JP2003116874A - Surgical microscope system - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a surgical microscope which allows to diagnose pathologically even a tumor tissue as being undistinguishable by preoperative imaging diagnosis and can efficiently provide an operator with the pathological diagnosis result. SOLUTION: The surgical microscope system 1 comprises a surgical microscope 7 for providing the microscopic image of an operation site, a (cofocus) light scanning probe 2 for providing the cofocus optical image for a subject, an observation device 3 for processing an image, and a navigation device 5 for detecting the observation position of the light scanning probe 2. The surgical microscope system 1 also is equipped with a determination input device 32 for inputting the determination result for a cell image 31 obtained from the light scanning probe 2, and a navigation device body 26 for providing at least two determination display based on the determination result input by the determination input device 32 and piling the determination images on a microscopic image obtained by the surgical microscope 7 according to the positional relativity between the observation position of the light scanning probe 2 and the operation site.

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 for acquiring tissue information of a surgical site using an optical scanning probe.

[0002]

2. Description of the Related Art Recently, a surgical microscope apparatus has been widely used in neurosurgery and the like. The above-mentioned surgical microscope apparatus obtains optical information of a test site using an optical scanning probe in addition to a surgical microscope for optically magnifying and observing a test site during surgery. The surgical microscope apparatus scans the focal point on the side of the subject to be examined with the optical scanning probe set in the confocal relationship to obtain optical information of the subject to be examined.

Such a surgical microscope apparatus is, for example,
JP-A-6-15422 and JP-A-2000-1219
As described in Japanese Patent Publication No. 61-61, in neurosurgery and the like, a method for diagnosing tissue cells has been proposed.

In tumor resection surgery in neurosurgery, the pathological diagnosis at many sites in the resected tumor must be carried out.
Further, regarding the tumor occurring in the brain parenchyma, the extraction site and method must be considered based on the benign / malignant judgment based on the pathological diagnosis. In particular, surgery to remove a malignant tumor involves waiting for the pathological diagnosis of the removed tumor during surgery to aim for total tumor removal, or whether the tumor is allowed to remain in order to minimize invasion of the brain parenchyma and tumor. You must decide how to remove the border. Under this circumstance, the tumor tissue which cannot be judged by the diagnostic image had to be interrupted or re-operated in order to wait for a professional judgment by a pathologist.

[0005]

However, the above-mentioned JP-A-6-15422 and JP-A-2000-12196 are known.
The surgical microscope apparatus described in Japanese Patent No. 1 discloses a method for carrying out cytodiagnosis, but it does not describe that the range of the mutation site in the brain structure is specified and recorded and displayed. Further, the above-mentioned JP-A-6-15422 and JP-A-20-
In the surgical microscope apparatus described in Japanese Unexamined Patent Publication No. 00-121961, when performing a cell diagnosis, the relationship between the position where the diagnosis is made and the image, the spread of abnormal cells, and the like are treated as different information. Therefore, the surgical microscope apparatus described in JP-A-6-15422 and JP-A-2000-121961 needs to consider a surgical method based on such information when performing surgery.

The present invention has been made in view of the above circumstances, and enables a pathological diagnosis of a tumor tissue that cannot be discriminated by a preoperative image diagnosis, and an operation capable of efficiently presenting the pathological diagnosis result to an operator. It is intended to provide a microscope for use.

[0007]

According to a first aspect of the present invention, a surgical microscope for obtaining a microscope image of a surgical site, an optical scanning probe for obtaining optical image information at a predetermined position in the surgical site, In a surgical microscope apparatus having a detection means for detecting a relative position between an observation position of an optical scanning probe and the surgical site, a determination input for inputting a determination result with respect to a cell image obtained by the optical scanning probe. Means, based on the determination result input by the determination input means,
Determination display means for performing at least two determination displays, and a determination display displayed by the determination display means based on the relative position between the observation position of the optical scanning probe and the surgical site detected by the detection means. A superimposing means for superimposing on a microscope image obtained by the surgical microscope. According to a second aspect of the present invention, in the surgical microscope apparatus according to the first aspect, based on the determination display displayed by the determination display means, a calculation unit that determines a predetermined range and the predetermined number determined by the calculation unit. It has a range display means for performing range display of the range, the superimposing means, at least one of the range display and the determination display is superimposed on the microscope image obtained by the surgical microscope, characterized in that There is. Further, claim 3 of the present invention is
The surgical microscope apparatus according to claim 1 or 2, wherein an image storage unit that stores the determination display displayed by the determination display unit and the cell image obtained by the optical scanning probe in association with each other, and selectively inputs the determination display. Based on the information input selectively by the selection input means and the selection input means for
Read-out means for reading the corresponding cell image from the image storage means and displaying it.
With this configuration, it is possible to realize a pathological diagnosis of a tumor tissue that cannot be discriminated by preoperative image diagnosis, and to realize a surgical microscope capable of efficiently presenting the pathological diagnosis result to an operator.

