CN116421321B - Vascular intervention robot capable of automatically withdrawing and returning intervention instrument - Google Patents

Vascular intervention robot capable of automatically withdrawing and returning intervention instrument Download PDF

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Publication number
CN116421321B
CN116421321B CN202310230480.XA CN202310230480A CN116421321B CN 116421321 B CN116421321 B CN 116421321B CN 202310230480 A CN202310230480 A CN 202310230480A CN 116421321 B CN116421321 B CN 116421321B
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interventional instrument
control module
position data
instrument
interventional
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CN116421321A (en
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王迎智
田飞
张萍萍
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Jixian Artificial Intelligence Co Ltd
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Jixian Artificial Intelligence Co Ltd
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    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/30Surgical robots
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/20Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
    • A61B2034/2046Tracking techniques
    • A61B2034/2059Mechanical position encoders
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/30Surgical robots
    • A61B2034/301Surgical robots for introducing or steering flexible instruments inserted into the body, e.g. catheters or endoscopes
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/30Surgical robots
    • A61B2034/303Surgical robots specifically adapted for manipulations within body lumens, e.g. within lumen of gut, spine, or blood vessels
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/30Surgical robots
    • A61B2034/305Details of wrist mechanisms at distal ends of robotic arms
    • YGENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
    • Y02TECHNOLOGIES OR APPLICATIONS FOR MITIGATION OR ADAPTATION AGAINST CLIMATE CHANGE
    • Y02PCLIMATE CHANGE MITIGATION TECHNOLOGIES IN THE PRODUCTION OR PROCESSING OF GOODS
    • Y02P90/00Enabling technologies with a potential contribution to greenhouse gas [GHG] emissions mitigation
    • Y02P90/02Total factory control, e.g. smart factories, flexible manufacturing systems [FMS] or integrated manufacturing systems [IMS]

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  • Health & Medical Sciences (AREA)
  • Surgery (AREA)
  • Engineering & Computer Science (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Biomedical Technology (AREA)
  • Robotics (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • Media Introduction/Drainage Providing Device (AREA)

Abstract

The invention relates to the technical field of medical treatment, in particular to a vascular intervention robot capable of automatically withdrawing and returning an intervention instrument, which comprises the following components: the device comprises a driving mechanism, a sensor and a control module; the control module receives a first control signal, the sensor acquires first position data and transmits the first position data to the control module, and the control module controls the driving mechanism to drive the interventional instrument to withdraw based on the first control signal; the first control signal is a user withdrawal signal, and the first position data is position data before the interventional instrument is withdrawn; the control module receives a second control signal, the sensor acquires second position data and transmits the second position data to the control module, the second control signal is a user return control signal, and the second position data is position data of the interventional instrument after withdrawal; the control module controls the driving mechanism to drive the interventional instrument to return according to the first position data and the second position data. Solves the problem of time waste caused by manual continuous operation of the interventional instrument when the doctor withdraws and returns to the operation.

Description

Vascular intervention robot capable of automatically withdrawing and returning intervention instrument
Technical Field
The invention relates to the technical field of medical treatment, in particular to a vascular intervention robot capable of automatically withdrawing and returning an intervention instrument.
Background
The disclosure of this background section is only intended to increase the understanding of the general background of the invention and is not necessarily to be construed as an admission or any form of suggestion that this information forms the prior art already known to those of ordinary skill in the art.
When Percutaneous Coronary Intervention (PCI) treatment is performed, a catheter needs to be guided by a guide wire to reach a coronary artery opening to contrast the coronary artery, at the moment, the guide wire needs to be withdrawn, a contrast agent is injected by a syringe pump to perform angiography, after the contrast is finished, the guide wire needs to be reinserted, the guide wire is pushed to a withdrawal position, and the guide wire is further pushed to a focus for further treatment. In the coronary stent implantation, the stenotic lesion is usually pre-expanded by a balloon, then the balloon is withdrawn, replaced by a balloon with a proper stent, and then pushed to the lesion again for stent placement.
