JP2018089114A - Medical support device, medical support method and support device - Google Patents

Abstract

PROBLEM TO BE SOLVED: To curtail contact of surgical equipment to an operation position when the body of a patient moves beyond a preset allowable range.SOLUTION: A medical support device includes: an arm 12 having a joint which is bendable at the joint; a support part 83B structured to support surgical equipment 81 which is a tool to execute a medical activity to a patient or acquire information for the medical activity for the arm; a prediction part structured to predict in advance that an operation position in the body of the patient by the surgical equipment moves beyond a preset allowable range on the basis an electric signal acquired from the body of the patient; and a contact curtailing part structured to curtail any contact between the surgical equipment and the operation position by separating the surgical equipment from the operation position or causing the surgical equipment to follow and move to the operation position when the prediction part predicts the movement.SELECTED DRAWING: Figure 1

Description

  The present invention relates to a medical support device that supports the handling of a surgical instrument that is a tool for performing a medical action on a patient or acquiring information for the medical action. In this specification, the term “patient” is not limited to a person who is actually afflicted, but also includes a subject who is examined whether or not he / she is afflicted.

  Conventionally, as described in Patent Document 1, for example, an operation device such as an endoscope is attached to the distal end of an arm (for example, a so-called multi-joint arm) that has a joint and can be bent by the joint, and performs the surgery. Techniques have been proposed for supporting an industrial device at a desired position.

Japanese Patent No. 5135069

  However, when the surgical position in the patient's body moves beyond a predetermined tolerance due to a patient having a seizure, etc., the surgical instrument that is fixedly supported by the articulated arm contacts the patient's body. There was a case. The treatment position is a position that is a target of medical practice by the surgical instrument or a position that is a target of information acquisition by the surgical instrument in the patient's body.

  The present invention has been made in view of these problems, and provides a technique for suppressing a surgical device from coming into contact with a treatment position when a patient's body moves beyond a preset allowable range. The purpose is that.

  The medical support device of the present invention includes an arm (12), a support unit (83B), a prediction unit (16, S3), and a contact suppression unit (17, S5, S5A). The arm includes a joint and can be bent at the joint. The support unit is configured to support the surgical device (81), which is a tool for performing a medical action on a patient or acquiring information for the medical action, on the arm. The prediction unit is configured to predict in advance that the treatment position (92) by the surgical instrument in the patient's body moves beyond a preset allowable range. When the prediction unit predicts the movement, the contact suppression unit isolates the surgical device from the surgical position or moves the surgical device to follow the surgical position, thereby moving the surgical device and the surgical device. It is comprised so that a contact with the said treatment position may be suppressed. Moreover, the said prediction part is comprised so that the said prediction may be performed based on the electrical signal obtained from the said patient's body.

  According to such a configuration, when the prediction unit predicts in advance based on an electrical signal obtained from the patient's body that the patient's treatment position moves beyond a preset allowable range, contact suppression is performed. The unit isolates or moves the surgical instrument from the treatment position. For this reason, when a patient's body moves exceeding the preset tolerance, it is possible to suppress the surgical device from coming into contact with the treatment position.

  In addition, since the prediction unit predicts the movement of the treatment position based on the electrical signal, the prediction can be performed well before the treatment position actually moves. For this reason, it can suppress more satisfactorily that a surgical instrument contacts a treatment position.

  Further, in the present invention, regardless of whether or not the prediction unit performs the prediction based on the electrical signal, the support unit and the contact suppression unit (17, S5) are configured as follows instead. May be. The support unit is configured to support the surgical device so as to be movable from a proximity position where the medical practice or information acquisition is performed to an isolation position isolated from the treatment position rather than the proximity position. . The contact suppression unit is configured to control contact between the surgical instrument and the treatment position by controlling the support unit and moving the surgical instrument from the proximity position to the isolation position. Yes.

  Also in this case, when the prediction unit predicts in advance based on the electrical signal obtained from the patient's body that the patient's treatment position moves beyond a preset allowable range, the contact suppression unit The equipment is isolated from the treatment position. For this reason, when a patient's body moves exceeding the preset tolerance, it is possible to suppress the surgical device from coming into contact with the treatment position. In addition, since the contact suppression unit controls the support unit to move the surgical instrument from the proximity position to the isolation position, the contact between the surgical instrument and the surgical position is suppressed. It is possible to more favorably suppress contact with.

  In the present invention, whether the prediction unit performs the prediction based on the electrical signal, or whether the support unit and the contact suppression unit move the surgical instrument from the proximity position to the isolation position. Regardless, instead, the arm and the contact suppression portion (17, S5A) may be configured as follows. The arm includes a brake (31A, 32A, 33A) that suppresses bending at the joint. The contact suppression unit is configured to control the brake to allow the bending, thereby moving the surgical device to follow the treatment position and suppressing contact between the surgical device and the treatment position. Has been.

