JP2000287995A - Microscope apparatus for surgery - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a microscope apparatus for surgery wherein there exists no possibility of damaging tissues at an objective sites for medical curing by the apex of an endoscope and even when an operator concentrates on operating a tool for treatment, safety can be confirmed and a lot of instrument are not necessary and a large sample is unnecessary and the range of activity and procedures for surgical operation of the operator are not restricted. SOLUTION: In a microscope apparatus for surgical operation consisting of a microscope for surgical operation and an endoscope 30, a balloon 41 for covering the side edge of the apex face and the neighborhood of the apex of the endoscope is provided at the apex part of an inserting part 36 of the endoscope 30. The pressure of the inside of this balloon is detected by a pressure detecting part 48 connected with a port 45 of the main body part 35. In addition, in accordance with change in the pressure detected by this pressure detecting part 48, it is analysed by an analytical part 49 and in addition, in accordance with the result, an alarm is outputted by an alarm part 50.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a surgical microscope apparatus used in a microsurgery for performing a fine operation, and more particularly, to an operation microscope in which an endoscope is approached to an operation under observation of the surgical microscope. The present invention relates to a surgical microscope apparatus for safely observing and treating a lesion while confirming safety by enlarging and observing a blind spot in a visual field with an endoscope.

[0002]

2. Description of the Related Art Conventionally, various types of surgical microscopes have been developed for microsurgery for performing fine operations.

For example, the position information of an endoscope or a treatment tool loop is superimposed on a CT or MRI tomographic image taken before surgery by using a position detecting and displaying means as disclosed in Japanese Patent Application Laid-Open No. 5-305073. In addition, a method has been adopted in which an endoscope or a treatment tool is introduced into a surgery while confirming the position.

[0004]

However, in the technique disclosed in Japanese Patent Application Laid-Open No. Hei 5-305073, since a tomographic image photographed before the operation is used, the target site and the surrounding tissue are not used for the operation. If the shape is deformed or the relative position shifts during the operation, the position cannot be confirmed accurately. In addition, CT and MRI do not have enough resolution to confirm small structures such as thin blood vessels and nerves, so it is necessary to cut thin blood vessels and nerves with the tip of an endoscope during surgery. However, there is a fear that a minute structure may be damaged.

In addition, since an endoscope or a treatment tool is superimposed on a tomographic image of CT or MRI to confirm a position, an actual observation of a lesion or a treatment tool under an operating microscope is performed for position confirmation. Can no longer concentrate on the operation of.

Further, in this technique, many devices such as a plurality of mark members provided for an operation, a plurality of dedicated signal members to be attached to an endoscope or a treatment tool, and a plurality of receiving members set in an operating room are prepared. In addition to the necessity, many of these devices occupy space in the operation room and in the operating room, which limits the range of activity of the operator. In addition, if there is an operator's hand or arm, or an endoscope or a treatment tool between a signal member provided on an instrument operated during the operation and a receiving member in the operating room, position detection can be performed. There is also a big problem that the movement of the operator himself or the endoscope or the treatment tool is restricted, which causes a trouble in the operation operation.

Therefore, the present invention relates to a surgical microscope apparatus used in a microsurgery for performing a fine operation, wherein the endoscope is brought close to the operation under the observation of the surgical microscope, and the visual field of the surgical microscope is obtained. When observing and treating while observing safety by enlarging the blind spot of the endoscope with an endoscope,
The risk of damaging minute structures such as minute blood vessels and nerves at the tip of the endoscope is suppressed, and even if the operator concentrates on observing the actual lesion or operating the treatment tool under an operating microscope The safety of the endoscope tip can be confirmed, and further, there is no need to prepare many devices, and it occupies space in the operation and the operating room, and restricts the scope of operation and the operation of the operator. It is an object of the present invention to provide a surgical microscope apparatus provided with no safety confirmation means.

[0008]

Means for Solving the Problems That is, the first invention is:
In a surgical microscope apparatus comprising an operating microscope for observing the entire operation and an endoscope for enlarging and observing the operation at a position close to the operation, an edge of the distal end surface of the endoscope and A balloon is provided which covers the vicinity of the distal end of the endoscope, detecting means for detecting the pressure inside the balloon, and warning means which operates according to a change in the pressure detected by the detecting means.

According to a second aspect of the present invention, there is provided a surgical microscope apparatus comprising an operating microscope for observing the entire operation and an endoscope for enlarging and observing the operation at a position close to the operation. It is provided so as to cover at least a part of the endoscope tip, and comprises a detecting means for detecting contact with the tissue, and a warning means which operates when the contact with the tissue is detected by the detecting means. Features.

