EP1284673A1 - Fully-automatic, robot-assisted camera guidance using position sensors for laparoscopic interventions - Google Patents

Fully-automatic, robot-assisted camera guidance using position sensors for laparoscopic interventions

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Publication number
EP1284673A1
EP1284673A1 EP01943111A EP01943111A EP1284673A1 EP 1284673 A1 EP1284673 A1 EP 1284673A1 EP 01943111 A EP01943111 A EP 01943111A EP 01943111 A EP01943111 A EP 01943111A EP 1284673 A1 EP1284673 A1 EP 1284673A1
Authority
EP
European Patent Office
Prior art keywords
laparoscope
surgical instrument
interventions
surgical
position sensors
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Withdrawn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
EP01943111A
Other languages
German (de)
French (fr)
Inventor
Johannes Bieger
Rainer Graumann
Norbert Rahn
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
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Siemens AG
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Filing date
Publication date
Application filed by Siemens AG filed Critical Siemens AG
Publication of EP1284673A1 publication Critical patent/EP1284673A1/en
Withdrawn legal-status Critical Current

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/00147—Holding or positioning arrangements
    • A61B1/00149—Holding or positioning arrangements using articulated arms
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/313—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor for introducing through surgical openings, e.g. laparoscopes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/20—Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/70—Manipulators specially adapted for use in surgery
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/06—Devices, other than using radiation, for detecting or locating foreign bodies ; determining position of probes within or on the body of the patient
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/06—Devices, other than using radiation, for detecting or locating foreign bodies ; determining position of probes within or on the body of the patient
    • A61B5/061—Determining position of a probe within the body employing means separate from the probe, e.g. sensing internal probe position employing impedance electrodes on the surface of the body
    • A61B5/064—Determining position of a probe within the body employing means separate from the probe, e.g. sensing internal probe position employing impedance electrodes on the surface of the body using markers
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, 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
    • A61B90/36—Image-producing devices or illumination devices not otherwise provided for
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B34/00—Computer-aided surgery; Manipulators or robots specially adapted for use in surgery
    • A61B34/20—Surgical navigation systems; Devices for tracking or guiding surgical instruments, e.g. for frameless stereotaxis
    • A61B2034/2046—Tracking techniques
    • A61B2034/2051—Electromagnetic tracking systems
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, 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
    • A61B90/36—Image-producing devices or illumination devices not otherwise provided for
    • A61B90/361—Image-producing devices, e.g. surgical cameras

Definitions

  • the present invention relates to an operating system for performing surgical interventions, as described in the preamble of appended claim 1, and to a method for tracking a laparoscope attached to a robot arm for visualizing surgical interventions, as described in the preamble of the appended claim 7 is described.
  • the camera is guided by an operation (OP) assistant who helps the surgeon during the procedure.
  • OP operation
  • Manual camera operation in addition to the additional personnel requirements and the resulting costs, the following problems:
  • the surgeon and the camera assistant must work together in the smallest space and in close consultation during the operation.
  • the assistant often has to work with foresight, since he not only has to use the camera to record the current position of the instruments, but also to support the surgeon's planned instrument guidance.
  • the object of the present invention is thus to provide an operating system for performing surgical interventions according to the preamble of appended claim 1 and a method for performing surgical interventions used in this operating system according to the preamble of appended claim 7, in which an accurate automatic positioning of the Laparoscope made possible by a robot.
  • This object is achieved by an operating system for performing surgical interventions according to the attached claim 1 and a method used in this operating system for tracking a laparoscope attached to a robot arm according to the attached claim 7.
  • the laparoscope inserted into the body is controlled or tracked fully automatically by a robot that receives its commands from a control computer.
  • the laparoscope is adjusted based on the determined positions of the surgical instrument, so that the surgical instrument is always in the field of vision of the laparoscope.
  • the navigation system used with the sensors attached to the laparoscope and the surgical instrument can be commercially available optical (for example polar system from Northern Digital), electromagnetic (for example electromagnetic bird system from Ascension) or on Act systems based on sound waves.
  • the position sensors can be both extracorporeal and on be attached to the tip or near the tip of the laparoscope or the surgical instrument.
  • the present invention is preferably used in minimally invasive, laparoscopic interventions.