  In this case, for example, the contact suppression unit controls a brake provided in advance in the medical support device, thereby moving the surgical device to follow the surgical position and suppressing the surgical device from contacting the surgical position. You may be able to. Therefore, there are cases where the configuration of the apparatus can be further simplified and the manufacturing cost of the apparatus can be further reduced.

  Further, in the medical support method of the present invention, a surgical instrument (a tool for performing a medical action on a patient or acquiring information for the medical action on an arm (12) provided with a joint and bendable by the joint) 81). Further, it is predicted in advance that the operation position (92) by the surgical instrument in the patient's body moves beyond a preset allowable range. And when the said movement is estimated by the said prediction, the contact with the said surgical equipment and the said treatment position is suppressed by moving the said surgical equipment in the direction isolated from the said treatment position.

  In this case, similarly to the medical support device in which the support unit and the contact suppression unit limit the movement of the surgical device from the proximity position to the isolation position, the surgical device is well suppressed from contacting the surgical position. can do.

  In addition, the support device of the present invention is a surgical instrument (81) that is a tool for performing a medical action on a patient or acquiring information for the medical action on an arm (12) that has a joint and can be bent by the joint. ), And includes a support portion (83B) and actuators (83D, 83F). The support unit is configured to support the surgical device so as to be movable from a proximity position where the medical practice or information acquisition is performed to an isolation position isolated from the treatment position rather than the proximity position. The actuator is configured to move the surgical instrument supported by the support portion from the proximity position to the isolation position within one second.

  The support device configured as described above is a machine that can be directly used for carrying out the medical support method. That is, if the surgical device is supported by the support portion, the surgical device and the treatment position are moved by moving the surgical device supported by the support portion from the proximity position to the isolation position within 1 second. Contact can be suppressed satisfactorily.

  In addition, “within 1 second” in this column indicates a certain standard that the degree is desirable, and is not a numerical value having maritime significance. Further, the reference numerals in parentheses described in this column and in the claims indicate the correspondence with the specific means described in the embodiment described later as one aspect, and the technical scope of the present invention. It is not limited.

It is a perspective view showing the appearance of the medical assistance device of a 1st embodiment. It is explanatory drawing showing the structure of the arm and control system in the medical assistance apparatus. It is explanatory drawing showing the internal structure of the support apparatus in the medical assistance apparatus. It is explanatory drawing showing operation | movement of the support apparatus. It is explanatory drawing showing the continuation of the operation | movement. It is a flowchart of the evacuation process in the said medical assistance apparatus. It is a flowchart of the evacuation process in the medical assistance apparatus of 2nd Embodiment.

Hereinafter, embodiments for carrying out the invention will be described with reference to the drawings.
[1. First Embodiment]
[1-1. Overall system configuration]
The support tracking system 1 shown in FIG. 1 includes a support tracking device 4 and a connection mechanism 9.

  The support follow-up device 4 is a device that supports the surgical instrument unit 80 as shown in FIG. 1 or supports the arm of a doctor who performs a medical practice. The support follow-up device 4 includes a placement unit 10, an arm 12, and a control device 14.

  A medical practice is an action performed based on medicine for the treatment, diagnosis, or prevention of a patient's injury or illness. Medical practice includes surgery and endoscopic surgery. Moreover, a doctor is a person who performs medical practice, for example, a surgeon.

  The surgical instrument unit 80 is a unit including a surgical instrument 81 and a support device 83 that supports the surgical instrument 81, as will be described in detail later. The surgical device 81 is a tool (that is, a device) that performs a medical action on a patient or information acquisition for the medical action. The surgical device 81 can include various devices such as an endoscope, an electric knife, forceps, and an inspection electrode. However, in the following description, the case where the surgical device 81 is an endoscope will be mainly described. To do.

The connection mechanism 9 is a mechanism that fixes the mounting portion 83 </ b> C of the support device 83 while being placed on the placement portion 10. The connection mechanism 9 has a known structure such as a connecting wire or a hook.
[1-2. Configuration of support follower]
Details of the structure of the support follower 4 will be described.

  The mounting unit 10 is a table on which a doctor's arm or the mounting unit 83C of the support device 83 is mounted. The mounting portion 10 is configured in a shape (for example, a U-shaped cross section) that is open upward. As a specific example of a doctor's arm, a forearm can be considered.

