JP2005261607A - Method and apparatus for guiding minimally invasive bending incision in tubular tissue - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To safely and quickly resect lesion tissue in a wide range three-dimensionally even by only the straight action of a cutter without damaging an endomembrane such as a mucous membrane. <P>SOLUTION: By the method of displacing and fixing the lesion tissue by bending a bending arm 11 provided on the tip of a tubular exterior while tracking the action of a manipulator tip A to the lesion tissue by a 3D image guiding mechanism C by ultrasonic waves or the like, advancing the cutter (drill) 16 housed inside the tubular exterior in that state, resecting and sucking the lesion tissue, and successively resecting and sucking the lesion tissue by changing the bending angle of the bending arm 11 and turning the tubular exterior 10 by a prescribed angle each, while the lesion tissue and the action of the cutter 16 during an operation are three-dimensionally and accurately recognized at all times, the lesion tissue in the wide range is safely and quickly resected by only the straight action of the cutter 16. <P>COPYRIGHT: (C)2005,JPO&NCIPI

Description

  The present invention relates to a tubular tissue minimally invasive excision method for excising a diseased tissue in a tubular tissue such as a prostate and a coronary artery, which excises an affected tissue with a drill housed in a tubular sheath at a distal end of a manipulator inserted into the tubular tissue. The present invention also relates to a tubular tissue minimally invasive excision method and apparatus for aspirating the tube tissue. Can be used as a surgical tool for treating tubular tissue, and used as a surgical instrument for benign prostatic hyperplasia in the urology department, a biopsy instrument for prostate cancer, a surgical instrument for treating arteriosclerosis in thoracic surgery and brain surgery, etc. Is possible.

Conventionally, various methods and apparatuses have been employed to treat or excise affected tissues in tubular tissues such as the prostate and coronary arteries and to extract pathological tissue samples (see, for example, Patent Document 1 and Patent Document 2 below) ).
JP-A-6-205785 (refer to claim 1) JP 2000-152941 A (refer to claim 1)

Patent Document 1 discloses a patient's pulse configured to remove the deposit by injecting high-pressure saline to a plaque deposit attached to a pulse, a vascular graft tissue, or the like. An apparatus and method for removing deposits in a tube. Further, the one disclosed in Patent Document 2 has a sharpened distal end portion and a port arranged at a proximal end portion for receiving a cut tissue portion, and the distal end blade of the cutter is a port of a puncher. The tissue part which was slid to the distal end side and sucked to the port side by vacuum is cut. The cutter is configured to be retracted to the position on the proximal end side in order to take out the tissue portion from the inside.

  However, in the conventional ones disclosed in these patent documents, for example, in the case of prostate surgery, a device equipped with a resectoscope is inserted transurethrally, and a high-pressure jet outlet which is a cutter for excising the affected tissue is inserted. The practitioner was performing an operation while monitoring the affected area with an endoscope or the like equipped with an ultrasonic transducer installed adjacently. Therefore, since it is difficult to grasp the entire affected tissue and skill is required, when the affected tissue is excised with a high pressure or a cutter, the surrounding tissue may be destroyed and the mucous membrane may be peeled off. The treatment time was prolonged, such as the accumulation in the bladder, and the time until suction after the operation was prolonged, causing various complications. Furthermore, when the ablation is performed, the prostate wall (capsule) may be crossed and the surrounding tissue may be damaged.

  In biopsy methods such as urological prostate cancer, a biopsy needle is inserted transrectally, a needle is inserted through the rectal wall, and a portion of the prostate tissue is inserted through the rectum. For this reason, bacteria and the like enter the prostatic tissue and cause complications such as acute prostatitis. Since the needle advances only in one direction from the rectal wall, it is difficult to collect the target affected tissue. Furthermore, in the arteriosclerotic surgical method, the arteriosclerotic stenosis of the coronary artery is expanded with a special balloon catheter or stent to achieve blood circulation, but there is a possibility of restenosis because the stenosis is not physically removed. Very expensive. If the artery is expanded and expanded, the intima is damaged, causing arteriosclerosis again. (In the first place, the cause of arteriosclerosis is due to injury of the intima) In addition, complications of intimal detachment are also regarded as a problem.