As described above, the retraction and the re-retraction of the guide wire or the balloon are required to be performed for a plurality of times in the whole operation process, and at present, a doctor is required to directly or indirectly manually and continuously control the retraction and the re-retraction of the interventional instrument (the guide wire or the balloon/stent, etc.), so that a certain waste of operation time is generated.
Disclosure of Invention
Aiming at the defects existing in the prior art, the embodiment of the invention aims to provide a vascular intervention robot capable of automatically withdrawing and returning an intervention instrument, and solves the problem of time waste caused by manual continuous operation of the intervention instrument during withdrawal and re-returning operations of doctors.
In order to achieve the above object, the embodiment of the present invention provides the following technical solutions:
a vascular intervention robot capable of automatically retracting and repositioning an intervention instrument, comprising: the device comprises a driving mechanism, a sensor and a control module; the control module receives a first control signal, the sensor acquires first position data and transmits the first position data to the control module, and the control module controls the driving mechanism to drive the interventional instrument to withdraw based on the first control signal; the first control signal is a user withdrawal signal, and the first position data is position data before the intervention instrument is withdrawn; the control module receives a second control signal, and the sensor acquires second position data and transmits the second position data to the control module, wherein the second control signal is a user return control signal, and the second position data is position data of the interventional instrument after withdrawal; the control module controls the driving mechanism to drive the interventional instrument to return according to the first position data and the second position data.
In another preferred embodiment of the invention, the automatic retraction and return interventional instrument comprises a guide wire, a balloon and a stent, the driving mechanism comprises a guide wire driving mechanism and a balloon/stent driving mechanism, and the sensor comprises a guide wire sensor and a balloon/stent sensor.
In another preferred embodiment of the present invention, the catheter further comprises a catheter position sensor, the catheter position sensor detects catheter position data and transmits the catheter position data to the control module, and the control module judges the relative positions of the catheter and the interventional instrument according to the interventional instrument first position data and the catheter position data; if the position of the interventional instrument is ahead of the catheter, controlling the interventional instrument driving mechanism to reduce the withdrawal speed and twisting the guide wire to retreat in the withdrawal process of the interventional instrument in front of the catheter; after the interventional instrument is withdrawn into the catheter, the interventional instrument driving mechanism is controlled to be withdrawn quickly.
In another preferred embodiment of the invention, a force sensor is also included, which detects the resistance to withdrawal or return of the interventional instrument, and stops withdrawal when the resistance exceeds a threshold value.
In another preferred embodiment of the present invention, the device further comprises an alarm module, wherein the alarm module alarms to a user when the resistance exceeds a threshold.
In another preferred embodiment of the invention, the control module compares the current position of the interventional instrument with the withdrawn target position, and if the current position of the interventional instrument is not in place, the control module continues to control the interventional instrument driving mechanism to execute the withdrawal operation.
In another preferred embodiment of the present invention, an instrument installation detection sensor is further included for detecting whether an interventional instrument replacement has occurred.
In another preferred embodiment of the invention, when the instrument installation detection sensor detects that the interventional instrument is replaced, a signal is sent to the control module, and the control module controls the interventional instrument to calibrate so that the interventional instrument reaches a fixed calibration zero point.
In another preferred embodiment of the invention, when the interventional instrument is replaced, the control module calculates an offset value from the calibrated zero value and the withdrawn position data and brings the offset value into the interventional instrument return data calculation.
In another preferred embodiment of the present invention, when the guide wire is returned, if the guide wire position is advanced from the catheter position, the control module limits the maximum return value of the guide wire not to exceed the current catheter position.