[0008]

BEST MODE FOR CARRYING OUT THE INVENTION Embodiments of the present invention will be described below with reference to the drawings. (First Embodiment) FIGS. 1 to 6 relate to a first embodiment of the present invention. FIG. 1 shows the configuration of a surgical microscope apparatus of the first embodiment, and FIG. 2 shows optical scanning. Fig. 3 shows an overview of a rigid sheath to which a probe is attached, Fig. 3 shows a state of obtaining an observation image of a surgical site by an optical scanning probe under observation by a surgical microscope device, and Figs. 4 to 6 show monitors of the surgical microscope device. FIG. 4 shows a display screen, FIG. 4 shows an observation image of a monitor on which a cell state image is superimposed, FIG. 5 shows an observation image of a monitor on which a plurality of determination markers are displayed, and FIG. 6 is a cell state image recorded in an image recording device. Fig. 7 shows an observed image of a monitor in which is displayed again.

As shown in FIG. 1, a surgical microscope apparatus 1 according to a first embodiment of the present invention comprises a confocal optical scanning probe (hereinafter simply referred to as optical scanning) for obtaining a confocal optical image of a subject. Probe 2) and a rear end of the optical scanning probe 2 are detachably connected to each other to supply a laser beam to the optical scanning probe 2 or an object by the optical scanning probe 2, more specifically, a head side. An observation device 3 that performs image processing or the like on the return light from, and a monitor 4a and a monitor 4b that display corresponding confocal images and the like by inputting a video signal output from the observation device 3, The navigation device 5 detects the observation position of the optical scanning probe 2.

Further, the surgical microscope apparatus 1 is provided with a surgical microscope 7 for magnifying and observing a surgical site 6 where surgery is to be performed on the head or the like (see FIG. 3). Further, in the present embodiment, the optical scanning probe 2 is attached to a rigid sheath 9 having a light emitting portion 8 for position detection as shown in FIG.

The observation device 3 is provided with a laser light source 11 therein. The laser light supplied from the laser light source 11 enters the single mode fiber 13 via the condenser lens 12.

The single mode fiber 13 is adapted to be incident on the single mode fiber 16 in the optical scanning probe 2 from the connector 15b connected to the connector receiver 15a via the coupler section 14 on the way. An optical scanning head 17 for performing optical scanning is connected to the far end (tip) of the single mode fiber 16. The laser beam from the optical scanning head 17 is supplied while being two-dimensionally scanned (via the condenser lens 35 on the hard sheath 9 side) to the surgical site 6 side of the subject.

The return light reflected on the side of the operating portion 6 is
The light enters the tip of the single mode fiber 16 (through the condenser lens 35 and the optical scanning head 17) and is guided to the coupler section 14 through an optical path opposite to the forward path.
Due to this, a part of it moves to the other single mode fiber 18 side. In this case, in the single mode fiber 16, the tip surface has a sufficiently small area size. The laser light emitted from the tip end surface of the single mode fiber 16 is condensed and supplied to the operation site 6 side through the optical system such as the condenser lens 35. In that case, the tip end of the single mode fiber 16 with respect to this optical system. It becomes a spot at the focal position where it has a confocal relationship with the surface.

Further, the reflected light on the side of the operation portion 6 is condensed by an optical system such as a condenser lens 35. However, as for the reflected light on the side of the operation portion 6, only the light reflected at the focal position is made incident on the tip surface of the single mode fiber 16. That is, the observation device 3 is adapted to detect the reflected light (also referred to as return light) at the confocal position with the tip surface of the single mode fiber 16.

This return light is generated by the single mode fiber 1
The light is incident on the optical sensor 19 from the near end (rear end) of No. 8. The single mode fiber 18 is provided with a damper 20 facing the far end. The damper 20 attenuates the light emitted from the far end of the single mode fiber 18 (that is, forms a non-reflecting end).

