JP2006288775A - System for supporting endoscopic surgery - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a system for supporting an endoscopic surgery capable of detecting that a flexible endoscope is twisted and the distal end part of the flexible endoscope is turned to a state different from a normal position and operating a dial without errors in order to move the distal end part of the flexible endoscope. <P>SOLUTION: The system 100 for supporting an endoscopic surgery includes the flexible endoscope 4 for surgeries provided with an operating implement projected from the endoscope distal end part of a hole formed inside the main body of the flexible endoscope for executing treatment, a camera and a wire for controlling the direction of the distal end of the endoscope, in which the control of the direction of the flexible distal end of the endoscope and the operation of the operating implement at the distal end are performed by a hand operation means. In the system 100, a flow path 5 where a contrast medium 5A flows is formed in the longitudinal direction of the main body of the flexible endoscope 4 on the main body wall surface of the flexible endoscope 4, and a twist detection means 20 for imaging tomographic images near the flexible distal end 4A of the endoscope including the formed flow path 5 and detecting the twist state of the flexible distal end 4A by the imaged tomographic images and a means 21 for correcting the operation amount of the hand operation means by the detected twist state of the flexible distal end 4A are provided. <P>COPYRIGHT: (C)2007,JPO&INPIT

Description

  The present invention relates to a system related to surgery using a flexible endoscope, and more particularly to a direction in which a flexible endoscope is moved on a monitor while detecting a position near the distal end of the flexible endoscope using an image diagnostic apparatus. The present invention relates to an endoscopic surgery support system that supports the above.

  In general, there are two types of endoscopes, a flexible endoscope and a rigid endoscope. In conventional surgical operations, the endoscope is rigid due to the ease of positioning of the endoscope tip and control of the endoscope tip. Surgery was performed using an endoscope.

  On the other hand, flexible endoscopes, such as gastric cameras, are inserted orally along luminal organs, the tip of the endoscope reaches the target affected part of the luminal organ, the affected part is observed with the camera, examinations, etc. Has been used.

  In recent years, CCD (Charge Coupled Device) image sensors have been miniaturized, and by increasing the resolution of CCD image sensors, flexible endoscopes have been made thinner, and tumors have been excised at the tip of the endoscope. It is now possible to insert surgical tools to be removed.

  Such a flexible endoscope is inserted into various luminal organs in the body, and the luminal organs in the body are winding. For this reason, the endoscope main body of the flexible endoscope has a soft and bent structure. In such a flexible endoscope, when the endoscope is bent for insertion into a luminal organ, due to the difference in curvature, an extension occurs outside the bent endoscope, and inside the bent endoscope. Compression occurs. Therefore, as the material of the flexible endoscope, a material that extends to some extent and can be compressed to some extent, for example, a synthetic resin is used. In addition, when using a material that stretches and compresses less than a synthetic resin, such as when using metal, a device that can be bent structurally, such as spirally winding the material into a cylindrical structure, is used. It is necessary.

  Furthermore, inside the endoscope body of the flexible endoscope, there is a hole for passing a wire for controlling the direction of the flexible endoscope tip, and inside the flexible endoscope body for performing treatment at the endoscope tip. There are multiple holes, such as a hole through which the surgical instrument is passed. The wire through which the wire is passed passes through the wire connected to the dial for controlling the distal end of the flexible endoscope at the hand of the surgeon performing the operation or for operating the distal surgical instrument. The mirror tip is connected by a wire.

  As such a surgery support device, a surgery support device in a surgery system using a camera that can easily confirm the operation of the camera and realize an efficient and smooth medical work has been proposed (for example, Patent Documents). 1).