  As shown in FIG. 2, the arm 12 is a multi-joint multi-joint arm. The arm 12 includes a plurality of joints 31, 32, 33, 34, 35, a base portion 41, a shoulder portion 42, a first arm portion 43, a second arm portion 44, springs 46 and 47, and a counterweight. 48 and a force sensor 50 are provided.

  The base portion 41 is disposed on the floor F and supports the entire arm 12. As shown in FIG. 1, the base portion 41 has casters 41 </ b> A and is configured to be easily movable on the floor F. The shoulder 42, the first arm 43, and the second arm 44 are links that constitute a link mechanism. The joints 31, 32, 33, 34, and 35 are rotary joints that rotate about the rotation axis.

  A shoulder portion 42 is connected to the upper end of the base portion 41 via a joint 31 so as to be rotatable around a vertical axis. One end of a first arm portion 43 is connected to the upper end of the shoulder portion 42 via a joint 32 so as to be rotatable about a horizontal axis. One end of the second arm portion 44 is connected to the other end of the first arm portion 43 via a joint 33 so as to be rotatable around a horizontal axis. The mounting portion 10 is connected to the other end of the second arm portion 44 through a joint 34 that can rotate around a horizontal axis and a joint 35 that has a rotation axis orthogonal to the joint 34.

  Springs 46 and 47 are provided between the first arm portion 43 and the second arm portion 44 and the joint 33, respectively. Further, the first arm portion 43 extends through the joint 32, and a counterweight 48 is provided at a tip portion thereof. The springs 46 and 47 and the counterweight 48 apply a biasing force upward in the vertical direction to the placement unit 10, and when the doctor's arm is placed on the placement unit 10, it is applied to the placement unit 10 and the arm 12. Balance power.

  That is, the urging force applied from the springs 46 and 47 and the counterweight 48 is balanced with the sum of the weight of the arm 12, the weight of the placement portion 10, and the weight of the arm, thereby supporting the placement portion 10. Here, it is ideal that the downward force and upward urging force due to its own weight are perfectly balanced, but considering that the doctor's hand works from above the affected area of the patient, It is set to urge the mounting part 10 with a very weak force upward. Note that the springs 46 and 47 may be omitted when a balance can be obtained only with the counterweight 48. Further, instead of the springs 46 and 47, another counterweight may be used.

  Each joint 31, 32, 33 is provided with a brake 31A, 32A, 33A that restricts the operation of the joint 31, 32, 33. The movements of the joints 31, 32, and 33 are rotational movements about the axis. Further, the term “restriction” refers to applying a braking force against rotational motion, and includes locking the rotation of each joint 31, 32, 33. In the present embodiment, electromagnetic brakes are used as the brakes 31A, 32A, 33A.

  Thereby, the wait mode, the lock mode, and the free mode are realized as the operation modes of the support follow-up device 4. The wait mode is an operation mode in which the movement of the placement unit 10 is restricted in a state where the object is not placed on the placement unit 10. The lock mode is an operation mode that restricts movement of the placement unit 10 in a state where an object is placed on the placement unit 10. The free mode is an operation mode in which the restriction on movement of the placement unit 10 is released.

  The wait mode is an operation mode that assumes a state where the doctor does not place an arm on the placement unit 10. In the weight mode, the joints 31, 32, and 33 are fixed by the brakes 31A, 32A, and 33A, the movement of the placement unit 10 is prohibited, and the position is fixed.

  The lock mode is an operation mode that assumes a state in which a doctor places his / her arm on the fixed placement unit 10. In the lock mode, the joints 31, 32, and 33 are fixed by the brakes 31A, 32A, and 33A, the movement of the placement unit 10 is prohibited, and the position is fixed. However, since the joints 34 and 35 have no brake, the angle of the placement unit 10 can be adjusted freely.

  The free mode is an operation mode that assumes a state in which the doctor moves the placement unit 10 following the arm. In the free mode, the joints 31, 32, and 33 are released from being fixed by the brakes 31A, 32A, and 33A, and the placement unit 10 can be moved freely. In the free mode, the force applied to the arm from the placement unit 10 is extremely small, and the sliding resistance of the brakes 31A, 32A, 33A is also small. Therefore, the doctor places the placement unit 10 on the arm without applying much force to the arm. It can be moved following.

  Furthermore, encoders 31B, 32B, and 33B that detect the rotation angles of the joints 31, 32, and 33 are provided in the joints 31, 32, and 33, respectively. A force sensor 50 is provided at the joint 35 that connects the placement unit 10 and the arm 12. The force sensor 50 detects the weight and torque applied to the placement unit 10.

