JP2003111773A - Operation system - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide an operation system which allows an operator who is poorly experienced with respect to an object case to easily and precisely select a surgical treating instrument and perform the optimum setting. SOLUTION: The operation system 1 is provided with an optical scanning probe 78 for obtaining an optical diagnostic image at the optional position of a part to be operated and an ultrasonic sucking apparatus 81 for treating the part to be operated. The system also includes an image memory 75 for recording the diagnostic image obtained by the optical scanning probe 78, a diagnostic image data base 74 for storing the images of the part to be treated and treatment part images having treatment information such as the setting states of an ultrasonic sucking implement 81 and a treatment apparatus, or the like, concerning the treatment, a comparison arithmetic part 76 for comparing the diagnostic image of the optical scanning probe 78 with a plurality of treatment part image stored in the diagnostic image data base 74 and a treatment apparatus setting information generating part 77 for setting the condition of the ultrasonic sucking implement 81 based on the arithmetic result.

Description

Detailed Description of the Invention

[0001]

FIELD OF THE INVENTION The present invention relates to a surgical system including an energy treatment device.

[0002]

2. Description of the Related Art In recent years, in the medical field, an operating system is constructed by combining an observing device and an operating device in accordance with a region to be operated and a procedure. As the observation device, an endoscope having a flexible insertion portion to be inserted into the body cavity from the oral cavity or anus or a flexible laparoscope having an insertion portion to be placed in the abdominal cavity through a trocar punctured in the abdominal wall (optical Tubes) and surgical microscopes that can magnify and observe minute nerves and blood vessels.

On the other hand, as a surgical device, there is a surgical device driven by a power source in addition to surgical instruments such as grasping forceps and a scalpel. As a surgical device driven by the electric power supplied from this power source, for example, ultrasonic treatment is used to vibrate the treatment instrument, and the vibration of the treatment instrument incises or coagulates or crushes the biological tissue that is the target site. There is an ultrasonic surgical device that sucks in and out, an electric scalpel device that incises and coagulates the living tissue that is the target site by the thermal action of high-frequency power, and a power treatment tool that finely crushes the living tissue by rotational force .

In the field of neurosurgery, as an example of a surgical system, there is a microscopic surgery system as a medical system for enlarging and observing fine nerves and blood vessels and performing surgery under microscope observation. In this surgical operation system under a microscope, a treatment is performed by operating a handpiece or the like while observing an enlarged target site through an eyepiece of a surgical microscope. For example, an energy treatment tool such as an ultrasonic suction device is used when performing treatment such as crushing or extracting a tumor. In this case, if the selection of the probe shape of the energy treatment tool to be used, the output setting, etc. are not appropriate, the usability will be reduced. In other words, experience was required to be able to accurately select the probe shape and set the output.

In order to solve the above-mentioned problems, the present applicant has proposed a surgical energy treatment system in Japanese Patent Application No. 2000-10920. In this surgical energy treatment system, the physical state of the tissue near the surgical site is automatically detected, and the energy treatment tool can be automatically set based on the detection result.

[0006]

However, an inexperienced operator may make trial and error in selecting the probe shape of the energy treatment tool and setting the output, which has been a factor in prolonging the operation.

The present invention has been made in view of the above circumstances, and it is an object of the present invention to provide a surgical system in which even an operator who has little experience with a target case can easily and accurately select a treatment tool and perform optimum setting. I have to.

[0008]

A surgical system according to the present invention comprises an optical scanning probe for acquiring an optical diagnostic image at an arbitrary position on a surgical site, and an energy treatment tool for treating the surgical site. A surgical system comprising a recording unit for recording a diagnostic image acquired by the optical scanning probe, a plurality of treatment region images having treatment region images and treatment information such as energy treatment instruments and treatment instrument setting states relating to the treatment. , A diagnostic image database that has been accumulated, a diagnostic image of the optical scanning probe, a comparison operation unit that compares a plurality of treatment site images accumulated in the diagnostic image database, and based on the operation result of this comparison operation unit And an energy treatment tool setting section for setting conditions of the energy treatment tool.

Further, it has a position detecting means for detecting the position of the optical scanning probe with respect to the operation part, and the comparison operation part has the position information detected by the position detecting means and the treatment site accumulated in the diagnostic image database. The position information of the image is used as a parameter in the calculation.

Further, the setting change means for changing the setting state of the energy treatment tool to a desired state, at least the set value changed by the setting change means and the diagnostic image acquired by the optical scanning probe are used for the diagnosis. Database registration means for registering a treatment site image in the image database is provided.

According to this configuration, the treatment site image most similar to the image of the treatment site is obtained from the diagnostic image database,
After that, the energy treatment tool is set via the energy treatment tool setting unit based on the treatment information included in the treatment region image.

Further, the comparison operation section compares the position data of the position detecting means with the position information of the treatment portion image to obtain a treatment portion image most similar to the treatment portion image.

Further, the treatment information recorded in the treatment region image read out from the diagnostic image database can be updated, and the treatment region image recording the updated treatment information is registered in the diagnostic image database.

[0014]

BEST MODE FOR CARRYING OUT THE INVENTION Embodiments of the present invention will be described below with reference to the drawings. 1 to 7 relate to a first embodiment of the present invention, FIG. 1 is a diagram illustrating a configuration of a surgical microscope system, and FIG. 2 is a diagram illustrating an internal configuration of a binocular eyepiece tube portion which is a mirror body, FIG. 3 is a side view of FIG. 2, which illustrates a configuration of an eyepiece optical system of a mirror body and a second observation optical system, FIG. 4 illustrates a superposition unit, and FIG. 5 illustrates a main part of a surgical microscope system. FIG. 6 is a diagram illustrating a configuration of a unit, FIG. 6 is a diagram illustrating an example of a treatment site image recorded in a database, and FIG. 7 is a diagram illustrating a microscope observation image and setting data displayed on a microscope.

As shown in FIG. 1, the surgical system of this embodiment is a surgical microscope system 1. This system is mainly composed of a microscope body 2 attached to a pedestal 3 and a measurement mounted on, for example, a cart. Device 18, A / D converter 17, workstation (hereinafter abbreviated as WS) 19, monitor 16
Etc. and a digitizer (optical position detection device) 12 installed at a predetermined position in the operating room.
A camera control unit for an endoscope, an optical scanning probe, an observation device for the optical scanning probe, and the like (not shown) are also installed. The pedestal 3 has a base 4 movable on the floor surface, a support 5 standing on the base 4, and an upper end of the support 5 with one end rotatably about an axis O1. , A first arm 6 incorporating a light source for illumination (not shown)
A second arm 7 having one end attached rotatably around an axis O2 provided at the other end of the first arm 6, and an axis O3 provided at the other end of the second arm 7. It is mainly configured with a third arm 8 whose one end is rotatably attached to the center. The mirror body 2 is provided at the other end of the third arm 8. The mirror 2 is capable of tilting in the front-back direction with respect to the operator's observation direction about the axis O4 and tilting in the left-right direction of the operator around the axis O5.

The second arm 7 is a pan tag clutch which is composed of a link mechanism and a spring member for balance adjustment in order to perform a vertical movement operation. Further, in order to adjust the position of the mirror body 2 spatially freely and fix the position, an electromagnetic brake (not shown) is provided on each of the rotating parts of the rotary shafts O1, ..., O5. These electromagnetic brakes are connected to an electromagnetic brake power supply circuit (not shown) built in the column 5.

The digitizer 12 is a receiving member 2
CCD cameras 13a, 13b and a camera holding member 14 for fixing the positions of the CCD cameras 13a, 13b
And a stand 15 that supports the camera holding member 14.

The CCD cameras 13a and 13b are connected to the measuring device 18, respectively. This measuring device 1
8 is connected to WS 19 via the A / D converter 17,
This WS 19 is connected to the monitor 16.

It should be noted that, in the WS 19, tomographic image data obtained by an image diagnostic apparatus (not shown) such as CT or MRI, or three-dimensional image data obtained by processing the tomographic image data to reconstruct three-dimensionally are recorded in advance before operation. Has been done.

As shown in FIGS. 2 and 3, a pair of left and right imaging lenses 20a and 20b are disposed inside the fixed housing 20 which constitutes the mirror body 2. This imaging lens 2
0a and 20b are optically connected to the observation optical system of the mirror body 2 so that the left and right observation light fluxes emitted from the mirror body 2 are made incident.

Reference numerals 21a and 21b denote the imaging lens 20.
These are mirrors that respectively reflect the light fluxes that have passed through a and 20b outward by 90 °, and image rotator prisms 22a and 22b are disposed on the emission optical axes thereof.

