but the source coils Cm1 / 3 to Cm3 / 3 are different from each other, such as 10 kHz, 12 kHz, and 14 kHz. By transmitting at the frequency, the signal is received by the sense coils Cx, Cy, Cz provided in the surgical rigid endoscope 21, and the source coil Cmi corresponding to the frequency can be recognized. .
When placing indwelling markers M3 / 1 to M3 / 3, serial number data is also inputted when inputting predetermined information to each indwelling marker Mi / 3 from the endoscopic device 2 side for digestive organs. This is made possible by programming together the information that “when receiving a burst wave from the drive coil Cd, a fundamental wave of 10 kHz, 12 kHz, and 14 kHz is transmitted and output”.
9B to 9D show the fundamental wave of the output signal. On this fundamental wave, unique information recorded in the memory 88a in each indwelling marker Mi / 3 is superimposed.

The indwelling marker Mi / n is placed in accordance with the diagnosis by the flexible endoscope 11 for digestive organs to the treatment target region such as an affected part by the endoscope system 1 having such a configuration, and the indwelling marker Mi / n is placed. A procedure of a surgical operation using the rigid endoscope 21 using / n will be described with reference to FIGS.
As shown in FIG. 10, in the first step S1, an endoscopy is performed with the flexible endoscope 11 for digestive organs.
Specifically, for example, as shown in FIG. 1, the gastrointestinal flexible endoscope 11 is inserted from the mouth side of the patient 4 and the inside of the digestive tract, for example, the inside of the stomach 33 is endoscopically examined.
By this endoscopy, treatment by this flexible endoscope 11, for example, EMR as mucosal resection under endoscopic observation is performed.

When there is a target region 5 that is easier to treat by a surgical operation using a rigid endoscope, the operator 16 places an indwelling marker Mi / n in the treatment target region 5 as shown in step S2. When the indwelling marker Mi / n is placed, three or more placement markers Mi / n are placed so as to surround the target region 5 with the grasping forceps 35 or the like.
When the indwelling marker Mi / n is placed, as shown in the enlarged view of FIG. 2, an indwelling marker Mi / n having an outer diameter smaller than the inner diameter of the channel 49 and a grip portion that can be inserted through the channel 49 are provided at the tip. When the grasping forceps 35 is employed, the operator 16 can easily place the patient 4 without causing pain to the patient 4.
Further, when placing the placement marker Mi / n, a hook or the like is attached in advance to the placement marker Mi / n, and the tip of the hook is inserted into the surface of the target region 5 such as an affected part, thereby placing the placement marker Mi / n. can do. Further, without using a hook or the like, the bioadhesive polymer applied to the outer surface of the placement marker Mi / n can be placed on the surface of the target region 5.

Then, as shown in step S <b> 3, the surgeon 16 inputs findings, indwelling date and time, a serial number for the total number n of indwelling markers Mi / n, and the like, by voice input using the microphone set 17, for example.
After performing this input, the CPU 58 in the processor device 13 transmits the input information from the drive coil 50 by performing transmission to the indwelling marker Mi / n or voice input for writing. The drive circuit 60 is activated.
Then, as shown in step S4, the indwelling marker Mi / n receives the signal by the source coil Cmi / n and uses it as a power source, and stores the information transmitted to the memory 88a in the IC chip 88.
Thereafter, the operator 16 pulls out the flexible endoscope 11 from the body cavity.
Then, at a later date, the surgeon performs a surgical operation with the rigid endoscope 21. A typical procedure in this case is shown in FIG.

As shown in step S <b> 11, the insertion portion 40 of the rigid endoscope 21 is inserted through the trocar 44 from the abdomen 4 a of the patient 4.
The endoscopic image captured by the CCD 63 of the rigid endoscope 21 is displayed on the display surface of the monitor 24.
Further, by operating the switch Sa or the like, a drive signal is transmitted from the drive coil Cd to the indwelling marker Mi / n as shown in step S12. In the following, n = 3.
Due to the transmission of this signal, the indwelling marker Mi / 3 is shifted from the transmission timing from the drive coil Cd sequentially as shown in FIG. 8 at times t1, t2, and t3 so as not to overlap. Signals (for position detection etc.) are sequentially transmitted from the source coil Cm1 / 3 to Cm3 / 3 (S13).
And the signal from each source coil Cmi / 3 is received by the sense coils Cx, Cy, Cz in the sense coil unit 43 attached to the rigid endoscope 21, and the source coil Cmi / 3 (its indwelling marker Mi / 3) is received. Each three-dimensional position is detected (S14). The detection (calculation) of the three-dimensional position can be performed by detecting the amplitude value and phase of the received signal.