In this patent document 1, the operation instruction input unit 10 receives an operation instruction from an operator of the endoscope 50, and then the control unit 20 operates the manipulator based on the operation instruction input from the operation instruction input unit 10. 40 is controlled. Here, in Patent Document 1, the control unit 20 causes the operation instruction unit 30 to present an operation instruction such as movement of the visual field or enlargement / reduction, thereby including the operator of the endoscope 50. The medical staff can easily confirm the operation instruction of the camera from the operation instruction unit 30 and can realize an efficient medical work, and the control unit 20 can operate the operation instruction from the operation instruction input unit 10 beyond the movable range. This is intended to realize a smooth medical work by presenting a warning corresponding to the above to the operation instruction unit 30.
JP 2004-105539 A

  In the case of such a conventional flexible endoscope, the distal end of the flexible endoscope is inserted into the affected part, and a dial as a hand operating means is turned and attached to a hole formed in the main body of the flexible endoscope. The tip of the flexible endoscope is bent by pulling with a wire. The movement of the tip of the flexible endoscope at this time can be up / down, left / right, front / back, and rotation, and the top / bottom / left / right movement of the tip of the flexible endoscope is moved in the up / down direction and in the left / right direction. It is moved using the dial. On the other hand, there is no rotation dial before and after the distal end portion of the flexible endoscope, and the operator moves the flexible endoscope body back and forth while holding the flexible endoscope body, and moves or rotates the distal end portion of the flexible endoscope back and forth. It is.

  In addition, a CCD image sensor is provided at the distal end of the flexible endoscope, and an image received by the CCD is input to an endoscope image processor outside the flexible endoscope body through an electric signal cable. . The endoscope image processor has a circuit that converts an electrical signal of the CCD into a video signal of the monitor, and outputs the video signal to the monitor. An image viewed from the distal end portion of the flexible endoscope is displayed on the monitor, and the surgeon moves the flexible endoscope to the affected area while viewing the image displayed on the monitor.

  However, in the distal end portion of the conventional flexible endoscope, the orientation of the distal end portion of the flexible endoscope and the twisted state are unknown. Therefore, if the flexible endoscope is twisted, the distal end of the flexible endoscope is not in a state different from the normal position. Therefore, the distal end of the flexible endoscope is operated by operating the dial at hand. When trying to move the part upward, the distal end of the flexible endoscope may move downward. Similarly, if you operate the hand dial to move the distal end of the flexible endoscope to the left, move it to the right, or operate the hand dial to move the distal end of the flexible endoscope forward. There is a problem in that it may be moved backwards or may be rotated to the right when the hand dial is operated to rotate the distal end of the flexible endoscope to the left.

  An object of the present invention is to detect that the flexible endoscope is twisted and the distal end portion of the flexible endoscope is in a state different from the normal position, and to move the distal end portion of the flexible endoscope. An object of the present invention is to provide an endoscopic surgery support system that can be operated without mistakes.

  An endoscopic surgery support system according to the present invention includes a surgical tool that is projected from an endoscope front end portion of a hole formed inside a flexible endoscope body, performs a treatment, a camera, and an endoscope front end. An endoscopic surgery support system including a soft endoscope for surgery, which includes a wire for controlling a direction, and controls the direction of the distal end of the flexible endoscope and the operation of the distal surgical instrument by a hand operation means. A flow path through which a contrast medium flows is formed in the longitudinal direction of the flexible endoscope main body on the wall surface of the endoscope, and a tomographic image near the distal end of the flexible endoscope including the formed flow path is captured. A torsion detecting means for detecting the twisted state of the flexible endoscope tip from the tomographic image and a means for correcting the operation amount of the hand operating means according to the detected twisted state of the flexible endoscope tip. Is.

  The tomographic image is formed by an MR apparatus or a CT apparatus.

  According to the present invention, it is detected that the flexible endoscope is twisted and the distal end portion of the flexible endoscope is different from the normal position, and the distal end portion of the flexible endoscope is moved. It is possible to operate without mistakes.

  The present invention provides a flow path for injecting a contrast medium in the longitudinal direction of the flexible endoscope body on the wall surface of the flexible endoscope body, and the distal end of the flexible endoscope is formed by the contrast medium injected into the flow path. Take a tomographic image of the neighborhood, detect the twisted state of the flexible endoscope tip based on the taken tomographic image, and indicate the amount of dial operation correction so that the flexible endoscope tip can be operated accurately. Realized.