The image rotator prism 22a,
Behind 22b, prisms 23a and 23b for inverting both observation light beams by 180 ° are arranged. Behind the prisms 23a and 23b, triangular prisms 24a and 24b are arranged and fixed to reflect the outgoing optical axis in a direction parallel to the observation optical axes OL and OR by the eyepiece optical system described later.

Then, the triangular prisms 24a, 24b
Is located behind the first intermediate image forming points 25a and 25b formed by the image forming lenses 20a and 20b, and a light guide described later is provided in the vicinity of the first intermediate image forming points 25a. The prisms 26a and 26b as means are provided so that the upper surfaces thereof substantially coincide with each other, and relay lenses 27a and 27b for relaying an image are disposed and fixed behind the first intermediate image formation points 25a and 25b. The prisms 23a and 23b, the triangular prisms 24a and 24b, and the relay lenses 27a and 27b are contained in the movable housing 28.

The movable housing 28 has a connecting portion 28.
a, 28b, the axis OP, that is, the prism 2
It is rotatable about the incident optical axes of 3a and 23b. Also, the rotator prisms 22a and 22b
Is the movable housing 2 by a cam mechanism or the like not shown.
It is rotatable about the axis OP by a half angle with respect to the rotation of the fixed housing 20 of FIG.

Reference numerals 29a and 29b denote incident / reflecting surfaces 30.
The parallel prism is composed of a and 30b and emission and reflection surfaces 31a and 31b, and is a reflecting member built in the eye width adjustment housings 7a and 7b. The first intermediate image forming point 25
The images transmitted from the a and 25b by the relay lenses 27a and 27b are output from the output reflection surfaces 31a and 31b of the parallel prisms 29a and 29b to the second intermediate image forming point 3 respectively.
An image is formed on 2a and 32b. Then, a pair of eyepiece optical systems 33a, 3 built in the eyepiece housings 8a, 8b.
3b, and the observation optical axis OR, as a microscope optical observation image,
It constitutes the OL.

Here, the eye width adjusting housings 7a, 7
b is a triangular prism 24 with respect to the movable housing 28.
a, 24b is rotatable about an axis substantially coincident with the output optical axis (vertical direction in the figure), and as shown in FIG. 3, retaining members 34a, 34b (reference numeral 34a in the figure
Only)) and is supported immovably in the axial direction. This structure and the parallel prisms 29a and 29b constitute a so-called Geetentop interpupillary adjustment mechanism.

On the other hand, as shown in FIG. 3, a second eyepiece housing 9 for accommodating the second observation optical system is provided outside the first observation optical system. The second observation optical system is a small LCD monitor 38 that displays an image of an endoscope or the like as an electronic image under the control of a controller (not shown), and an optical axis OL2 emitted from the LCD monitor 38.
The relay optical systems 39 and 41 arranged above, the prism 40 arranged inside the relay optical systems 39 and 41 for reflecting the optical axis OL2 by approximately 90 °, and the prism 40
And a prism 43 for polarizing the optical axis reflected by the prism toward the observation optical axis OL direction. A second eyepiece optical system 42 is optically arranged and connected on the outgoing optical axis OL2. The observation optical axes OL and OL2 intersect each other near the exit pupil position.

The small LCD monitor 38 is provided in the movable housing 2 below the interpupillary adjustment housing 7a.
It is arranged and fixed between 8 and. Although only the left optical path is shown in the figure, the right optical path has the same configuration.

As shown in FIG. 4, the objective optical system 4 is attached to the mirror body 2.
4, a variable power optical system 45, and an eyepiece optical system are built in to form a pair of left and right optical paths. The objective optical system 44 is provided with a focus variable mechanism and a focal length detecting sensor. Further, the variable power optical system 45 is provided with a variable power mechanism and a variable power detection sensor.

The mirror body 2 is provided with an optical path inserting means 46 composed of a half mirror and an image inserting optical system 47. The image inserting optical system 47 converts the light beam emitted from the image superimposing monitor 48 into an afocal light beam and inserts the optical path. It is adapted to be incident on the means 46. Reference numeral 48a is a cable for sending an image signal to an image superimposing monitor (also referred to as an LCD for superimposing) 48.

As shown in FIG. 5, in the present system 1, an optical scanning probe 78 for observing, for example, a cell image which is a diagnostic image of a surgical site in which an index 78a whose position can be detected by the digitizer 12 is arranged, and its observation device. 79, an ultrasonic suction device 81 to which a handpiece 82 as an energy treatment tool is connected, and a second workstation (hereinafter abbreviated as 2WS) 73 for recording a diagnostic image and performing image processing are provided. ing.

The 2WS 73 has a diagnostic image database (hereinafter abbreviated as DB) 7 in which treatment site images are accumulated.
4, an image memory 75, which is a recording unit, and a comparison calculation unit 76.
And a treatment instrument setting information generation unit 77 which is an energy treatment instrument setting unit. Then, the comparison calculation unit 7
6, the DB 74, the treatment tool setting information generating unit 77, the ultrasonic suction device 81, the image memory 75, and the WS 19 are connected. In addition, the observation device 79 uses the image memory 7
Connected to 5. Further, an image generating section 87 and an ultrasonic suction device 81 are connected to the treatment instrument setting information generating section 77, and the LCD 38 for displaying an image is connected to the image generating section 87.

In the DB 74, data 83 as shown in FIG. 6, for example, is recorded as one of the treatment region images. The data 83 includes information about a treatment site, information about a case, image data 84 about a case, various set values 85 when a treatment is performed, and the handpiece 82.
Various types of information such as the shape 86 are stored. In other words, the image acquired by the optical scanning probe and the type and setting condition of the handpiece when the image is treated are one data.

The operation of the surgical microscope system 1 configured as described above will be described. The operator using this system 1 is assumed to be an operator who has little experience with the target case.

First, the operator moves the mirror body 2 and adjusts it so that the operation site can be observed. Then, the observation optical system of the microscope is operated by a foot switch (not shown) or the like to start observation of the surgical site. Then, the operator uses the optical scanning probe 78 to perform a cell diagnosis of the surgical site, and obtains a diagnostic image of the surgical site, for example, as shown by the applicant in Japanese Patent Application No. 2000-151090.

Then, the digitizer 12 detects the tip position of the optical scanning probe 78 by detecting the index 78a attached to the optical scanning probe 78. Therefore, when the diagnostic image is acquired by the optical scanning probe 78, the tip position information of the optical scanning probe 78 is transmitted to the image memory 75 via the WS 19 and the comparison operation unit 76 together with the diagnostic image. In addition, the diagnostic image acquired by the operator is also stored in the image memory 7 from the observation device 79.
5 is transmitted.

That is, in the image memory 75, the diagnostic image acquired by the observation device 79 and the tip position information of the optical scanning probe 78 when the diagnostic image is acquired are combined and recorded as diagnostic image data.

Next, the comparison operation unit 76 acquires the diagnostic image data from the image memory 75, while the DB 74
The comparison calculation with the treatment site image data stored in is performed. That is, in the comparison calculation unit 76, the DB 74
Image group data stored in the image memory 75 and the image memory 75.
Performs pattern matching with the diagnostic image data acquired from.

By this pattern matching, the treatment site image data most similar to the diagnostic image data among the image group data in the DB 74 is displayed, for example, as shown in FIG.
The data 83 shown in is selected. Then, this data 8
Information regarding the condition setting of the treatment tool from the information stored in No. 3 is transmitted from the comparison calculation unit 76 to the treatment tool setting information generation unit 77.

Next, in the treatment instrument setting information generating section 77,
Information for condition setting is sent to the LC through the image generation unit 87.
The information for setting is transferred to the ultrasonic suction device 81 while being displayed on D38. At this time, the operator is observing the microscope with the microscope observation image 88 shown in FIG.
Setting data 89 including output setting information and probe type information to be used is displayed via the second observation optical system.

On the other hand, the ultrasonic suction device 81 to which the setting information has been transferred acquires the information sent from the treatment instrument setting information generating section 77. This completes the setting of the ultrasonic suction device 81. After this, the operator
The probe B displayed (instructed) on the observation optical system is connected to the ultrasonic suction device 81 to start the treatment of the surgical site.

As described above, after transmitting the acquired diagnostic image to the image memory, the comparison operation unit acquires the diagnostic image data transmitted to the image memory, and at the same time, compares the diagnostic image data stored in the DB with the treatment site image data. By performing a comparison operation to obtain the treatment site image data that is most similar to the diagnostic image data, the information regarding the condition setting of the treatment tool is selected from the information stored in the treatment site image data. By transferring the treatment tool to the treatment tool via the generation unit, the condition of the treatment tool can be optimally set.

