JP2004337474A - Medical guiding manipulator - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide an operative tool manipulator which is provided with an operative tool such as knife and endoscope at the top end, and can be guided through a channel to a diseased part, even if it is impossible to approach directly from the outside of a body to the diseased part and the approach space is narrow. <P>SOLUTION: The operative tool manipulator comprises the first, the second, and the third manipulator bodies 12, 13, and 14 and a guiding manipulator 10, wherein the manipulator bodies can be moved independently of each others by the driving of a drive device 11 using a driving source such as motor and cylinder. The manipulator bodies 12-14 are set to be approachable by each others and to have their multiarticular structures allowing specific parts to be bendable. The guiding manipulator 10 can approach and bend to push through non-linear narrow crevices S1, S2, and so on and make a channel to the diseased part, and the crevices S1 and S2 are widened gradually toward the diseased part so that a channel may be formed and maintained for a cut manipulator to guide succeedingly inside the body. <P>COPYRIGHT: (C)2005,JPO&NCIPI

Description

[0001]
TECHNICAL FIELD OF THE INVENTION
The present invention relates to a medical leading manipulator, and more particularly, to a medical leading manipulator for securing a space for guiding a surgical instrument manipulator having a surgical instrument such as a scalpel or an endoscope at a distal end side into a body.
[0002]
[Prior art]
Conventional hip surgery is performed such that various muscle tissues called gluteus maximus and sartorius are incised, and various fascias are peeled off so as not to damage an artery. However, in such a hip joint operation, an operator secures a wide operating field as a working space because the operator strikes a cutting tool having a shape similar to “only” on an affected part and cuts a predetermined bone part. There must be. Therefore, before the cutting, a large incision of each living tissue is required, which not only increases the burden on the patient, but also takes time to recover the blood vessels, muscle fibers and nerves after the operation, and requires complete rehabilitation and rehabilitation. There is a problem that it takes a very long time to recover.
[0003]
By the way, in recent abdominal cavity surgery or the like, a small hole is made in the abdomen of a patient, and a surgical tool manipulator in which a surgical tool such as an endoscope, a scalpel, forceps, or the like is provided on the distal end side in the hole (for example, Patent Document 1) And the like, and an operator performs a surgical operation by remotely operating the surgical tool manipulator. Since such a method does not require a large incision in the abdomen, the burden on the patient is small, and a relatively short recovery is possible. Therefore, if the above-mentioned hip surgery is performed using this method, the burden on the patient at the time of surgery can be greatly reduced, as in the case of the abdominal surgery, etc., and the recovery period of the patient after the surgery is greatly reduced. Can be expected.
[0004]
[Patent Document 1]
JP-A-10-296671
[Problems to be solved by the invention]
However, in the method using the surgical tool manipulator, due to the structure of the surgical tool manipulator, it can be used only when it is possible to linearly approach the affected part from outside the body, such as the hip joint surgery, etc. At present, it cannot be applied to surgery in which the approach from the outside of the body to the affected part cannot be performed linearly and the approach space cannot be sufficiently secured. That is, at the time of the hip joint operation or the like, tissues such as organs, muscles, blood vessels, and nerves are arranged in a complicated manner before reaching the diseased part from outside the body, and in order to allow the surgical tool manipulator from outside the body to reach the diseased part. However, the surgical manipulator must be non-linearly advanced from the outside of the body to the affected area while expanding the narrow gap between the tissues to the minimum necessary, and the operation tool manipulator cannot perform such operations. is there.
[0006]
[Object of the invention]
The present invention has been devised in view of such a problem, and its purpose is to reach the affected part from the outside of the body with a simple trajectory such as a straight line or an arc, and the approach space is narrow. Even in such a case, an object of the present invention is to provide a medical leading manipulator that can guide a surgical instrument manipulator provided with a surgical tool such as a scalpel or an endoscope on the distal end side to an affected part.
