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.
Medical interventions on patients are often performed using an endoscope, with
the image information from the inside of the body
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
or injure organs. To avoid such injuries
The doctor must prepare much slower.
is therefore desirable
if an endoscopic surgery performing doctor for the preparation
by means of suitable imaging image information from the tissue to
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.
Invention is therefore based on the object, a marker and a
specify medical device of the type mentioned above such that
a minimally invasive
medical intervention on a patient with image information
registration with two different imaging devices
obtained image information allows
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
the patient reversible in the direction of the support element hinged or
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
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
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.
a minimally invasive procedure can in this way z. B.
video images taken with an endoscope and ultrasound images recorded intraoperatively
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
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.
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
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.
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.
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
The invention provides that the marker three of the support element
having protruding or spreading registration elements.
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.
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 object of the invention is, moreover, also
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
the invention is in the attached
schematic drawing showing a marker according to the invention
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.
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.