The positional information is sent to the CPU 70, and the plane including the three placement markers M1 / 3 to M3 / 3 and the three placement markers M1 / 3 to M3 / 3, for example, from the three placement markers M1 / 3 to M3 / 3. The coordinates of the center position are calculated (S15). Note that a normal vector perpendicular to the plane may be calculated from the plane including the indwelling markers M1 / 3 to M3 / 3.
These pieces of information are sent from the CPU 70 to the video signal processing circuit 75, superimposed on the video signal and output to the monitor 24, and information on the target area is displayed together with the endoscopic image (S16).
In addition, information input by the surgeon 16 and stored in the memory 88 a is also read and input to the CPU 70. This information is also sent from the CPU 70 to the video signal processing circuit 75, superimposed on the video signal, output to the monitor 24, and displayed on the monitor 24 (S17).
A display example on the monitor 24 in this case is shown in FIG. An endoscopic image captured by the CCD 63 of the rigid endoscope 21 is displayed in the endoscopic image display area Re, and adjacent to the display area Re, the distal end of the insertion portion 40 of the rigid endoscope 21 is displayed. A guide image serving as a guide in the insertion direction on the side is displayed in the insertion guide display area Rg. Information such as findings by the operator 16 is displayed in the memory storage information display area Rm.

In the insertion guide display area Rg of FIG. 12, the position of the objective lens 62 is set as the origin and 2 of the placement marker Mi / n (more specifically, M1 / 3 to M3 / 3) on a plane perpendicular to the visual field direction S. The dimension position (for example, (y ′, z ′) as described below) is schematically displayed. That is, the positions of the indwelling markers M1 / 3 to M3 / 3 that are shifted from the visual field direction S are displayed.
When the position of the objective lens 62 is set as the origin and the visual field direction S is set in the x ′ direction, for example, the x ′ direction is set in a direction perpendicular to the monitor screen, and the detected indwelling markers M1 / 3 to M3 / 3 are detected. In order to visually indicate the position, the positions of the indwelling markers M1 / 3 to M3 / 3 are shifted in the visual field direction S by the x ′ component at the indwelling markers M1 / 3 to M3 / 3 (the center position O). Is shown using y ′ and z ′ components perpendicular to the x ′ direction.
That is, the monitor screen relatively shows the y ′ and z ′ components of the indwelling markers M1 / 3 to M3 / 3.

Further, since it becomes difficult to visually grasp the value of the x ′ component as it is, for example, two concentric circles H and C having different sizes proportional to the value of the x ′ component are displayed. The sizes of the circles H and C are set so as to be proportional to the size of the x ′ component at the distance from the position P of the distal end portion 40a to the placement marker Mi / n. For example, the circle C is displayed with the value of the x ′ component at the distance from the position P of the tip 40a to the placement markers M1 / 3 to M3 / 3 (the center position O) as the radius. By displaying in this way, it becomes easy to visually perform the operation of bringing the distal end portion 40a closer to the target region 5 side.
In the specific example of FIG. 12, the information 5a of the target area 5 is displayed on the right side of the visual field direction S. Therefore, if the surgeon 16 changes the distal end portion 40a of the insertion portion 40 to the right side, the target area 5 It can be easily seen visually that the side can be approached.

In FIG. 12, the center position of the placement markers M1 / 3 to M3 / 3 is O, and the normal vector V of the surface including these from the center position O of the placement markers M1 / 3 to M3 / 3 is displayed. By displaying the normal belt V, it can be determined whether the tip 40a is approaching from a direction perpendicular to the surface, whether it is approaching from an oblique direction, or the like.
Thus, the surgeon refers to the information displayed on the monitor 24 and approaches the target area 5 by adjusting the orientation of the insertion portion 40 of the rigid endoscope 21 (S18).