The detection signal photoelectrically converted by the optical sensor 19 is amplified by the amplifier 21, and then the video processing circuit 22.
It is designed to be input to. This video processing circuit 22
Uses a scanning control signal from a light control circuit 23 for controlling the optical scanning head 17 to perform a process of visualizing a detection signal and output a video signal. The navigation device 5 also has a digitizer 25 for position detection. The digitizer 25 is configured to detect, for example, infrared rays by the light emitting unit 8 and output a position signal thereof to the navigation device body 26.

Further, this navigation device body 26
Is input with a signal obtained by imaging, for example, the head of the surgical microscope 7 or the TV camera 27 arranged around the surgical microscope 7 (as the operation unit 6 performing the operation). The navigation device body 26 is adapted to convert and output a video signal representing a microscope image of the head. At the same time, the navigation device body 26 has the digitizer 2
2 detects the position of the light emitting unit 8 shown in FIG. 2, and further detects the observation position on the head of the optical scanning head 17 at a position separated from the light emitting unit 8 in the predetermined direction by a predetermined distance, and the navigation image It is also designed to generate.

The observing device 3 includes the image processing device 22.
The video signals from the navigation device body 26 are combined by the mixer 24 and displayed as a navigation image on the monitor 4a.
The video processing device 22 is connected to the monitor 4b and the image recording device 30.

The video signal from the video processing device 22 is
It is directly output to the monitor 4b, and the cell state image 31 of the subject by the optical scanning probe 2 is displayed on the monitor 4b. The image recording device 30 records the cell-like image 31 from the video processing device 22.

Further, the navigation device body 26
Is connected to the determination input device 32. The determination input device 32 is for inputting a determination result with respect to the cell-like image 31 displayed on the monitor 4b.

FIG. 2 shows the shape of the optical scanning probe 2 and the overall appearance of the bayonet type rigid sheath 9. The hollow bayonet-type hard sheath 9 includes a rigid grip portion 38 having bent portions at least at two positions, and a thin sheath portion (insertion sheath portion) 34 in which the distal end side of the grip portion 38 is hard and thin.
And are formed.

The optical scanning probe 2 is inserted into the rigid sheath 9 from the near end (rear end) of the grip portion 38,
The insertion position is positioned so that the tip of the optical scanning probe 2 closely faces and faces the condenser lens 35 at the tip of the small-diameter sheath portion 34, and the fixing portion 36 of the optical scanning probe 2 is fixed and picked 37.
It is designed so that it can be detachably fixed.

Further, the rigid sheath 9 has a light emitting portion 8 for detecting the position by the digitizer 25 attached to the grip portion 38 on the rear end side. The light emitting unit 8 is attached with several light emitting elements 8a to 8c that generate infrared rays. A remote switch holder 39 is attached to the grip 38. The remote switch holder 39 includes at least two remote switches 40a,
The remote switch 40b is attached.

The remote switch 40a and the remote switch holder 40b are connected to the navigation apparatus body 26 by a signal line 40c (see FIG. 1).
The connector 15b at the rear end of the optical scanning probe 2 is detachably connected to the connector receiver 15a of the observation device 3 as shown in FIG. Also, this connector 15b is
A connection pin (not shown) for a signal line connected to the optical scanning head 17 is also provided. As a result, the optical scanning probe 2 is connected to the optical scanning control circuit 23 via the connector receiver 15a.

In the surgical microscope apparatus 1 of the present embodiment having such a configuration, the position information of the observation position at which the optical scanning probe 2 actually magnifies and observes the microscope image showing the surgical site to be operated such as the head. Image superimposing the image and cell aspect image 3 by the optical scanning probe 2
It can be recorded in the image recording device 28 as image information in which 1 and 2 are paired, and can be observed by the monitor 4a.

Next, the operation of this embodiment will be described. As shown in FIG. 1, in the optical scanning probe 2, the connector 15b is connected to the observation device 3. The navigation device 5 is also set as shown in FIG. And
As shown in FIG. 3, under observation with the surgical microscope 7, the scanning head 17 of the optical scanning probe 2 is attached to the rigid sheath 9 and guided to the operation portion 6. The TV camera 27 images the surgical site 6, and the image of the surgical site 6 is displayed on the monitor 4a as a navigation image 33 by the navigation device body 26 in FIG. This navigation image 33 is
The optical scanning head 1 of the optical scanning probe 2 for magnifying and observing (an arbitrary observation position in) the surgical site 6 on this image.
A pointer 10 indicating the observation position 7 is displayed.