  The control device 14 is mainly configured by a known microcomputer having a CPU and a semiconductor memory (hereinafter referred to as a memory) such as a RAM, a ROM, and a flash memory. Various functions of the control device 14 are realized by the CPU executing a program stored in a non-transitional physical recording medium. In this example, the memory corresponds to a non-transitional tangible recording medium that stores a program. Further, by executing this program, a method corresponding to the program is executed. The number of microcomputers constituting the control device 14 may be one or plural.

[1-3. Configuration of control device]
As shown in FIG. 2, the control device 14 includes a mode switching unit 15, a prediction unit 16, a contact suppression unit 17, a prohibition unit 18, and a function configuration realized by the CPU executing the program. An endoscope processing unit 19. The method of realizing these elements constituting the control device 14 is not limited to software, and some or all of the elements may be realized using hardware that combines a logic circuit, an analog circuit, and the like.

  The mode switching unit 15 executes processing for switching the operation mode to any one of the wait mode, the free mode, and the lock mode by controlling the brakes 31A, 32A, and 33A. That is, the mode switching unit 15 switches the operation mode to any one of the wait mode, the free mode, and the lock mode by controlling the brakes 31A, 32A, and 33A. Such a process is well known from the applicants' previous published applications and will not be described in detail here.

  The prediction unit 16 determines whether or not the body of the patient into which the surgical instrument 81 is inserted moves due to the patient's seizure or the like in the biological signal input from the seizure measurement sensor 61 connected to the control device 14. Predict based on. For example, when the seizure measurement sensor 61 is a camera that captures the movement of a part (for example, an affected part) in which the surgical instrument 81 is inserted, or the movement of a part linked to the movement of the part, the prediction unit 16 The prediction may be performed by inputting the speed of movement as a biological signal.

  In addition, when the seizure measurement sensor 61 detects an electrical signal corresponding to an action potential when the muscle of the part into which the surgical instrument 81 is inserted or the muscle linked to the movement of the part contracts, the prediction is performed. The unit 16 may perform the prediction by inputting the electrical signal as a biological signal. For example, when an electrical signal is obtained that suggests that the muscle moves beyond a general range, it may be predicted that the region will move due to a seizure or the like.

  When the seizure measuring sensor 61 is an electroencephalograph, the predicting unit 16 receives the electroencephalogram as a biological signal, so that the prediction is based on whether the electroencephalogram is a waveform specific to epileptic seizures or the like. May be performed. Further, when the seizure measurement sensor 61 is an electrocardiogram measuring device or the like, whether or not a heart or nervous system seizure occurs when the predicting unit 16 receives the waveform or heart rate of the electrocardiogram as a biological signal. Such prediction may be performed. When the seizure measurement sensor 61 is a sensor that applies an electrical stimulus to the nervous system and detects the response signal, the prediction unit 16 receives the response signal as a biological signal, so that the response signal is the nervous system. The prediction may be made based on whether or not it suggests seizures.

  The seizure measurement sensor 61 may be a sheet sensor placed under the patient, may be a sensor that measures a patient's movement in a non-contact manner using a laser, and is another sensor. May be. Furthermore, the seizure measurement sensor 61 is not limited to seizures, and may detect other unexpected body movements, such as an unexpected movement of a patient in a partial anesthesia operation.

  When the predicting unit 16 predicts that the body of the patient into which the surgical device 81 is inserted moves due to the patient's seizure or the like, the contact suppressing unit 17 drives the mechanism described later to drive the surgical device 81. Evacuate from patient's body.

  The prohibition unit 18 prohibits the operation of the contact suppression unit 17 according to conditions, thereby suppressing the surgical device 81 from being retracted due to a malfunction of the contact suppression unit 17 due to noise, or retracting the surgical device 81. The operation of the contact suppressing unit 17 is prohibited when it is not necessary to do so.

  The endoscope processing unit 19, when the surgical instrument 81 is an endoscope, displays a captured image by the endoscope on a monitor 63 connected to the control device 14. Execute.

[1-4. Configuration of surgical equipment unit]
As shown in FIG. 3, the surgical instrument unit 80 includes a long surgical instrument 81 and a support device 83 that supports it. The surgical instrument 81 is configured such that the proximal end portion 81A has a larger diameter than the distal end portion 81B inserted into the patient's body. The support device 83 includes a support portion 83B having a hollow portion 83A. The support portion 83B is configured in a cylinder shape in which the base end portion 81A of the surgical instrument 81 is slidably inserted into the hollow portion 83A.

  A mounting portion 83C projects from the outer peripheral surface of the support portion 83B in a direction perpendicular to the axial direction of the hollow portion 83A (that is, the sliding direction of the base end portion 81A). The mounting portion 83C is fixed on the placement portion 10 by the connection mechanism 9 as described above.