As described above, the insertion guide display area Rg displays the center position O of the target area 5 as well as the visual field direction S by the objective lens 62 of the distal end portion 40a of the rigid endoscope 21, and the target area 5 Since the normal vector V of the surface is also displayed, the distal end portion 40a of the insertion portion 40 can be approached to the center position O of the target region 5 smoothly. It is also easy to visually recognize whether or not approaching or observing from the direction of the normal vector V and from the direction perpendicular to the surface of the target region 5.
Approaching the target area 5, the target area 5 is placed in the observation field of view of the objective lens 62 of the rigid endoscope 21, and treatment is performed using a treatment tool (not shown) (S19). In addition, the placed placement markers M1 / 3 to M3 / 3 are removed. Then, the surgical operation is completed.
A supplementary explanation will be given for the display of the target area 5 accompanying the position calculation of the indwelling marker Mi / 3 in FIG.

The position of the distal end portion 40a of the rigid endoscope 21 is (xo, yo, zo).
In this case, the position (xo, yo, zo) of the distal end portion 40a of the rigid endoscope 21 and the visual field direction S of the objective lens 62 are as follows: 1) Sense coil Cx in the sense coil unit 43 attached to the handle portion 41 , Cy, Cz and their respective orientations, and the physical position and direction when the sense coil unit 43 is mounted on the rigid endoscope 21 are determined in advance.
Therefore, if the positions of the sense coils Cx, Cy, Cz in the sense coil unit 43 and the respective directions are known, the position (xo, yo, zo) of the distal end portion 40a and the visual field direction S of the objective lens 62 can be determined. Is possible. Then, after calculating the position (xo, yo, zo) of the distal end portion 40a and displaying the calculated result of the position of the indwelling marker Mi / 3 on the monitor 24, the position of the distal end portion 40a is coordinated as described above. By displaying it as the origin, it is possible to easily approach the tip 40a visually to the indwelling marker Mi / 3.

In the case of the present embodiment, since the sense coil unit 43 is mounted on the handle portion 41, there is no interference with other components built in the distal end portion 40a such as the optical system of the rigid endoscope 21.
In this embodiment, the sense coils Cx, Cy, Cz and the like are detachably attached to the handle portion 41. However, a sense coil for position detection can be provided at the distal end portion 40a of the rigid endoscope 21. For example, the position and the visual field direction S of the distal end portion 40a of the rigid endoscope 21 can be determined from the position and orientation of the sense coil. Therefore, the sense coil may be arranged at the tip 40a in this way.
Thus, according to the present embodiment, it is possible to easily perform a surgical operation or the like.

  In the above-described embodiment, the rigid endoscope 21 can detect the position of the distal end portion 40a and the visual field direction S, and smoothly approach the target region 5 where the placement marker Mi / n is placed. Although the configuration and operation that can be performed have been described, the present invention can also be applied to the flexible endoscope 11 as in Example 2 below.

Next, a second embodiment of the present invention will be described with reference to FIG. FIG. 13 shows an endoscope system 1B provided with Example 2 of the present invention.
The endoscope system 1B has a configuration in which the sense coils Cx, Cy, Cz are arranged at the distal end portion 30a of the flexible endoscope 11 in FIG. 1 or FIG. The position of the distal end portion 30a of the endoscope 11 and the visual field direction S ′ by the objective lens 46 provided at the distal end portion 30a can be detected.
That is, the position of the distal end portion 30a of the insertion portion 30 of the flexible endoscope 11 and the visual field direction S ′ of the objective lens 46 can be obtained by providing the sense coils Cx, Cy, Cz if the distal end portion 30a is provided with the sense coils Cx, Cy, Cz. From the position of Cz and the direction thereof, the position of the distal end portion 30a of the flexible endoscope 11 and the visual field direction S ′ can be determined.
Moreover, since the imaging part in the front-end | tip part 30a of the flexible endoscope 11 is generally comprised by the hard member, it is the softness | flexibility by incorporating sense coil Cx, Cy, Cz in the position shifted backward only by the known position. The position of the distal end portion 30a of the endoscope 11 and the visual field direction S ′ can be determined. (If the sense coils Cx, Cy, Cz are arranged as described above, there is no interference with other components built in the distal end portion 30a such as an optical system such as the objective lens 46 of the flexible endoscope 11).