  Therefore, in the present invention, various problems in the conventional tubular tissue resection method or apparatus are solved, and the affected tissue and the behavior of the cutter during the operation are treated with almost no damage to the inner membrane such as mucous membrane which is a normal tissue. To provide a tubular tissue minimally invasive bending resection guiding method and apparatus capable of safely and quickly resecting a wide range of affected tissues only by the linear behavior of a cutter while always grasping dimensionally. With the goal.

  Therefore, the present invention is a tubular tissue minimally invasive excision method for excising the affected tissue in a tubular tissue such as prostate and coronary artery, and excise the affected tissue with a drill housed in a tubular sheath at the tip of a manipulator inserted into the tubular tissue In the method of minimally invasive excision of the tubular tissue that sucks it, the bend provided at the distal end of the tubular sheath while tracking the behavior of the manipulator tip with respect to the affected tissue by a 3D image guiding mechanism such as ultrasonic, X-ray CT, MRI, etc. The affected tissue is displaced and fixed by bending the arm, and in this state, the drill accommodated in the tubular sheath is moved straight to excise and suck the affected tissue, and the bending angle of the bending arm is changed and the tubular sheath is The diseased tissue is sequentially excised and aspirated by rotation by a predetermined angle. The present invention also relates to a tubular tissue minimally invasive excision apparatus for excising an affected tissue in a tubular tissue such as a prostate or a coronary artery, a rotatable tubular sheath at the tip of a manipulator inserted into the tubular tissue, and the tubular sheath accommodated in the tubular sheath. A 3D image guiding mechanism by ultrasonic, X-ray CT, MRI, etc. that tracks the behavior of the manipulator tip with respect to the affected tissue; It is comprised from the bending | flexion bending arm provided in the front-end | tip of the said tubular exterior. Further, the present invention is characterized in that the drill is further retractably accommodated in a tubular cutter installed in a tubular exterior of a manipulator so as to advance and retract. Further, the present invention is characterized in that a perfusion tube for supplying perfusate to the affected tissue is disposed in the tubular cutter, and the perfusate is sucked and refluxed together with the excision piece. Further, the present invention is characterized in that the tubular cutter itself constitutes a reflux passage for the perfusate, and these are used as means for solving the problems.

  The present invention is a tubular tissue minimally invasive excision method for excising affected tissue in a tubular tissue such as prostate and coronary artery, which excises affected tissue with a drill housed in a tubular sheath at the distal end of a manipulator inserted into the tubular tissue. In a tubular tissue minimally invasive excision method for sucking this, a bending arm provided at the distal end of the tubular sheath while tracking the behavior of the manipulator tip with respect to the affected tissue by a 3D image guiding mechanism such as ultrasonic, X-ray CT, MRI, etc. In this state, the affected part tissue is displaced and fixed, and in this state, the drill accommodated in the tubular sheath is moved straight to excise and suck the affected part tissue, and the bending angle of the bending arm is changed and the tubular sheath is predetermined. By the excision method that sequentially removes and sucks the affected tissue by rotating each angle, the behavior of the affected tissue and the cutter during the treatment is always three-dimensionally. While accurately grasping, the bending angle of the bending arm at the tip of the manipulator is changed, and the tubular sheath is rotated by a predetermined angle, so that the intima of the mucous membrane that is normal tissue is hardly damaged, and the cutter It became possible to remove a wide range of affected tissues safely and quickly even with only a linear behavior.

  Further, in a tubular tissue minimally invasive excision apparatus for excising affected tissue in tubular tissue such as prostate and coronary artery, a rotatable tubular sheath at the tip of a manipulator inserted into the tubular tissue, and a drill accommodated in the tubular sheath A recirculation passage for sucking and recirculating the excision of the affected tissue excised by the drill, a 3D image guiding mechanism by ultrasonic, X-ray CT, MRI, etc. for tracking the behavior of the manipulator tip with respect to the affected tissue, and the tubular exterior With a flexible bending arm provided at the tip of the arm, the excision means such as a drill at the tip of the manipulator and the behavior of the bending arm can always be accurately performed only by adding a three-dimensional image guiding mechanism. In particular, it is possible to excise extensively and recirculate outside the body while more accurately grasping the three-dimensional displacement due to the bending arm of the affected tissue. Device can be realized that.

