DE102009016059A1 - Marker i.e. fiducial, for minimal-invasive insertion into body of patient by utilizing endoscope, has registration elements fastened to carrier element, where registration elements are reversibly hinged in direction of carrier element - Google Patents

Marker i.e. fiducial, for minimal-invasive insertion into body of patient by utilizing endoscope, has registration elements fastened to carrier element, where registration elements are reversibly hinged in direction of carrier element

Info

Publication number
DE102009016059A1
DE102009016059A1 DE102009016059A DE102009016059A DE102009016059A1 DE 102009016059 A1 DE102009016059 A1 DE 102009016059A1 DE 102009016059 A DE102009016059 A DE 102009016059A DE 102009016059 A DE102009016059 A DE 102009016059A DE 102009016059 A1 DE102009016059 A1 DE 102009016059A1
Authority
DE
Germany
Prior art keywords
marker
element
body
patient
registration
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Withdrawn
Application number
DE102009016059A
Other languages
German (de)
Inventor
Georg Prof. Nollert
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Siemens AG
Original Assignee
Siemens AG
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Siemens AG filed Critical Siemens AG
Priority to DE102009016059A priority Critical patent/DE102009016059A1/en
Publication of DE102009016059A1 publication Critical patent/DE102009016059A1/en
Application status is Withdrawn legal-status Critical

Links

Classifications

    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/39Markers, e.g. radio-opaque or breast lesions markers
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61BDIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/39Markers, e.g. radio-opaque or breast lesions markers
    • A61B2090/3987Applicators for implanting markers

Abstract

The invention relates to a marker (1) for minimally invasive introduction into the body, for minimally invasive removal from the body of a patient and for reversible attachment to a tissue of the patient in the interior of the body, comprising a support element (2) and at least one on the Carrier element (2) fixed and by the support element (2) projecting or spreading registration element (7, 8, 9), which minimally invasive introduction of the marker (1) into the body of the patient and for minimally invasive removal of the marker (1) from the body of the patient reversible in the direction of the support element (2) is hinged or bendable. The invention also relates to a medical device comprising at least one such marker (1) and an endoscope with an instrument channel, wherein the at least one marker (1) can be introduced through the instrument channel of the endoscope into the body of a patient and removed again from the body of the patient is.