  • a robot from Computer-Motion, Goleta, California, USA, for example, can be used with the robot that guides the camera.
  • FIG. 1 schematically shows an operating system according to the invention.
  • the camera or laparoscope 5 is inserted into the patient's body, for example in the region of the upper abdomen in FIG. 1, and moved with the aid of the robot 4 by a robot arm 10 - the laparoscope 5 is over an instrument holder 8 fixed with the robot arm 10.
  • the laparoscope 5 and one or more surgical instruments 6 are provided with position sensors 7, which generate orientation information, with the aid of which the positions of the laparoscope 5 and the surgical instrument 6 are calculated in the navigation system 3 and forwarded to a control computer 1.
  • the position detection and calculation can take place continuously or at intervals.
  • an electromagnetic navigation system is assumed in which an electromagnetic field 9 is emitted by an emitter 2, which is connected to the navigation system 3 or a central unit of the navigation system via an interface 12. This electromagnetic field is detected by the position sensors 7 which, due to the electromagnetic field 9
  • the present invention is suitable for use with a mono (with one optic) as well as with a stereo (with two optics) laparoscope.
  • the control computer 1 sends the commands for tracking the laparoscope 5 to the robot 4 via an interface 13.
  • the robot 4 based on the commands received from the control computer 1, guides the laparoscope 5 attached to the robot arm 10 in accordance with the movements of the surgeon guided surgical instrument 6.
  • the laparoscope 5 can be moved in six degrees of freedom with the aid of the articulated arm 10: right-left, up-down, near-far, tilt, tilt, rotate. It is possible to exclude a certain number of degrees of freedom. This is particularly important when movement of the laparoscope 5 in certain directions or at certain solid angles jeopardize surgical safety or when the surgical instruments 6 are only guided in a certain area of the operating field.
  • the control computer 3 continuously or at intervals detects the spatial positions and solid angles of the laparoscope 5 (camera) and the surgical instruments 6 on the basis of the position sensors 7 attached there.
  • the control computer 1 recognizes that the laparoscope 5 and the surgical instrument 6 are in positions in which the surgical instrument 6 cannot be detected by the camera, the control computer 1 gives the robot 4 the command via a (for example serial or parallel) interface 13 to move in such a way that the surgical instrument 6 is in the middle o which is in a defined area of the camera viewing angle.
  • the distance between the laparoscope 5 and the surgical instrument 6 can also be regulated in this way in such a way that the distance does not fall short of or exceed a predefinable tolerance interval.
  • the detection of the spatial coordinates of the laparoscope 5 and the surgical instruments 6 and the corresponding activation of the robot arm 10 thus take place in a control loop.

Abstract

The invention relates to an operating system for carrying out operation interventions, comprising a laparoscope (5) for visualizing the interventions, said laparoscope being mounted on a robot arm, and a surgical instrument (6) for carrying out the interventions. The laparoscope (5) is guided automatically with a robot arm (10), using positions of the laparoscope (5) and the surgical instrument (6) detected by position sensors (7), so that the surgical instrument (6) is always in the field of vision of the laparoscope (5). The invention also relates to a method for guiding a laparoscope mounted on a robot arm, used in this operating system.

Description

Beschreibung description
Vollautomatische, robotergestützte Kameraführung unter Verwendung von Positionssensoren für laparoskopische EingriffeFully automatic, robot-assisted camera guidance using position sensors for laparoscopic interventions
Die vorliegende Erfindung betrifft ein Operationssystem zum Durchführen von operativen Eingriffen, wie es im Oberbegriff des beigefügten /Anspruches 1 beschrieben ist, und ein Verfahren zum Nachführen eines an einem Roboterarm angebrachten La- paroskops zum Visualisieren von operativen Eingriffen, wie es im Oberbegriff des beigefügten Anspruches 7 beschrieben ist.The present invention relates to an operating system for performing surgical interventions, as described in the preamble of appended claim 1, and to a method for tracking a laparoscope attached to a robot arm for visualizing surgical interventions, as described in the preamble of the appended claim 7 is described.
Die minimalinvasive Chirurgie gewinnt als Alternative zu einem offenen chirurgischen Eingriff immer mehr an Bedeutung. Bei diesen Eingriffen handelt es sich um Operationsmethoden, bei denen Operationen mit möglichst kleinen Operationswunden durchgeführt werden.Minimally invasive surgery is becoming increasingly important as an alternative to open surgery. These interventions are surgical methods in which operations are carried out with the smallest possible surgical wounds.