On the premise of using the flexible endoscope 11 as described above, an indwelling marker Mi / 3 is placed in the living body.
The positions of the spaces of the placement markers M1 / 3 to M3 / 3 are (x1, y1, z1), (x2, y2, z2), and (x3, y3, z3).
A coordinate system in which the visual field direction S ′ of the flexible endoscope 11 is Z axis, the origin is the visual field center of the optical system, the upper direction of the visual field is the positive direction of Y, and the right direction of the visual field is the positive direction of X is XYZ space. To do.

  In this coordinate system, the displayed endoscopic image is expressed as a plane perpendicular to the Z axis.

  The origins of X, Y, and Z are the same as the position of the distal end portion 30a of the flexible endoscope 11 described above.

Positions (x1, y1, z1), (x2, y2, z2), (x3) of indwelling markers M1 / 3 to M3 / 3 detected by the sense coils Cx, Cy, Cz provided in the flexible endoscope 11 , Y3, z3) are converted as X, Y, Z space values, respectively.
These coordinates are (X1, Y1, Z1), (X2, Y2, Z2), and (X3, Y3, Z3).
Assuming that the distal end portion 30a of the flexible endoscope 11 approaches the indwelling marker M1 / 3, this is equivalent to bringing the origin of the XYZ space and the coordinates of (X1, Y1, Z1) closer.

Therefore, the distance D between the tip and the indwelling marker M1 / 3 is the distance between the origin of the X, Y, Z space and the point (X1, Y1, Z1). In the calculation formula, simple calculation is possible as the square root of the sum of squares of each term of (X1, Y1, Z1), and this distance can be displayed on the screen.
On the other hand, as to which direction the distal end portion 30a of the flexible endoscope 11 is directed is the direction in which the indwelling marker M1 / 3 and the distal end portion 30a of the flexible endoscope 11 approach each other, the endoscope Since the image is perpendicular to the Z axis on the screen, the position of the indwelling marker M1 / 3 projected on the XY plane, that is, the origin of the X, Y, Z space (X1, Y1, 0) It is expressed by a vector W toward
By expressing this on the screen, a user who performs endoscopic examination or treatment such as an operator can easily determine in which direction the distal end of the endoscope should be directed.

For example, if both X1 and Y1 are positive, it is possible to issue an arrow in the upper right direction, and the placement marker M1 / 3 exists in that direction. A display example on the monitor 14 corresponding to this case is shown on the display surface of the monitor 14 in FIG.
Also, for example, if both X1 and Y1 are negative, an arrow can be issued in the diagonally downward left direction, and the indwelling marker M1 / 3 exists in that direction.
Even in this case, it is possible to easily visually approach the distal end portion 30a of the insertion portion 30 to the indwelling marker M / 3 and the like, and the treatment with the flexible endoscope 11 is facilitated.
In FIG. 13, the processor device 13 ′ has the same configuration as the processor device 23 in FIG. 1, and the processor device 23 ′ has the same configuration as the processor device 13 in FIG. 1. In this case, the rigid endoscope 21 is connected to a unit 43 ′ having a built-in drive coil (corresponding to the drive coil unit 37 in FIG. 1).

In FIG. 13, treatment or the like is first performed with the rigid endoscope 21, and in this case, when treatment with the flexible endoscope 11 is easier, treatment is not shown under the observation of the rigid endoscope 11. An indwelling marker M1 / 3 to M3 / 3 is indwelled using grasping forceps or the like, and then the distal end portion 30a is approached by the flexible endoscope 11 toward the indwelling marker M1 / 3 to M3 / 3.
That is, the placement of the placement markers M1 / 3 to M3 / 3 by the flexible endoscope 11 in the first embodiment, and the rigid endoscope 21 to the target region 5 where the placement markers M1 / 3 to M3 / 3 are placed thereafter. This corresponds to a case where the functions of the flexible endoscope 11 and the rigid endoscope 21 are exchanged in the procedure of the approach.
As described above, according to the present embodiment, there are almost the same effects as in the first embodiment.