A third aspect of the present invention is a surgical microscope apparatus comprising an operating microscope for observing the entire operation and an endoscope for enlarging and observing the operation at a position close to the operation. A photographing means for photographing the whole image; a marker provided on the outer peripheral surface near the distal end of the insertion portion of the endoscope; a detecting means for detecting a relative position between the whole operation and the marker; And a warning means that operates when the vehicle deviates by a distance of.

According to the first aspect of the present invention, the distal end of the endoscope is surrounded by an elastic balloon, and the pressure of the liquid filling the balloon is monitored at hand, and when an abnormal pressure change in the balloon is confirmed. Means are provided to alert the surgeon.

According to the second aspect of the present invention, there is provided a detecting means for detecting whether or not a tissue has come into contact with the distal end of the endoscope, and a means for giving a warning to an operator when the contact with the tissue is confirmed. ing.

According to the third aspect of the present invention, a means for detecting a marker provided near the distal end of the endoscope is provided in the imaging optical system of the surgical microscope, and the observation range of the surgical microscope and the relative position of the marker are provided. For warning the operator when the marker deviates from the observation range by a predetermined distance or more.

[0014]

Embodiments of the present invention will be described below with reference to the drawings.

First, a first embodiment of the present invention will be described with reference to FIGS.

FIG. 1A is a diagram showing an endoscope and a configuration of a surgical microscope apparatus according to a first embodiment of the present invention.
FIG. 1B is an enlarged view of the distal end portion of the endoscope of FIG. 1A, FIG. 2 is a configuration diagram schematically showing the entire surgical microscope apparatus according to the first embodiment, FIG. 3 is an enlarged side view of the mirror portion of FIG. 2, and FIG. 4 is a diagram illustrating an internal configuration of the mirror portion.

The surgical microscope apparatus 1 has a base 3 on which a gantry 2 can move on a floor surface, and a column 4 standing vertically on the base 3. Further, one end of a first arm 5 having a built-in illumination light source device (not shown) is provided on the support 4 so as to be rotatable about an axis A1.

Further, the other end of the first arm 5 is attached to one end of a second arm 7 so as to be rotatable about an axis A2. The second arm 7 is configured by a pantograph arm including a link mechanism and a balance adjustment spring member for performing a vertical movement operation. Furthermore, the second arm 7
At the other end, a third arm 8 rotatable about an axis A3 is attached.

The third arm 8 is vertically lowered with respect to the observation direction of the operator 33 of the mirror body 9 about the axis A4.
This arm enables the operator 33 to move up and down in the left-right direction around the center 5. The other end of the third arm 8 is provided with the mirror body 9.

Further, in order to fix the position of the lens body 9 after the position adjustment, the rotating parts of the rotating shafts A1 to A5 are provided with respective electromagnetic brakes (not shown). The electromagnetic brake is connected to an electromagnetic brake power supply circuit (not shown) built in the column 4. Further, as shown in FIG. 3, the electromagnetic brake power supply circuit is connected to a switch 12 provided on a grip 11 fixed integrally to the mirror body 9.

As shown in FIG. 4, the mirror 9 includes an objective lens 13, a variable power optical system 14, and a pair of imaging lenses 15
a, 15b, and a pair of eyepieces 16a, 16b, which are respectively arranged in order on the observation optical axis from the operation, and constitute a stereoscopic observation optical system. The image plane formed by the image forming lens is arranged so as to be position-adjustable as far as the focal positions of the eyepiece lenses a and 16b.

In the mirror body 9, a half mirror 17 is disposed between the variable power optical system 14 and the pair of image forming lenses 15a and 15b to polarize a part of the light beam 90 ° horizontally.
Further, a mirror 18 that reflects the light beam polarized by the half mirror 17 further upward is provided in the mirror body 9.

A camera box 21 is mounted on the mirror body 9, and an imaging lens 19 and a CCD camera 20 are arranged in the camera box 21. The CCD camera 20
Are fixed so as to be arranged on the image forming plane of the image forming lens 19.

As shown in FIG. 3, a holder 24 is mounted on the mirror body 9. The holder 24 has three arms 25, 26, 27 and six rotatable joints 2.
5a, 25b, 26a, 26b, 27a, and 27b.
0 is detachably attached.