[0007]
[Means for Solving the Problems]
In order to achieve the above object, the present invention includes a plurality of manipulator bodies that travel through a gap in a living body,
Each of the manipulator main bodies is provided so as to be capable of being separated from and approaching to each other, and a predetermined portion is provided in a multi-joint structure capable of being bent and displaced, and the manipulator body is capable of moving while expanding the gap by the separation and approach and bending displacement. Has been adopted. According to such a configuration, each manipulator body gradually expands a narrow gap existing nonlinearly to the diseased part toward the diseased part by the bending operation and the separation approaching operation in the process of going to the diseased part from outside the body. In this way, a living tissue can be dissected, and a passage for allowing a subsequent surgical tool manipulator to approach the affected part can be secured. Further, by maintaining the posture of the manipulator body when it reaches the affected part, the state of the passage can be maintained. At this time, the living tissue around the passage is protected by the respective manipulator main bodies located on the inner wall side of the passage, and the risk of damage to the living tissue by a subsequent surgical instrument manipulator can also be reduced. When each manipulator body separates the living tissue, the gap existing in a non-linear manner can be expanded without difficulty by a partial bending operation or the like, thereby also reducing the possibility of damaging the living tissue. can do. In general, by using the medical leading manipulator, it is impossible to linearly approach from the outside of the body to the affected part, and even in a hip joint operation or the like in which the approach space cannot be sufficiently secured, such as conventionally performed abdominal cavity surgery and the like As in the case above, surgery using a surgical tool manipulator provided with a surgical tool such as a scalpel or an endoscope on the distal side becomes possible, and the burden on the patient during surgery can be greatly reduced, and the patient after the surgery can be operated. It is expected that the recovery period of the can be greatly reduced.
[0008]
In the present invention, at least three manipulator bodies are provided, and while maintaining the expanded state of the gap with any two of them, the remaining one approaches the gap existing on the other side, and a configuration may be adopted. preferable. With this configuration, it is possible to form and maintain a passage for guiding the surgical instrument manipulator to the affected part with a relatively simple structure.
[0009]
BEST MODE FOR CARRYING OUT THE INVENTION
Hereinafter, embodiments of the present invention will be described with reference to the drawings.
[0010]
FIG. 1 is a schematic configuration diagram of a medical manipulator according to the present embodiment. In this figure, a leading manipulator 10 has first, second and third manipulator bodies 12, 13, 13, which can operate independently of each other by driving a driving device 11 which uses a motor, a cylinder or the like (not shown) as a driving source. 14 is provided.
[0011]
Each of the manipulator bodies 12 to 14 is provided in a substantially round bar shape having a multi-joint structure that is identical to each other, and includes a plurality of manipulator forming bodies 16 and joint portions 17 that connect the manipulator forming bodies 16 so as to be relatively displaceable. It is comprised including.
[0012]
The manipulator forming body 16 located at the foremost side of each of the manipulator main bodies 12 to 14 is provided in a conical shape with a sharp tip end, while the manipulator forming body 16 at other positions is provided in a substantially cylindrical shape. . The wires W connected to the driving device 11 are independently fixed to the respective manipulator forming bodies 16. In FIG. 1, the notation of the wire W is simplified in order to avoid complicating the drawing.
[0013]
As shown in FIG. 2, the joint 17 has a well-known joint structure that connects the manipulator forming bodies 16 so as to allow one degree of relative rotation.
[0014]
Each of the manipulator bodies 12 to 14 having the above configuration is connected to the driving device 11 so as to realize a known master-slave method or the like, and can perform a predetermined operation by a remote operation of a user (operator). Has become. In other words, the manipulator bodies 12 to 14 can be independently moved in the axial direction by driving of the driving device 11, and can be moved in a direction in which they are separated from each other. Further, by driving the driving device 11, the wire W connected to the manipulator forming body 16 at a predetermined site designated by the operator is pulled toward the driving device 11, so that the manipulator forming body 16 becomes adjacent to the manipulator forming body 16. Is set to be bent and displaced over a predetermined angle. Although not shown, in the present embodiment, the wires W are fixed to each manipulator forming body 16 at two positions separated by about 180 degrees in the circumferential direction, and the two wires W are selectively connected to each other. As a result, the target manipulator formed body 16 is rotationally displaced in both the forward and reverse directions with respect to the adjacent manipulator formed body 16.
[0015]
Next, the operation of the leading manipulator 10 during the hip joint operation will be described. In the following, of the movements of the manipulator bodies 12 to 14 in the axial direction, movement in the direction F in FIG. 1 is referred to as forward movement, and movement in the direction R in the drawing opposite thereto is referred to as retraction. In addition, the manipulator forming body 16 is referred to as a distal end on the left end side in FIG. 1 and is also referred to as a first, second,..., Nth manipulator forming body 16 in order from the front end side.
