JPH10108824A - Lighting system for operation - Google Patents

Abstract

PROBLEM TO BE SOLVED: To illuminate the inside of a patient body so that an image for imaging an operation position in the patient body is light and has high picture quality as a whole to surely grap the state of the operation position. SOLUTION: This lighting system for operation has optical fibers 31-34 disposed sequentially longitudinally in a rod-like hanging-up means 1 for lifting the abdomen of a patient M. The hanging-up means 1 during light projecting assumes an aspect of a linear illuminant and illuminates uniformly a wide range in the patient's body in a direction different from the photographing direction, so that a proper image is easily obtained by an endoscope without a troublesome adjusting operation or the like.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a surgical instrument used for illuminating a surgical site in a patient when performing a surgical operation inside the body while observing the body cavity of the patient with an endoscope without cutting. BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a lighting device, and particularly to a technique for appropriately illuminating a surgical site in a body.

[0002]

2. Description of the Related Art In recent years, in a surgical operation for removing an affected part in a body cavity, for example, a surgical operation for removing a gallbladder or a lung tumor, a body is not cut with a scalpel and then cut. In many cases, trocars with forceps or endoscopes are inserted into the body through several holes, and the affected part is resected without incising the patient's body while observing the surgical site with the endoscope. Are coming.

[0003] For example, when performing an abdominal operation without an incision under an endoscope, as shown in FIG. 11, a high-pressure carbon dioxide gas is fed into an abdominal cavity Ma of a patient M, or a rod-shaped lifting device is used. (Not shown), the abdominal wall Mb is lifted up to expand the abdominal cavity Ma, and the abdominal cavity M is extended by the endoscope F fitted into the trocar Ta inserted from the abdominal wall Mb.
While observing the inside of a, necessary operations such as excision of the affected part are performed by operating the forceps Ka and Kb fitted in the trocars Tb and Tc. More specifically, the endoscope F has a CCD
An imaging camera Ca using a (charge transfer element) and an optical fiber fa for projecting illumination light for illuminating the inside of a body cavity are provided. Then, light from the light source LA placed outside the body is transmitted to the distal end of the optical fiber (light emitting means) of the endoscope F via the relay optical fiber fb, and is emitted therefrom as illumination light to the surgical site. In this way, the surgical site illuminated by the illumination light is photographed by the imaging camera Ca and displayed on the screen of the television monitor TV. Therefore, the practitioner (doctor) can smoothly perform the operation while watching the image of the operation site displayed on the screen of the television monitor TV. As described above, a surgical operation performed only by making a small hole in the body of the patient M and without incising the body of the patient M has a small burden on the patient M, and thus has an increased chance of being applied. It is in the current situation.

[0004]

However, in the case of the conventional non-incision surgical operation, the image of the surgical site in the patient's body displayed on the screen of the television monitor TV has a strong tendency to darken the peripheral portion, and the surgeon does not perform the operation. However, there is a problem that it is difficult to accurately grasp the situation of the operation site.

[0005] With the illumination light emitted from the tip of the thin endoscope F,
A wide area in the body corresponding to the entire screen of the TV monitor TV is not covered, and only a narrow area corresponding to the center area of the momentum screen is illuminated brightly, and the peripheral portion where the illumination light does not sufficiently spread becomes inevitably dark. . if,
If you make the periphery also bright, this time the center will be too bright and halation will occur,
The center is hard to observe.

A light control means for equalizing the light quantity distribution of the illumination light by an aperture mechanism or the like, or an image processing means for processing a video signal obtained by a video camera is provided, so that the overall brightness is suppressed while suppressing halation. It is not unthinkable that there are ways to improve the video. However, in the case of the former improvement method using the dimming means, since the operation of adjusting the aperture mechanism so that the light amount distribution of the illumination light becomes uniform over a wide range is very complicated, the problem cannot be solved correctly. In the case of the latter improvement method by image processing,
Since the S / N ratio of an image signal in a peripheral portion having a small amount of light is originally low, even if the brightness is increased by forcibly increasing the amplification degree,
The problem is not solved correctly because the video quality is low.

In addition, in the conventional case, the projection direction of the illuminating light for illuminating the surgical site in the patient and the imaging direction of the imaging camera coincide with each other so as to be completely the same.
The image of the surgical site displayed on the screen of the television monitor TV has a poor three-dimensional effect because the shadow is weak.