Further, as shown in FIG. 1, the optical scanning probe 2
The confocal optical signal obtained at the observation position by the optical scanning head 17 is imaged by the video processing circuit 22 to become a confocal scanning image, in this case, a cell aspect image 31, which is displayed on the monitor 4b. To be done.

When the remote switch 40a or the remote switch 40b described with reference to FIG. 2 is pressed, the optical scanning probe 2 records the cell state image 31 in the image recording device 30, and the navigation device 26 positions it. Record the coordinates. The cell-like image 31 is mixed with the navigation image 33 by the mixer 24 and can be simultaneously displayed on the display screen of the monitor 4a via the image recording device 28 as shown in FIG.

FIG. 4 shows the display on the monitor 4a. As shown in FIG. 4, on the display screen of the monitor 4a, an operation part image 41 taken by the TV camera 27 connected to the navigation device 26 or a TV camera in the microscope system 44 (not shown) is displayed. 41
The cell-like image 42 is displayed on the child screen inside. Monitor 4
The pathological diagnosis of the cell-like image 31 displayed in b is judged to be malignant or benign, and this judgment is input to the navigation device 26 by the judgment input device 32.

Then, the result of the judgment made by the pathologist is displayed by the navigation device 26 by replacing the pointer 10 on the operative image 41 with judgment markers 43a and 43b. For example, when the tissue of the cell-like image 31 is malignant, the pathological diagnostician determines that the malignancy determination marker 43
a, when the tissue of the cell-like image 31 is benign, a marker having a different color or shape, such as the benign determination marker 43b, is displayed in the operation image 41.
Is displayed in. Then, these malignancy determination markers 43a,
Based on the distribution of the benign judgment marker 43b, the navigation device body 26 judges the range of the malignant portion and displays the judged malignant range as shown in FIG.

FIG. 5 shows a monitor 4 displaying a plurality of judgment markers.
The observation image of a is shown. The navigation device body 26 is
Benign determination markers 45a to 45d and malignancy determination marker 4
The range of the malignant portion is determined based on the distribution of 5e to 45h, and the malignant range display 46 is performed.

The malignant range display 46 has two markers (for example, a malignant judgment marker and a benign judgment marker which are close to each other (for example,
A boundary between the malignancy determination marker 45a and the benign determination marker 45e is used as a boundary line, and the determination input device 32 can set whether to be close to the benign determination marker 45a or the malignant determination marker 45e. As a result, the operator can judge the excision portion and confirm that the malignant tumor is left behind.

Further, the navigation device body 26 can redisplay the cell-like image 47 recorded in the image recording device 30 at each marker position as shown in FIG.
FIG. 6 shows a cell state image 47 recorded in the image recording device 30.
The observation image of the monitor 4a which re-displayed is shown.

The navigation device body 26 is provided with the marker 4
By aligning the index 48 with the portion displaying 5i by the optical scanning probe 2 or the index control means (not shown), the cell-like image 47 recorded in the image recording device 30 at each marker position can be displayed again. it can. This allows the operator to confirm the diagnosis site again.

Therefore, this embodiment has the following effects. The present embodiment has an effect that the pathological diagnosis and the surgery can be smoothly advanced. Further, according to the present embodiment, the operation and the patient can complete the operation in a short time, and the burden and pain can be reduced. More specifically, according to the present embodiment, by displaying / recording / reproducing a combination of a cell-like image and an image of a region where surgery is actually being performed, it is possible to detect microscopic image information of cells. The correlation with the diagnosis position can be easily confirmed. In the present embodiment, the range of the malignant tumor is further displayed, so that it is possible to easily determine the resection range.

(Second Embodiment) FIGS. 7 and 8 relate to a second embodiment of the present invention, and FIG. 7 shows the configuration of a surgical microscope apparatus in the surgical form of the second embodiment. FIG. 8 shows a configuration example of a surgical system using the surgical microscope apparatus of FIG. 7 in a hospital or between hospitals. In the second embodiment,
The present invention is applied to a surgical system within a hospital or between hospitals.