As shown in FIGS. 2 and 3, the endoscope 30 does not block the optical axis O1 connecting the treatment target part 32 of the patient 31 disposed below the mirror body 9. The endoscope 30 is fixed at the position.

FIG. 1A is a diagram showing the overall appearance and configuration of the endoscope 30. As shown in FIG.

The endoscope 30 has a main body 35 and an insertion portion 36, and is provided with an illumination optical system (not shown) extending from the hand to the distal end, and an observation optical system (not shown).
By illuminating the treatment site located in front of the insertion section 36 with the illumination light, the observation image of the treatment site can be transmitted to the user.

The distal end surface 38 of the insertion portion 36 has a structure shown in FIG.
As shown in FIG. 2, an objective lens 39 located at the tip of the observation optical system and an emission end 40 of the illumination optical system are arranged. The objective lens 39 is, as shown in FIG.
It may be provided obliquely with respect to the insertion section 36 so that illumination and observation can be performed obliquely in front of the insertion section 36.
May be provided so as to be perpendicular to the insertion portion 36 so that illumination and observation in front of the insertion portion 36 can be performed. Observation may be made possible.

A balloon 41 is provided at a position covering the outer periphery of the distal end surface 38 of the insertion section 36 and the vicinity of the insertion section distal end.
The inside of the balloon 41 is filled with a fluid 42 such as a liquid or a gas.

A port 45 is provided in the main body 35, and a channel 46 connecting the port 45 and the balloon 41 is provided along the insertion portion 36. The port 45 has a base 47 for injecting and discharging the fluid 42 and a pressure detecting unit 48 for detecting the pressure of the liquid.
Is connected. The pressure detecting section 48 is connected to an analyzing section 49 for analyzing a change in pressure, and further connected to the analyzing section 49 is a warning section 50 for issuing a warning according to a predetermined pressure change.

The fluid 42 is a liquid such as physiological saline or sterilized water, or a gas such as air or an inert gas.

The warning unit 50 includes a speaker for generating a warning sound, a lamp for notifying the warning by light, or an eyepiece 16a for superimposing and displaying the warning on an observation image of a surgical microscope. , 16b or CCD
Warning display superimposing means provided near the camera 20, etc.
Any one may be used.

Further, although not shown, a CCD camera is connected to a hand of the main body 35 of the endoscope 30 so as to be located on an image plane of an observation image transmitted by the observation optical system of the endoscope 30. , Has been fixed.

In such a configuration, the surgeon 33 looks at the eyepieces 16a and 16b, observes the entire operation, and confirms the safety of the operation, while checking the safety of the endoscope 30 attached to the holder 24. The distal end of the insertion section 36 is made to approach the surgical site. With the endoscope 30, an enlarged image of the operation or an observation image of the side surface or the back surface of the tissue that cannot be seen with the operation microscope can be obtained from a place very close to the operation.

Since the endoscope 30 is attached to the holder 24, camera shake during operation of the endoscope 30 can be suppressed. It is possible to release the hand from the endoscope 30 and concentrate on the operation of the treatment tool (not shown).

By the way, the microscope image is obtained from the eyepiece 16.
a and 16b, the CCD camera 20
, And projected on a television monitor (not shown) for viewing. The endoscope image can be captured by a CCD camera (not shown) connected to the endoscope 30 and projected on a television monitor (not shown) for viewing. Further, the observation image of the microscope and the observation image of the endoscope can be displayed side by side on the same monitor.

When a fluid such as physiological saline is injected by connecting a syringe or the like to a base 47 provided on the main body of the endoscope 30, the fluid flows into the balloon 41 through the channel 46 to fill the balloon 41. . The balloon 41 covers the outer periphery of the endoscope distal end surface 38 and the vicinity of the endoscope distal end, and plays a role of a cushion so that the tissue is not damaged by the endoscope 30.

Further, the fluid 42 in the balloon 41 communicates with a pressure detecting section 48 connected to a port 45 via a channel 46.
The pressure of the fluid 42 within 1 is measured.

The pressure data detected by the pressure detecting section 48 is sent to the analyzing section 49, and first, a pressure value in an initial state is stored. Thereafter, during operation of the endoscope 30, the pressure determined to be abnormal is monitored while monitoring the presence or absence of a pressure change when a tissue or another treatment tool touches the balloon 41 at the distal end of the endoscope to compress the balloon. If a change has occurred, an “abnormal” signal is sent to the warning unit 50.