One or more technical solutions provided in the embodiments of the present invention at least have the following technical effects or advantages:
1. at present, no matter in a mode of operating the guide wire purely manually or in a mode of operating the guide wire by using a rocker of the interventional robot, doctors need to continuously control simple actions such as advancing, retreating, rotating and the like of the guide wire, so that the waste of operation time is caused. According to the invention, the length of the interventional instrument such as the guide wire or the balloon/stent entering the human body is acquired through the acquisition of the multiple sensors, the data are input into the control module, the control module controls the interventional instrument driving mechanism to complete the automatic withdrawal and the automatic return of the interventional instrument such as the guide wire or the balloon/stent, the repeated operation of the doctor on the simple withdrawal and the return actions of the interventional instrument such as the guide wire or the balloon/stent in the actual vascular interventional operation is reduced, and the operation time is saved.
2. The invention controls the guide wire to twist the guide wire and retract slowly when the guide wire is in front of the catheter by detecting the relative position of the guide wire and the catheter, and the guide wire retracts quickly after entering the catheter, thereby improving the retracting speed on the premise of ensuring the retracting safety.
3. In the automatic withdrawal and return processes, the force sensor can accurately acquire the resistance of the interventional instrument such as a guide wire or a balloon/stent in the motion process in real time, and stop the motion in time when the resistance exceeds a threshold value, so that the safety is ensured.
4. According to the invention, the instrument installation detection sensor is used for detecting whether the interventional instrument is replaced or not, calibration is carried out after replacement, and the offset value is brought into return data calculation, so that the return precision after replacement of the interventional instrument is ensured, and the vascular interventional robot can meet the actual requirements more.
Additional aspects of the invention will be set forth in the description which follows, and in part will be obvious from the description, or may be learned by practice of the invention.
In order to make the above objects, features and advantages of the present invention more comprehensible, preferred embodiments accompanied with figures are described in detail below.
Drawings
The accompanying drawings, which are included to provide a further understanding of the invention and are incorporated in and constitute a part of this specification, illustrate embodiments of the invention and together with the description serve to explain the invention.
FIG. 1 is a schematic diagram of a vascular interventional robot drive mechanism according to an embodiment of the present invention;
FIG. 2 is a flowchart of a withdraw operation of an embodiment of the present invention;
FIG. 3 is a flowchart of a return operation of an embodiment of the present invention;
in the figure: 1. a catheter drive mechanism; 2. a guide wire driving mechanism; 3. balloon/stent drive mechanism; 4. a catheter position sensor; 5. a guidewire position sensor; 6. balloon/stent position sensor;
the mutual spacing or dimensions are exaggerated for the purpose of showing the positions of the various parts, and the schematic illustrations are used for illustration only.
Detailed Description
It should be noted that the following detailed description is illustrative and is intended to provide further explanation of the invention. Unless defined otherwise, all technical and scientific terms used herein have the same meaning as commonly understood by one of ordinary skill in the art to which this invention belongs.
As described in the background art, at present, a doctor is required to directly or indirectly manually and continuously control the withdrawal and the re-returning of an interventional instrument (a guide wire or a balloon/stent and the like), a certain waste of operation time is generated, and in order to solve the technical problems, the invention provides a vascular interventional robot capable of automatically withdrawing and returning the interventional instrument.
The driving mechanism of the vascular interventional robot is shown in fig. 1, and the catheter driving mechanism 1 is arranged at the forefront end of the whole driving structure and is used for driving and controlling the advancing and retreating and rotating of the catheter; the guide wire driving mechanism 2 is arranged at the middle section and is used for driving and controlling the advancing and retreating and rotation of the guide wire; the balloon/stent driving mechanism 3 is at the rearmost end and is used for driving and controlling the advancing and retreating of the balloon/stent.