  Further, when the drill is housed in a tubular cutter installed in a tubular manner of the manipulator so as to be able to advance and retract further, the combination of changing the angle of the bending arm and rotating the tubular sheath of the manipulator In spite of the fact that all three-dimensional affected tissue can be excised, the drill is guided by a tubular cutter and only needs to be repeated in a straight line, so the structure of the drill is simplified. The Furthermore, when a perfusion tube for supplying perfusate to the affected tissue is disposed in the tubular cutter and the perfusate is aspirated and refluxed together with the excision piece, cellular damage to the excision part The burden is reduced and the recirculation of the excised piece becomes smooth. In addition, when the tubular cutter itself constitutes the reflux path for the perfusate, it is not necessary to install a special reflux pipe, so that the structure is simplified.

  Hereinafter, the present invention will be described in detail with reference to the drawings. FIG. 1 is an overall system diagram showing one embodiment of a tubular tissue minimally invasive bending resection guiding method and apparatus according to the present invention. FIG. 2 is a perspective view and a side view of the bending arm and cutter at the tip of the manipulator. FIG. 3 is a perspective view showing a state where the bending arm is bent by the transmission rod. FIG. 4 is a diagram for explaining the supply of the perfusate by the roller pump in the cutter and how the perfusate recirculates together with the excised pieces. FIG. 5 is a view showing a state of arrangement of the drill in the cutter. FIG. 6 is a perspective view of a drive unit in which the drill shaft drive motor 21 and the like are accommodated. FIG. 7 is a cross-sectional view for explaining the principle of three-dimensional excision of a tubular tissue (affected tissue) using a bending arm. FIG. 8 is a cross-sectional view showing a damaged state of the intima and an excised state of the tubular tissue. FIG. 9 is an axial sectional view of a manipulator including a bending arm and a cutter. FIG. 10 is a vertical (transverse direction) cross-sectional view orthogonal to the axial direction of a manipulator including a bending arm and a cutter. FIG. 11 is a photograph of an experimental apparatus example.

  This will be described in detail below. As shown in FIG. 1, the basic configuration of the present invention is a tubular tissue minimally invasive excision method for excising an affected tissue in a tubular tissue such as a prostate and a coronary artery, and a tubular sheath at the tip of a manipulator inserted into the tubular tissue. In a method for minimally invasive excision of a tubular tissue in which a diseased tissue is excised while being excised with a drill accommodated in a cutter (accommodated in a cutter 16), ultrasonic and X-ray CT While being tracked by the 3D image guiding mechanism C by MRI or the like, the bending arm 11 provided at the tip of the tubular sheath 10 is bent to displace and fix the affected tissue, and in this state, the tissue is accommodated in the tubular sheath 10. The affected tissue is excised and aspirated by moving the drill straight, and the affected part is sequentially changed by changing the bending angle of the bending arm 11 and rotating the tubular sheath 10 by a predetermined angle. Ablation method for ablating-sucking woven is characterized in.

  As shown in FIG. 1, the manipulator has a tubular outer sheath that is driven by the drive unit 6 at the front of the main body 4 when the main body 4 is installed on the surgical instrument holder and the operator operates the controller 5. 10 adjustment of the rotation angle, advance / retreat and rotation drive of a drill 18 (see FIG. 4 described later) in the cutter 16, adjustment of the bending angle of the bending arm 11, and a perfusion mechanism B connected to the outside of the manipulator. The roller pump 7 is driven to rotate. In the case of image acquisition by ultrasound, the probe 1 is brought into contact with the body surface corresponding to the prostate of the patient P, and in the case of image acquisition by X-ray CT or MRI, the patient P is a cylindrical multi-scanning device like a one-dot chain line. 1 '. The probe 1 or the multi-scanning apparatus 1 'is connected to an image diagnostic apparatus 2 that constitutes a 3D image guiding mechanism. The image diagnostic apparatus 2 is connected to a plurality of cross-sections (in the example shown, a vertical cross-section by a vertical cross-section monitor 3A and a cross-section by a cross-section monitor 3B), an image guidance monitor 3, and a manipulator tip for a diseased tissue, that is, a bending resection mechanism The behavior of A is tracked to appropriately guide the excision of the affected tissue by the practitioner's drill 18 and the bending angle of the bending arm 11. A roller pump 7 is connected to the outside of the manipulator drive unit 6. By rotating the roller pump 7, the perfusate 8 is supplied from the distal end of the tubular cutter 16 at the distal end of the manipulator through the perfusion tube 17, and is refluxed together with the excision piece 9 excised by the drill 18 through the reflux passage 20.