Description

  • The The invention relates to a marker for minimally invasive introduction in the body, for minimally invasive removal from the body of a patient and for reversible attachment to a tissue in the body interior of the patient as well a medical device with such a marker.
  • Minimally invasive Medical interventions on patients are often performed using an endoscope, with the image information from the inside of the body for one provided a medical intervention physician become. The image information is usually around Video images in which the surface of an organ or tissue. Therefore, an endoscopic operating doctor at the preparation, d. H. when peeling off or ablation of upper anatomical tissue structures for the better View of a target tissue, initially do not see what is behind or under the surface of a located at the top tissue structure. In an open surgical procedure The doctor can tell by palpation if structures like For example, vessels, nerves or Nodes are located under the top fabric structure. Since this at a endoscopic intervention with the help of pure video images is not possible there is a risk of being under the top tissue structure Vessels, nerves or injure organs. To avoid such injuries The doctor must prepare much slower.
  • It is therefore desirable if an endoscopic surgery performing doctor for the preparation by means of suitable imaging image information from the tissue to disposal would have, which is behind or below the visible in the video image surface of located at the top tissue structure. It would be advantageous with this endoscopic To be able to register video images, by means of, for example, superimposed or with each other fused image information to get a better overview and thus to be able to make the intervention more targeted and safer.
  • Of the Invention is therefore based on the object, a marker and a specify medical device of the type mentioned above such that for support a minimally invasive medical intervention on a patient with image information registration with two different imaging devices obtained image information allows becomes.
  • To The invention solves this problem by a marker for minimally invasive Introduction into the body, for minimally invasive removal from the body of a patient and for reversible attachment to a tissue of the patient inside the body comprising, a carrier element and at least one on the carrier element attached and from the support element protruding or spreading registration element, which for minimally invasive introduction of the marker into the body of the Patients and for minimally invasive removal of the marker from the body the patient reversible in the direction of the support element hinged or is bendable.
  • It Thus, it is proposed to form a marker such that it minimally invasive, for example through an instrument channel of an endoscope, in the body a patient is insertable and that he is following a minimally invasive medical procedure again minimally invasive, for example, in the same way by the instrument channel of the endoscope, from the body is removable. The marker has over it at least one foldable or bendable registration element, which in image taken with different imaging devices is visible or identifiable, so that with the various imaging devices obtained images based on the images of the marker or the Registration element of the marker superimposed on each other in the images or can be fused together.
  • at a minimally invasive procedure can in this way z. B. video images taken with an endoscope and ultrasound images recorded intraoperatively or X-rays superimposed on each other or fused together, making a one minimally invasive Interventional physician, for example, for the preparation also image information from the tissue available that is below the surface of the tissue visible in the video image located.
  • To a variant of the invention, the preferably pen or tubular support member its rear end with a fixing device for fixing of the marker on a tissue of the patient. Especially If the fastening device is a clamping device for atraumatic anchoring or arrangement of the marker on a Tissue of the patient.
  • To an embodiment the invention is the at least one of the support member projecting or spreading, reversible in the direction of the support element hinged or foldable registration element a strut. Preferably, the strut is formed of an elastic material or is by means of a spring element of the support element splayed.
  • According to another embodiment of the Invention, the at least one registration element at least partially to the support element can be applied. Preferably, the registration element is arranged at the front end of the support element, which is opposite to the fastening device. If the marker is thus pushed, for example, through the instrument channel of an endoscope, the registration element bends in the opposite direction to the thrust direction of the marker and, depending on the design of the marker or of the carrier and registration element and the diameter of the instrument channel, may also be partly completely undermined to the support element.
  • A Variant of the invention provides that the at least one registration element at its free end, especially for better identification in image information, with a geometrically defined element is provided. Preferably, the geometrically defined element a sphere, an ellipsoid, a cube or a cuboid.
  • To Another variant of the invention is the at least one Registration element at a defined angle of the support element from or is at a defined angle of the support element splayed.
  • A other embodiment The invention provides that the marker three of the support element having protruding or spreading registration elements. Preferably the angle between two registration elements about 120 °. Are the Registration elements of markers with different geometrical provided elements, so the markers are well in the image information, in particular for the registration differ.
  • To a further embodiment the invention, the marker at its front end, so the End, which is provided with the fastening device end opposite, an eyelet, in particular for minimally invasive removal of the marker from the body of the Patients on. The marker can be grasped at the eyelet or with a String etc. are provided to him, for example, through the instrument channel of the endoscope.
  • The The object of the invention is, moreover, also solved by a medical device comprising at least one described above and an endoscope with an instrument channel, wherein the at least one marker passes through the instrument channel of the Endoscope in the body a patient einbringbar and removable from the body of the patient is.
  • One embodiment the invention is in the attached schematic drawing showing a marker according to the invention shows.
  • The marker 1 , which may also be referred to as fiducial, in the case of the present embodiment of the invention comprises a pin-shaped or cylindrical support element 2 whose central axis M is the major axis H of the marker 1 represents.
