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
  • A61B1/012—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 characterised by internal passages or accessories therefor
  • A61B1/018—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 characterised by internal passages or accessories therefor for receiving instruments
• • 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 diagnostic devices within or on the body of the patient
  • A61B5/065—Determining position of the probe employing exclusively positioning means located on or in the probe, e.g. using position sensors arranged on the probe
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods
  • A61B2017/00017—Electrical control of surgical instruments
  • A61B2017/00022—Sensing or detecting at the treatment site
  • A61B2017/00026—Conductivity or impedance, e.g. of tissue
  • A61B2017/0003—Conductivity or impedance, e.g. of tissue of parts of the instruments
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods
  • A61B17/00234—Surgical instruments, devices or methods for minimally invasive surgery
  • A61B2017/00292—Surgical instruments, devices or methods for minimally invasive surgery mounted on or guided by flexible, e.g. catheter-like, means
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
  • A61B17/00—Surgical instruments, devices or methods
  • A61B17/22—Implements for squeezing-off ulcers or the like on inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; for invasive removal or destruction of calculus using mechanical vibrations; for removing obstructions in blood vessels, not otherwise provided for
  • A61B2017/22072—Implements for squeezing-off ulcers or the like on inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; for invasive removal or destruction of calculus using mechanical vibrations; for removing obstructions in blood vessels, not otherwise provided for with an instrument channel, e.g. for replacing one instrument by the other
  • A61B2017/22074—Implements for squeezing-off ulcers or the like on inner organs of the body; Implements for scraping-out cavities of body organs, e.g. bones; for invasive removal or destruction of calculus using mechanical vibrations; for removing obstructions in blood vessels, not otherwise provided for with an instrument channel, e.g. for replacing one instrument by the other the instrument being only slidable in a channel, e.g. advancing optical fibre through a channel
• • 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
  • A61B90/06—Measuring instruments not otherwise provided for
  • A61B2090/062—Measuring instruments not otherwise provided for penetration depth