[0016]
The hip joint operation described here is an operation performed using a cutting manipulator (surgical instrument manipulator) (not shown) having a laser scalpel function, and the cutting manipulator is capable of cutting a bone tissue from its distal end side with a laser beam (Er. (YAG laser). This cutting manipulator is inserted from a hole (insertion position) opened on the side near the waist of the patient at the distal end side, and is near the affected part serving as a connection part between the femur and the iliac connected to the upper end side of the femur. To the target position). At this time, since various living tissues such as organs, muscles, bones, blood vessels, and nerves are densely present from the insertion position to the target position, not only the cutting manipulator cannot move linearly in the body, but also the cutting manipulator. The gap (passage) for passing through is also narrow. Therefore, before inserting the cutting manipulator into the body, the leading manipulator 10 is inserted into the body, and the leading manipulator 10 acts so as to secure a passage for the cutting manipulator. That is, the manipulator main bodies 12 to 14 maintain the passage of the cutting manipulator while moving nonlinearly from the insertion position to the target position prior to the cutting manipulator by an operation of an operator. At this time, an endoscope manipulator (surgical instrument manipulator) not shown is inserted into the body together with each of the manipulator main bodies 12 to 14 so that the operator can visually check an image inside the body to form a passage to the target position. Is found, and the robot proceeds while expanding the gap using the manipulator bodies 12 to 14.
[0017]
Specifically, the three manipulator bodies 12 to 14 gradually advance toward each of the gaps while moving in each gap while performing bending displacement and separation and approach, and from the insertion position, Forming a non-linear path of the cutting manipulator to reach a target position;
[0018]
An example of the above operation will be described with reference to FIGS. Here, in order to simplify the drawing, the two first and second gaps S1 and S2 to be targets are formed in a ring shape, but the actual gap can be seen in a joint portion of a muscle mass or the like. It has a complicated shape.
[0019]
First, as shown in FIG. 3, the distal ends of the manipulator bodies 12 to 14 are opposed to a first gap S1 located outside the body with respect to the second gap S2. Then, the first and second manipulator main bodies 12 and 13 are advanced toward the first gap S1 by the operation of the operator, and their distal ends are placed in the first gap S1 as shown in FIG. insert. Next, the first and second manipulator bodies 12, 13 operate in a direction away from each other, and the first gap S1 is expanded with elastic deformation (see FIG. 5). At this time, the movements of the first and second manipulator bodies 12 and 13 are temporarily stopped, and the expanded state of the first gap S1 is maintained, and one of the paths of the subsequent cutting manipulator (not shown) is formed. A part is formed. Then, the third manipulator main body 14 moves forward, and as shown in FIG. 6, the third manipulator main body 14 is inserted into the expanded first gap S1, and the third manipulator main body 14 As shown in (2), the front end is advanced so as to be inserted into the next second gap S2. At this time, the third manipulator main body 14 is configured so that the second manipulator formed body 16 is bent and displaced, so that the third manipulator formed body 16 is adjacent to the first manipulator main body 12. Abuts on the inner wall portion of the gap S1, and that state is maintained. Next, the first manipulator body 12 advances toward the second gap S2 as shown in FIG. 8 while shifting laterally toward the second manipulator body 13. At this time, the first gap S1 is maintained in the expanded state described above by the second and third manipulator bodies 13 and 14. Then, the first manipulator main body 12 abuts on the inner wall portion of the first gap S1 at a position adjacent to the second manipulator main body 13. Next, the second manipulator main body 13 is shifted laterally toward the third manipulator main body 14, and as shown in FIG. 9, the first gap S1 is positioned adjacent to the third manipulator main body 14. Contact the inner wall. Then, as shown in FIG. 10, the first and third manipulator bodies 12, 14 with the distal ends inserted into the second gap S <b> 2 are separated from each other, and each of the second manipulator formed bodies is separated from each other. The second gap S2 is also in the expanded state by bending and displacing each of the second gap 16 and the second gap S2. At this time, the second manipulator body 13 moves along the inner wall portion so as to maintain the expanded state of the first gap S1. The above operation is alternately repeated until the leading end of the leading manipulator 10 reaches the target position. When the leading end of the leading manipulator 10 reaches the target position, the gaps S1, S2,... Are expanded by bending displacement of the manipulator forming bodies 16 of the first to third manipulator bodies 12 to 14. The state is maintained, and a passage from the insertion position to the target position is formed. Summarizing the above, in the present embodiment, while maintaining the expanded state of the gaps S1, S2,... In any two of the manipulator bodies 12 to 14, the remaining gap S2 is present in the other one. , Each manipulator body 12 to 14 pushes through the non-linear narrow gaps S1, S2... Serving as a passage to the affected part, and gradually expands these gaps S1, S2 toward the affected part. Thus, a path to the affected part for the cutting manipulator (not shown) is secured.