As a result, even an operator who has little experience with the target case can quickly and surely set the energy treatment tool without trial and error, and the operation time can be shortened.

The second embodiment will be described below.
The present embodiment is an embodiment in which the condition setting of the treatment portion based on the treatment site image data obtained in the first embodiment is manually changed, and then the condition setting can be stored in the database. In addition to the above contents, the display image position of the second observation optical system capable of displaying the condition setting of the treatment tool can be changed.

Regarding this matter, the present applicant filed a Japanese Patent Application 2000
No. 193,223 proposes a surgical microscope. In this surgical microscope, a second observation optical system is provided as an observation optical system different from the observation optical system for the microscope so that the operator can set the energy treatment tool and the like without taking the eye from the microscope eyepiece. , And is displayed on the second observation optical system for confirmation.

However, in this surgical microscope, when the display position of the second observation optical system is fixed, it is desired to compare the image displayed on the second observation optical system with the microscope observation image. In this case, or even if the display image of the second observation optical system is erased, there is a problem that it cannot be used properly, for example, it is desired not to interfere with observation of the microscope image.

In this embodiment, in addition to the first embodiment,
The purpose is to be able to manually set the treatment tool and to be able to move the display position of the second observation optical system depending on the state of use of the observation optical system.

8 to 15 relate to the second embodiment of the present invention, FIG. 8 is a view for explaining another configuration of the surgical microscope system, and FIG. 9 is a side view for explaining the internal configuration of the binocular eyepiece tube portion. FIG. 10, FIG. 10 is a view for explaining the relationship between the pinion gear and the rack, FIG. 11 is a view from the direction of arrow A in FIG. 10, and FIG. 12 is a screen for changing the microscope observation image and the setting state of the ultrasonic suction device. FIG. 13 is a diagram for explaining a state in which the eyepiece housing is moved with respect to the movable housing, and FIG. 14 is a relationship between a microscope observation image before the eyepiece housing is moved and a screen by the second observation optical system. FIG. 15 is a diagram showing a relationship between a microscope observation image after the eyepiece housing is moved and a screen by the second observation optical system. The surgical microscope system of the present embodiment can manually set the condition of the treatment tool, and the operator who uses it is an operator who has a lot of experience with the target case.

As shown in FIG. 8, the surgical microscope system 1A of the present embodiment is provided with a superimposed image generating section 80, a line-of-sight detecting device 101 and a registration switch 102, and is provided with a 2WS73.
A DB information generation unit 100 is provided in A. In the 2WS73A of the present embodiment, the comparison operation unit 76 has a DB
The information generation unit 100 is connected. The DB 74, the registration switch 102, and the treatment instrument setting information generating unit 77 are connected to the DB information generating unit 100.

A line-of-sight detection device 101 and a superimposed image generation unit 80 are connected to the treatment instrument setting information generation unit 77. This superimposition image generation unit 80 has a superimposition LC
D48 is connected. Other configurations are the same as those in the first embodiment, and the same members are designated by the same reference numerals and the description thereof will be omitted.

Further, as shown in FIG. 9, a pinion gear 104 is arranged in one surface 103 of the movable housing 28. In addition, at a predetermined position of the movable housing 28,
A knob for rotating the pinion gear 104 (see FIG. 11).
No. 200) is provided.

On the other hand, on the eyepiece housing 9 side, a rack 106 formed in a predetermined curved shape that meshes with the pinion gear 104 is arranged. Further, the eye-gaze detecting device 101 is attached to an eye-piece portion of the eye-piece housing 9. As shown in FIG. 10, an elongated opening 107 is formed on the one surface 103.
A curved rack 106 projecting from the eyepiece housing 9 is engaged and disposed at 07. That is, as shown in FIG. 11, the pinion gear 104 and the rack 106 mesh with each other. Other configurations are the same as those in the first embodiment, and the same members are designated by the same reference numerals and the description thereof will be omitted.

The operation of the surgical microscope system 1A configured as described above will be described. In this embodiment as well, as in the first embodiment, first, the microscope is brought into an observation state. And a diagnostic image obtained by the optical scanning probe 78,
The comparison calculation unit 76 compares and calculates the treatment site image data recorded in the DB 74 to set the ultrasonic suction device 81.

If the operator wants to change the setting of the ultrasonic suction device 81 before or during the treatment, the operator displays the setting state of the ultrasonic suction device 81 shown in FIG. 12 displayed on the second observation optical system. Gaze at the manual setting area 110 of the screen 108 displaying.

Then, the sight line detecting device 101 provided in the eyepiece housing 9 detects that the operator is gazing at the manually set area 110. Then, the information is transmitted to the treatment instrument setting information generation unit 77, and the treatment instrument setting information generation unit 77 switches the setting state of the ultrasonic suction device 81 to the change mode in which the manual change is possible.

Then, the operator receives the setting change display area 11
Gaze at any one of 1, 112, 113, 114. As a result, the setting conditions of the ultrasonic suction device 81 can be changed by detecting the line of sight. Specifically, when the operator gazes at the setting change display area 111, the line-of-sight detection device 10
1 detects that, and notifies the treatment tool setting information generation unit 77 that the setting change display 111 is being viewed. Then,
In this treatment instrument setting information generating unit 77, the suction condition is set to 10%.
The instruction to raise is transferred to the ultrasonic suction device 81, the setting of the ultrasonic suction device 81 is changed, and the treatment of the surgical site is started or restarted. Regarding the detection by the line-of-sight detection device 101, for example, there is an example disclosed in Japanese Patent Publication No. 11-501403.

On the other hand, the treatment instrument setting information generating section 77 informs the DB information generating section 100 that the setting has been changed. Then, the diagnostic image data compared with the treatment site image data is transmitted from the comparison calculation unit 76 to the DB information generation unit 100.

Here, when the operator determines that it is necessary to newly record the set value for which the setting has been changed, the operator pushes the registration switch 102. Then, the diagnostic image data and a new ultrasonic suction device 81 corresponding to the diagnostic image data
A set of information on the setting conditions for is transmitted to the DB 74 and is newly registered as the data of the form shown in FIG.

As described above, after the experienced operator changes the setting condition by the manual setting, the setting value and the diagnostic image data are newly registered and stored, so that the treatment site image data registered in the database is stored. Can be upgraded.

When the manual setting is performed by detecting the line of sight, the screen 108 formed by the second observation optical system may be difficult to see. In this case, the knob 200 provided on the movable housing 28 is turned to rotate the pinion gear 10
4 is rotated in a predetermined direction. Then, by rotating the pinion gear 104, the rack 106 is moved, and the eyepiece housing 9 draws an arc corresponding to the curved shape of the rack 106 and moves about the axis of the rack 106.

As a result, before the movement of the eyepiece housing 9, the eyepiece housing 9 (one-dot chain line in FIG. 13) arranged as shown in FIG. 9 is moved, but after the movement, the eyepiece optical system 33a as shown in FIG. The distance from is far away. Before and after this movement, the eye points of the microscope observation image and the image of the second observation optical system are always kept constant.

Therefore, as shown in FIG. 14, the operator's eyes have a microscope observation image 88 and a screen 1 formed by the second observation optical system.
08 from the state (L) away from each other, the microscope observation image 88 and the screen 10 by the second observation optical system as shown in FIG.
8 and 8 are approaching each other (l). By this,
A screen 108 of the second observation optical system shows a microscope observation image 88.
Does not interfere with the observation field of view.

Therefore, when it is not expected that the setting conditions of the energy treatment device will be changed, the case shown in FIG.
As shown in FIG. 4, the microscope observation image 88 and the screen 108 are kept in a separated state (L), and when it is expected to change frequently, as shown in FIG.
And the screen 108 are brought close to each other (1). As a result, the operator's line-of-sight movement is reduced.

Then, the energy treatment tool is set at the position of the second observation optical system in the state shown in FIG. 15, and then, secondly, before the operation, the energy is treated in order to confirm the position of the operation part. After the confirmation of the position is completed, the second observation optical system is placed in a state (L) away from the microscope observation image 88 as shown in FIG. 14, and the microscope observation image 88 is observed.
Also, the treatment with the energy treatment tool is performed.

As described above, by changing the display position or the angle of the second observation optical system, observation can be performed at a position desired by the operator.