In bestimmten Bereichen dieser minimalinvasiven Chirurgie, z.B. bei laparoskopischen Eingriffen, bei denen Instrumente durch kleine Eintrittsöffnungen in den Bauchraum des Patienten eingebracht und dort durch einen Chirurgen geführt und operativ eingesetzt werden, ergibt sich die Notwendigkeit, die Instrumente mit einer zusätzlich in den Bauchraum einge- brachten Kamera (Laparoskop) auf einem externen Bildschirm zu visualisieren. Diese Operationstechnik wird heute z.B. bei der Resektion der Gallenblase routinemäßig eingesetzt. Der Chirurg kontrolliert dabei die Bewegung der Instrumente nur über den Bildschirm.In certain areas of this minimally invasive surgery, e.g. In laparoscopic interventions, in which instruments are inserted through small entry openings into the patient's abdominal cavity and guided there by a surgeon and used surgically, there is a need to use an external camera (laparoscope) to insert the instruments into an external device Visualize screen. This surgical technique is used today e.g. used routinely for resection of the gallbladder. The surgeon only controls the movement of the instruments on the screen.
Beim Stand der Technik wird während des Eingriffes die Kamera durch einen Operations (OP) -Assistenten, der dem Chirurgen behilflich ist, geführt. Durch die manuelle Kameraführung ergeben sich jedoch, neben des zusätzlichen Personalbedarfes und der dadurch entstehenden Kosten, folgende Probleme: Der Chirurg und der kameraführende Assistent müssen während der Operation auf engstem Raum und in engster Absprache zusammenarbeiten. Der Assistent muss oft sehr vorausschauend arbeiten, da er mit der Kamera nicht nur die aktuelle Positi- on von den Instrumenten erfassen, sondern auch die geplante Instrumentenführung des Chirurgen unterstützen muss.In the prior art, the camera is guided by an operation (OP) assistant who helps the surgeon during the procedure. Manual camera operation, however, in addition to the additional personnel requirements and the resulting costs, the following problems: The surgeon and the camera assistant must work together in the smallest space and in close consultation during the operation. The assistant often has to work with foresight, since he not only has to use the camera to record the current position of the instruments, but also to support the surgeon's planned instrument guidance.
Bei nachlassender Aufmerksamkeit und Ermüdung des Assistenten, insbesondere bei lang andauernden Operationsprozeduren, wird die Kameraführung unpräzise und unruhig. Weiterhin müssen die vom Chirurgen an den kameraführenden OP-Assistenten gegebenen Instruktionen sehr präzise sein. Diese Instruktionen können manchmal missinterpretiert werden.With waning attention and fatigue of the assistant, especially with long-lasting surgical procedures, the camera work becomes imprecise and restless. Furthermore, the instructions given by the surgeon to the camera-operating surgical assistants must be very precise. These instructions can sometimes be misinterpreted.
Außerdem erfordert die Kameraführung im allgemeinen keine hochqualifizierte Ausbildung, so dass Operationsassistenten diese Aufgabe nicht allzu gerne wahrnehmen.In addition, camera work generally does not require highly qualified training, so that surgical assistants do not enjoy performing this task.
Ein Lösungsansatz, die geschilderten Probleme zu minimieren, besteht darin, die Kamera mit Instrumentenhalterungen zu fixieren. Dabei entfällt allerdings nicht die Nachführung der Kamera durch einen OP-Assistenten während der Operation.One solution to minimize the problems described is to fix the camera with instrument holders. However, there is no omission of the camera being tracked by an operating room assistant during the operation.
Auch ist der Einsatz eines Roboters, mit dessen Hilfe das La- paroskop interaktiv durch den Chirurgen gesteuert und bewegt wird, bekannt. Jedoch muss sich der Chirurg bei diesem Verfahren zusätzlich auf die Steuerung der Kamera konzentrieren.The use of a robot, with the aid of which the surgeon is controlled and moved interactively by the surgeon, is also known. However, with this procedure, the surgeon must also focus on controlling the camera.