As shown in FIG. 7, the surgical microscope apparatus 51 according to the second embodiment has a rigid sheath 9 to which the optical scanning probe 2 is attached, an operating microscope 52, the operating microscope 52 and the operating microscope 52. The optical scanning probe 2 is connected via the image processing circuit 22 and the microscope system 53, respectively, and the navigation device 54 and the endoscope TV camera 5 are connected.
5, a system control device 56 connected to the system control device 5, an image file device 57 connected to the system control device 56, and
It has a V monitor 58 and a network interface (hereinafter, network I / F) 59 connected to the network.

The system control device 56 is a device (or system or device) such as the connected microscope system 53.
Connected to the system control device 56 and the device control unit 61 for controlling the transmission of video data and the like to the external device via the network I / F 59 and the control of receiving the video data and the like from the external device side. The video control unit 62 controls the video signal of the device.

The device control section 61 uses the microscope system 53 via a local communication line 61a such as RS232C.
Image processing circuit 22, navigation device 54, endoscope TV camera 55, image file device 57, TV monitor 5
8 and the network I / F 59.

Further, the image control section 62 is arranged so that the microscope system 53 and the image processing circuit 2 are connected via the image communication line 62a.
2, navigation device 54, TV camera 5 for the endoscope
5, the image file device 57, the TV monitor 58, and the network I / F 59. Then, the video input from the optical scanning probe 2, the endoscopic TV camera 55, and the like is controlled to be output to the image filing device 57, the TV monitor 58, and the like.

On the other hand, the device control section 61 uses the RS232
The above-described microscope system 53, the image processing circuit 22, the navigation device 54, the endoscope TV camera 55, and the network I / F 5 via the local communication line 61a such as C.
9, the TV monitor 58 and the image filing device 57 are connected to change the settings of these devices.

Further, the device control section 61 is provided with a data line 6
1b is connected to the network I / F 59, and video signal data, audio data, computer data, etc. are transmitted to the external device connected to the network via the network I / F 59, or the external device side is connected. I am able to receive from.

The optical scanning head 17 of the optical scanning probe 2
The process of imaging the signal captured by is similar to that of the first embodiment. Other configurations are similar to those of the first embodiment.

A surgical microscope apparatus 5 constructed in this way
1 is used in a hospital or between hospitals as shown in FIG. 8 and constitutes a surgical system. FIG. 8 shows a configuration example of a surgery system in a hospital or between hospitals.

In the operating room 63, a microscope system 53, a (confocal) optical scanning probe device 64, a navigation device 54, a TV monitor 58, etc., which are almost the same as those described in FIG. 7, are connected to the system control device 56. Has been done.
The optical scanning probe device 64 includes the optical probe 2 and the image processing circuit 22 mounted on the rigid sheath 9 shown in FIG.
Is a device including.

The system controller 56 is connected to a network server 65 connected to the network via a network I / F 59. This network server 65 is connected to the CT / MRI room 6 via the network.
Connected to 6. This CT / MR room 66 is
The MRI apparatus 67 is connected to the data storage apparatus 68, and the data storage apparatus 68 is connected to the network server 65. Further, the CT / MRI apparatus 67 is adapted to store the preoperative diagnostic image in the data storage apparatus 68. Then, the CT / MRI apparatus 67 can transmit the preoperative diagnostic image to the outside via the network.

On the other hand, the network server 65 is connected to a personal computer (hereinafter abbreviated as a personal computer) 70 of a pathologist 69 inside or outside the hospital. The personal computer 70 is connected to the data storage device 71. Then, the pathologist 69 can receive the image information and the like transmitted via the network via the personal computer 70, save it in the data storage device 71, and display it on the personal computer monitor 70b.
Reference numeral 70a is a PC body of the personal computer 70. The pathologist 63 can also send the result of pathological diagnosis to the operating room 63 via the network.

Next, the operation of this embodiment will be described. In this embodiment, the flow of the video signal is almost the same as in the first embodiment, but the video signal is centrally controlled by the video control unit 62 of the system controller 56.

In FIG. 7, the surgical microscope 52 has a built-in TV camera (not shown) to photograph, for example, the head (as the surgical operating portion 6). The signal from the TV camera is subjected to image processing by the video processing circuit 22 to become a video signal, which is transmitted to the navigation device 54 via the video control unit 62 of the system control device 56.