The third embodiment will be described below.
Japanese Examined Patent Publication (Kokoku) No. 5-61612 discloses a drive control device in which the number of operation switches is reduced by using operation switches of a plurality of drive systems of a microscope. However, during the operation, it is desirable for the operator to be able to perform the treatment without taking his eyes off the eyepiece part of the microscope, which can shorten the time.

When operating energy treatment tools, endoscopes, etc. in addition to the microscope, the number of operation switches such as hand switches and foot switches naturally makes the operator's switch operation complicated. In particular, even if a foot switch is provided in addition to the microscope to switch the operation of the energy treatment tool or the endoscope, it is necessary to rub the foot or look from the eyepiece to find the predetermined switch for the switch. You have to let go.

For this reason, there has been a demand for a surgical microscope system in which a predetermined switch can be selected from among the operation switches without removing the eye from the eyepiece and the switching can be performed easily and reliably.

16 to 19 relate to the third embodiment of the present invention. FIG. 16 is a view for explaining another configuration of the surgical microscope system, and FIG. 17 shows the relationship between the operation switch of the foot switch and the sensor. FIG. 18 is a diagram illustrating an endoscopic switch position notification image displayed on a microscope image, and FIG. 19 is a diagram illustrating an ultrasonic switch position notification image displayed on a microscope image. .

As shown in FIG. 16, the operation control unit 122 of the surgical microscope system 1B according to the present embodiment includes a microscope control unit 121 for performing drive control (zoom, focus, etc.) of the optical system of the microscope, and a microscope foot. A foot switch layout change setting unit (described as an FS layout change setting unit in the drawing) 123 for changing the functional layout of the switch 125, an optical sensor detection unit 124, a superimposed image generation 80, and an ultrasonic suction device 81.
And are connected. Then, the optical sensor detection unit 12
4 is an optical sensor A provided on the foot switch 125.
126, an optical sensor B127, an optical sensor C128, and an optical sensor D129 are connected.

On the other hand, the ultrasonic suction device 81 has a switch 1
A handpiece 120 having 34 is connected. The switch 134 is connected to the operation control unit 122 via the ultrasonic suction device 81. The superimposing image generation unit 80 is connected to the superimposing LCD 28.

As shown in FIG. 17, an optical sensor A 126 is installed on the operation switch 130 provided on the foot switch 125 of the surgical microscope. Similarly, the operation switch 131 includes the optical sensor B127 and the operation switch 1
An optical sensor C128 is installed at 32, and an optical sensor D129 is installed at the operation switch 133.

The setting state of the foot switch 125 is
When switching to a state desired by the operator, for example, by switching a function switch (not shown) of the foot switch arrangement change setting unit 123, the operation switch 130,
The functions 131, 132, and 133 can be set.

Specifically, in the case of operating the microscope, the operation switches 130, 131, 132, 133 are set at arbitrary positions.
Four functions of focus up / down and zoom up / down can be arranged respectively.

Further, in the case of the ultrasonic suction device, four functions of water feed amount up / down and suction pressure up / down can be arranged at arbitrary positions of the operation switches 130, 131, 132, 133, respectively. it can. Further, in the case of the ultrasonic suction device, it is possible to assign some switches to focus up / down of the microscope and the remaining switches to suction pressure up / down of the ultrasonic suction device.

Then, the set contents are stored in the operation control unit 12
2 detects and transmits to the superimposition image generation part 80. Also,
When the ultrasonic suction device is held, the operation control unit 122 detects the operation by operating the switch 134, and controls the operation switches 130, 131, 132, 133 provided on the foot switch 125. At least a part of the object is changed from the microscope side to the surgical instrument side.

As a result, the superimposed image generation section 80 generates a switch position notification image for notifying the function of the operation switch of the foot switch 125 according to the detection state of the operation control section 122.

The operation of the surgical microscope system 1B configured as described above will be described. Similar to the above-described embodiment, first, the operator puts the microscope in an observation state. The operator operates the foot switch 125 to operate the observation optical system of the microscope.
Put your feet on top of. At this time, for example, when the operator's foot is placed on the operation switch 130 of the foot switch 125, the optical sensor 126 corresponding to the operation switch 130 reacts. As a result, the optical sensor detection unit 124
Then, it is detected that the foot is placed on the operation switch 130.

Then, the optical sensor detection unit 124 transmits the detected position to the operation control unit 122 and the superposed image generation unit 80. In the superposed image generation unit 80, the arrangement of the operation target switches of the foot switch 125 is transmitted to the superposition LCD 48, and the endoscopic switch position notification image 137 is superposed on the microscope observation image 88 as shown in FIG.

At this time, the operation switches on which the feet are placed are displayed, for example, with their edges darkened. Then, after confirming the operation target of the operation switch on which the foot is currently placed among the foot switches 125, the observation state of the microscope is changed.

When the ultrasonic suction device 81 and the hand piece 120 are used to treat the surgical site, the switch 134 installed on the hand piece 120 is operated. Then, the instruction signal at that time is the ultrasonic suction device 8
1 is transmitted to the operation control unit 122. Then, the operation control unit 122 switches the operation target of the foot switch 125 from the microscope side to the ultrasonic suction device 81 side and sends an instruction signal to the superimposed image generation unit 80 to switch the superimposed image to be superimposed on the microscope observation image 88. The transmitted and superimposed image is transmitted from the endoscope switch position notification image 137 to the ultrasonic switch position notification image 1 in the ultrasonic suction mode shown in FIG.
Switch to 38. This ultrasonic switch position notification image 1
38, operation allocation 138a of the foot switch 125
And the setting state 138b of the ultrasonic suction device are displayed.

Then, the edge of the display portion corresponding to the operation switch on which the operator's foot is placed is darkly displayed.

As a result, the operator can know the positional relationship between the operating switches of the foot switch and the positions of the operating switches currently being operated and the operating switches to be switched, without taking the eye away from the microscope eyepiece. At the same time, the set value of the ultrasonic suction device can be known.

In this way, by superimposing and displaying the positional relationship of the plurality of operation switches provided on the foot switch on the microscope image, the setting state of the operation switches provided on the foot switch can be set without taking the eyes off. You can check.

Further, even if the assignment of each operation switch of the foot switch is changed, the operator can confirm the operation target of the foot switch on the microscope image without taking his eyes off the eyepiece. .

Furthermore, the operator can easily confirm in which direction the foot should be moved to perform the desired switch operation by confirming the functional layout of the operation switches displayed in the field of view of the surgical microscope. As a result, erroneous operation of the operation switch can be reliably prevented.

Further, when the surgical instrument is grasped, by operating the switch, the control unit switches at least a part of the object to be controlled by the foot switch from the microscope to the surgical instrument. Therefore, the operator uses the foot switch. Can be set.

Although the setting of the treatment tool has been described in the present embodiment, it may be applied to the setting change (focus, zoom, image rotation, etc.) of the endoscope and the ultrasonic observation apparatus. Also, this time, the switch provided on the treatment tool was used to switch the setting between the microscope and the treatment tool. However, even if the usage state of the probe is detected by the acceleration sensor provided on the probe, the same effect can be obtained. it can.

By the way, Japanese Patent Application 2000 filed by the present applicant
In the fifth and sixth embodiments of No. 194807, there is shown a mode in which endoscopic observation and ultrasonic observation are performed at the same time as observation of a surgical microscope. The observation optical system can display an ultrasonic observation image for observation.

However, when an observing device such as a surgical microscope, an endoscope, or an ultrasonic device is used during surgery, if each image is displayed without correlation between the devices, each image is displayed. It is difficult to see which position corresponds to other devices.

Therefore, there has been a demand for a surgical microscope system that correlates the positional relationship of images obtained by the respective observation devices and displays the correspondence between the observed images in an easy-to-understand manner.

The fourth embodiment will be described below.
In this embodiment, attention is paid to the following purposes.

For observing the surgical site, including a surgical microscope,
Various observation devices such as an endoscope and an ultrasonic observation device for observing a blind spot of a surgical microscope are used. When various observation devices are used in this way, it becomes difficult for the operator to understand the correspondence between the observation positions. In the present embodiment, the observation position of the surgical microscope, the observation image of the endoscope used for blind spot observation of the surgical microscope and the correlation of each observation image of the ultrasonic image by the ultrasonic observation device should be clearly shown to the operator. Is intended for.