Ein weiterer Lösungsansatz wird in dem Dokument US 5 820 545 "Method of Tracking a Surgical Instrument with a Mono or Stereo Laparoscope" beschrieben. Dabei werden die in den Körper eingeführten chirurgischen Instrumente mit farbcodierten Markierungen versehen. Diese Markierungen werden von der in den Körper eingeführten Kamera detektiert, wobei die Kamera (La- paroskop) mit Hilfe eines Roboters so positioniert wird, dass sich die bei der Operation geführten chirurgischen Instrumente stets im Blickfeld der Kamera befinden. Soll jedoch auch der Abstand der chirurgischen Instrumente von der eingeführten Kamera durch den Roboter geregelt werden, ist der Einsatz einer Stereokamera bzw. eines Stereo-Laparoskops, d.h. einer Kamera mit zwei optischen Einrichtungen, notwendig.Another approach is described in the document US Pat. No. 5,820,545 "Method of Tracking a Surgical Instrument with a Mono or Stereo Laparoscope". The surgical instruments inserted into the body are provided with color-coded markings. These markings are detected by the camera inserted into the body, the camera (laparoscope) being positioned with the aid of a robot so that the surgical instruments guided during the operation are always in the field of vision of the camera. But should also If the distance between the surgical instruments and the inserted camera is regulated by the robot, the use of a stereo camera or a stereo laparoscope, ie a camera with two optical devices, is necessary.
Dieses Verfahren hat jedoch den Nachteil, dass sich die Instrumente zur Nachführung der Kamera stets im Blickfeld der Kamera befinden müssen, da die Kamera sonst die Position der Instrumente verliert. Außerdem kann die Nachführung der Kame- ra durch Verunreinigungen (beispielsweise durch Blut) der Farbmarkierungen beeinträchtigt werden.However, this method has the disadvantage that the instruments for tracking the camera must always be in the field of view of the camera, since otherwise the camera loses the position of the instruments. In addition, the tracking of the camera can be impaired by impurities (for example blood) in the color markings.
Das Dokument WO 97/29709 AI, „Medical Procedures and Appara- tus Using Intrabody Probes)", beschreibt ein Verfahren und eine Vorrichtung, bei denen eine Instrumentensonde durch den Körper eines Patienten geführt wird. Dabei wird die Position dieser Instru entensonde relativ zu einer weiteren, in dem Körper des Patienten befindlichen Sonde, ermittelt und die Instrumentensonde, basierend auf der ermittelten relativen Position zueinander, durch den Körper geführt.The document WO 97/29709 AI, "Medical Procedures and Apparatus Using Intrabody Probes)" describes a method and a device in which an instrument probe is guided through the body of a patient. The position of this instrument probe is relative to one Another probe located in the patient's body is determined and the instrument probe is guided through the body based on the determined relative position to one another.
Das Dokument Cinquin, P. et al, „Computer Asisted Medical In- terverventions" , IEEE Engineering in Medicine and Biology, May/June 1995, Seiten 254 bis 263, beschreibt Computer-ge- stütze operative Eingriffe unter Anwendung von Positions- und Formsensoren .The document Cinquin, P. et al, "Computer Asisted Medical Interventions", IEEE Engineering in Medicine and Biology, May / June 1995, pages 254 to 263, describes computer-assisted surgical interventions using position and shape sensors ,
Die Aufgabe der vorliegenden Erfindung ist somit, ein Operationssystem zum Durchführen von operativen Eingriffen gemäß dem Oberbegriff des beigefügten Anspruches 1 und ein in diesem Operationssystem angewendetes Verfahren zum Durchführen von operativen Eingriffen gemäß dem Oberbegriff des beigefügten Anspruches 7 bereitzustellen, bei denen eine genaue automatische Positionierung des Laparoskops durch einen Roboter ermöglicht wird. Diese Aufgabe wird durch ein Operationssyste zum Durchführen von operativen Eingriffen gemäß dem beigefügten Anspruch 1 und ein in diesem Operationssystem angewendetes Verfahren zum Nachführen eines an einem Roboterarm angebrachten Laparoskops gemäß dem beigefügten Anspruch 7 gelöst.The object of the present invention is thus to provide an operating system for performing surgical interventions according to the preamble of appended claim 1 and a method for performing surgical interventions used in this operating system according to the preamble of appended claim 7, in which an accurate automatic positioning of the Laparoscope made possible by a robot. This object is achieved by an operating system for performing surgical interventions according to the attached claim 1 and a method used in this operating system for tracking a laparoscope attached to a robot arm according to the attached claim 7.