When the operator 33 recognizes the sound, light, warning display on the observation image, etc. emitted from the warning section 50, it is determined that there is a possibility that the tip of the endoscope may come into contact with tissue or other treatment tools. Is done. As a result, operations such as operation observation and treatment are immediately interrupted, and an operation for ensuring safety of the endoscope tip can be performed.

As described above, when the operator 33 concentrates on the microscope image or the endoscope 30, the operator often forgets to confirm the position of the tip of the endoscope 30. According to this, since the outer periphery of the endoscope distal end surface 38 and the vicinity of the endoscope distal end are covered with the balloon 41, the balloon 41 becomes a cushion, and even if the distal end of the endoscope 30 is pressed against the tissue, the tissue may be damaged. Is reduced.

Further, even if the operator 33 concentrates on operations such as observation and treatment of the operation, the change in pressure when the balloon 41 is pressed by the contact of the tissue with the balloon 41 and other treatment tools can be detected by sound, sound, or the like.
Since it can be recognized by light, warning display on the observation image, etc., it is possible to confirm that there is a risk that tissue or other treatment tools may come into contact with the endoscope tip, and to immediately perform the operation to ensure safety of the endoscope tip Can wake up.

As shown in FIGS. 5 (a) and 5 (b), when a plurality of projections 54 are provided on the outer periphery of the balloon 53 so that the balloon can be easily deformed even with a small stress, the pressure change is reduced. Detection can be performed with high sensitivity.

Further, similarly to the first embodiment, the pressure in the balloon 53 can be monitored by a pressure detecting unit (not shown) through a channel 55.

Although not shown, a piezoelectric element having a shape that does not damage the tissue is provided at the tip of the endoscope 30 instead of the balloon, and a pressure conversion circuit connected to the end of the endoscope 30 by a lead wire is provided. It is good also as a form which sends an electric signal.

Next, a second embodiment of the present invention will be described.

FIG. 6 illustrates an endoscope used together with a surgical microscope apparatus (not shown), and is an enlarged view of a distal end portion of an insertion section and a view showing the appearance and configuration of the insertion section and the main body.

In FIG. 6, a piezoelectric element 64 is provided at a distal end 62 of an insertion section 61 of an endoscope 60 at a position covering the distal end of the distal end 62. A lead wire 65 extends from the piezoelectric element 64 to the main body 63 at hand. The analysis unit 49 and the warning unit 50 are connected to the lead wire 65 at hand.

The warning unit 50 is, as in the first embodiment, a speaker for generating a warning sound, a lamp for notifying a warning by light, or a warning superimposed on an observation image of a surgical microscope. Any of an eyepiece of an operating microscope, a warning display superimposing means provided near a CCD camera, or the like may be used for display.

Further, means for changing the sensitivity of the piezoelectric element 64 and the set value of the analysis unit 49 may be provided so that contact with a minute tissue can be detected or control can be performed so as to suppress malfunction.

In such a configuration, when the distal end of the endoscope is pressed against the tissue during the operation, first, the piezoelectric element 6 is pressed.
4 contacts the tissue. Then, the signal of the contact pressure of the tissue detected by the piezoelectric element 64 is sent to the analysis unit 49 and the warning unit 50 via the lead wire 65. Thereby, the warning unit 5
At 0, a warning is issued to the operator 33 by sound, light, warning display on the observation image, or the like.

According to the second embodiment, since no fluid is used unlike the first embodiment, preparation can be simplified.

Next, a third embodiment of the present invention will be described.

FIG. 7 is an enlarged cross-sectional view of a distal end portion of an endoscope used with an operating microscope apparatus (not shown).

In FIG. 7, a probe 72 having a spherical tip is provided in the distal end of the endoscope 70. The distal end of the probe 72 projects forward from the distal end surface 73 of the endoscope 70, and is slidable in the longitudinal axis direction of the endoscope 70.

Behind the rear end face 74 of the probe 72, a spring 75 is provided coaxially with the probe 72.
The probe 72 is biased forward. Further, a position sensor 76 is provided near the rear end of the probe 72 along the probe 72, and detects the position of the rear end surface of the probe 72. A lead wire 77 extends rearward from the position sensor 76 and is connected to an analysis unit and a warning unit (not shown) provided on the hand side of the endoscope 70.

The other configuration is the same as that of the above-described second embodiment, and the description is omitted.

In such a configuration, during the operation, when the tip of the endoscope approaches the tissue and the probe 72 touches the tissue, the probe 72 moves backward. Then, the movement of the probe 72 is detected by the position sensor 76, and a signal as a result of the detection is sent to the analysis unit and the warning unit via the lead wire 77. Thus, a warning is issued to the operator by the warning unit.