Hereinafter, embodiments of the present invention will be described in detail.
FIG. 1 shows an overall system configuration diagram of an endoscopic surgery support system, and FIGS. 2 to 5 show configuration diagrams of the endoscope shown in FIG.

  In FIG. 1, reference numeral 100 denotes an endoscopic surgery support system, which is a system for guiding a flexible endoscope. Reference numeral 1 denotes a CT gantry, 2 denotes an X-ray tube attached to the CT gantry 1, and 3 denotes a detector for detecting X-rays emitted from the X-ray tube 2. Reference numeral 4 denotes a soft endoscope, and reference numeral 5 denotes a contrast agent flow path formed on the wall surface of the soft endoscope 4 in the longitudinal direction of the soft endoscope 4. The contrast agent flow path 5 is composed of a single conduit, and has an inlet for inserting the contrast agent and an outlet for discharging the contrast agent. It flows through the channel 5 and is discharged from the outlet. Opening and closing valves 6 and 7 are provided at the inlet and outlet of the flow path 5. A pump 8 is connected to the on-off valve 6, and a tank 9 is connected to the pump 8. From this on-off valve 6, the contrast medium is supplied from the tank 9 to the flow path 5 by the operation of the pump 8. A tank 9 is connected to the on-off valve 7, and the contrast agent discharged from the outlet of the flow path 5 is returned from the on-off valve 7 to the tank 9. The on-off valves 6 and 7 and the pump 8 are controlled by the control device 10 and controlled to be driven in synchronization.

  The flexible endoscope 4 is provided with a rotation drive device 11, a right drive device 12, a vertical drive device 13, and a front / rear drive device 14. The rotation drive device 11 is a device that rotates the flexible endoscope 4 by a predetermined angle about the cylinder central axis. The right drive device 12 is a device that moves the distal end portion of the flexible endoscope 4 to the left and right in the insertion direction of the flexible endoscope 4. If you turn sideways and move further, you will head back. The vertical drive device 13 is a device that moves the distal end of the flexible endoscope 4 in the vertical direction. To be precise, the vertical drive device 13 does not translate upward or downward, but moves to warp backward. . Therefore, in the case of 90 degrees in the upward direction with respect to the front, the front end of the endoscope faces directly upward, and further moves toward the rear when moved further. The front-rear drive device 14 is a device for moving the flexible endoscope 4 along the cylinder direction. Since the flexible endoscope 4 is not a rigid body, the flexible endoscope 4 follows the insertion path of the flexible endoscope 4. The tip of the mirror 4 moves, and the tip of the flexible endoscope 4 does not necessarily move in parallel in the front-rear direction.

  Reference numeral 15 denotes an image processing apparatus. In the case of a CT apparatus, the image processing apparatus 15 is based on X-ray information transmitted through the patient detected by the detector 3 in the CT apparatus 1 and a tomographic image of the patient body 3 This corresponds to an arithmetic device that calculates a dimension reconstructed image.

  Reference numeral 16 denotes a 3D image database (storage device). The 3D image database 16 is a storage device that stores tomographic images and three-dimensional volume data calculated by the image processing device 15. Tomographic images and intraoperative tomographic images are stored.

  17 is a subtraction image calculation device, 18 is an extracted image capturing unit of the flexible endoscope (flexible outer tube) 4, 19 is a subtraction synchronization device, and 20 is a twist amount measuring device of the flexible endoscope (flexible outer tube) 4. , 21 is an operation input coordinate conversion calculation device that converts coordinates input to the rotary drive device 11, the right drive device 12, the vertical drive device 13 and the front and rear drive device 14 into coordinates corrected by correction values corresponding to torsion. is there. The operation input coordinate transformation calculation device 21 has a command signal indicating how to operate the distal end of the flexible endoscope (flexible outer cylinder) 4 from the flexible endoscope (flexible outer cylinder) operation method input device 22. Is entered.