Gemäß der vorliegenden Erfindung wird das in den Körper eingeführte Laparoskop vollautomatisch durch einen Roboter, der seine Befehle von einem Steuerrechner erhält, gesteuert bzw. nachgeführt. Die Nachführung des Laparoskops erfolgt aufgrund der ermittelten Positionen des chirurgischen Instruments, so dass sich das chirurgische Instrument stets im Blickfeld des Laparoskops befindet.According to the present invention, the laparoscope inserted into the body is controlled or tracked fully automatically by a robot that receives its commands from a control computer. The laparoscope is adjusted based on the determined positions of the surgical instrument, so that the surgical instrument is always in the field of vision of the laparoscope.
Zum einen entfällt bei der erfindungsgemäßen, automatischen Kameraführung die manuelle Kameraführung durch einen Assistenten mit den beschriebenen Nachteilen. Zum anderen kann sich der Chirurg voll auf seine eigentliche Aufgabe, d.h. das Führen der chirurgischen Instrumente, konzentrieren.On the one hand, manual camera control by an assistant with the described disadvantages is eliminated in the automatic camera control according to the invention. On the other hand, the surgeon can fully concentrate on his actual task, i.e. guiding the surgical instruments, focus.
Bei dem verwendeten Navigationssystem mit den an dem Laparoskop und dem chirurgischen Instrument angebrachten Sensoren kann es sich um kommerziell erhältliche optische (z.B. Pola- ris-System der Fa. Northern Digital), elektromagnetische (z.B. elektromagnetisches Bird-System der Fa. Ascension) oder auf Schallwellen basierende Systeme handeln.The navigation system used with the sensors attached to the laparoscope and the surgical instrument can be commercially available optical (for example polar system from Northern Digital), electromagnetic (for example electromagnetic bird system from Ascension) or on Act systems based on sound waves.
Beim Einsatz von optischen System ist darauf zu achten, dass die Positionssensoren extrakorporal angebracht sind, d.h. , dass sich die Positionssensoren während des operativen Eingriffes außerhalb des Körpers befinden müssen, um eine optische Verbindung zu einem Sender bzw. untereinander zu ermöglichen.When using optical systems, make sure that the position sensors are attached extracorporeally, i.e. that the position sensors must be located outside the body during the surgical procedure in order to enable an optical connection to a transmitter or to each other.
Bei den elektromagnetischen und den Schall-basierten Systemen können die Positionssensoren sowohl extrakorporal als auch an der Spitze bzw. in der Nähe der Spitze des Laparoskops bzw. des chirurgischen Instruments angebracht sein.In the electromagnetic and sound-based systems, the position sensors can be both extracorporeal and on be attached to the tip or near the tip of the laparoscope or the surgical instrument.
Bei der extrakorporalen Befestigung können lediglich starre Instrumente verwendet werden, bei denen durch eine Kalibrierung die empfangenen Koordinaten der extrakorporal angebrachten Sensoren auf die Instrumentenspitze umgerechnet werden.In the case of extracorporeal attachment, only rigid instruments can be used, in which the received coordinates of the extracorporeally attached sensors are converted to the instrument tip by calibration.
Bei der Befestigung der Positionssensoren an der Spitze bzw.--' in der Nähe der Spitze des Laparoskops bzw. chirurgischen Instruments werden die Positionssensoren beim Eingriff mit in den Körper eingeführt. Das hat den Vorteil, dass auch flexible Instrumente eingesetzt werden können. Jedoch beanspruchen diese Instrumente mit Positionssensoren auch mehr Raum im Körper .In the fitting of the position sensors at the tip or .-- 'in the vicinity of the tip of the laparoscope and surgical instrument position sensors upon engagement with are inserted into the body. This has the advantage that flexible instruments can also be used. However, these instruments with position sensors also take up more space in the body.
Die vorliegende Erfindung findet bevorzugt bei minimal- invasiven, laparoskopischen Eingriffen Anwendung.The present invention is preferably used in minimally invasive, laparoscopic interventions.