  FIG. 2 is a perspective view and a side view of the bending arm and cutter at the tip of the manipulator. FIG. 2A shows a state in which a bending arm (arm exterior) 11 is provided so as to be freely bent at the distal end of the tubular exterior 10 in the manipulator. FIG. 2B shows a state in which the cutter 16 has advanced with the bending arm 11 bent. An inclined notch is provided on the upper side of the bending arm 11 on the side of the arm restraint point 15 (FIG. 2C described later), so that the cutter 16 can be advanced even when the bending angle of the bending arm 11 is small. Has been. The tubular sheath 10 is configured to be rotatable as indicated by an arrow within a predetermined angle. FIG. 2C clearly shows that the bending arm 11 is bent about the arm restraint point (support shaft) 15 via the bending link 14 by pushing out the central link 13.

  FIG. 3 is a perspective view showing a state where the bending arm is bent by the transmission rod. The central link 13 is pushed out by pushing out the power transmission rod 12 (FIG. 3 (B)) disposed inside the tubular sheath 10 of the manipulator so as to be able to advance and retreat, and the bent arm is interposed via the left and right links 14,14. 11 bends around an arm restraint point (support shaft) 15.

  FIG. 4 is a diagram for explaining the supply of the perfusate by the roller pump in the cutter and how the perfusate recirculates together with the excised pieces. A perfusion tube 17 and a drill 18 are further provided in a tubular cutter 16 that is disposed in the manipulator 10 so as to be capable of moving forward and backward. Through the perfusion tube 17, the perfusate 8 is supplied to the affected tissue being excised by the drill 18 by the roller pump 7 connected to the outside of the manipulator. The excision piece 9 of the affected tissue cut by the drill 18 is sucked out of the body together with the perfusate 8 using the tubular interior of the cutter 16 as the reflux passage 20.

  FIG. 5 is a view showing a state of arrangement of the drill in the cutter. In the tubular cutter 16, as described above, the perfusion tube 17 and the drill 18 are disposed, and the drill 18 is rotated while being advanced by a drill shaft 19 that is rotated by receiving power from a drive unit described later, Resect the affected tissue. The drill 18 is composed of a spiral blade and a groove, and can remove the excised piece of the affected tissue and the perfusate using the groove as a passage.

  FIG. 6 is a perspective view of a drive unit in which the drill shaft drive motor 21 and the like are accommodated. In the drive unit 6, the perfusion tube 17 and the return passage 20 change directions and enter the tubular sheath 10 in the manipulator. Further, a drill shaft drive motor 21 for rotationally driving the shaft 19 of the drill 18 disposed in the tubular cutter 16 is installed in the drive unit 6.

  FIG. 7 is a cross-sectional view for explaining the principle of three-dimensional excision of a tubular tissue (affected tissue) using a bending arm. As shown in FIG. 7A, the tubular sheath 10 in the manipulator is inserted into the affected part of the tubular tissue such as the prostate while the bending arm 11 is linearly extended. What is displayed as tubular tissue in the figure represents the affected tissue. From this state, as shown in FIG. 7B, the bending arm 11 is bent to displace the affected tissue. By appropriately adjusting the bending angle, it is possible to excise all the affected tissue in the upper half of one plane (for example, a paper surface). The lower half of the affected tissue can be excised by re-piercing the tubular sheath 10 in the manipulator so that the bending arm 11 is bent upward.

  Next, as shown by the rotation (rotation in the figure) arrow in FIG. 7B, the tubular sheath 10 of the manipulator is rotated by a predetermined angle range, the cutter 16 is pushed out, and the affected tissue is excised with the drill 18. By doing so, all the affected part tissues | organisms of the direction orthogonal to a paper surface can also be excised. FIG. 8 shows a state in which all of the affected tissue is removed by sequentially repeating the angle adjustment of the bending arm 11 and the rotation of the tubular sheath 10 for each predetermined angle range in this manner. FIG. 8A shows a state where the upper affected tissue is excised, and FIG. 8B shows a state where the lower affected tissue is also excised. According to the present invention, as shown in FIG. 8, the damaged portion of the tubular tissue intima is only one point by the cutter 16 (two points including the excision of the lower affected tissue), and the damage to the intima is minimized. It becomes possible to suppress to.