  Note that the present invention can also be applied to a case where surgery is performed using surgical manipulators 92a and 92b constituting the robot surgery 91 as shown in FIG.

The slave manipulator 92a has a surgical instrument 94 having an insertion portion 93 whose tip is inserted into the body c through the insertion hole b in the abdominal wall 4a of the patient, and linear motion and rotation for supporting the surgical instrument 94. And a robot 95 having a plurality of axes having a degree of freedom.
The distal end portion of the insertion portion 93 includes a three-dimensional (three-dimensional) scope 96 and a pair of treatment tools 97a and 97b.
The distal end portion of the three-dimensional scope 96 and the pair of treatment tools 97a and 97b can be bent with multiple degrees of freedom.
On the other hand, a master manipulator 92b having a multi-joint structure is provided as an operating means, and a head mounted display (abbreviated as HMD) 98 to be worn by the operator 103 and a pair of treatment instruments are provided at the distal end of the master manipulator 92b. Operating arms 99a and 99b are provided.

The slave manipulator 92a and the master manipulator 92b are connected to the control device 100, the position of the tip of the master manipulator 92b corresponds to the position of the slave manipulator 92a, and the position of the rotating part of the HMD 98 is the curvature of the three-dimensional scope 96. The control device 100 controls the operation arms 99a and 99b so as to correspond to the corners and to operate corresponding to the positions of the treatment tools 97a and 97b.
The slave manipulator 92a is provided with an actuator (not shown), an encoder 101 for detecting its rotational position, and a speed reducer (not shown). An encoder 102 is provided at the joint portion of the master manipulator 92b, the rotating portion of the HMD 98, and the joint portions of the operation arms 99a and 99b.
Then, when the operator 103 operates the master manipulator 92b while observing the image displayed on the HMD 98, the slave manipulator 92a operates following this operation, and operates the surgical instrument 94 inserted into the body c. be able to.

In addition, the encoder 102 is attached to the head of the operator 103 on the head of the HMD 98 and the rotation axis of the HMD 98, and when the operator 103 moves the head, the encoder 102 follows the movement of the operator 102 and is fixed to the slave manipulator 92a. The three-dimensional scope 96 thus displayed displays an image of the field of view on the HMD 98, and the operator 103 can perform treatment in a sense of presence that is in the body c. In FIG. 14, reference symbols A1 to A5 indicate portions that can be rotated or moved.
Also in this case, for example, if a sense coil is provided at the tip of the three-dimensional scope 96 and an indwelling marker is placed in the target region in the body c, the three-dimensional position at the tip of the three-dimensional scope 96 If the position of the indwelling marker is displayed on the display surface of the HMD 98 together with the stereoscopic image, the position of the indwelling marker is optically visually recognized as in the above-described embodiment. Even in such a case, the tip of the three-dimensional scope 96 can be easily approached to the position of the indwelling marker.
It should be noted that embodiments configured by partially combining the above-described embodiments and the like also belong to the present invention.

  When treating an affected area in the body, by placing a marker that electromagnetically transmits a signal, the tip of the endoscope can be approached smoothly to the marker using an electromagnetic sensor provided on the endoscope. This makes it easy to perform treatment under endoscopic observation.

[Appendix]
1. In Claim 1, It has a drive element which transmits electromagnetic waves from the said marker.
2. 2. The sensor according to claim 1, wherein the sensor is connected to a position calculating unit that calculates a relative positional relationship with the marker.
3. In Supplementary Note 1, the position calculation unit is connected to a display unit that displays a relative positional relationship between the sensor and the marker.
4). The sensor unit according to claim 1, wherein a sensor unit including the sensor is detachably attached to the endoscope.