The navigation device 54 adds the cell-like image of the optical scanning probe 2 and observation position information, and displays the observation image on the monitor 58 as a video signal via the video control unit 62. In addition, the cell-like image by the optical scanning probe 2 and the video processing circuit 22 is transmitted to the network I / F 59 via the video control unit 62, and is transmitted as image data inside or outside the hospital, and at the same time, an image file device. 57.

On the other hand, the operating room 63 receives the diagnostic result for the cell-like image as determination data from the network and transmits it to the navigation device 54 via the device control unit 61 of the system control device 56.

Based on the transmitted judgment data, the navigation device 54 displays the benign judgment marker 45a, the malignancy judgment marker 45e, the malignant range display 46, etc. which are the same as those described in FIG. 5 of the first embodiment. Predicate image 4 added
1 is displayed on the monitor 58 via the video control unit 62. On the other hand, the device control unit 61 performs centralized control of each connected device, changes settings of each connected device, and switches input / output of video signals.

As described above, the surgical system is centrally controlled by the device control unit 61 and the image control unit 62 of the system control unit 56, so that the microscope system 53 and the endoscope TV can be used.
It is also possible to transmit a video such as a preoperative diagnostic image from the camera 55 or the CT / MRI room 66 shown in FIG. 8 to an arbitrary network and display it on the monitor 58.

In FIG. 8, the operating room 63 has a navigation device 54 as described in the first embodiment.
The treatment with the microscope system 53, the cell state of the mutant tissue with the optical scanning probe 64, etc. are observed under the guidance of 1. The TV monitor 58 in the operating room 63 is a microscope observation image, a navigation image, a cell state image, or the CT / MRI room 6
The preoperative diagnosis image and the like from 6 are displayed.

When the optical probe device 64 captures the target tissue, the remote switches 40a and 40b are depressed in the same manner as described in the first embodiment, so that FIG.
As described above, the pointer 10 is displayed in the observation image, and the cell state image at that time is recorded. The recorded cell state image is used by the cell diagnostician 69 via the network.
To the computer 70, and the storage device 7 is sent as appropriate.
Accumulated in 1.

Personal computer monitor 70b of pathologist 69
On the screen, a cell state image (not shown) accumulated in the storage device 71 is displayed. The pathologist 69 transmits information on whether the tissue is malignant to the operating room 63 from these image information via the network.

The operating room 63 records and displays the information from the pathologist 63 as a benign judgment marker and a malignancy judgment marker, and displays a malignant range display 46 indicating a malignant range on the screen. As a result, the second embodiment is similar to the first embodiment.
In addition to obtaining the same effects as those of the embodiment, it is possible to proceed with diagnosis / surgery in real time without actually having a pathologist at the surgery site.

(Third Embodiment) FIGS. 9 to 11 relate to a third embodiment of the present invention. FIG. 9 shows the configuration of a surgical microscope apparatus of the third embodiment, and FIG. 11A shows an optical field of view of the surgical microscope, FIG. 10A shows an observation image of the optical field of view, FIG. 10B shows a navigation image displayed on the overlay monitor of the surgical microscope, and FIG.
Indicates the optical field of view of the surgical microscope in which the navigation image is superimposed on the observation image.

In the first and second embodiments, the observation position information, the judgment result by the pathologist and the malignant range display are added to the observation image displayed on the monitor. The third embodiment is configured to add observation position information, a determination result by a pathologist and a malignant range display to the optical field of the surgical microscope. The rest of the configuration is almost the same as that of the first embodiment, so the description thereof will be omitted, and the same configurations will be denoted by the same reference numerals.

That is, as shown in FIG. 9, the surgical microscope apparatus 81 according to the third embodiment includes an operating microscope 52B and an operating microscope 52B.
A navigation device main body 26B for displaying the observation position information, the judgment result by the pathologist and the malignant range display is added to the observation range of the optical field of the operating microscope 52B.

A TV camera (not shown) for picking up an optical field of view of the surgical microscope 52B is connected to the navigation device 26B and outputs a signal of the picked up optical field of view to the navigation device 26B. The surgical microscope 52B has an overlay monitor (not shown) in the optical system of this optical field. The overlay monitor is connected to the mixer 24 of the observation device 3B, and the video signal from the mixer 24 is input.

The navigation device 26B detects the position of the surgical microscope 52B with respect to the operation portion, and calculates the tip position of the optical scanning probe 2 with respect to the observation range of the optical field of the surgical microscope 52B. ing.