  A solenoid 83E for projecting or retracting the stopper 83D toward the radial center is provided inside the hollow portion 83A on the outer peripheral surface of the support device 83. The solenoid 83E may be configured to project the stopper 83D when energized and retract the stopper 83D when deenergized, or retract the stopper 83D when energized and project the stopper 83D when deenergized. Good. Further, the solenoid 83E may be configured to project or retract the stopper 83D according to the energization direction.

  A spring 83F is inserted into the hollow portion 83A. The spring 83F is configured as a so-called tension coil spring, and is attached between the base end portion 81A and the bottom surface 83G so as to pull the base end portion 81A of the surgical instrument 81 toward the bottom surface 83G of the hollow portion 83A. .

  When the surgical instrument 81 is used, the surgical instrument 81 is pulled out in a direction protruding from the hollow portion 83A against the urging force of the spring 83F. When the stopper 83D protrudes toward the radial center of the hollow portion 83A in a state where the proximal end portion 81A is pulled out from the stopper 83D in the distal direction, the proximal end portion 81A is stopped as shown in FIG. Engage with 83D. Accordingly, the surgical instrument 81 is maintained in a state of protruding from the support device 83 against the urging force of the spring 83F.

  In this way, the surgical instrument 81 maintained in a position protruding from the support device 83 passes through the narrowed portion 91 in the human body 90 such as a patient, as shown in FIG. 92 can be approached. In other words, the surgical device 81 is arranged at a position close to the affected part 92. For example, when the surgical instrument 81 is an endoscope, a camera provided at the distal end portion 81B can be brought close to the affected area 92 and the affected area 92 can be photographed in detail.

  In this state, when the solenoid 83E is driven and the stopper 83D is retracted from the center in the radial direction of the hollow portion 83A, the engagement between the stopper 83D and the base end portion 81A is released. Then, as indicated by an arrow A in FIG. 5, the surgical instrument 81 rapidly moves in the direction of the support device 83 due to the urging force of the spring 83 </ b> F and moves to a position retracted from the narrowed portion 91 (that is, an isolation position). Here, the rapid movement means a speed at which the movement from the proximity position to the isolation position is completed within at least one second. Therefore, in the present embodiment, contact between the human body 90 and the surgical instrument 81 is suppressed by the following processing.

[1-5. processing]
Next, the saving process executed by the control device 14 will be described with reference to the flowchart of FIG. In this process, first, whether or not the endoscope as the surgical instrument 81 is in use is determined by S1 as a process by the prohibition unit 18. If the endoscope is not used and it is determined No in S1, the process waits in S1 as it is. In addition, when it is determined No in S <b> 1, even when the surgical instrument 81 attached to the support device 83 is an endoscope and is not in use, an electric knife is used as the surgical instrument 81 in the support device 83. Etc. are also included. In the latter case, a case in which noise generated by an electric knife or the like is superimposed on a biological signal and an error occurs in the prediction result by the prediction unit 16 can be excluded from the processing target.

  On the other hand, if it is determined in S1 that the endoscope is being used (that is, Yes), the process proceeds to S2. In S <b> 2, a biological signal input from the seizure measurement sensor 61 connected to the control device 14 is input.

  Subsequently, the process proceeds to S3 as a process by the prediction unit 16, and it is determined whether or not the biological signal input in S2 exceeds the seizure determination threshold. Even if the seizure measurement sensor 61 acquires any of the above-described biological signals, whether or not the patient's body moves due to the seizure or the like of the patient is determined by quantifying the biological signal and using a threshold value ( That is, it is made by comparing with the seizure determination threshold). If it is determined in S3 that the biological signal does not exceed the seizure determination threshold (ie, No), the patient's body is considered not to move due to the patient's seizure, and the processing is as described above. The process proceeds to S1.

  On the other hand, if it is determined in S3 that the biological signal exceeds the seizure determination threshold (that is, Yes), the process proceeds to S4 as processing by the prohibition unit 18, and noise is superimposed on the biological signal. It is determined whether or not there is a possibility. If there is a possibility that noise is superimposed, it is determined Yes in S4, and the process proceeds to S1 described above. If it is determined in S4 that there is no possibility that noise is superimposed (ie, No), the process proceeds to S5, and after the endoscope retract command is output, the process is temporarily terminated.

  S5 is processing as the contact suppression unit 17, and when the endoscope retract command is output in this way, the solenoid 83E is driven and the stopper 83D is retracted from the hollow portion 83A. Then, the surgical instrument 81 (that is, the endoscope) moves rapidly in the direction of the support device 83. For example, in the example of FIG. 5, the surgical instrument 81 moves from the narrow portion 91 to a position retracted.