[0020]
Thereafter, the cutting manipulator having the same articulated structure as each of the manipulator bodies 12 to 14 accompanies bending displacement of an intermediate portion, and the distal end side thereof is guided to the target position without difficulty. The tool inserted into the passage formed by the leading manipulator 10 is not limited to the above-described cutting manipulator, but it is of course possible to insert another surgical tool manipulator or the like with forceps or the like attached to the distal end side. .
[0021]
Therefore, according to such an embodiment, the surgical instrument manipulator cannot be approached linearly from the outside of the body to the affected part, and even if the gap that becomes the passage is narrow, the gap is expanded and the surgical instrument is expanded. An effect is obtained that the manipulator can be guided to the affected part. Therefore, it is possible to apply a surgery using a robot that does not require a large incision to an affected part where it is difficult to approach the surgical tool manipulator.
[0022]
The structure of the manipulator bodies 12 to 14 is not limited to the structure of the above embodiment, and various structures can be adopted as long as the manipulators can be relatively moved while partially bending and displacing.
[0023]
Further, in the above-described embodiment, the manipulator bodies 12 to 14 are manually operated by remote operation by an operator. However, the present invention is not limited to this. If the path of the approach and the size of the gap are grasped, the driving device 11 is controlled to automatically move the manipulator bodies 12 to 14 to the affected part according to the image data and the like. Is also good.
[0024]
Further, the leading manipulator 10 can of course be applied to other operations of the hip joint operation described above.
[0025]
In addition, each configuration in the present invention is not limited to the illustrated configuration example, and various changes can be made as long as substantially the same operation is achieved.
[0026]
【The invention's effect】
As described above, according to the present invention, a surgical instrument manipulator provided with a surgical tool such as a scalpel or an endoscope on the distal end side cannot linearly approach from outside the body to the affected part, and the approach space is narrow. Even in this case, it is possible to secure a passage for guiding the surgical instrument manipulator to the affected part, and it is possible to perform a surgery by a robot or the like using a surgical instrument manipulator or the like with a small burden on a patient and a short hospitalization period.
[Brief description of the drawings]
FIG. 1 is a schematic configuration diagram of a leading manipulator according to the present embodiment.
FIG. 2 is a schematic perspective view in which a part of FIG. 1 is enlarged.
FIG. 3 is a schematic diagram (part 1) for explaining the operation of the manipulator.
FIG. 4 is a schematic diagram (part 2) for explaining the operation of the manipulator.
FIG. 5 is a schematic view (part 3) for explaining the operation of the manipulator.
FIG. 6 is a schematic diagram (part 4) for explaining the operation of the manipulator.
FIG. 7 is a schematic view (part 5) for explaining the operation of the manipulator.
FIG. 8 is a schematic view (part 6) for explaining the operation of the manipulator.
FIG. 9 is a schematic view (part 7) for explaining the operation of the manipulator.
FIG. 10 is a schematic diagram (part 8) for explaining the operation of the manipulator.
[Explanation of symbols]
10 Leading manipulator 12 First manipulator body 13 Second manipulator body 14 Third manipulator body

Claims (2)

Equipped with a plurality of manipulator bodies that progress through gaps in the living body,
Each of the manipulator bodies is provided so as to be capable of being separated from and approaching to each other, and a predetermined portion is provided in a multi-joint structure capable of being bent and displaced, and the manipulator is capable of moving while expanding the gap by the separation and approach and bending displacement. Medical leading manipulator. 2. The manipulator body according to claim 1, wherein at least three manipulator bodies are provided, and one of the manipulator bodies approaches an existing gap with the other manipulator maintaining the expanded state of the gap. Leading medical manipulator.

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