The front end of the driving mechanism is provided with a catheter position sensor 4 for detecting the advancing and retreating length of the catheter. The rear part of the catheter driving mechanism 1 is provided with a guide wire position sensor 5, the guide wire is driven by the guide wire driving structure and enters the catheter of the catheter driving structure, and enters a human body through the catheter, and the guide wire position sensor 5 can accurately acquire the advancing and retreating length of the guide wire through the catheter. The balloon/stent sensor is arranged at the rear part of the guide wire driving mechanism 2, the balloon/stent is guided by the guide wire through the guide wire driving mechanism 2 under the drive of the balloon/stent driving mechanism 3, and finally enters the human body through the catheter, and the balloon/stent position sensor 6 mechanism can accurately acquire the advancing and retreating length of the balloon/stent.
The implementation flow of the automatic withdrawing part of the vascular intervention robot is as shown in fig. 2:
after detecting the command of withdrawing the one-key issued by the user through the control key, the vascular interventional robot starts to start the program module shown in fig. 2 to execute the operation of withdrawing the interventional instrument such as the guide wire or the balloon/stent. (the specific execution of the wire withdrawal or the withdrawal of the balloon/stent is determined by the corresponding key pressed, and the execution logic is similar although the execution mechanisms are different, so the withdrawal operation logic of the wire and the balloon/stent are described together)
Interventional instrument position acquisition: the positions of the catheter, the guide wire and the balloon/stent advanced and retracted are detected by a catheter position sensor, a guide wire position sensor and a balloon/stent position sensor, and the above data are stored in a memory. This step will take the current position of the catheter, guidewire and balloon/stent for control of the withdrawal operation.
Withdrawal: after the position of the interventional instrument is acquired, the control module controls the interventional instrument to conduct withdrawal operation.
If the guide wire is withdrawn, the control module judges the relative positions of the guide wire and the guide wire by judging the positions of the guide wire and the guide wire, and if the position of the guide wire is ahead of the guide wire, the control module controls the guide wire driving mechanism to operate the operation of twisting the guide wire to withdraw by a similar hand and controls the slow rotation of the guide wire to withdraw until the guide wire withdraws from the guide wire; when the guide wire is retracted into the catheter, the control module controls the guide wire driving mechanism to be quickly retracted because the guide wire is in a certain channel;
if the balloon/stent is withdrawn, the control module judges the relative position of the balloon/stent and the catheter when the balloon/stent is withdrawn because the balloon/stent is guided by the guide wire, and the balloon/stent is withdrawn at a slow speed and a uniform speed when the balloon/stent exceeds the catheter part, and the control module properly increases the withdrawal speed of the balloon/stent after the balloon/stent is withdrawn in the catheter.
Resistance data acquisition: the guide wire driving mechanism and the balloon/stent driving mechanism are respectively provided with a force sensor, and the control module acquires the resistance of the guide wire or the balloon/stent in the movement process by reading the data of the force sensors.
Judging whether the reading resistance is too large: judging whether the resistance of the guide wire or the balloon/stent in the motion process exceeds a threshold value which can cause damage to the blood vessel or not in the withdrawal process, stopping withdrawal immediately if the resistance of the guide wire or the balloon/stent exceeds the threshold value, and alarming through a UI interface, wherein a doctor determines specific conditions at the moment, and the guide wire or the balloon/stent is withdrawn by adopting a manual withdrawal mode or a rocker control mode; if not, normally executing the operation.
Judging whether to withdraw the bit: the control module compares the current position of the guidewire or balloon/stent with the withdrawn target position during each program cycle to determine if the guidewire or balloon/stent is withdrawn, and if not, continues to perform the withdrawal operation.
And (5) retracting data storage: the relative positions of the catheter and the guide wire and the balloon/stent (the control module is used for judging the mutual lead-lag relationship when the three interventional instruments are returned) are stored by the memory for use in a return operation.
The implementation flow of the automatic return part of the vascular intervention robot is as shown in fig. 3:
after the vascular intervention robot detects a one-key return instruction issued by a user through a control key, starting to start a program module shown in fig. 3 to execute return operation of the intervention instruments such as a guide wire or a balloon/stent. (the specific execution of the return of the guide wire or the return of the balloon/stent is determined by the pressed corresponding keys, and the execution logic is similar although the execution mechanisms are different, so that the return operation logic of the guide wire and the balloon/stent are described together)
Interventional instrument position acquisition: the control module obtains the position value of each interventional instrument through the catheter position sensor, the guide wire position sensor and the balloon/bracket position sensor.