According to the third embodiment, the portion exposed to the outside of the endoscope 70 is formed as a probe so as to be connected to a tissue, so that the third embodiment is different from the second embodiment described above. Resistant to rubbing and cleaning sterilization.

Next, a fourth embodiment of the present invention will be described with reference to FIGS.

FIG. 8 is an external view of an endoscope used together with a surgical microscope apparatus (not shown), and FIG. 9 is a view when the endoscope is brought close to the operation to observe an enlarged operation or observe a blind spot of the operation microscope. FIG. 4 is a view showing an observation image of the surgical microscope of FIG.

The endoscope 80 is composed of an insertion section 81 and a main body section 82, and one or more color markers 83 are provided on the outer surface near the tip of the insertion section 81. Then, within a range of an observation image 84 as shown in FIG. 9 captured by a CCD camera of a surgical microscope (not shown), the color marker 83 is formed using an image calculation processing circuit having a color correlation calculation circuit (not shown). The presence or absence is detected.

The image processing circuit is connected to a warning unit (not shown), and when the color marker 83 is not present in the observed image, a signal is sent to the warning unit.

The other configuration and the operation of the fourth embodiment are the same as those of the above-described second embodiment, and therefore the description is omitted.

According to the fourth embodiment, since the endoscope does not require any components other than the color markers, the endoscope is extremely easy to clean, sterilize, and handle.

Next, a fifth embodiment of the present invention will be described with reference to FIGS.

In FIG. 10, the fixed frames 91a and 91b are sandwiched so as to sandwich the entrance 90 of the treatment target portion 32 of the patient 31.
Is fixed. A light emitting element 92 is mounted on one fixed frame 91a, and a light receiving element 93 is mounted on the other fixed frame 91b.
It is positioned to cross zero. Further, a notification unit 94 is connected to the light receiving element 93.

In such a configuration, when an endoscope or a treatment tool 95 (not shown) is inserted through the entrance 90, the light output from the light emitting element 92 emits light.
So that it does not reach the light receiving element. Therefore, the operator is notified by the notification section 94 connected to the light receiving element 93, and the operator places the endoscope or the treatment tool 95 in the treatment target site.
Can be recognized.

As described above, according to the fifth embodiment,
Even without looking into the surgical microscope image or directly looking at the treatment target site, the surgeon can always recognize that the endoscope or treatment tool is present at the treatment target site, and can confirm safety through surgery. .

[0070]

As described above, according to the present invention, in a microsurgery for performing a fine operation, the endoscope is brought close to the operation under the observation of the operation microscope to reduce the blind spot of the visual field of the operation microscope. When performing observation or treatment while confirming the safety of surgery by magnifying observation with an endoscope, the risk of damaging small blood vessels, nerves, and minute structures at the end of the endoscope can be suppressed, and the operator can The ability to confirm the safety of the endoscope tip even when focused on actual observation of lesions and operation of treatment tools under an operating microscope, and also requires many devices for safety confirmation In addition, these devices can safely perform observation and processing without occupying space in an operation and an operating room by using these devices, and without limiting the scope of operation and operation of an operator.

[Brief description of the drawings]

FIG. 1A is a diagram showing an endoscope and a configuration of a surgical microscope apparatus according to a first embodiment of the present invention, and FIG. 1B is an enlarged view of a distal end portion of the endoscope in FIG. FIG.

FIG. 2 is a configuration diagram schematically showing the entire surgical microscope apparatus according to the first embodiment.

FIG. 3 is an enlarged side view showing a mirror portion of FIG. 2;

FIG. 4 is a diagram showing an internal configuration of a mirror portion of FIG. 2;

FIG. 5 shows a modification of the first embodiment,
(A) is a perspective view showing an enlarged end portion of the endoscope,
FIG. 2B is an enlarged side sectional view showing a distal end portion of the endoscope.

FIG. 6 is a view for explaining a second embodiment of the present invention, and is an enlarged view of a distal end portion of an insertion portion of an endoscope and a diagram showing appearances and configurations of an insertion portion and a main body portion.

FIG. 7 is an enlarged sectional view of a distal end portion of an endoscope for explaining a third embodiment of the present invention.

FIG. 8 is a view for explaining a fourth embodiment of the present invention, and is an external view of an endoscope.