  9 and 10 follow the behavior of the bending resection mechanism A (FIG. 1) at the tip of the manipulator, and appropriately guide the practitioner's cutter 16 or drill 18 to remove the affected tissue and the bending angle of the bending arm 11. FIG. 5 is a diagram illustrating an image guiding mechanism for obtaining relative position information between the bending resection mechanism A and an affected tissue. FIG. 9 is an image of an axial section of the manipulator including the bending arm 11 and the cutter 16 or a section of the bending arm 11 in the bending direction plane. The state of displacement of the tubular tissue and the insertion portion of the cutter 16 are mainly confirmed. FIG. 10 is an image of a cross section in the vertical direction (transverse direction) orthogonal to the axial direction of the manipulator including the bending arm 11 and the cutter 16. Confirmation is mainly performed to prevent the inserted cutter 16 from penetrating out of the tubular tissue.

  In the excision of the affected tissue by the present bending excision mechanism A, these two images are simultaneously displayed (3A and 3B in FIG. 1), and the excision proceeds by obtaining the relative position information between the flexion excision mechanism A and the affected tissue. . Note that, as described above, any of ultrasound, X-ray CT, and MRI (magnetic resonance imaging apparatus) can be used as the image diagnosis apparatus 2. As described above, the bend angle of the bending arm 11 at the tip of the manipulator is changed while the affected tissue and the behavior of the cutter 16 are always accurately grasped three-dimensionally, and the tubular sheath 10 is rotated by a predetermined angle. By doing so, it becomes possible to safely and quickly perform excision of a wide range of affected tissues only by the linear behavior of the cutter 16 without damaging the inner membrane such as mucous membrane which is a normal tissue.

  The driving range of the bending resection mechanism A used in the experiment and the force generated at the tip of the bending arm 11 are as follows: outer diameter of the tubular sheath 10: 8 mm, bending range of the bending arm 11: 0 to 45 °, insertion range of the cutter 16 : 0 to 35 mm, effective rotation angle of main body of tubular sheath 10: -180 to 180 °, bending arm tip generating force: 650 gf. Currently, since the mechanism is being developed as a mechanism for treating benign prostatic hyperplasia, the outer diameter is set to 8 mm, the length of the bending arm 11 is set to 20 mm, the outer diameter is set to 6 mm, and the insertion stroke of the cutter 16 is set to 35 mm. Further, the force generated at the tip of the bending arm 11 was set to 650 gf in consideration of the influence from the enlarged prostate tissue (average 40 g) and the surrounding tissue. The outer diameter: 8 mm is housed in the same size as a conventionally used urological resection mirror. With respect to prostate cancer biopsy and coronary artery treatment instead of prostatic hypertrophy, the size of the cutter 16 can be greatly reduced, so the outer diameter can be further reduced.

<Resection efficiency evaluation of perfusion resection mechanism>
The excision efficiency of the present invention was evaluated. As shown in FIG. 11, porcine thigh muscles were excised and the amount of excision was measured. The cutter 16 was inserted into the experimental tissue for 1 minute, the drill 18 was rotated to cut the tissue into small pieces, and the tissue pieces were sucked by the roller pump 7. This evaluation experiment is also intended for surgery for benign prostatic hyperplasia. The excision efficiency was 0.7 g / min. In conventional surgery, an average of 20 g of enlarged tissue is removed every 90 minutes, so the efficiency is 0.2 g / min. From this, a significant increase in excision efficiency can be expected.