Then, the navigation device 26B
Displays the calculated tip position of the optical scanning probe 2 as a pointer on the overlay monitor of the surgical microscope 52B, and displays the judgment result of malignancy or benignity by the pathologist from the judgment input device 32. A navigation image to be displayed as a determination marker is generated and output to the mixer 24 of the observation device 3B.

Further, the navigation device 26B is
Based on the distribution of the judgment marker, the range of the malignant part is judged,
The determined malignant range is superimposed on the navigation image. The observation device 3B has substantially the same configuration as the observation device 3 described in the first embodiment except the image recording device 28.

The surgical microscope apparatus 81 of the present embodiment having such a configuration can display the observation position information, the judgment result by the pathologist and the malignant range display in the observation range of the optical field of the surgical microscope 52B. Is.

Next, the operation of this embodiment will be described. The surgical microscope 52B obtains an optical visual field 82 of the predicate, for example, as shown in FIG. At this time, a signal of an observation image obtained by imaging the operation portion is input to the navigation device body 26B.

The navigation device 26B detects the position of the surgical microscope 52B with respect to the surgical site, and the surgical microscope 5B is detected.
A navigation image 90 that causes a pointer 91 indicating the tip position 2a of the optical scanning probe 2 to be displayed on the overlay monitor of the surgical microscope 52B with respect to the observation range of the optical field 82 of 2B is generated.

The mixer 24 of the observation device 3B outputs the video signal from the navigation device 26B to the overlay monitor of the surgical microscope 52B and displays it in the optical field of view 82 of the surgical microscope 52B. At this time, the optical scanning probe 2
When the remote switch 40a or 40b is pressed, the monitor 4b displays the cell state image 31 of the subject by the optical scanning probe 2 and records it in the image recording device 30 (see FIG. 9).

The pathologist diagnoses the malignancy / benignity of the tissue while observing the cell-like image 31 displayed on the monitor 4b, and inputs the determination result to the navigation device 26B by the determination input means 32.

Based on the input determination result, the navigation device 26B replaces the benign marker 92a, the malignant marker 92b, etc. with the positions actually observed by the optical scanning probe 2, as shown in FIG. 10 (b). It is superimposed on 90 and is output to the overlay monitor of the surgical microscope 52B.

At this time, since the positional relationship of the navigation image is calculated by the navigation device 26B, even if the optical field of view 82 of the surgical microscope 52B is moved, the benign judgment marker 92a and the malignancy judgment marker 92b for the operation site are displayed. The positional relationship of the pointer 91 is maintained. Then, the navigation image 90 is superimposed on the optical image of the surgical microscope 52B by the overlay monitor.
Is displayed in the optical field of view 82.

Then, based on the distribution of the benign judgment marker 92a and the malignancy judgment marker 92b, the navigation device main body 26B judges the range of the malignant portion, superimposes the judged malignant range 93 on the navigation image 90 and overlay monitor. And display it in the optical field of view 82 of the surgical microscope 52B.

As a result, in the third embodiment, in addition to obtaining the same effect as that of the first embodiment, the operator can confirm the lesion area without taking his eyes off the microscope, and
In excision of tissue, it is possible to confirm the remaining tissue in real time.

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

[Additional Notes] (Additional Item 1) A surgical microscope for obtaining a microscopic image of a surgical site, and an optical scanning probe for acquiring optical image information at a predetermined position in the surgical site.
In a surgical microscope apparatus having a detection means for detecting a relative position between the observation position of the optical scanning probe and the surgical site, with respect to a cell image obtained by the optical scanning probe,
A determination input means for inputting a determination result, a determination display means for performing at least two determination displays based on the determination result input by the determination input means, and the optical scanning probe detected by the detection means Surgery for superimposing a determination display displayed by the determination display means on a microscope image obtained by the surgical microscope based on the relative position between the observation position and the surgical site. Microscope device.

(Additional Item 2) A calculation means for determining a predetermined range based on the judgment display displayed by the judgment display means and a range display means for displaying the range of the predetermined range determined by the calculation means. And the superposition means,
The surgical microscope apparatus according to appendix 1, wherein at least one of the range display and the determination display is superimposed and displayed on the microscope image obtained by the surgical microscope.