Bei dem Roboter, der die Kamera führt, kann beispielsweise ein Roboter der Fa. Computer-Motion, Goleta, Kalifornien, USA eingesetzt werden.A robot from Computer-Motion, Goleta, California, USA, for example, can be used with the robot that guides the camera.
Die vorliegende Erfindung wird nachfolgend anhand eines bevorzugten Ausführungsbeispieles unter Bezug auf die beigefügte Figur näher erläutert, in der die einzige Figur 1 schematisch ein erfindungsgemäßes Operationssystem zeigt.The present invention is explained in more detail below on the basis of a preferred exemplary embodiment with reference to the attached figure, in which the only FIG. 1 schematically shows an operating system according to the invention.
Wie in Figur 1 gezeigt ist, wird die Kamera bzw. das Laparoskop 5 in den Körper des Patienten, in der Figur 1 beispielsweise im Bereich des Oberbauchs, eingeführt und mit Hilfe des Roboters 4 durch einen Roboterarm 10 bewegt - das Laparoskop 5 ist dabei über eine Instrumentenhalterung 8 mit dem Roboterarm 10 fixiert. Das Laparoskop 5 sowie ein oder mehrere chirurgische Instrumente 6 sind mit Positionssensoren 7 versehen, die Orientierungsinformationen erzeugen, mit deren Hilfe in dem Navigationssystem 3 die Positionen des Laparoskops 5 und des chirur- gischen Instruments 6 berechnet und an einen Steuerrechner 1 weitergegeben werden. Die Positionserfassung und -berechnung kann dabei kontinuierlich oder in Intervallen erfolgen.As shown in FIG. 1, the camera or laparoscope 5 is inserted into the patient's body, for example in the region of the upper abdomen in FIG. 1, and moved with the aid of the robot 4 by a robot arm 10 - the laparoscope 5 is over an instrument holder 8 fixed with the robot arm 10. The laparoscope 5 and one or more surgical instruments 6 are provided with position sensors 7, which generate orientation information, with the aid of which the positions of the laparoscope 5 and the surgical instrument 6 are calculated in the navigation system 3 and forwarded to a control computer 1. The position detection and calculation can take place continuously or at intervals.
Im Beispiel von Figur 1 wird von einem elektromagnetischen Navigationssystem ausgegangen, bei dem von einem Emitter 2, der über eine Schnittstelle 12 mit dem Navigationssystem 3 bzw. einer Zentraleinheit des Navigationssystems verbunden ist, ein elektromagnetisches Feld 9 ausgesendet wird. Dieses elektromagnetische Feld wird von den Positionssensoren 7 de- tektiert, die aufgrund des elektromagnetischen Feldes 9 dieIn the example of FIG. 1, an electromagnetic navigation system is assumed in which an electromagnetic field 9 is emitted by an emitter 2, which is connected to the navigation system 3 or a central unit of the navigation system via an interface 12. This electromagnetic field is detected by the position sensors 7 which, due to the electromagnetic field 9
Orientierungsinformationen erzeugen. Mit Hilfe der Positions- sensoren 7 können die Raumpositionen und Raumwinkel des Laparoskops und der/des chirurgischen Instrumente/s 6 bzw. deren Raumpositionen zueinander sehr genau detektiert werden. Diese Raumpositionen und Winkelinformationen werden durch den Steuerrechner 1 erfasst, der daraufhin den Roboter 4 so ansteuert und somit das Laparoskop 5 so ausrichtet, dass sich alle zu überwachenden chirurgischen Instrumente 6 im Blickfeld der Kamera, deren Bilder auf einem Bildschirm ausgegeben werden, und somit im Blickfeld des Chirurgen befinden.Generate orientation information. With the help of the position sensors 7, the spatial positions and solid angles of the laparoscope and the surgical instrument (s) 6 or their spatial positions relative to one another can be detected very precisely. These spatial positions and angle information are recorded by the control computer 1, which then controls the robot 4 and thus aligns the laparoscope 5 so that all surgical instruments 6 to be monitored are in the field of view of the camera, the images of which are output on a screen, and thus in The surgeon's field of vision.
Die vorliegende Erfindung eignet sich sowohl für den Einsatz mit einem Mono- (mit einer Optik) als auch mit einem Stereo- (mit zwei Optiken) Laparoskop.The present invention is suitable for use with a mono (with one optic) as well as with a stereo (with two optics) laparoscope.