20 to 31 relate to the fourth embodiment of the present invention. FIG. 20 is a diagram showing the appearance of the microscope body and the endoscope connecting / holding device, and FIG. FIG. 22 is a cross-sectional view of a state in which optical and mechanical connection with an endoscope is viewed from above, FIG. 22 is a diagram illustrating connection in the vicinity of a sterilization adapter, and FIG. 23 is a diagram illustrating an endoscope inserted in the sterilization adapter. FIG. 24 is a diagram illustrating a main configuration of an ultrasonic observation system, FIG. 25 is a diagram illustrating a scope holder of the ultrasonic observation system, and FIG. 26 is a diagram illustrating a system including an ultrasonic probe and peripheral devices thereof. FIG. 27 is a diagram for explaining another configuration of the surgical microscope system, FIG. 28 is a diagram showing a state in which the ultrasonic probe is moved up and down, and FIG. 29 is a state in which the probe holding portion of the ultrasonic probe is arranged above. Fig. 30 is a table View explaining an example of a screen, FIG. 31
FIG. 9 is a diagram illustrating another example of the display screen.

As shown in FIGS. 20 to 22, an endoscope connecting / holding device 55 is rotatably supported by the microscope body 2 about a shaft B as a displacement means. The flange 142 a arranged inside the microscope body 2 prevents the endoscope connecting / holding device 55 from coming out of the microscope body 2. As a result, the endoscope connecting / holding device 55 is rotatable about the axis B with respect to the microscope body 2.

In FIG. 21, the endoscope connecting / holding device 5 is shown.
5, a casing 55a for housing a fixing screw 56 for fixing the endoscope connecting / holding device 55 to the microscope body 2 is provided. The fixing screw 56 is provided with a retaining flange 56a, and is biased toward the microscope body 2 side by a compression spring 57. The microscope body 2 is provided with female screws 21a and 21b facing the fixing screw 56 when the endoscope connecting / holding device 55 is in a horizontal state.

Here, a camera head is arranged on the axis B in the microscope body 2, and a lens, a prism, etc. are arranged on the axis B in the endoscope connecting / holding device 55 in a direction opposite to the camera head. An observation optical system 58 (illustrated by a thick solid line) composed of the optical elements is arranged.

Since both the observation optical system 58 and the camera head are coaxially arranged on the axis B, the endoscope connection / holding device 55 (on the axis B) is attached to the microscope body 2.
When rotated, only the image can be rotated without eccentricity. The observation optical system 58 has its direction changed by an optical element such as a prism (not shown) and is guided to the tip C of the endoscope connecting / holding device 55.

Further, in FIG. 21, a light guide fiber 53 is arranged on the left side of the axis B in the microscope body 2. A first illumination light transmission section 59 is provided in the endoscope connection / holding device 55 facing the light guide fiber 53. A second illumination light transmission unit 60 is provided at a position point-symmetrical to the first illumination light transmission unit 59 with respect to the axis B. These illumination light transmitters 59, 60 include
For example, a single fiber made of plastic is used.
These are also guided to the tip of the endoscope connecting / holding device 55,
The first illumination light transmission section 59 is arranged on the front side in the plane of the paper, and the second illumination light transmission section 60 is arranged on the rear side in the plane of the paper. That is, in FIG. 20, the first illumination light transmission section 59
, And the second illumination light transmission section 60 is located on the lower side.

On the other hand, when the endoscope connecting / holding device 55 is set on the side opposite to the position shown in FIGS. 20 and 21 with respect to the microscope body 2, the endoscope connecting / holding device 55 is rotated about the axis B by 180 degrees. . The light guide fiber 53 faces the second illumination light transmission section 60, the second illumination light transmission section 60 is arranged on the upper side, and the first illumination light transmission section 59 is arranged on the lower side. Become. That is, the illumination transmission section facing the light guide fiber 53 is always located on the upper side.

Returning to FIG. 20, reference numeral 61 is an image rotating ring for rotating the transmitted image of the observation optical system 58. The image rotation ring 61 rotates an image rotator (not shown) in the observation optical system. Further, reference numeral 62 is a zoom ring, which enlarges or reduces an image by moving a zoom lens (not shown) in the observation optical system 58 in the axial direction.

On the other hand, reference numeral 50 indicates an eccentricity adjusting knob,
It has an X adjustment knob 50a, a Y adjustment knob 50b, and a Z adjustment knob 50c. The Y adjustment knob 50b is provided so as to penetrate in the vertical direction so that the knob can be operated from the upper side when the knob is turned to the opposite side about the axis B. The X adjustment knob 50a and the Y adjustment knob 50b correct the eccentricity of the transmission image between the endoscope and the observation optical system 58 by moving an adjustment lens (not shown) in the observation optical system 58 in the X and Y directions. The adjustment knob 50c adjusts the focus between the endoscope and the observation optical system 58 by moving a focus lens (not shown) in the observation optical system 58 in the axial direction.

These knobs 50a, 50b, 50c
20 is provided in the arrangement shown in FIG. 20 so that the operator can visually confirm the operation direction, and has a structure in which the lens is moved by an internal mechanism such as a link (not shown). Reference numeral 51 is a sterilization adapter as a connecting portion.

As shown in FIG. 22, a sterilizing adapter connecting portion 63 is formed at the tip of the endoscope connecting / holding device 55. Rectangular recess 64 in the sterilization adapter connection 63
The rectangular recess 64 is provided with an observation light incident part 63a, a first illumination light emitting part 64b, and a second illumination light emitting part 64c. An observation optical system 58, a first illumination light transmission section 59, and a second illumination light transmission section 60 are provided on the rear end side thereof. A protrusion 63 a is provided on the outer periphery of the sterilization adapter connection portion 63.

Reference numeral 65 is an endoscope connection with the microscope body 2
It is a sterile drape that covers the holding device 55. An attachment ring 66 made of an elastic material to be attached to the sterilization adapter connection portion 63 is provided, and a groove 66a is formed on the inner surface of the ring 66.

The sterilization adapter 51 is made of a material such as stainless steel that can withstand high-pressure steam sterilization and EOG (ethylene oxide gas) sterilization.
A mold recess 68 and a hook 69 are provided. An observation light emitting end 68a and an illumination light emitting end 68b are arranged in the U-shaped recess 68. A cover glass (not shown) is provided at the observation light emitting end 68a and the illumination light emitting end 68b, and the observation light incident portion 64a is unclean because it cannot be sterilized.
And the first illumination light emitting portion 64b and the second illumination light emitting end 64c to the observation system connection portion and the illumination light connection portion of the endoscope connector that need to be sterilized and kept clean as described later. Are separated.

Reference numeral 71d is an endoscope connector. It is shaped to fit in the U-shaped recess 68 of the sterilization adapter 51,
The observation system connection part 72a and the illumination system connection part 72b are provided.
Here, the endoscope connector 71d of the endoscope has a U-shaped recess 68.
However, the rectangular convex portion 67 of the sterilization adapter 51 is vertically inserted into the rectangular concave portion 64 of the sterilization adapter connection portion 63 so as to be fitted in two directions.

When performing an operation, first, it is determined which side of the endoscope connection / holding device 55 should be arranged with respect to the body. Here, it is assumed that it is decided to arrange on the side shown in FIG. Here, as shown in FIG. 21, when the endoscope connecting / holding device 55 is rotated horizontally, the tip of the fixing screw 56 enters at the female screw 21a by the urging force of the compression spring 57. . In this state, the fixing screw 56 is screwed in to fix the endoscope connecting / holding device 55 to the microscope body 2.

In this state, as shown in FIG. 21, it is the first illumination light transmitting portion 59 that faces the light guide fiber 53, and this is the first illumination light emitting portion 64.
It is connected to b. That is, the illumination light is emitted from the illumination emitting section 64b.

Next, the sterile drape 54 shown in FIG. 22 is attached to the sterile adapter connecting portion 63. It is fixed by fitting the groove 66a in the attachment ring 66 into the protrusion 52a.

In this state, the sterilized adapter 51, which has been sterilized, is placed so that the hook 69 faces upward.
Attach to.

As a result, the illumination light emitting end 68b provided in the U-shaped recess 68 and the illumination light emitting portion 64b are electrically connected. By connecting the endoscope connector 71d according to the U-shaped recess 68 of the sterilization adapter 51, the illumination system connecting portion 72b and the illumination light emitting end 68b are electrically connected. As a result, the illumination light from the light guide fiber 53 is guided to the illumination system connecting portion 72b, and illumination is performed from the tip of the endoscope. The cable of the endoscope is hooked on the hook 69 as needed.

In another operation, when the endoscope connecting / holding device 55 is set to the side opposite to the one shown in FIG. 20 with respect to the microscope body 2, the following work is carried out before applying the sterile drape.