FIG. 9 is a view for explaining a fourth embodiment of the present invention, in which an endoscope is brought close to an operation, and an operation microscope is observed while enlarging the operation and observing a blind spot of the operation microscope. It is the figure which showed the image.

FIG. 10 is a view for explaining a fifth embodiment of the present invention, and is a diagram showing the vicinity of a treatment target site of a patient.

FIG. 11 is a sectional view for explaining a fifth embodiment of the present invention and showing the vicinity of a treatment target site of a patient.

[Explanation of symbols]

 DESCRIPTION OF SYMBOLS 1 Operating microscope apparatus, 2 bases, 3 bases, 4 columns, 5 1st arm, 7 2nd arm, 8 3rd arm, 9 mirror body, 11 grip, 12 switch, 13, 39 objective lens, 14 variable power optics System, 15a, 15b, 19 imaging lens, 16a, 16b eyepiece, 17 half mirror, 18 mirror, 20 CCD camera, 24 holder, 28 fixing part, 30 endoscope, 31 patient, 32 treatment site, 33 surgery Person, 35 body part, 36 insertion part, 38 tip surface, 40 emission end, 41 balloon, 42 fluid, 45 port, 47 base, 48 pressure detection part, 49 analysis part, 50 warning part.

Continued on the front page (72) Inventor Keiji Shiota 2-43-2 Hatagaya, Shibuya-ku, Tokyo Inside Olympus Optical Industrial Co., Ltd. (72) Inventor Koji Yasunaga 2-43-2 Hatagaya, Shibuya-ku, Tokyo Olympus Optical Within Kogyo Co., Ltd. (72) Inventor Naritasu Kishioka 2-43-2 Hatagaya, Shibuya-ku, Tokyo Olympus Optical Co., Ltd. (72) Inventor Shinsho Yasukui 2-34-2 Hatagaya, Shibuya-ku, Tokyo Olympus Within Optical Industry Co., Ltd. (72) Inventor Toshiya Sugai 2-43-2 Hatagaya, Shibuya-ku, Tokyo Olympus Optical Industry Co., Ltd. (72) Inventor Hibiki Imagawa 2-43-2, Hatagaya, Shibuya-ku, Tokyo Olympus Inside Optical Industry Co., Ltd. (72) Koji Shimomura, Inventor Koji Shimomura 2-43-2, Hatagaya, Shibuya-ku, Tokyo Inside Olympus Optical Industry Co., Ltd. (72) Kazutaka Nakachi 2-43-2, Hatagaya, Shibuya-ku, Tokyo Ori (72) Who Nakamura Takeaki Tokyo, Shibuya-ku, Hatagaya 2-chome No. 43 No. 2 Olympus Optical Industry Co., Ltd. in

Claims (5)

[Claims] 1. A surgical microscope apparatus comprising: a surgical microscope for observing the entire operation; and an endoscope for enlarging and observing the operation at a position close to the operation. A balloon that covers an edge of the surface and the vicinity of the endoscope end; a detection unit that detects a pressure inside the balloon; and a warning unit that operates according to a change in pressure detected by the detection unit. A surgical microscope apparatus characterized by the above-mentioned. 2. An operation microscope apparatus comprising: an operation microscope for observing the entire operation; and an endoscope for enlarging and observing the operation at a position close to the operation. Surgical means provided so as to cover at least a part thereof, comprising: detecting means for detecting contact with tissue; and warning means which operates when the detecting means detects contact with the tissue. Microscope equipment. 3. The detecting means includes a piezoelectric element provided near the distal end of the endoscope so as to be capable of contacting tissue, and a means for analyzing a signal of the piezoelectric element. The surgical microscope apparatus according to claim 2, wherein the apparatus operates according to an analysis result of the analysis means. 4. The detecting means includes: a movable part provided at the tip of the endoscope so as to be capable of contacting tissue; a detecting means for detecting a force applied to the movable part; and a signal from the detecting means. 3. The surgical microscope apparatus according to claim 2, further comprising: a warning unit that operates in response to a change in a predetermined stress in the analysis unit. 5. A surgical microscope apparatus comprising an operating microscope for observing the whole operation and an endoscope for enlarging and observing the operation at a position close to the operation, wherein an entire image of the operation is taken. Imaging means, a marker provided on the outer peripheral surface near the distal end of the insertion portion of the endoscope, detecting means for detecting a relative position between the entire operation and the marker, and the marker deviated from the entire operation image by a predetermined distance. A surgical microscope apparatus comprising: a warning unit that operates at the time.