5. In Supplementary Note 3, the information storage unit stores information that enables calculation of a relative positional relationship between a position where the sensor unit is attached and the tip portion.
6). An endoscope provided with an objective optical system at the distal end of the elongated insertion portion;
A sensor that is provided in the endoscope and electromagnetically detects a position of a marker that is placed in a target site and capable of transmitting electromagnetic waves;
Signal processing for calculating a relative positional relationship between the marker position and the tip portion based on an output signal of the sensor, calculating a visual field direction of the objective optical system, and displaying the relative positional relationship on a display unit Signal processing means for performing,
An endoscopic apparatus comprising:
7). In Supplementary Note 6, the signal processing means performs signal processing for displaying a relative visual field direction with respect to the position of the marker.
8). In Supplementary Note 6, the signal processing means performs a process of reading information stored in the marker.

1 is an overall configuration diagram of an endoscope system including Example 1 of the present invention. FIG. The block diagram which shows the whole structure of a 1st endoscope apparatus. The block diagram which shows the whole structure of a 2nd endoscope apparatus. The figure which shows the internal structure of a rigid endoscope. The figure which shows the structure of the outline of an indwelling marker. The figure which shows the mode of position detection etc. of a sense coil, an indwelling marker, and a front-end | tip part. The figure which shows the example which sets an indwelling marker according to the shape of an object part. The figure which shows the timing etc. of the drive waveform by a drive coil, the signal waveform transmitted from the source coil of an indwelling marker by the drive. The figure which shows the timing of the signal waveform etc. which change the frequency from the drive coil by a drive coil, and the frequency from the source coil of an indwelling marker by the drive. The flowchart figure which shows the procedure which indwells an indwelling marker by the endoscopy by the flexible endoscope for digestive organs. The flowchart figure which shows the procedure to treat at the time of surgical operation by the rigid endoscope after the indwelling marker placement by the flexible endoscope for digestive organs. The figure which shows the example of a display of the endoscopic image etc. on a monitor. The block diagram which shows the whole structure of the endoscope system provided with Example 2 of this invention. The figure which shows the principal part of the surgery system using a manipulator.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 ... Endoscopy system 2, 3 ... Endoscope apparatus 4 ... Patient 5 ... Target part (target area | region)
DESCRIPTION OF SYMBOLS 11 ... Flexible endoscope 12, 22 ... Light source device 13, 23 ... Processor device 14, 24 ... Monitor 15, 25 ... Keyboard 16 ... Operator 17 ... Microphone set 21 ... Rigid endoscope 30, 40 ... Insert part 30a, 40a ... distal end portion 31, 41 ... handle portion 32, 42 ... universal cable portion 33 ... stomach 35 ... grasping forceps 37 ... drive coil unit 40 ... insertion portion 40a ... distal end portion 43 ... sense coil unit 50 ... drive coil 48 ... drive & Signal processing circuit 59 ... Speech recognition circuit 62 ... Objective lens 69 ... IC memory 88a ... Memory Cx, Cy, Cz ... Sense coil Cd ... Drive coil M1 / 2 to M3 / 3 ... Indwelling marker S ... Visual field direction

Claims (4)

In a medical device having an insertion portion for insertion into a body cavity,
A sensor that is disposed on a proximal end side of the insertion portion in the medical device and electromagnetically detects a position of a marker placed on a target site in the body cavity from a position outside the body cavity;
In the medical device, based on the information on the first positional relationship between the position where the sensor is disposed and the position of the distal end portion of the insertion portion, and the output signal of the sensor, the distal end portion of the insertion portion A second positional relationship detecting means capable of detecting a relative second positional relationship between the position of the marker and the position of the marker;
A medical device comprising:   The medical device according to claim 1, wherein the sensor is detachably disposed on a proximal end side of the insertion portion. Further comprising first positional relationship information storage means for storing information relating to the first positional relationship;
The second positional relationship detecting unit is configured to detect the position of the distal end portion of the insertion unit based on the information related to the first positional relationship stored in the first positional relationship information storage unit and the output signal of the sensor, and The medical device according to claim 1, wherein the second positional relationship relative to the position of the marker can be detected.   The information relating to the first positional relationship includes information relating to a distance or a spatial coordinate position between a position where the sensor is disposed and a position of a distal end portion of the insertion portion. 4. The medical device according to any one of 3.

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