  • At the rear end 3 of the carrier element 2 is a fastening device in the form of a clamping device 4 arranged. By means of the clamping device 4 can the marker 1 be atraumatically anchored to a tissue of a patient, such as an organ, reversibly anchored or attached.
  • At the front end 5 of the marker 1 in the case of the present embodiment of the invention is an eyelet 6 arranged, which can be used to the marker 1 to grab or attach a string to it, especially around the marker 1 for minimally invasive removal from a patient's body into an instrument channel of an endoscope.
  • In the case of the present embodiment of the invention are at the front end of the marker 1 or of the carrier element 2 three registration elements 7 to 9 arranged with a defined length. For the registration elements 7 to 9 are struts that of the support element 2 protrude or from the support element 2 abspreizen. In its present basic position, the angle is one of the registration elements 7 to 9 with the carrier element 2 or the main axis H includes about 90 °. The angle between two registration elements 7 to 9 is present in the circumferential direction about 120 °.
  • In the marker shown in the figure 1 assigns each registration element 7 to 9 at its free end on a geometrically defined element. In the case of the present embodiment of the invention, each has registration elements 7 to 9 a ball 10 on. Instead of a ball 10 can be a registration element 7 to 9 also have an ellipsoid, a cube, a cuboid or another geometrically defined element. A marker can be individualized in this way, in particular in order to be able to distinguish its image in image information from the images of other markers for image registration.
  • The registration elements 7 to 9 of the marker 1 are designed such that they oppose the preferred feed direction V of the marker 1 in the direction of the carrier element 2 or the main H axis are hinged or bendable. This can be done in such a way that the registration elements 7 to 9 from an elastic, z. B. a rubber-like material. Another possibility is, as shown in the figure, that each of the registration elements 7 to 9 by a schematically indicated spring element 11 from the carrier element 2 is spread. In this case, each is a registration item 7 to 9 preferably via one joint, z. B. a hinge joint 12 on the carrier element 2 arranged.
  • Will the marker 1 introduced in the feed direction V, for example, in an instrument channel of a not explicitly shown endoscope, the registration elements 7 to 9 in the direction of the carrier element 2 folded down or bent over. Depending on the diameter of the instrument channel, the registration elements 7 to 9 completely or even partially on the support element 2 issue. If the diameter of the instrument channel becomes relatively large, the registration elements become 7 to 9 under certain circumstances only slightly bent, which does not have to come to rest on the support element. It is crucial that by folding or folding off the registration elements 7 to 9 , to whatever degree, the maximum diameter of the marker relative to the major axis H of the support element 1 is significantly reduced, leaving the marker 1 through an instrument channel of an endoscope and thus minimally invasive can be introduced into the body of a patient.
  • The marker 1 or its components, in particular the geometrically defined elements 10 are formed from a suitable material for the particular application or the imaging device used in each case. If x-ray imaging is used in addition to video imaging in a minimally invasive endoscopic procedure, for example, the components are a marker 1 , but especially the geometrically defined elements 10 of the marker 1 from a radiopaque material, e.g. As a metal such as gold, so that they are in X-rays, be it projection shots or tomographic images for CT, visible. If an ultrasound device or a magnetic resonance device is used as an additional imaging device, the material or materials for the marker 1 to choose accordingly, so that the image of the marker 1 is identifiable in the corresponding images.
  • As already mentioned several times are usually several markers 1 preferably but not necessarily minimally invasively introduced into the body of a patient via an instrument channel of an endoscope and preferably by means of video image at the desired tissue sites in the body of the patient with the aid of the clamping device 4 anchored. Subsequently, with further imaging devices, images of the body interior of the patient can be obtained, in which the markers 1 are displayed or identifiable. Based on the markers visible in the video images 1 and the marker imaged in the images obtained with the imaging devices 1 a registration can be made so that the images can be superimposed or fused together. In this way, a physician performing the minimally invasive procedure can obtain information about tissue underneath the surface of a topmost tissue that can be recognized in a video image, and this information can be used for the procedure, for example, for a surgical procedure. B. use the preparation of tissue layers.
  • a Video image can one or more X-ray images, Superimposed on ultrasound images, MR images and / or PET / CT images or be merged with it.
  • For example, the endoscopic video can point to those with markers 1 liver can be combined with intraoperatively recorded ultrasound images of the liver or intraoperatively recorded or reconstructed 3D X-ray images of the liver.
  • Furthermore, a preoperatively recorded PET / CT image of a tissue with an after arrangement of the marker 1 On the tissue reconstructed 3D X-ray image of the tissue are first registered on the basis of anatomical landmarks and the result image then based on the markers 1 be displayed in endoscopic video images, so that the doctor can detect, for example, the location of a tumor under a tissue surface.
  • The superimposition or fusion of images obtained with different imaging devices using the markers 1 or the images of the markers 1 is even after introduction of CO 2 z. B. in the abdomen possible, as with markers 1 provided tissues do not change themselves in their anatomy, but only in their position relative to each other, what with the markers 1 can be detected.
  • When the procedure is over, the markers can be used 1 again minimally invasive z. B. be removed via the instrument channel of an endoscope from the body.
  • The marker 1 is in the case of the present embodiment of the invention is substantially rotationally symmetrical with a defined by the length of the registration elements and the geo metric defined maximum outer diameter. The marker 1 however, it does not necessarily have to be rotationally symmetrical be.
  • Furthermore, the registration elements do not necessarily have to be at the front end 5 be arranged of the support element. The arrangement can also be towards the back end 3 be postponed.
  • In addition, the marker can 1 also have less or more registration element.