Der Steuerrechner 1 sendet die Befehle zur Nachführung des Laparoskops 5 über eine Schnittstelle 13 (Interface) an den Roboter 4. Der Roboter 4 führt, aufgrund der vom Steuerrechner 1 empfangenen Befehle, das am Roboterarm 10 befestigte Laparoskop 5 entsprechend der Bewegungen des durch den Chirurgen geführten chirurgischen Instruments 6 nach. Die Bewegung des Laparoskops 5 kann mit Hilfe des Gelenkarmes 10 in sechs Freiheitsgraden erfolgen: rechts-links, auf-ab, nah-fern, neigen, kippen, drehen. Dabei ist es möglich, eine bestimmte Anzahl von Freiheitsgraden auszuschließen. Das ist besonders dann wichtig, wenn eine Bewegung des Laparoskops 5 in bestimmte Richtungen oder um bestimmte Raumwinkel die Operationssicherheit gefährden oder wenn die chirurgischen Instrumente 6 nur in einem bestimmten Bereich des Operationsfeldes geführt werden.The control computer 1 sends the commands for tracking the laparoscope 5 to the robot 4 via an interface 13. The robot 4, based on the commands received from the control computer 1, guides the laparoscope 5 attached to the robot arm 10 in accordance with the movements of the surgeon guided surgical instrument 6. The laparoscope 5 can be moved in six degrees of freedom with the aid of the articulated arm 10: right-left, up-down, near-far, tilt, tilt, rotate. It is possible to exclude a certain number of degrees of freedom. This is particularly important when movement of the laparoscope 5 in certain directions or at certain solid angles jeopardize surgical safety or when the surgical instruments 6 are only guided in a certain area of the operating field.
Der Steuerrechner 3 erfasst kontinuierlich oder in Intervallen die Raumpositionen und Raumwinkel des Laparoskops 5 (Kamera) und der chirurgischen Instrumente 6 aufgrund der dort angebrachten Positionssensoren 7. Erkennt der Steuerrechner 1, dass sich Laparoskop 5 und chirurgisches Instrument 6 in Positionen befinden, in der das chirurgische Instrument 6 nicht von der Kamera erfasst werden kann, erteilt der Steuerrechner 1 an den Roboter 4 über eine (beispielsweise serielle oder parallele) Schnittstelle 13 den Befehl, sich so zu bewe- gen, dass sich das chirurgische Instrument 6 in der Mitte o- der in einem definierten Bereich des Kamerablickwinkels befindet. Ebenfalls kann die Entfernung zwischen dem Laparoskop 5 und dem chirurgischen Instrument 6 auf diese Weise so geregelt werden, dass die Entfernung ein vorgebbares Toleranzin- tervall nicht unter- oder überschreitet. Die Erfassung der Raumkoordinaten des Laparoskops 5 und der chirurgischen Instrumente 6 und die entsprechende Ansteuerung des Roboterarms 10 läuft so in einem Regelkreis ab. The control computer 3 continuously or at intervals detects the spatial positions and solid angles of the laparoscope 5 (camera) and the surgical instruments 6 on the basis of the position sensors 7 attached there. The control computer 1 recognizes that the laparoscope 5 and the surgical instrument 6 are in positions in which the surgical instrument 6 cannot be detected by the camera, the control computer 1 gives the robot 4 the command via a (for example serial or parallel) interface 13 to move in such a way that the surgical instrument 6 is in the middle o which is in a defined area of the camera viewing angle. The distance between the laparoscope 5 and the surgical instrument 6 can also be regulated in this way in such a way that the distance does not fall short of or exceed a predefinable tolerance interval. The detection of the spatial coordinates of the laparoscope 5 and the surgical instruments 6 and the corresponding activation of the robot arm 10 thus take place in a control loop.