The fixing screw 56 shown in FIG. 21 is loosened and pulled out from the female screw 21a. The endoscope connecting / holding device 55 is rotated about the axis B. Fixing screw 56 at female screw 21b
Is inserted, and similarly, it is fixed by tightening the fixing screw 56. Light guide fiber 53 by rotating 180 degrees
The second illumination light transmission unit 60 faces the. Also,
By the rotation of 180 degrees, the second illumination light transmission section 60 and the illumination light emission end 64c are located on the upper side. In this state, the sterilization drape 65 is covered, the cable hook of the sterilization adapter 51 is attached upward, and the endoscope connector 71d is connected.

The illumination light from the light guide fiber 53 is transmitted through the second illumination light transmission section 60 and the second illumination light emission end 64.
c and the illumination light emitting end 68b, the illumination system connecting portion 72b
It is guided up to and illuminated from the tip of the endoscope.

Next, it is confirmed whether or not the observation image of the endoscope has eccentricity, and if there is eccentricity, the X adjustment knob 50a and the Y adjustment knob 50b of the eccentricity adjustment knob 50 are turned to rotate the lens (not shown). Move and adjust so that the observed image is in the center of the monitor. Next, it is confirmed whether or not the focus is proper, and if there is blurring, the Z adjustment knob 50c is used for adjustment. When the adjustment up to this point is completed, take the scope and observe the surgical site.

When the monitor image is rotating with respect to the viewing direction, the image rotating ring 61 is rotated to adjust the direction. If the magnification is not appropriate, turn the zoom ring 62 to make the magnification appropriate.

When not using the endoscope, the endoscope is held by the holder. Further, when replacing the endoscope with a different viewing direction, the endoscope connector 71d is pulled out and the endoscope connector of another endoscope is connected. The endoscope connector is connected to the endoscope connection / holding device 55 in the non-sterile and unclean area through the sterilizable and clean area sterilization adapter 51, so that the endoscope connector is always kept clean, so that the exchange is easy. Is.

Further, the endoscope connecting / holding device 55 is attached to the shaft B.
Since it can be largely moved to both sides of the microscope body portion 2 around, the endoscope can be suitably connected and held on the dominant arm side of the operator. In addition, the sterilization adapter 51 can be used to replace the endoscope during the operation.

As shown in FIG. 23, the endoscope 71 has an insertion portion 71a and a main body portion 71b, and the main body portion 71b.
From there, an endoscope cable 71c extends, and the observation system connecting portion 72a is provided at the end thereof. This endoscope 71
The endoscope connector 71d includes an observation system connecting portion 72a,
The illumination system connection part 72b is provided. This endoscope 7
The main body 71b of No. 1 has a predetermined index 7 for position detection.
1e is installed.

A configuration for acquiring a three-dimensional ultrasonic observation image of the surgical site will be described with reference to FIGS. 24 to 26. The ultrasonic observation system 201 according to the present embodiment includes a scope holder (arm mechanism portion) 202 that can be spatially moved freely.
And an ultrasonic probe holder 202 detachably connected to the scope holder 202.

Further, the scope holder 202 is provided with an attachment portion 204 detachably attached to a side rail (not shown) of the surgical bed and an arm body 205. Here, the mounting portion 20 of the scope holder 202
4 is provided with a mounting portion main body 206 and a base 207 extending from the mounting portion main body 206. Further, the attachment portion main body 206 is provided with a hook-shaped engagement portion 208 which is attached by being hooked on the side rail of the surgical bed.

Further, the mounting portion main body 206 is provided with an engaging portion 20.
A fixing knob 209 for fixing the mounting portion main body 206 to the bedside rail is provided at a position opposed to 8. The fixed knob 209 is attached by being screwed into the attachment portion main body 206, and has a screw portion extending toward the engagement portion 208. A pressing member is provided at the end of the threaded portion of the fixed knob 209 so as to be in pressure contact with the mounting surface of the bedside rail.

Therefore, when the engaging portion 208 is hooked on the bedside rail, the fixing knob 209 is tightened, and the pressing member of the fixing knob 209 is brought into pressure contact with the attachment surface of the bedside rail. Can be fixed to the bedside rail.

Further, the base 207 of the mounting portion 204 is
A vertical arm 211 forming the arm body 205 is rotatably attached. The vertical arm 211 extends vertically upward from the base 207 and is rotatably supported about a vertical first axis O6 coinciding with the longitudinal axis thereof.

Further, an adjusting knob 212 for adjusting the amount of rotation of the vertical arm 211 about the first axis O6 is attached to the base 207 by screwing.
The adjusting knob 212 is provided with a screw portion extending in the direction orthogonal to the first axis O6 and extending in the direction of the vertical arm 211. At the end of this threaded portion, a pressing member is provided that is pressed against the outer peripheral surface of the vertical arm 211. Therefore, the amount of rotational force of the vertical arm 211 is determined by the amount of tightening of the adjustment knob 212 with respect to the base 207, that is, the degree of pressure contact of the pressing member with respect to the vertical arm 211.

At the upper end of the vertical arm 211, one end of the first link arm 213 constituting the arm body 205 is centered on the second axis O7 which is orthogonal to the first axis O6 via the joint 214. Is rotatably attached to. At the other end of the first link arm 213, one end of the second link arm 215 forming the arm body 205 is connected to the third axis O7 parallel to the second axis O7 via the joint 216.
It is attached so that it can rotate around 8.

Furthermore, one end of the second link arm 215 is centered on a fourth axis O9 extending in a direction orthogonal to the third axis O8 (axial direction of the second link arm 215). It is rotatably supported.

At the other end of the second link arm 215, a connecting shaft portion (attachment mounting portion) 217 is connected via a joint portion 218 to a fifth shaft O9 orthogonal to the fourth shaft O9.
It is rotatably supported around 10. This connecting shaft 2
As shown in FIG. 2 (B), two notches 219a and 219b are formed on the outer peripheral surface of the tip 17.

A rotational force amount adjusting mechanism (not shown) is provided inside each joint 214, 216, 218. As a result, the link arms 213 and 21 are attached by the weight of the ultrasonic probe 203 detachably connected to the scope holder 202 and the arm body 205 holding the ultrasonic probe 203.
5 is prevented from rotating naturally around each of the axes O7 to O10.

Further, the connecting shaft portion 2 of the scope holder 202
The first ultrasonic probe holder (attachment) or the second ultrasonic probe holder (attachment) for connecting the ultrasonic probe 203 to which the ultrasonic probe 203 is detachably connected is appropriately selected as 17 as necessary. It can be installed by default.

Here, the first ultrasonic probe holder is formed by, for example, a radial scan ultrasonic probe holder. The first ultrasonic probe holder is provided with a holder body and a mounting portion for removably attaching the holder body to the connecting shaft portion of the scope holder.

Further, the holder body is provided with a fixed portion and a movable portion. In the fixed part of this holder body,
A linear drive mechanism for moving the movable part b along the vertical direction is incorporated. The linear drive mechanism includes a drive motor 225a, a first gear 226 driven by the motor 225a, and the first gear 2
26 and a second gear 227 meshed with the second gear 227, and a third gear 228 meshed with the second gear 227.
And an encoder 229 that operates according to the rotation of the third gear 228.

In addition, the movable portion 224b of the holder body 222.
The probe mounting hole portion 230 into which the ultrasonic probe 203 is inserted and fixed, and the second gear 2 of the fixing portion 224a.
A rack 231 that is meshed with 27 is provided. The rack 231 extends vertically. Then, with the rotation of the second gear 227, the rack 231
Is moved in the vertical direction, which causes the movable part 224b to move.
Are supported so as to be movable up and down with respect to the fixed portion 224a. In addition, stoppers (not shown) are provided at the upper end and the lower end of the rack 231 of the movable portion 224b so as not to move further. Further, the movable portion 224b is formed with an inclined portion 230a at the upper end portion of the probe mounting hole portion 230 for releasably locking the ultrasonic probe 203.

Further, the first ultrasonic probe holder 202
The fixing portion 224 of the holder main body 222 is attached to the mounting portion 223 of the
A pair of pin holding plates 232a and 232b is provided so as to project from a. Here, the engagement pin 233a is attached to one pin holding plate 232a, and the engagement pin 233b is attached to the other pin holding plate 232b. These engaging pins 233a and 233b are pin holding plates 232a and
It is movably supported in the inner and outer directions of 232b. Then, the engaging pin 233a of the pin holding plate 232a
And the engaging pin 233b of the pin holding plate 232a are constantly urged by a spring member (not shown) in a direction in which they are projected inward, so that the engagement shaft 233b of the connecting shaft portion 217 of the scope holder 202 is cut against the cutout portions 219a and 219b. It is adapted to be engaged and disengaged.