The present invention has been made in view of the above circumstances, and an image showing a surgical site in a patient is bright and high-quality overall, and the state of the surgical site can be accurately grasped. An object of the present invention is to provide a surgical lighting device that can perform lighting and has no difficulty in implementation.

[0009]

According to a first aspect of the present invention, there is provided a surgical lighting apparatus according to the first aspect of the present invention, wherein a surgical operation is performed in a non-incision state while observing a body cavity of a patient with an endoscope. A surgical lighting device having a light projecting means for projecting illumination light for illuminating a surgical site in a patient, the surgical lighting device comprising: The light projecting means is provided in a rod-shaped lifting device that lifts a body wall and expands a body cavity by being lifted while being inserted.

[0010] The invention described in claim 2 is the same as the claim 1.
In this surgical lighting device, a plurality of light projecting means are arranged in order along the longitudinal direction of the lifting device.

[0011] The invention according to claim 3 is based on claim 1.
Alternatively, in the surgical lighting device described in Item 2, the imaging means is provided in addition to the rod-shaped lifting device.

(Operation) Next, the operation when the surgical lighting device of the present invention illuminates a surgical site in a patient will be described. First, a plurality of holes for inserting a trocar, into which an endoscope or forceps are inserted as necessary, into a patient's body to be operated, and a light projecting light for illuminating a surgical site in the patient's body. Two holes are respectively opened through which the rod-shaped lifting device in which the means is disposed is inserted. Next, a bar-shaped lifting device is inserted into the patient's body so as to pass through the two holes, and the patient's body is lifted by lifting the lifting device, thereby expanding the body cavity and simultaneously opening the other holes. Insert and set the trocar into which the endoscope has been fitted. Then, following the start of illumination of the surgical site in the patient by the light projecting means of the lifting device and the start of imaging of the surgical site by the endoscope, procedures necessary for the surgery are performed one after another.

According to the first aspect of the present invention, since the light projecting means is provided on the lifting device, a wide area within the patient can be uniformly illuminated from above, and an image having a good S / N ratio can be obtained. Is obtained, and in the case of using a separate endoscope, illumination light is projected from a direction different from the photographing direction, so that a shaded image is obtained. Further, in implementing the surgical lighting device of the first aspect, it is necessary to dispose the light projecting means in the lifting tool, but the light projecting means is assembled to a rod-like body having a thickness similar to that of the endoscope. There is no difficulty because only a small amount of work is required, and no complicated operation is required when actually performing the lighting.

In the surgical lighting device according to the second aspect of the present invention, the plurality of light irradiation means are arranged in order along the longitudinal direction of the lifting tool. The lifting tool takes on the appearance of a linear illuminant, and emits illumination light from the whole.

In the surgical lighting device according to the third aspect, the lifting means is provided with the image pickup means, so that an image can be obtained in a state where the operation site in the patient is viewed from directly above.

[0016]

Next, an embodiment of the present invention will be described with reference to the drawings. FIG. 1 is a schematic diagram showing a state in which a non-incision type surgical operation is performed in the abdomen using the surgical lighting apparatus according to the embodiment. FIG. 2 shows the entire configuration of the surgical lighting apparatus according to the embodiment. FIG. 3 is a schematic diagram showing a state in which the abdominal cavity (body cavity) of a patient on which surgery is performed is expanded by a rod-shaped lifting device.

In the case of the operation shown in FIG. 1, a rod-shaped lifting device 1 is used to expand the abdominal cavity Ma of the patient M so that the operation can be performed without incision. The lifting tool 1 is set by passing through the body of the patient M so as to pass over the holes 2 and 3 opened in the body of the patient M. On the other hand, the gantry 4 composed of a pair of left and right columns 5, 6 joined at the upper end by a connection plate 7 is a patient M
It is installed to straddle. In the upper part of this mount 4,
A round bar 10 to which a pair of reels 8 and 9 are fixed is rotatably passed over the columns 5 and 6, and the ends of wires 11 and 12 wound on the reels 8 and 9 are both ends of the lifting tool 1. Each is fixed in the vicinity.