[1-6. effect]
According to the first embodiment described in detail above, the following effects can be obtained.
(1A) When it is predicted in advance that the biological signal exceeds the seizure determination threshold value and thereby the surgical operation position of the patient or the like moves beyond a preset allowable range, an endoscope retraction command is output. The As a result, the surgical instrument 81 moves rapidly toward the support device 83. For this reason, in this embodiment, it can suppress satisfactorily that the operation equipment 81 (namely, endoscope) contacts the treatment positions such as the affected part 92 and the narrow part 91.

  (1B) When the seizure measurement sensor 61 obtains an electrical signal obtained from the patient's body, such as an electrical signal corresponding to an action potential when the muscle contracts, and the prediction is made based on the electrical signal, The prediction can be performed well before the treatment position moves. For this reason, it can suppress more favorably that the surgical instrument 81 contacts a treatment position.

  (1C) The surgical instrument 81 is formed in a long shape as shown in FIG. 3, and the direction from the proximity position to the isolation position is the long direction of the surgical instrument 81 supported by the support device 83. Match. For this reason, it is possible to satisfactorily suppress the surgical device 81 coming into contact with the treatment position such as the narrow portion 91 while moving from the proximity position to the isolation position.

  (1D) In addition, the surgical instrument 81 moves (that is, retracts) from the proximity position set in advance to the support device 83 to the isolation position, and the retraction is completed within one second. For this reason, in this embodiment, it can suppress more favorably that the operation equipment 81 contacts a treatment position.

  (1E) In the above embodiment, when noise is easily superimposed on a biological signal due to the use of an electric knife, when the endoscope is not being used, or when there is a possibility that noise is superimposed on the biological signal, The endoscope retract command is not output. For this reason, it is suppressed that the surgical instrument 81 is retracted due to a malfunction of the contact suppressor 17 due to noise, or the operation of the contact suppressor 17 is prohibited when there is no need to retract the surgical instrument 81. be able to.

[1-7. Correspondence with Claimed Elements]
In the embodiment, the support follow-up system 1 and the support device 83 correspond to a medical support device, and the narrow portion 91 and the affected portion 92 correspond to a treatment position. Of the evacuation processing, S3 corresponds to the prediction unit, S5 corresponds to the contact suppression unit, and S1 and S4 correspond to the prohibition unit.

[2. Second Embodiment]
[2-1. Difference from the first embodiment]
Since the basic configuration of the second embodiment is the same as that of the first embodiment, the description of the common configuration will be omitted, and the description will focus on the differences. Note that the same reference numerals as those in the first embodiment indicate the same configuration, and the preceding description is referred to.

  In the first embodiment described above, when the biological signal exceeds the seizure determination threshold value and there is no possibility that noise is superimposed on the biological signal, an endoscope withdrawal command is output. In contrast, the second embodiment is different from the first embodiment in that the following joint fixation release command is output.

  That is, the medical support apparatus of this embodiment is similar in mechanical configuration to that of the first embodiment, and is different in that S5 of the evacuation process by the control apparatus 14 is changed to S5A shown in FIG. In the present embodiment, the support device 83 does not necessarily support the surgical instrument 81 so as to be able to protrude / retract. For example, the surgical instrument 81 may be directly fixed to the placement unit 10.

  As shown in FIG. 7, in this embodiment, it is determined in S3 that the biological signal has exceeded the seizure determination threshold (that is, Yes), and there is no possibility that noise is superimposed on the biological signal ( That is, if it is determined in S4 described above, the process proceeds to S5A. In S <b> 5 </ b> A, a command for controlling the brakes 31 </ b> A to 33 </ b> A in the arm 12 and releasing the fixation of the joints 31 to 33 is output. Then, even if the narrow part 91 and the affected part 92 are moved, the surgical instrument 81 moves to follow them, and the surgical instrument 81 is prevented from strongly contacting the narrow part 91 and the affected part 92. it can.

[2-2. effect]
According to the second embodiment described in detail above, in addition to the effects (1B) and (1E) of the first embodiment described above, the following effects can be obtained.

  (2A) When the biological signal exceeds the seizure determination threshold value, and it is predicted in advance that the operation position of the patient or the like moves beyond a preset allowable range, a joint fixation release command is output. . As a result, the surgical instrument 81 can move freely, and even if the narrowed part 91 and the affected part 92 move, the surgical instrument 81 moves following them. For this reason, in this embodiment, it can suppress satisfactorily that the operation equipment 81 contacts the treatment positions such as the affected part 92 and the narrow part 91.