Claims

Patentansprüche claims
1. Operationssystem zum Durchführen von operativen Eingriffen, mit einem an einem Roboterarm (10) angebrachten Laparoskop (5) zum Visualisieren der Eingriffe, einem chirurgischen Instrument (6) zum Durchführen der Eingriffe, gekennzeic net durch jeweils einen Positionssensor (7) an Laparoskop (5) und chirurgischem Instrument (6) zum Erzeugen von Orientierungsinformationen, und einem Navigationssyste (3) zum Ermitteln der Positionen von Laparoskop (5) und chirurgischem Instrument (6) anhand der von den Positionssensoren (7) erzeugten OrientierungsInformationen, wobei mit Hilfe der ermittelten Positionen das Laparoskop (5) automatisch durch den Roboterarm (10) so nachgeführt wird, dass sich das chirurgische Instrument (6) im Blickfeld des Laparoskops (5) befindet.1.Operating system for performing surgical interventions, with a laparoscope (5) attached to a robot arm (10) for visualizing the interventions, a surgical instrument (6) for performing the interventions, characterized by a position sensor (7) on a laparoscope ( 5) and surgical instrument (6) for generating orientation information, and a navigation system (3) for determining the positions of the laparoscope (5) and surgical instrument (6) on the basis of the orientation information generated by the position sensors (7), with the aid of the determined Positions the laparoscope (5) is automatically tracked by the robot arm (10) so that the surgical instrument (6) is in the field of view of the laparoscope (5).
2. Operationssystem gemäß Anspruch 1, dadurch gekennzeichnet, dass das Navigationssystem (3) auf Schallwellen basiert.2. Operating system according to claim 1, characterized in that the navigation system (3) is based on sound waves.
3. Operationssystem gemäß Anspruch 1, dadurch geken zeichnet, dass das Navigationssystem (3) auf elektromagnetischen Wellen basiert.3. Operating system according to claim 1, characterized in that the navigation system (3) is based on electromagnetic waves.
4. Operationssystem gemäß Anspruch 1, dadurch gekennzeichnet, dass das Navigationssystem (3) auf optischen Wellen basiert.4. Operating system according to claim 1, characterized in that the navigation system (3) is based on optical waves.
5. Operationssystem gemäß einem der Ansprüche 1 bis 4, dadurch gekennzeichnet, dass die Positionssensoren (7) an der Spitze des Laparoskops (5) bzw. des chirurgischen Instrumentes (6) angebracht sind. 5. Operating system according to one of claims 1 to 4, characterized in that the position sensors (7) are attached to the tip of the laparoscope (5) or the surgical instrument (6).
6. Operationssystem gemäß einem der Ansprüche 1 bis 5, dadurch gekennzeichnet, dass die Positionssensoren (7) extrakorporal an dem Lapa- roskop (5) bzw. dem chirurgischen Instrument (6) angebracht sind.6. Operating system according to one of claims 1 to 5, characterized in that the position sensors (7) are attached extracorporeally to the laparoscope (5) or the surgical instrument (6).
7. Verfahren zum Nachführen eines an einem Roboterarm (10) angebrachten Laparoskops (5) zum Visualisieren von operativen Eingriffen, mit einem chirurgischen Instrument (6) zum Durchführen der Eingriffe, mit den Schritten: Erzeugen von Orientierungsinformationen von Laparoskop (5) und chirurgischem Instrument (β),7. A method for tracking a laparoscope (5) attached to a robot arm (10) for visualizing surgical interventions, with a surgical instrument (6) for performing the operations, comprising the steps: generating orientation information from the laparoscope (5) and the surgical instrument (β),
Ermitteln der Positionen von Laparoskop (5) und chirurgischem Instrument (6) anhand der erzeugten Orientierungsinformationen, und automatisches Nachführen des Laparoskopes (5) mit Hilfe der ermittelten Positionen derart, dass sich das chirurgische Instrument (6) im Blickfeld des Laparoskops (5) befindet.Determining the positions of the laparoscope (5) and the surgical instrument (6) on the basis of the orientation information generated, and automatically tracking the laparoscope (5) with the aid of the determined positions such that the surgical instrument (6) is in the field of vision of the laparoscope (5) ,
8. Verfahren gemäß Anspruch 7 , dadurch gekennzeic net, dass es bei minimalinvasiven chirurgischen Eingriffen eingesetzt wird. 8. The method according to claim 7, characterized in that it is used in minimally invasive surgical interventions.
EP01943111A 2000-05-22 2001-05-17 Fully-automatic, robot-assisted camera guidance using position sensors for laparoscopic interventions Withdrawn EP1284673A1 (en)

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