The left end of the round bar 10 is connected to the rotating shaft of the electric motor 13, and when the electric motor 13 rotates according to a command from the motor driving unit 14, the round bar 10 also rotates in conjunction therewith. With the rotation of the round bar 10, the wires 11, 12 are wound around the winding frames 8, 9, and when the rotation directions are opposite, the wires 11, 12 are paid out. When the wires 11 and 12 are wound, the lifting device 1 moves upward, and when the wires 11 and 12 are drawn out, the lifting device 1 moves downward. Of course, when expanding the abdominal cavity Ma of the patient M, as shown in FIG. 1, the wires 11 and 12 are wound up, the lifting tool 1 is moved upward from the position indicated by the alternate long and short dash line W, and the abdominal wall Mb is lifted. Will be kept. Then, as shown in FIG. 3, the abdominal cavity Ma has expanded only in the space between the lifted abdominal wall Mb shown by the solid line and the unabated abdominal wall Mb shown by the dashed line V. As described above, the method of expanding the abdominal cavity Ma of the patient M with the rod-shaped lifting device 1 has no fear of carbon dioxide poisoning and has an airtight measure to prevent gas leakage, as compared with the method of introducing and expanding high-pressure carbon dioxide gas into the abdominal cavity. Because there are some advantages such as not having to take it,
Useful for non-incision surgery.

Further, in addition to the holes 2 and 3,
Holes 21 to 23 for inserting trocars 18 to 20 into which a laparoscope (endoscope) 15 and forceps 16 and 17 are fitted are also opened, and the trocars 18 to 20 are inserted into the patient through the holes 21 to 23. . The laparoscope 15 is an imaging camera 2 using an optical fiber 24 for projecting light and a CCD.
5, the light of the laparoscopic light source 26 is emitted from the optical fiber 24 via the optical fiber 27, and the operation site in the patient is photographed by the imaging camera 25.
The video signal from the imaging camera 25 is transmitted to the video controller 2
After the necessary processing such as amplification is performed in step 8, the TV monitor 2
9 to be displayed on the screen as an image of the surgical site.

On the other hand, as shown in FIGS. 2 (a) and 2 (b), a surgical lighting device according to an embodiment for illuminating the inside of the patient M is provided along the longitudinal direction in the lifting device 1 described above. It comprises four optical fibers (light projecting means) 31 to 34 which are arranged and inserted in order and a main light source 35.
The light of No. 5 is configured to be projected downward as illumination light from the downward slope of the tip through the optical fibers 31 to 34. The rod-shaped lifting device 1 of the embodiment is made of a transparent resin pipe of about 5 mm in diameter and about 30 cm in length made of acrylic resin or the like, and can transmit the irradiation light emitted from the optical fibers 31 to 34. The space of the transparent resin pipe is filled with a transparent resin, and the optical fibers 31 to 34 are filled.
May be firmly fixed so that no misalignment occurs. At that time, a light dispersing agent may be mixed in the transparent resin to make the illumination light more uniform.

The main light source 3 includes light supply switches 31a to 34a and light amount adjustment knobs 31b to 34b in addition to the power-on switch 35a. Power on switch 3
After turning on the halogen lamp (not shown) by turning on 5a and turning on the light supply switches 31a to 34a, light is supplied to the corresponding optical fiber. The light amount of each optical fiber is changed by light amount adjustment knobs 31b to 34b. It goes without saying that the light supply switches 31a to 34a and the light amount adjustment knobs 31b to 34b can be individually turned on and adjusted.

Next, the setting and lighting operation of the surgical lighting device having the above-described configuration will be described in relation to the progress of the surgery. First, a rod-shaped lifting device 1 is attached to the body of the patient M.
Holes 2 and 3 for inserting the trocars and trocars 18 to 20
The holes 21 to 23 into which are inserted. Then, after the lifting tool 1 is inserted into the holes 2 and 3, the electric motor 13 is rotated to wind the wires 11 and 12, and the lifting tool 1 is moved upward to lift the abdominal wall Mb and expand the abdominal cavity Ma. Then, the trocars 18 to 20 into which the endoscope 15 and the forceps 16 and 17 are fitted are inserted into the holes 21 to 23. By operating the light supply switches 31a to 34a and the light amount adjustment knobs 31b to 34b of the main light source 35, the optical fibers 31 to 3 are operated.
4 starts supplying illumination light from the lifting tool 1 and supplies light to
6 is started to emit illumination light from the endoscope 15, and the image of the surgical site taken by the imaging camera 25 is displayed on the television monitor 29. The doctor operates the scissors or cutters at the tips of the forceps 16 and 17 while watching the image on the television monitor 29 to proceed with the operation.