  (2B) Further, as described above, when the arm 12 is set to urge the mounting portion 10 with a very weak force upward in the safe direction, the joints 31 to 33 are released from being fixed. In some cases, the surgical instrument 81 can be isolated from the treatment position. In that case, the surgical device 81 can be more effectively prevented from coming into contact with the treatment position.

[3. Other Embodiments]
As mentioned above, although the form for implementing this invention was demonstrated, this invention is not limited to the above-mentioned embodiment, It can implement in various deformation | transformation.

  (3A) In each of the above embodiments, when the patient's body moves due to a seizure or the like, the surgical instrument 81 can be retracted or followed, but the present invention is not limited to this. For example, when the patient's body moves due to the patient's backing (that is, coughing), an earthquake, or the like, the same processing as S5 or S5A may be executed. In this case, the former backing can be predicted based on an electrical signal obtained from the patient's body when an image obtained by photographing the treatment position or the like changes unintentionally. The latter earthquake can be predicted when an image obtained by imaging the treatment position or the like changes unintentionally or based on an earthquake forecast such as an emergency earthquake warning.

  (3B) In the first embodiment, the support device 83 retracts the surgical instrument 81 using the biasing force of the spring 83F configured as a tension coil spring, but is not limited thereto. Various actuators such as a compression coil spring, an electromagnetic actuator, and a small motor can be used for retracting the surgical instrument 81. Further, the surgical instrument 81 may be retracted by moving or deforming the arm 12 with a small motor or the like.

  (3C) In the first embodiment, the surgical instrument 81 is retracted when the patient's body moves due to a seizure or the like, but the present invention is not limited to this. For example, the support device to which the present invention is applied includes a device that retracts the surgical instrument 81 when a doctor performs a switch operation or the like.

  (3D) In the first embodiment, the support device 83 retracts the surgical instrument 81 linearly along the longitudinal direction of the surgical instrument 81, but is not limited thereto. For example, when the surgical instrument is curved in an arc shape, it may be retracted in a direction along the arc. That is, the surgical instrument may be retracted along the shape of the narrow portion. Further, the surgical instrument 81 may be retracted while drawing an arc toward the direction in which the narrow part 91 is largely opened on the body surface, and the direction is independent of the shape of the narrow part 91 and the shape of the surgical instrument 81. May be evacuated.

  (3E) In the second embodiment, the surgical instrument 81 is moved following the treatment position by allowing the arm 12 to be bent, but the present invention is not limited to this. For example, the surgical instrument 81 may be moved to follow the surgical position by changing the connection state of the surgical instrument 81 to the placement unit 10 so that the surgical instrument 81 can be freely displaced as if connected by a single thread. .

  (3F) In each of the above embodiments, when the endoscope is not in use or when there is a possibility that noise is superimposed on the biological signal, the endoscope retract command or the joint fixation release command is not output. It is not limited. Such noise countermeasures do not necessarily need to be implemented, and whether or not to output an endoscope retraction command or a joint fixation release command (that is, the process of S5 or S5A) is switched according to a switch operation by a doctor. May be. Further, whether or not to output an endoscope retraction command or a joint fixation release command (that is, the process of S5 or S5A) may be switched according to other conditions.

  (3G) In each of the above embodiments, the surgical device 81 is inserted into the narrow portion 91 of the human body 90. However, the surgical device 81 is a tool that performs medical practice or information acquisition in the vicinity of the body surface. It may be. In that case, when the patient's body moves, the surgical instrument 81 is isolated from the body surface or moves following the body surface.

  (3H) A plurality of functions of one constituent element in the embodiment may be realized by a plurality of constituent elements, or a single function of one constituent element may be realized by a plurality of constituent elements. . Further, a plurality of functions possessed by a plurality of constituent elements may be realized by one constituent element, or one function realized by a plurality of constituent elements may be realized by one constituent element. Moreover, you may abbreviate | omit a part of structure of the said embodiment. In addition, at least a part of the configuration of the embodiment may be added to or replaced with the configuration of the other embodiment. In addition, all the aspects included in the technical idea specified only by the wording described in the claim are embodiment of this invention.

  (3I) In addition to the medical support device described above, a system including the medical support device as a constituent element, a program for causing a computer to function as the medical support device, and a non-transitional actual recording such as a semiconductor memory storing the program The present invention can also be realized in various forms such as a medium and a medical support method.