Claims (13)

  1. Markers ( 1 for minimally invasive introduction into the body, for minimally invasive removal from the body of a patient and for reversible attachment to a tissue of the patient in the interior of the body, comprising a support element ( 2 ) and at least one on the support element ( 2 ) and fastened by the carrier element ( 2 ) projecting or spreading registration element ( 7 . 8th . 9 ), which is used for the minimally invasive introduction of the marker ( 1 ) in the body of the patient and for minimally invasive removal of the marker ( 1 ) reversibly from the patient's body in the direction of the carrier element ( 2 ) is hinged or bendable.
  2. Marker according to Claim 1, in which the support element ( 2 ) at its rear end ( 3 ) with a fastening device ( 4 ) for fixing the marker ( 1 ) is provided on a tissue of the patient.
  3. Marker according to claim 2, wherein the fastening device comprises a clamping device ( 4 ).
  4. Marker according to one of claims 1 to 3, wherein the at least one of the support element ( 2 ) projecting or spreading, reversible in the direction of the support element ( 2 ) hinged or foldable registration element ( 7 . 8th . 9 ) a strut ( 7 . 8th . 9 ).
  5. Marker according to claim 4, wherein the strut ( 7 . 8th . 9 ) is formed of an elastic material or by means of a spring element ( 11 ) of the carrier element ( 2 ) protrudes or spreads.
  6. Marker according to one of claims 1 to 5, wherein the at least one registration element ( 7 . 8th . 9 ) at least partially to the support element ( 2 ) can be applied.
  7. Marker according to one of claims 1 to 6, wherein the at least one registration element ( 7 . 8th . 9 ) at its free end with a geometrically defined element ( 10 ) is provided.
  8. Marker according to claim 7, wherein the geometrically defined element is a sphere ( 10 ), an ellipsoid, a cube or a cuboid.
  9. Marker according to one of claims 1 to 8, wherein the at least one registration element ( 7 . 8th . 9 ) at a defined angle of the support element ( 2 ) protrudes or spreads.
  10. Marker according to one of claims 1 to 9, which three of the support element ( 2 ) protruding or spread registration elements ( 7 . 8th . 9 ) having.
  11. Marker according to claim 9, in which the angle between two registration elements ( 7 . 8th . 9 ) is about 120 °.
  12. Marker according to one of claims 1 to 11, which at its front end an eyelet ( 6 ) having.
  13. Medical device comprising at least one marker according to one of claims 1 to 12 and an endoscope with an instrument channel, wherein the at least one marker ( 1 ) can be introduced through the instrument channel of the endoscope into the body of a patient and removed again from the body of the patient.
DE102009016059A 2009-04-02 2009-04-02 Marker i.e. fiducial, for minimal-invasive insertion into body of patient by utilizing endoscope, has registration elements fastened to carrier element, where registration elements are reversibly hinged in direction of carrier element Withdrawn DE102009016059A1 (en)

Priority Applications (1)

Application Number Priority Date Filing Date Title
DE102009016059A DE102009016059A1 (en) 2009-04-02 2009-04-02 Marker i.e. fiducial, for minimal-invasive insertion into body of patient by utilizing endoscope, has registration elements fastened to carrier element, where registration elements are reversibly hinged in direction of carrier element

Applications Claiming Priority (1)

Application Number Priority Date Filing Date Title
DE102009016059A DE102009016059A1 (en) 2009-04-02 2009-04-02 Marker i.e. fiducial, for minimal-invasive insertion into body of patient by utilizing endoscope, has registration elements fastened to carrier element, where registration elements are reversibly hinged in direction of carrier element

Publications (1)

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DE102009016059A1 true DE102009016059A1 (en) 2010-10-14

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Cited By (1)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN103735314A (en) * 2012-10-01 2014-04-23 西门子公司 Medical instrument, medicine system and method for displaying the position of a position marker

Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP1163888A1 (en) * 2000-06-16 2001-12-19 Inrad, Inc. Apparatus for the percutaneous marking of a lesion
WO2004045444A2 (en) * 2002-11-18 2004-06-03 Inrad, Inc. Tissue localizing and marking device and method of using same
US6766186B1 (en) * 1999-06-16 2004-07-20 C. R. Bard, Inc. Post biospy tissue marker and method of use
DE102005002944A1 (en) * 2005-01-18 2006-07-27 Charité - Universitätsmedizin Berlin (Charité) Endoscopic marking agent as well as instruments for application and detection of the marking agent as well as for operative fixation of the marked tissue area
DE202006019649U1 (en) * 2006-12-22 2007-08-16 Brainlab Ag Guiding tube -fixing device for attaching or fixing guiding tube at structure for supplying substance, has mounting element, fixed joint in fastening element and fixed holding device on joint

Patent Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US6766186B1 (en) * 1999-06-16 2004-07-20 C. R. Bard, Inc. Post biospy tissue marker and method of use
EP1163888A1 (en) * 2000-06-16 2001-12-19 Inrad, Inc. Apparatus for the percutaneous marking of a lesion
WO2004045444A2 (en) * 2002-11-18 2004-06-03 Inrad, Inc. Tissue localizing and marking device and method of using same
DE102005002944A1 (en) * 2005-01-18 2006-07-27 Charité - Universitätsmedizin Berlin (Charité) Endoscopic marking agent as well as instruments for application and detection of the marking agent as well as for operative fixation of the marked tissue area
DE202006019649U1 (en) * 2006-12-22 2007-08-16 Brainlab Ag Guiding tube -fixing device for attaching or fixing guiding tube at structure for supplying substance, has mounting element, fixed joint in fastening element and fixed holding device on joint

Cited By (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN103735314A (en) * 2012-10-01 2014-04-23 西门子公司 Medical instrument, medicine system and method for displaying the position of a position marker
DE102012217942A1 (en) * 2012-10-01 2014-06-12 Siemens Aktiengesellschaft Medical instrument, medical system and method for displaying the position of a placemark
CN103735314B (en) * 2012-10-01 2016-03-09 西门子公司 Medical devices for displaying the position of the position mark, medical system and method

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R119 Application deemed withdrawn, or ip right lapsed, due to non-payment of renewal fee

Effective date: 20131101