Judging whether the replacement of the interventional instrument occurs or not: sometimes it is necessary to replace the interventional instrument after its withdrawal, for example, to replace a different pre-bent catheter, to replace the guide wire with a working guide wire, to replace a different sized dilation balloon, to replace the dilation balloon with a stented balloon, etc. If the interventional instrument is required to be replaced after being withdrawn, a doctor is required to manually operate the corresponding driving mechanism, the instrument to be replaced is taken down, a new instrument is reinstalled, the control module judges whether the operation of taking down the instrument exists or not by detecting the instrument installation detection sensor of each driving mechanism, and if the operation of taking down and reinstalling the instrument exists, the replacement operation of the interventional instrument is considered to occur, and the position calibration of the interventional instrument is required.
Interventional instrument position calibration: after the control module detects that the interventional instrument is replaced, the corresponding driving mechanism is controlled to calibrate the position of the interventional instrument, and the interventional instrument is controlled to reach the respective fixed calibration zero point. Specifically, after the control module detects that the interventional instrument is replaced, the control module judges that the current instrument position is an indefinite value, so the control module controls the replaced instrument to carry out a back-out operation until the replacement instrument is returned to a fixed calibration zero point of each interventional instrument, and the main controller judges that the instrument arrives by detecting the jump of sensor signals installed at the positions. It should be noted that, this fixed calibration zero is located closest to the driving mechanism, i.e. the calibration zero is located further back, and the retraction operation of the interventional instrument will not normally be retracted to the position of the calibration zero.
And (3) withdrawing data acquisition: the control module reads the data values corresponding to the last withdrawal operation of the interventional instrument, including the position values of the interventional instrument (catheter, guide wire, balloon stent, etc.) before withdrawal, the position values of the interventional instrument after withdrawal, and the relative position values of the catheter and guide wire and the catheter and balloon/stent before withdrawal. If the interventional instrument is replaced, calculating an offset value by combining the zero value after the calibration of the interventional instrument and the position value of the interventional instrument after the completion of the withdrawal operation, and carrying the offset value into the calculation of the return data of the interventional instrument.
Performing interventional instrument return: if the guide wire is subjected to return control, if the guide wire position is advanced to the catheter position, the control module limits the guide wire position, the maximum return value of the guide wire position is limited not to exceed the current catheter position, and the rest distance can be controlled by a doctor through a rocker to drive the guide wire to return through a guide wire driving mechanism. If the guide wire position is lagged behind the catheter position, returning according to the withdrawal position;
if the balloon/stent is returned, the control module returns according to the withdrawal position no matter whether the balloon/stent is lagging or leading the catheter because the balloon/stent is advanced by the guide wire, the balloon/stent returns at a faster speed a when the balloon/stent does not exceed the catheter, and the control module slows down the return speed to b to continue the return operation when the balloon/stent moves to the leading catheter.
Resistance data acquisition: the guide wire driving mechanism and the balloon/stent driving mechanism are respectively provided with a force sensor, and the control module acquires the resistance of the guide wire or the balloon/stent in the movement process by reading the data of the force sensors.
Judging whether the resistance is too large: in the return process, judging whether the resistance of the guide wire or the balloon/stent in the movement process exceeds a threshold value which can cause damage to the blood vessel, if the resistance of the guide wire or the balloon/stent exceeds the threshold value, immediately stopping the return, alarming through a UI interface, determining specific conditions by a doctor, and selecting to return the guide wire or the balloon/stent in a manual return mode or a rocker control mode; if not, normally executing the operation.