Four optical fibers 3 in the lifting device 1
Since 1 to 34 are arranged in order along the longitudinal direction of the lifting device 1, the lifting device 1 assumes the form of a linear illuminant during light projection and uniformly illuminates a wide range in the patient's body. The image on the television monitor 29 is bright and has high image quality as a whole. Further, since the light projecting directions of the optical fibers 31 to 34 are different from the photographing direction of the photographing camera 25 of the laparoscope 15, the image on the television monitor 29 is appropriately shaded.
It is a good three-dimensional image.

Next, another embodiment of the present invention will be described. FIG. 4 shows a configuration around a bar-shaped lifting device of a surgical lighting device according to another embodiment. The other embodiment apparatus has the same configuration as that of the previous embodiment except that an imaging camera (imaging means) 36 is provided in addition to the rod-shaped lifting tool 1, and therefore only the configuration around the imaging camera 36 will be described. The description of the other parts is omitted. Imaging camera 36 attached to lifting device 1
Are a reflection mirror 36a, a lens 36b and a CCD 36
c, the inside of the abdominal cavity is illuminated by the optical fibers 31 to 34, and the image of the operation site in the abdominal cavity projected on the reflection mirror 36a is formed on the CCD 36c via the lens 36b and converted into a video signal. After that, it is taken out through the cable 36d and sent to a television monitor (not shown).

In the case of the other embodiment, the image displayed on the television monitor is an image viewed from directly above, and the positional relationship of each part can be easily grasped, so that the situation of the surgical site can be grasped accurately. In the case of the other embodiments, it is not necessary to use an endoscope to obtain an image of the surgical site. In this case, it is not necessary to make a hole for the endoscope on the patient, so that the burden on the patient is reduced. Is less. Of course, an endoscope may also be used in other embodiments. In this case, images obtained from two directions can be obtained, so that the situation of the surgical site can be grasped more accurately. The field of view can be changed by rotating or sliding the rod-shaped lifting tool 1.

The present invention is not limited to the above embodiment, but can be modified as follows, for example. (1) In the embodiment, the light from the external main light source 35 is guided to the optical fibers 31 to 34 and projected.
As shown in (a) and (b), a structure in which three ultra-small halogen lamps (light emitting means) 41 to 43 are arranged in order along the longitudinal direction of the lifting device 1 in the lifting device 1. However, this is a modified example having the same effect as the above embodiment. In this case, a power supply 44 is used instead of the main light source 35.

(2) In the embodiment, the light from the main light source 35 can be selectively supplied to each of the optical fibers 31 to 34. However, the light from the main light source 35 is always supplied to all the optical fibers 31.
A configuration in which the components are simultaneously supplied to ３４34 is a modified example.

(3) As a modified example, as shown in FIG. 6, a configuration in which a light reflection layer 45 is provided on the upper half and side surfaces of the inner surface of the lifting device 1 of the embodiment to improve the light projection efficiency is given.

(4) In the case of the embodiment, the optical fiber 31
~ 34 was cut obliquely at the tip,
As shown in FIG. 7, an optical fiber 46 whose tip is shaped and cut vertically is used, and a mirror 4 tilted obliquely downward is used.
A configuration in which 7 is provided in front of the optical fiber 46 is a modified example.

(5) In the case of the embodiment, the lifting device 1 has a cylindrical shape. However, as shown in FIG. 8, a lifting device 48 having the shape of a half-body of a vertically divided cylinder is used, and the optical fiber 31 is provided on the inner surface. A configuration in which the components 34 to 34 are fixed with a transparent resin 49 is a modified example. Also in this case, a uniform dispersing agent may be mixed in the transparent resin 49 to make the illumination light uniform.

(6) In the case of the embodiment, the lifting tool is a tube made of transparent resin, but a tube made of an opaque material such as stainless steel is used, and a light transmitting hole is formed in the lower wall of the tube. A configuration in which illumination light is projected from the light transmitting hole is a modified example.