DESCRIPTION OF SYMBOLS 1 ... Support tracking system 4 ... Support tracking apparatus 12 ... Arm 14 ... Control apparatus 16 ... Prediction part 17 ... Contact suppression part 18 ... Prohibition part 31, 32, 33, 34, 35 ... Joint 31A, 32A, 33A ... Brake 61 ... Seizure measurement sensor 80 ... surgical instrument unit 81 ... surgical instrument 83 ... support device 83A ... hollow part 83B ... support part 83D ... stopper 83E ... solenoid 83F ... spring 91 ... narrow part 92 ... affected part

Claims (10)

An arm (12) provided with a joint (31, 32, 33, 34, 35) and bendable at the joint;
A support unit (83B) configured to support a surgical instrument (81), which is a tool for performing a medical action on a patient or information acquisition for the medical action, on the arm;
A prediction unit (16, S3) configured to predict in advance that the surgical position (91, 92) by the surgical device in the patient's body moves beyond a preset allowable range;
When the predicting unit predicts the movement, the surgical instrument is separated from the surgical position or the surgical instrument is moved to follow the surgical position to thereby move the surgical instrument and the surgical position. A contact suppression portion (17, S5, S5A) configured to suppress contact;
With
The said prediction part is a medical assistance apparatus comprised so that the said prediction might be performed based on the electrical signal obtained from the said patient's body. The medical support device according to claim 1,
The medical support device, wherein the electrical signal is an electrical signal corresponding to an action potential when the muscle of the patient contracts. An arm (12) provided with a joint (31, 32, 33, 34, 35) and bendable at the joint;
A support unit (83B) configured to support a surgical instrument (81), which is a tool for performing a medical action on a patient or information acquisition for the medical action, on the arm;
A prediction unit (16, S3) configured to predict in advance that the surgical position (91, 92) by the surgical device in the patient's body moves beyond a preset allowable range;
When the prediction unit predicts the movement, the contact suppressing unit (17 configured to suppress contact between the surgical device and the surgical position by isolating the surgical device from the surgical position. , S5),
With
The support unit is configured to support the surgical device so as to be movable from a proximity position where the medical practice or information acquisition is performed to an isolation position isolated from the treatment position rather than the proximity position.
The contact suppression unit is configured to suppress contact between the surgical instrument and the treatment position by controlling the support unit and moving the surgical instrument from the proximity position to the isolation position. Medical support device. The medical support device according to claim 3,
The surgical support device is configured in a long shape, and a direction from the proximity position toward the isolation position matches a long direction of the surgical device supported by the support portion. The medical support device according to claim 3 or 4,
The support unit is a medical support device configured to move the surgical instrument from the proximity position to the isolation position within one second when the control by the contact suppression unit is performed. An arm (12) provided with a joint (31, 32, 33, 34, 35) and bendable at the joint;
A support unit (83B) configured to support a surgical instrument (81), which is a tool for performing a medical action on a patient or information acquisition for the medical action, on the arm;
A prediction unit (16, S3) configured to predict in advance that the surgical position (91, 92) by the surgical device in the patient's body moves beyond a preset allowable range;
When the prediction unit predicts the movement, a contact suppression unit configured to suppress contact between the surgical device and the surgical position by moving the surgical device to follow the surgical position ( 17, S5A)
With
The arm includes a brake (31A, 32A, 33A) that suppresses bending in the joint,
The said contact suppression part is a medical assistance apparatus comprised so that contact with the said surgical equipment and the said treatment position may be suppressed by controlling the said brake and permitting the said bending. The medical support device according to any one of claims 1 to 6,
Regardless of the prediction result by the prediction unit, a prohibition unit (18, S1, S4) that prohibits the surgical device from being moved by the contact suppression unit,
A medical support apparatus further provided. Surgical equipment which is a tool for performing medical action on a patient or acquiring information for the medical action on an arm (12) which has a joint (31, 32, 33, 34, 35) and can be bent by the joint. (81)
Predicting that the surgical position (91, 92) by the surgical device in the patient's body moves beyond a preset tolerance,
A medical support method that suppresses contact between the surgical instrument and the surgical position by moving the surgical instrument in a direction to isolate the surgical instrument from the surgical position when the movement is predicted by the prediction. Surgical equipment which is a tool for performing medical action on a patient or acquiring information for the medical action on an arm (12) which has a joint (31, 32, 33, 34, 35) and can be bent by the joint. A support device for supporting (81),
A support portion (83B) configured to support the surgical device so as to be movable from a proximity position where the medical practice or information acquisition is performed to an isolation position isolated from the treatment position rather than the proximity position; ,
An actuator (83D, 83F) configured to move the surgical instrument supported by the support portion from the proximity position to the isolation position within 1 second;
A support device comprising: The support device according to claim 9,
The surgical device is configured in a long shape, and a direction from the proximity position toward the isolation position matches a long direction of the surgical device supported by the support portion.

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