  As described above, the embodiments of the present invention have been described. However, within the scope of the spirit of the present invention, the shape, type, material, and rotation of a tubular tissue part such as a target prostate, coronary artery, and the like, and a tubular sheath at the distal end of a manipulator. Moving form, cutter shape (preferably a circular cross section is adopted, but an oval shape or the like may also be adopted), form, material and its arrangement in a tubular sheath and its advancing and retracting form, perfusion tube in the cutter and Type of 3D image guidance mechanism that monitors and guides the shape and type of drills (multiple pieces may be installed), materials and their arrangement, drill advancement and retraction, and the behavior of the bending and cutting mechanism at the tip of the manipulator (super) Sound wave, X-ray CT, MRI, etc.), shape of bending arm, type, material and bending form, shape of reflux passage, type, material and configuration related to tubular exterior, shape of monitor, Wherein the controller of the shape, form, shape of the roller pump, for the format or the like can be appropriately selected. In addition, the specifications described in the examples are illustrative and should not be interpreted in a limited manner.

1 is an overall system diagram showing one embodiment of a tubular tissue minimally invasive bending resection guiding method and apparatus according to the present invention. It is the perspective view and side view of the bending arm and cutter of the manipulator tip which are the same. It is a perspective view which shows the state by which a bending arm is bent by the transmission rod. It is a figure explaining supply of the perfusate by the roller pump in a cutter, and a mode that perfusate recirculates with a cutting piece. It is a figure which shows the arrangement | positioning state of the drill in a cutter similarly. It is a perspective view of the drive part in which the shaft drive motor for drills, etc. were accommodated. It is sectional drawing explaining the principle of the three-dimensional excision of the tubular tissue (affected part tissue) using the bending arm. It is sectional drawing which shows the damage state of an intima, and the excision state of a tubular structure | tissue similarly. It is an axial sectional view of a manipulator including a bending arm and a cutter. FIG. 2 is a vertical (transverse direction) cross-sectional view orthogonal to the axial direction of a manipulator including a bending arm and a cutter. FIG.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 Probe 2 Diagnostic imaging apparatus 3 Monitor 3A Longitudinal section monitor 3B Cross section monitor 4 Manipulator main body part 5 Controller 6 Drive part 7 Roller pump 8 Perfusate 9 Excision piece 10 Tubular exterior 11 Bending arm (arm exterior)
12 Power transmission rod 13 Central link 14 Bending link 15 Arm restraint point (support shaft)
16 Cutter 17 Perfusion tube 18 Drill 19 Drill shaft 20 Return passage 21 Drill shaft drive motor A Bending mechanism B Perfusion mechanism C Image guidance mechanism P Patient

Claims (5)

Tubular tissue minimally invasive excision method for excising affected tissue in tubular tissue such as prostate and coronary artery, and aspirating this while excising the affected tissue with a drill housed in the tubular sheath at the tip of the manipulator inserted into the tubular tissue In the method of minimally invasive excision of tubular tissue, the bend arm provided at the distal end of the tubular sheath is bent while the behavior of the manipulator tip with respect to the affected tissue is tracked by a 3D image guiding mechanism using ultrasonic waves, X-ray CT, MRI or the like. The affected tissue is displaced and fixed, and in this state, the drill accommodated in the tubular sheath is moved straight to excise and suck the affected tissue, and the bending angle of the bending arm is changed and the tubular sheath is rotated by a predetermined angle. A tubular tissue minimally invasive bending excision guiding method characterized by sequentially removing and aspirating affected tissue by movement. In a tubular tissue minimally invasive excision apparatus for excising affected tissue in tubular tissue such as prostate and coronary artery, a rotatable tubular sheath at the distal end of a manipulator inserted into the tubular tissue, a drill accommodated in the tubular sheath, A recirculation passage for sucking and recirculating the excision of the affected tissue cut by the drill, a 3D image guiding mechanism by ultrasonic, X-ray CT, MRI, etc. for tracking the behavior of the manipulator tip with respect to the affected tissue, and the tip of the tubular sheath A tubular tissue minimally invasive bending excision guiding device characterized in that it comprises a bendable bending arm provided on the tube. The tubular tissue minimally invasive bending resection guide device according to claim 2, wherein the drill is further slidably accommodated in a tubular cutter that is removably installed in a tubular exterior of a manipulator. 4. The apparatus according to claim 2, wherein a perfusion tube for supplying a perfusate to the affected tissue is disposed in the tubular cutter, and the perfusate is aspirated and refluxed together with the excision piece. Tubular tissue minimally invasive bending resection guide device. The tubular tissue minimally invasive bending resection guide device according to any one of claims 2 to 4, wherein the tubular cutter itself constitutes a reflux passage for the perfusate.

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