Definitions

• the invention relates to a device for measuring a position of a surgical working instrument relative to a working channel of an endoscope into which the working instrument is introduced.
• DE 198 58 375 A1 discloses an endoscope with an inserted working instrument which has an electrode which can be displaced within the working instrument.
• a switch is provided, via the actuation or non-actuation of which a coagulation current can be switched. The determination of the position here depends on a switching contact mounted in a defined manner on the work instrument.
• the invention is based on the object of disclosing a device of the abovementioned type in such a way that the position of the surgical working instrument relative to the working channel of an endoscope, into which the working instrument is introduced, can be detected reliably in a simple manner.
• a device having a generator for generating a measurement signal, means for coupling the measurement signal into the working channel and / or the working instrument and / or the endoscope, and a measuring device for measuring a positional effect corresponding to the working instrument exerts its position in the working channel on the measurement signal and to generate a display signal depending on the effect.
• An essential point of the invention is therefore that an interaction between see the working instrument and the endoscope or its working channel is detected, this interaction is a measure of how far the endoscope is inserted into the working channel.
• the interaction may be an electrical interaction or a mechanical interaction, in particular a pneumatic or acoustic interaction.
• the generator is designed such that it generates an alternating current signal or a pulsed direct current signal (with high-frequency alternating current components) as measurement signal, and the measuring device establishes a (complex) resistance between the working instrument and at least parts of the endoscope / or measures at least portions of a wall of the working channel as a positional effect.
• the measurement signal must have at least a frequency of above 300 kHz, since at these frequencies neuromuscular irritations no longer occur.
• the maximum voltage level must also be limited so as not to cause thermal damage in the patient.
• the working instrument forms, together with the (electrically conductive) working channel or its walls or a separate line embedded within the walls, a capacitance or a high-frequency line, so that the capacitance or the length the line can be determined with the distributed over them capacity.
• a resonant circuit or a PLL circuit is suitable, in which the complex resistor is arranged as a variable element for determining a resonant frequency of the resonant circuit or the PLL circuit.
• the surgical instrument comprises a probe with an electrode
• the complex resistance between the electrode and the endoscope and / or the wall of the working channel is measured.
• no separate measuring electrode is necessary here.
• the measuring device for measuring a DC or alternating pressure of a gas in the working channel and / or in a lumen of the working instrument is formed.
• the generator for generating a DC or alternating pressure in the working channel and / or at a distal end of the working channel and / or in the probe as a measuring signal can be constructed very easily.
• a gas supply device which promotes gas in the working channel, the back pressure or the flow resistance in the working channel depends on the length over which the working instrument is inserted into the working channel and thereby reduces its cross section. If the measuring device measures acoustic properties of the system, then the radiation impedance of the working channel (or of a lumen of the working instrument) or else a resonance frequency in the working channel can be measured. Such measuring instruments are easy to set up. The measuring signals are harmless to the patient.
• the measuring device comprises a microphone or similar transducer, which is attached to a proximal end of a lumen of the working instrument.
• the microphone acts as a kind of "probe microphone", which measures the sound introduced into the working channel.
• the measuring device comprises a pressure transducer, which is preferably attached to a proximal end of a lumen of the working instrument, wherein the generator for generating a gas pressure in the working channel and / or in a body cavity is formed, in which the endoscope is insertable.
• a pressure transducer which is preferably attached to a proximal end of a lumen of the working instrument, wherein the generator for generating a gas pressure in the working channel and / or in a body cavity is formed, in which the endoscope is insertable.
• the measuring device may be designed to detect the absolute position of the working instrument within the working channel.
• the measuring device may comprise a change detector for detecting a change in the measuring signal during a change in the position of the working instrument in the working channel. Then, when the working instrument emerges from the working channel (from its distal end) again, then no change would be displayed and the user knows where the instrument is located.
• the above object is achieved by a method for measuring a position of a surgical working instrument relative to a working channel of an endoscope into which the working tool is inserted, by the following steps:
• Generating a measurement signal coupling the measurement signal into the working channel and / or the working instrument and / or the endoscope, measuring a positional effect, which the working instrument according to its position in the working channel on the measurement signal and generating an indication signal depending on the effect.
• the described device for measuring a position of a surgical working instrument is released relative to a working channel of an endoscope into which the working instrument is inserted and for generating an indication signal as a function of the position, wherein a gas supply, depending on the indication signal Suction, a power supply or the supply of a fluid to the working instrument or in the working channel is controlled.
• a gas supply depending on the indication signal Suction, a power supply or the supply of a fluid to the working instrument or in the working channel is controlled.
• FIG. 1 is a highly schematic representation of an endoscope with partially inserted working instrument and periphery
• FIG. 3 shows a partial circuit of the arrangement according to FIG. 1, FIG.
• FIG. 4 shows another embodiment of the invention with an acoustic measuring device and
• FIG - Fig. 5 is a wide imple mentation form of the invention with a pneumatic
• Fig. 1 is (very heavily schematized) shown an endoscope, as it is used in particular in the medical field.
• the endoscope 10 has an optical system 11 which is either connected to an eyepiece device via a glass fiber strand (the arrangement has been shown in the figures) or - and this is generally the case in modern endoscopes - comprises a CCD camera ,
• a working channel 12 is provided, which has a wall 13.
• This wall 13 and the endoscope 10 consists essentially of MetaU.
• a working instrument 20 can be inserted until a distal end 21 of the working instrument 20 emerges from the proximal end 15 of the working channel 12, as shown in Fig. 2. In this position, the distal end 21 of the working instrument 20 is in the field of view of the optic 11 of the endoscope 10.
• the working instrument 20 shown here is an APC probe, as it is known for example from DE 41 39 029 C2 or US 5,207,675.
• a probe has a lumen 23, via which noble gas can be supplied from a gas source 28.
• an electrode 24 is arranged, which is connected at its proximal end to an HF-surgery device.
• this working instrument 20 must be in a position as shown in FIG. 2 so that the user can bring the distal end 21 of the working instrument 20 into proximity to a tissue to be coagulated.
• the electrode 24 of the working instrument 20 and, on the other hand, the (electrically conductive) wall 13 of the working channel are included in a measuring bridge 31, which on the one hand scans a voltage drop across a capacitor C and two resistors R and feeds it to an evaluation device 40 and, on the other hand a high frequency signal (300 kHz) with a defined (low) voltage from a generator 30 is fed into the system.
• the capacitor C is in this case preferably chosen so that when fully inserted into the working channel 12 working instrument 20, the bridge 31 is tuned.
• a similar circuit is shown in Fig. 3 with a PLL gate whose output signal (the tuning frequency corresponding) of the evaluation circuit 40 is fed.
• the evaluation circuit 40 generates a measurement signal which corresponds to the distance by which the working instrument 20 is inserted into the working channel 12.
• the display is a display device 41 and possibly a speaker 42, the arrangement may be made, for example, such that an acoustically perceptible signal is generated whose pitch corresponds to the insertion depth of the working instrument 20 in Hä ⁇ channel 12. Then, when (as shown in FIG. 2) the distal end 21 of the working instrument 20 begins to exit the distal end 14 of the working channel 12, the capacitance between the electrode 24 and the endoscope 10 or wall 13 of the working channel changes 12 no longer, so that the operator can easily notice the exit of the distal end 21 of the working channel 12.
• an acoustic measuring system is provided. This comprises an electro-acoustic transducer or loudspeaker 33, which is connected to the proximal end 15 of the working channel 12 and is fed by a generator 30 'with a sound signal. The sound signal is received via a corresponding electromechanical transducer, for example a microphone 32, which is preceded by the lumen 23 of the working instrument 20 as in a probe microphone.
• the output signal of the converter 32 is again supplied to the evaluation device 40 after appropriate signal processing. Based on the switching level, it can be determined where the distal end 21 is located in the working channel 12 and, in particular, whether it emerges from the distal end 14 of the working channel 12, since in this area the recordable sound pressure drops abruptly. Of course, it would be possible here to swap the two sound transducers 32 and 33, ie to feed the sound signal into the lumen 23 of the working instrument 20 and to measure the sound pressure at the distal end 15 of the working channel 12.
• the acoustic properties of the working channel 12 are determined with inserted Hä ⁇ instrument 20. This can e.g. by the determination of the acoustic impedance, which is provided in the arrangement of FIG. 4 for the transducer 33 and which is dependent on the penetration depth of the working instrument 20 in the working channel 12. Eben ⁇ if alternatively, it is possible to have an acoustic resonance frequency within the Häka ⁇ nals 12, which in turn depends on the depth of insertion of the working instrument 20. Thus, the acoustic measurement similar to the electrical measurement as described above is performed by determining the interaction within the system consisting of working instrument 20 and working channel 12.
• a "static" pressure is determined which is generated by a pressure source 34, introduced into the proximal end 15 of the working channel 12 and via the lumen 23 of the working instrument 20 to a pressure transducer 43 on The measuring signal is then fed back to the evaluation device 40.
• the pressure which is present at the pressure transducer 43 corresponds to the gas pressure at the distal end 21 of the working instrument 20, the lumen 23 of which is actuated by a valve 29 (see Fig. 1) is shut off, which binds this lumen 23 ver ⁇ with the argon gas source 28.
• gas source 34 it is also possible not to connect the gas source 34 to the working channel 12, but to supply gas (for example for insufflation) to a body cavity by means of a separate conduit into which the endoscope 10 is inserted.
• the working instrument 20 would then measure a maximum pressure when the working channel 12 is open proximally when the distal end 21 emerges from the distal end 14 of the working channel 12, since no pressure drop (due to the flow through the working channel) occurs more.
• the valve 29 is then released for opening by a separate signal when the distal end 21 of the working instrument 20 has exited the working channel 12 by a sufficiently large amount (see Fig. 2 and accompanying description).
• the basic principle of the invention is that the working channel 12 is considered in the endoscope 10 together with the working instrument 20 used as an overall system, so that the interactions between the two parts can be used to generate a measuring signal.