Further, on the outer surface side of each of the pin holding plates 232a, 232b, the operation knob 2 for pulling the engaging pins 233a, 233b toward the outside of the mounting portion 223.
34a and 234b are provided, respectively. The probe 203 is provided with an index (not shown) for position detection.

In FIG. 26, reference numeral 269 is an ultrasonic drive device for driving the ultrasonic probe 203. The ultrasonic driving device 269 includes a motor 270 for driving an ultrasonic vibrator (not shown) and an encoder 2 for detecting the position.
71 and 71 are provided. In addition, the ultrasonic drive device 269
The motor 2 built in this ultrasonic drive device 269.
An ultrasonic observation device 272 for driving 70, detecting an encoder 271, or acquiring a two-dimensional image obtained by an ultrasonic transducer is connected. A foot switch 273 and a three-dimensional image generation device 274 are connected to the ultrasonic observation device 272.

The foot switch 273 has a first ultrasonic probe holder 20 for radial scan (not shown).
The motor drive device 275 for driving the motor 225a incorporated in the No. 2 is connected. Further, the foot switch 273 is provided with an ultrasonic wave observation switch (not shown) for controlling ON / OFF of the ultrasonic wave observation device 272 and a motor drive switch (not shown) for operating the motor drive device 275.

The encoder 229 built in the first ultrasonic probe holder 202 includes the encoder 22
A movement amount detection device 276 for detecting the value of 9 is connected. The movement amount detection device 276 is connected to the ultrasonic observation device 272 and the three-dimensional image generation device 274. Further, a monitor 277 is connected to the three-dimensional image generation device 274.

Then, the respective output signals from the ultrasonic observation device 272 and the movement amount detection device 276 are input to the three-dimensional image generation device 274, and are generated by the three-dimensional image generation device 274 based on these input information. A three-dimensional image is displayed on the monitor 277.

The connection shaft portion 2 of the scope holder 202
The same applies to the case of connecting the second ultrasonic probe holder 202 for forward scanning (not shown) to 17.

As shown in FIG. 27, the surgical microscope system 1C of the present embodiment is similar to the first embodiment, in that it includes a digitizer 12, a measuring device 18, an A / D converter 17 and a WS19.
The WS 19 and the superimposition image generation unit 80 are connected, and the superimposition image generation unit 80 and the superimposition LCD 48 are connected. Further, the WS 19 is connected with a mirror body control unit 304 for detecting focus and zoom information of the microscope. The three-dimensional image generation device 274 has a WS
19 is connected.

An image generation section 87 and a field-of-view image generation section 305 are connected to the television camera 140 for an endoscope. An LCD 36a for displaying an image in the field of view of the microscope is connected to the in-field image generation unit 305.
An LCD 38 that displays an image of the second observation optical system is connected to the image generation unit 87.

In the observation, first, the endoscope 7
1 is attached to the side surface of the body portion, and then the endoscope 71 is placed in an observation state to observe the operation portion. In addition, ultrasonic observation is performed to obtain an image of the inside of the surgical site. At this time, the above-mentioned 3
The ultrasonic observation system is used to obtain a three-dimensional ultrasonic observation image, and the ultrasonic image in the radial direction of the operation site is observed.

As shown in FIGS. 28 and 29, a radial scan ultrasonic probe 203 provided with an indicator (not shown) that can be detected by the digitizer 12 is moved in a direction perpendicular to the radial direction (arrow direction in the figure) to make a plurality. Acquire an ultrasonic image of. The ultrasonic image acquired at this time is
It is transmitted to the three-dimensional image generation device 274. On the other hand, the ultrasonic probe 20 detected by the digitizer 12 during ultrasonic observation
The spatial position information of No. 3 is transmitted from the WS 19 to the three-dimensional image generation device 274.

That is, the spatial position information and the ultrasonic image are paired and recorded in the three-dimensional image generating device 274, and the data is accumulated to correlate the three-dimensional ultrasonic image with the surgical site position space. Is generated, transmitted to WS 19, and recorded.

The operator observes the surgical site with the endoscope 71 in order to confirm the blind spot of the microscope body 2 of the microscope. At this time, when it is desired to confirm the information inside the tissue in the observation direction of the endoscope 71, an image changeover switch (not shown) is pressed. As a result, an ultrasonic image is displayed on the second observation optical system.

The observation image observed by the endoscope 71 is an LC for displaying an in-field display image 306 from the endoscope TV camera 140 via the in-field image generating section 305.
It is displayed as an endoscopic image on D36a. The observation direction of the tip position of the endoscope 71 is detected by the digitizer 12, and the detection result is transmitted to the WS 19.

That is, in the WS 19, based on the transmitted information on the observation direction of the endoscope, a three-dimensional ultrasonic image 144 matching the observation direction of the endoscope 71 is obtained from the previously recorded three-dimensional ultrasonic image. Reconstruct the image.

The three-dimensional ultrasonic image 144 thus generated is transmitted to the image generating section 87 and is displayed on the LCD 38 as an image as shown in FIG. As a result, the operator can observe the three-dimensional ultrasonic image 144 through the second observation optical system.

The operator confirms the presence of a tumor or the like by confirming the information on the inside of the operation site in the observation direction of the endoscope 71. When an image changeover switch (not shown) is pressed, an ultrasonic cross-sectional image at the microscope focus position is displayed on the second observation optical system, and a three-dimensional ultrasonic image in the endoscope observation direction is superimposed on the microscope observation visual field. Switch to mode.

At this time, the observation position of the microscope is calculated from the position information of the microscope mirror body 2 sent from the digitizer 12 to the WS 19 and the focus and magnification information sent from the mirror body control unit 304 to the WS 19.

Based on this observation position, the two-dimensional ultrasonic image 147 of the plane perpendicular to the observation optical axis direction of the mirror body 2 is reconstructed from the three-dimensional ultrasonic image 144 recorded in the WS 19, and the image generation unit 87, The second observation optical system is displayed on the LCD 38 as shown in FIG.

The focus position information 145 of the microscope body 2 is also included.
And the three-dimensional ultrasonic image 146 in the observation direction of the endoscope 71,
By transmitting from the WS 19 to the superimposed image generation unit 80 and the superimposing LCD 48, the display is performed as shown in FIG.
Then, the focal position 145 of the microscope body 2 is compared with the ultrasonic image 147 at that position to confirm the information inside the surgical site.

That is, the ultrasonic observation apparatus captures an observation image in front of the surgical site or in the radial direction, records the observation image information together with the position information detected by the position detection unit, and the position detection unit uses the operation microscope. By detecting the observation position and the observation position of the endoscope and correlating the focus position of the microscope and the observation position of the ultrasonic image, and the observation position of the endoscopic image and the ultrasonic image, The sound wave observation image is displayed on the in-field display means.

As described above, the internal tissue information in the observation direction of the endoscope, for example, blood vessels and tumors can be confirmed by the ultrasonic observation image, and the internal state of the tissue is also preliminarily observed in the blind spot of the surgical microscope. Can be surely grasped and the treatment can be advanced. This ensures that the tumor is not left unremoved.

The present invention is not limited to the embodiments described above, and various modifications can be made without departing from the gist of the invention.

[Additional Notes] According to the above-described embodiment of the present invention described in detail above, the following configuration can be obtained.

(1) In a surgical system including an optical scanning probe for acquiring an optical diagnostic image at an arbitrary position of a surgical site and an energy treatment tool for treating the surgical site, the surgical system acquires the optical diagnostic image. A recording unit for recording a diagnostic image, a plurality of treatment region images having treatment region images and treatment information such as energy treatment instruments and treatment instrument setting states relating to the treatment, and a diagnostic image database, and the optical scanning probe Diagnostic images,
A comparison operation unit that compares a plurality of treatment site images accumulated in the diagnostic image database, and an energy treatment tool setting unit that sets conditions of the energy treatment tool based on a calculation result of the comparison operation unit, A surgical system comprising:

(2) It has a position detection means for detecting the position of the optical scanning probe with respect to the operation portion, and the comparison operation portion has the position information detected by the position detection means and the position accumulated in the diagnostic image database. The microscope system according to appendix 1, wherein the information is used as a parameter at the time of calculation.

(3) The setting changing means for changing the setting state of the energy treatment device to a desired state, at least the setting value changed by the setting changing means and the diagnostic image acquired by the optical scanning probe are The surgical operation system according to appendix 1 or 2, further comprising: a database registration unit that registers a treatment site image in a diagnostic image database.