(7) In the embodiment, the lifting device 1 has a linear shape. However, as shown in FIG. 9, a light projecting means is provided on a lifting device 50 having a curved shape that is curved like a bow when viewed from above. The configuration having the above configuration is cited as a modification.
In this case, there is an advantage that the lifting tool 50 is located at a position outside the operation area 51 and the operation becomes easy.

(8) In another embodiment, FIG.
As a modified example, as shown in (1), the imaging camera 37 has the same configuration except that the imaging camera is a reflection mirror 37a, a relay lens group 37b, and an external CCD 37c. The image of the operation site in the abdominal cavity projected on the reflection mirror 37a is transmitted to the CC via the relay lens group 37b.
An image is formed on D37c and converted into a video signal. In this modification, since the CCD 37c has an external configuration, there is an advantage that the outer diameter of the lifting tool 1 can be reduced.

(9) Further, two sets of imaging cameras as shown in FIG. 4 may be arranged side by side in the lifting device to display a stereoscopic image of a surgical site in the abdominal cavity.

[0035]

According to the surgical lighting device of the first aspect of the present invention, a wide range within the patient is uniformly illuminated from above by the light projecting means provided in the lifting device, so that an image can be displayed. In addition to being bright and having high image quality with good S / N ratio,
The shooting direction of the endoscope and the projection direction of the illumination light are different,
It is possible to accurately grasp the situation of the surgical site, for example, the image is rich in a three-dimensional effect. Also, when performing, there is a certain degree of work to incorporate the light projecting means into the rod-shaped lifting device, and no complicated adjustment operation is required.

According to the surgical lighting device of the second aspect of the present invention, the lifting tool, in which the plurality of light projecting means are arranged along the longitudinal direction, exhibits a linear illuminant during light projection. Since a wide area within the patient is more uniformly illuminated, a brighter and higher quality image can be obtained.

According to the surgical lighting device of the third aspect of the present invention, the image of the surgical site can be obtained without using an endoscope by the imaging means provided in addition to the lifting device, and the surgical site in the patient can be identified. Since an image of a state peeping from above can be obtained, the situation of the surgical site can be accurately grasped.

[Brief description of the drawings]

FIG. 1 is a view showing a state of a surgical operation performed using an apparatus according to an embodiment.

FIG. 2 is a diagram illustrating an overall configuration of a surgical lighting apparatus according to an embodiment.

FIG. 3 is a view showing a state in which a patient's abdominal cavity is expanded by a lifting device.

FIG. 4 is a cross-sectional view illustrating a configuration of a lifting device of a surgical lighting device according to another embodiment.

FIG. 5 is a diagram showing an overall configuration of a surgical lighting device according to a modified example.

FIG. 6 is a partial longitudinal sectional view of a lifting device according to another modification.

FIG. 7 is a partial longitudinal sectional view of a lifting device according to another modification.

FIG. 8 is a cross-sectional view of a lifting device according to another modification.

FIG. 9 is a plan view showing a lifter having a curved shape according to another modification.

FIG. 10 is a cross-sectional view showing a configuration of a lifting device of a surgical lighting device according to another modification.

FIG. 11 is a view showing a state of a conventional non-incision type surgical operation.

[Explanation of symbols]

 1, 48, 50: a rod-shaped lifting device 15: a laparoscope 31 to 34, 46 as an endoscope optical fiber 36, 37 as an illuminating means, an imaging camera 41 to 43 as an imaging means 41 to 43, as an illuminating means Halogen lamp M… Patient Ma… Abdominal cavity as body cavity

Claims (3)

[Claims] 1. An apparatus used for performing a surgical operation on a patient's body without an incision while observing the inside of the body cavity of the patient with an endoscope, and emits illumination light for illuminating a surgical site in the patient's body. In a surgical lighting device provided with light emitting means for emitting light, the light is projected into a rod-shaped lifting device that lifts a body wall and expands a body cavity by being lifted while being inserted into a patient's body during a surgical operation. A surgical lighting device, wherein light means is provided. 2. The surgical lighting device according to claim 1, wherein a plurality of light projecting means are arranged in order along the longitudinal direction of the lifting device. 3. The surgical lighting device according to claim 1, wherein the rod-shaped lifting device is provided with imaging means.