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• Life Sciences & Earth Sciences (AREA)
• Health & Medical Sciences (AREA)
• Surgery (AREA)
• Engineering & Computer Science (AREA)
• Molecular Biology (AREA)
• General Health & Medical Sciences (AREA)
• Pathology (AREA)
• Biomedical Technology (AREA)
• Heart & Thoracic Surgery (AREA)
• Medical Informatics (AREA)
• Physics & Mathematics (AREA)
• Veterinary Medicine (AREA)
• Animal Behavior & Ethology (AREA)
• Biophysics (AREA)
• Public Health (AREA)
• Human Computer Interaction (AREA)
• Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
• Optics & Photonics (AREA)
• Radiology & Medical Imaging (AREA)
• Endoscopes (AREA)
• Instruments For Viewing The Inside Of Hollow Bodies (AREA)
• Surgical Instruments (AREA)

Applications Claiming Priority (2)

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• 2004
  • 2004-08-12 DE DE102004039202A patent/DE102004039202B3/de not_active Expired - Fee Related
• 2005
  • 2005-08-05 WO PCT/EP2005/008531 patent/WO2006018163A2/de not_active Ceased
  • 2005-08-05 JP JP2007525232A patent/JP4897682B2/ja not_active Expired - Fee Related
  • 2005-08-05 EP EP05788656A patent/EP1781159A2/de not_active Withdrawn
  • 2005-08-05 CN CN2005800268550A patent/CN101001564B/zh not_active Expired - Fee Related
  • 2005-08-05 US US11/573,493 patent/US20090209809A1/en not_active Abandoned

Non-Patent Citations (1)

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