Whether the return is successful: and in each program cycle, the control module compares the current position of the guide wire or the balloon/stent with the returned target position to determine whether the guide wire or the balloon/stent is returned to the proper position, and if the guide wire or the balloon/stent is not in the proper position, the control module continues to execute the return operation.
And (3) storing return data: the position before the return and the position after the return are stored, and the relative positions of the catheter, the guide wire and the balloon/stent are stored for later use.
While the foregoing description of the embodiments of the present invention has been presented in conjunction with the drawings, it should be understood that it is not intended to limit the scope of the invention, but rather, it is intended to cover all modifications or variations within the scope of the invention as defined by the claims of the present invention.

Claims (8)

1. A vascular interventional robot capable of automatically retracting and repositioning an interventional instrument, comprising: the device comprises a driving mechanism, a sensor and a control module;
the automatic-withdrawal and-return interventional instrument comprises a guide wire, a balloon and a bracket, wherein the driving mechanism comprises a guide wire driving mechanism and a balloon/bracket driving mechanism, and the sensor comprises a guide wire sensor and a balloon/bracket sensor;
the control module receives a first control signal, the sensor acquires first position data and transmits the first position data to the control module, and the control module controls the driving mechanism to drive the interventional instrument to withdraw based on the first control signal;
the method comprises the following steps: the catheter position sensor detects catheter position data and transmits the data to the control module, and the control module judges the relative positions of the catheter and the interventional instrument according to the first position data of the interventional instrument and the catheter position data; if the position of the interventional instrument is ahead of the catheter, controlling the interventional instrument driving mechanism to reduce the withdrawal speed and twisting the guide wire to retreat in the withdrawal process of the interventional instrument in front of the catheter; when the interventional instrument is withdrawn into the catheter, controlling the interventional instrument driving mechanism to withdraw quickly;
the first control signal is a user withdrawal signal, and the first position data is position data before the intervention instrument is withdrawn;
the control module receives a second control signal, and the sensor acquires second position data and transmits the second position data to the control module, wherein the second control signal is a user return control signal, and the second position data is position data of the interventional instrument after withdrawal;
the control module controls the driving mechanism to drive the interventional instrument to return according to the first position data and the second position data.
2. The vascular interventional robot of claim 1, further comprising a force sensor that detects resistance experienced by the interventional instrument during retraction or retraction, the retraction being stopped when the resistance exceeds a threshold.
3. The vascular interventional robot of claim 2, further comprising an alert module that alerts a user when the resistance exceeds a threshold.
4. The vascular interventional robot of claim 1 capable of automatically retracting and repositioning an interventional instrument, wherein the control module compares the current position of the interventional instrument with the retracted target position and if not in place continues to control the interventional instrument drive mechanism to perform the retraction operation.
5. The vascular interventional robot of claim 1, further comprising an instrument installation detection sensor for detecting whether an interventional instrument change has occurred.
6. The vascular interventional robot of claim 5, wherein the control module controls the interventional instrument to calibrate to a fixed calibration zero point when the instrument installation detection sensor detects replacement of the interventional instrument.
7. The vascular interventional robot of claim 6, wherein the control module calculates an offset value from the calibrated zero value and the withdrawn position data and brings the offset value into the interventional instrument return data calculation when the interventional instrument is replaced.
8. The vascular interventional robot capable of automatically retracting and repositioning an interventional instrument of claim 1, wherein the control module defines that the maximum guidewire repositioning value does not exceed the current catheter position if the guidewire position is advanced from the catheter position when repositioning the guidewire.
CN202310230480.XA 2023-03-06 2023-03-06 Vascular intervention robot capable of automatically withdrawing and returning intervention instrument Active CN116421321B (en)

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CN208892634U (en) * 2018-06-16 2019-05-24 深圳北芯生命科技有限公司 Insertion type medical instrument withdraws system
CN111035474A (en) * 2019-12-17 2020-04-21 宁波健世生物科技有限公司 Controllable guiding device for implanted instrument
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