(Additional Item 3) Image storage means for storing the determination display displayed by the determination display means and the cell image obtained by the optical scanning probe in association with each other, and a selection for selectively inputting the determination display. 3. The additional item 1 or 2, further comprising: an input unit, and a reading unit that reads out and displays a corresponding cell image from the image storage unit based on information selectively input by the selection input unit. Surgical microscope device.

(Additional Item 4) The cell image obtained by the movement changing means and the optical scanning probe for moving or changing the judgment display and the range display according to the change of the optical field of the surgical microscope is transmitted. The surgical microscope apparatus according to any one of appendices 1 to 3, further comprising a transmission display means for displaying.

(Additional Item 5) The above-mentioned superimposing means superimposes at least one of the judgment display and the range display on the optical field of view of the surgical microscope.
The surgical microscope apparatus according to Item 3.

(Supplementary Note 6) The supplementary means is characterized in that the superimposing means superimposes at least one of the determination display and the range display on the microscope image obtained by the surgical microscope. Surgical microscope device.

[0081]

As described above, according to the present invention, it is possible to perform a pathological diagnosis of a tumor tissue that cannot be discriminated by a preoperative image diagnosis and efficiently present the result of the pathological diagnosis to an operator. Can be realized.

[Brief description of drawings]

FIG. 1 is a configuration diagram of a surgical microscope apparatus according to a first embodiment.

FIG. 2 is a diagram showing an overview of a rigid sheath equipped with an optical scanning probe.

FIG. 3 is a diagram showing a state in which a confocal image of the surgical site is obtained by an optical scanning probe under observation with a surgical microscope.

FIG. 4 is a diagram showing an observation image of a monitor on which a cell-like image is superimposed.

FIG. 5 is a diagram showing an observation image of a monitor displaying a plurality of determination markers.

FIG. 6 is a diagram showing an observation image of a monitor on which a cell state image recorded in an image recording device is displayed again.

FIG. 7 is a configuration diagram of a surgical microscope apparatus in a surgical form according to a second embodiment.

FIG. 8 is a diagram showing a configuration example of a surgical system in a hospital or between hospitals using the surgical microscope apparatus of FIG.

FIG. 9 is a configuration diagram of a surgical microscope apparatus according to a third embodiment.

FIG. 10 is a diagram showing an optical field of view of a surgical microscope.

FIG. 11 is a diagram showing an optical field of view of a surgical microscope in which a navigation image is superimposed on an observation image.

[Explanation of symbols]

1 ... Microscope device for surgery 2 ... Optical scanning probe 3 ... Observation device 4a, 4b ... Monitor 5 ... Navigation device 6 ... surgery department 7 ... Operating microscope 8 ... Light emitting part 9 ... Hard sheath 10 ... Pointer 11 ... Laser light source 17 ... Optical scanning head 19 ... Optical sensor 22 ... Image processing circuit 23 ... Optical scanning control circuit 24 ... Mixer 25 ... Digitizer 26 ... Navigation device body 27 ... TV camera 28, 30 ... Image recording device 31 ... Cell aspect image 32 ... Judgment input device 33 ... Navigation image

Claims (3)

[Claims] 1. A surgical microscope for obtaining a microscope image of a surgical site, an optical scanning probe for acquiring optical image information at a predetermined position in the surgical site, an observation position of the optical scanning probe, and the surgical site. In a surgical microscope apparatus having a detection unit for detecting a relative position, a determination input unit for inputting a determination result with respect to a cell image obtained by the optical scanning probe, and a determination input by the determination input unit On the basis of the result, at least two determination display means are displayed, and based on the relative position between the observation position of the optical scanning probe and the surgical site detected by the detection means, the determination display means displays the display. A surgical microscope apparatus comprising: a superimposing unit that superimposes a determination display on a microscope image obtained by the surgical microscope. 2. A calculation means for determining a predetermined range based on the judgment display displayed by the judgment display means, and a range display means for displaying the range of the predetermined range determined by the calculation means, The surgical microscope apparatus according to claim 1, wherein the superimposing means superimposes and displays at least one of the range display and the determination display on the microscope image obtained by the surgical microscope. 3. An image storage unit for storing the determination display displayed by the determination display unit in association with the cell image obtained by the optical scanning probe, and a selection input unit for selectively inputting the determination display. The operation microscope according to claim 1 or 2, further comprising: readout means for reading out and displaying a corresponding cell image from the image storage means based on information selectively input by the selection input means. apparatus.