(4) The operating system according to appendix 3, wherein the setting changing means is a line-of-sight detecting means provided in the operating microscope.

(5) A microscope which is a first observing means having an observing optical system for magnifying and observing a surgical site, and an image different from the observed image obtained by this microscope in the observation field of the microscope. An image display unit, a second observation unit for observing the surgical site, a position detection unit that detects the observation position of the microscope and the observation position of the second observation unit, and takes a correlation between these positions, In a surgical microscope system having: a recording unit for recording a diagnostic image of a surgical site, based on a detection result of the position detecting unit, the microscope or the second observation from a plurality of diagnostic images recorded in the recording unit. Surgical microscope system having an image processing unit for reconstructing an image that matches the observation direction of the device, and a display control unit for displaying the output image from the image processing unit on the in-field image display device.

(6) The surgical microscope system according to appendix 5, wherein the in-field image display means is an image superimposing means for superimposing an image on an optical image of a microscope.

(7) The surgical microscope system according to appendix 6, wherein the display control section displays the output image from the image processing section in correlation with the optical image of the microscope.

(8) The surgical microscope system according to any one of appendices 5 to 7, wherein the image processing section constructs a diagnostic image in a direction perpendicular to the observation optical axis of the microscope.

(9) The surgical microscope system according to any one of appendices 5 to 7, wherein the image processing section constructs a diagnostic image corresponding to the observation direction of the second observation means.

(10) A surgical microscope having a plurality of electric drive mechanisms, in-field image display means for displaying an image in the observation visual field of this surgical microscope, and a foot switch for operating the electric drive mechanism. A setting changing unit that appropriately changes the arrangement position of the operation unit of the foot switch, a detection unit that detects that the foot is placed on the foot switch, and a foot in the visual field image display unit according to the detection result of the detection unit. And a display control unit for visually notifying the switch position of the operation unit on which the surgical microscope is mounted.

(11) A surgical microscope, a foot switch for operating a plurality of electric drive units of the surgical microscope, a surgical instrument having a setting unit for performing a predetermined setting, and a usage state of the surgical instrument are detected. A surgical microscope system comprising: a sensor; and a control unit that assigns at least a part of the function of the foot switch to the surgical instrument according to a detection result of the sensor.

(12) The setting unit of the surgical instrument is an output setting unit of the energy treatment instrument, which is a surgical instrument.
The microscope system for surgery according to 1.

(13) The surgical microscope system according to appendix 11, wherein the setting unit of the surgical instrument is a setting unit that performs at least one of focus, zoom, and image rotation of the endoscope.

(14) The surgical microscope system according to appendix 11, wherein the setting unit of the surgical instrument is a setting unit for performing at least one of image size change and image rotation of the ultrasonic observation apparatus.

(15) The surgical microscope system as set forth in appendix 11, wherein the sensor is a switch provided in a grip portion of the surgical instrument.

(16) The surgical microscope system as set forth in appendix 11, wherein the sensor is an acceleration sensor provided in a grip portion of the surgical instrument.

[0175]

As described above, according to the present invention, even an operator who has little experience with a target case can easily and accurately select a treatment tool and perform optimum setting, and according to the observation state, It is possible to provide a surgical system capable of moving the display image position of the observation optical system.

[Brief description of drawings]

1 to 7 relate to a first embodiment of the present invention, and FIG. 1 is a diagram illustrating a configuration of a surgical microscope system.

FIG. 2 is a diagram for explaining an internal configuration of a binocular eyepiece tube portion which is a mirror body.

FIG. 3 is a side view of FIG. 2 and is a view for explaining a configuration of an eyepiece optical system of a mirror body and a second observation optical system.

FIG. 4 is a diagram illustrating a superposition unit.

FIG. 5 is a diagram illustrating a configuration of a main part of a surgical microscope system.

FIG. 6 is a diagram showing an example of a treatment site image recorded in a database.

FIG. 7 is a view showing a microscope observation image displayed on a microscope and setting data.

8 to 15 relate to a second embodiment of the present invention, and FIG. 8 is a diagram for explaining another configuration of the surgical microscope system.

FIG. 9 is a side view for explaining the internal configuration of the binocular eyepiece tube unit.

FIG. 10 is a diagram illustrating a relationship between a pinion gear and a rack.

11 is an arrow view from the direction of arrow A in FIG.

FIG. 12 is a diagram illustrating a microscope observation image and a screen for changing the setting state of the ultrasonic suction device.

FIG. 13 is a diagram illustrating a state where the eyepiece housing has moved with respect to the movable housing.

FIG. 14 is a diagram showing a relationship between a microscope observation image before the eyepiece housing is moved and a screen by the second observation optical system.

FIG. 15 is a diagram showing a relationship between a microscope observation image after the eyepiece housing is moved and a screen by the second observation optical system.

16 to 19 are views showing a third embodiment of the present invention, and FIG. 16 is a diagram for explaining another configuration of the surgical microscope system.

FIG. 17 is a diagram illustrating a relationship between an operation switch of a foot switch and a sensor.

FIG. 18 is a diagram illustrating an endoscope switch position notification image displayed on a microscope image.

FIG. 19 is a diagram illustrating an ultrasonic switch position notification image displayed on a microscope image.

20 to 31 relate to a fourth embodiment of the present invention, and FIG. 20 is a view showing the appearance of a microscope body and an endoscope connecting / holding device.

FIG. 21 is a cross-sectional view of a state in which an optical and mechanical connection between a microscope body and an endoscope is viewed from above.

FIG. 22 is a diagram for explaining the connection near the sterilization adapter.

FIG. 23 is a diagram illustrating an endoscope inserted in a sterilization adapter.

FIG. 24 is a diagram illustrating a configuration of main parts of an ultrasonic observation system.

FIG. 25 is a diagram illustrating a scope holder of an ultrasonic observation system.

FIG. 26 is a diagram illustrating a system including an ultrasonic probe and its peripheral devices.

FIG. 27 is a view for explaining still another configuration of the surgical microscope system.

FIG. 28 is a view showing a state where the ultrasonic probe is moved up and down.

FIG. 29 is a view showing a state where the probe holding portion of the ultrasonic probe is arranged above.

FIG. 30 is a diagram illustrating an example of a display screen.

FIG. 31 is a diagram illustrating another example of the display screen.

[Explanation of symbols]

1 ... Operating microscope system 12 ... Digitizer 18 ... Measuring device 19 ... Workstation 73 ... Second workstation 74 ... Diagnostic image database (DB) 75 ... Image memory 76 ... Comparison operation unit 77 ... Treatment tool setting information generation unit 78 ... Optical scanning probe 79 ... Observation device 87 ... Image generation unit

   ─────────────────────────────────────────────────── ─── Continued front page    (72) Inventor Motoichi Nakamura             2-43 Hatagaya, Shibuya-ku, Tokyo Ori             Inside Npus Optical Industry Co., Ltd. F term (reference) 4C061 AA23 CC06 DD01 HH51 HH56                 4C301 BB03 BB13 BB26 BB30 EE11                       FF04 FF21 FF26 GA03 GA20                       GD10 JC13 KK17                 4C601 BB03 BB05 BB09 BB12 BB14                       BB24 EE09 FE01 FF11 FF16                       GA01 GA03 GA17 GA21 GA29                       GA30 JC15 JC20 JC25 JC26                       KK21 KK22

Claims (3)

[Claims] 1. A surgical system including an optical scanning probe for acquiring an optical diagnostic image at an arbitrary position of a surgical site, and an energy treatment tool for treating the surgical site, the optical scanning probe acquiring the optical diagnostic image. A recording unit that records a diagnostic image, a diagnostic image database that stores a plurality of treatment region images having treatment region images and treatment information such as energy treatment instruments and treatment instrument setting states related to this treatment, and a diagnosis of the optical scanning probe. A comparison calculation unit that compares an image with a plurality of treatment site images accumulated in the diagnostic image database, and an energy treatment tool setting that sets conditions of the energy treatment tool based on a calculation result of the comparison calculation unit. And a surgical system. 2. A position detecting means for detecting the position of the optical scanning probe with respect to the operation portion, wherein the comparison operation portion stores the position information detected by the position detecting means and the treatment site accumulated in the diagnostic image database. The microscope system according to claim 1, wherein the position information of the image is used as a parameter at the time of calculation. 3. The setting change means for changing the setting state of the energy treatment device to a desired state, and at least the set value changed by the setting change means and a diagnostic image acquired by the optical scanning probe, A database registration means for registering a treatment site image in an image database, and the surgical system according to claim 1 or 2.