  Based on the output from the extracted image capturing unit 18 of the flexible endoscope (flexible outer cylinder) 4, the tip position measuring device 23 detects the position of the tip of the flexible endoscope (flexible outer cylinder) 4, The insertion path extraction unit 24 detects the insertion path of the flexible endoscope (flexible outer cylinder) 4.

  In the flexible endoscope (flexible outer cylinder) extraction calculation device 25, the flexible endoscope (flexible outer cylinder) is obtained from the output from the insertion path extraction unit 24 and the flexible endoscope (flexible outer cylinder) shape data 26. ) 4 is extracted. The calculation result in the flexible endoscope (flexible outer tube) extraction calculation device 25 is superimposed on the organ image cut out by the 3D image cut-out device 27 and superimposed image calculation device 28 and displayed on the monitor screen 29.

  FIG. 2 shows an arrangement state of a flow path 5 of contrast medium formed in the longitudinal direction of the flexible endoscope 4 on the wall surface of the flexible endoscope (flexible outer cylinder) 4 shown in FIG. ing. As is apparent from FIG. 2, the flow path 5 through which the contrast agent 5A flows is disposed in the forward direction while the two flow paths maintain a predetermined interval in the longitudinal direction of the wall surface of the flexible endoscope (flexible outer cylinder) 4. Then, the distal end portion is divided into left and right portions, circulates around the flexible endoscope distal end portion 4A, joins, and one flow path is provided in a return path so that the contrast agent is returned. Therefore, the contrast agent that flows in the flow path 5 is inserted from one direction and discharged in the other direction as shown in FIG. A pump 8 is connected to the inlet of the flow path 5 via an on-off valve 6, and a contrast agent is sent from the tank 9 by driving the pump 8. Further, a tank 9 is connected to the outlet of the flow path 5 via the on-off valve 7, and the contrast agent discharged from the outlet of the flow path 5 is returned to the tank 9. The on-off valves 6 and 7 and the pump 8 are controlled by a control circuit 10.

  When the flexible endoscope (flexible outer cylinder) 4 inserted in the body is twisted, the contrast agent 5A is caused to flow along the twist of the flexible endoscope (flexible outer cylinder) 4 as shown in FIG. The flow path 5 is twisted. For this reason, twisting of the flexible endoscope (flexible outer tube) 4 is performed by operating the dial to move the distal end portion 4A of the flexible endoscope 4 by measuring the twist of the flow path 5 through which the contrast agent 5A flows. The correction amount can be calculated, and thus the dial 4 can be operated without error in order to move the distal end portion 4A of the flexible endoscope 4.

  FIG. 4 shows the detection of the twist amount, the tip position, and the operation method of the flexible endoscope (flexible outer cylinder) 4 by contrast image measurement. FIG. 4A is a plan view of the contrast agent 5A in the flow channel 5 of the flexible endoscope (flexible outer cylinder) 4 when the flexible endoscope (flexible outer cylinder) 4 is in a straight state. . In FIG. 4A, since the flexible endoscope (flexible outer cylinder) 4 is in a straight state, the contrast agent 5A in the flow path 5 is also in a straight state. Two flow paths 5 indicated by a one-dot chain line indicate an insertion forward path, and one flow path 5 indicated by a solid line indicates a discharge return path.

  FIG. 4B shows a case where the flexible endoscope (flexible outer cylinder) 4 is twisted. It can be seen that the forward path and the return path of the flow path 5 are separated from each other from the combined position, and are twisted by half a turn at the farthest part of the belly. The distance between the forward path and the return path of the flow path 5 is proportional to the twist amount θ. Then, the forward path and the return path of the flow path 5 are again combined, and it can be seen that one rotation of twist is generated.

  FIG. 4C shows an insertion path of the flexible endoscope (flexible outer cylinder) 4. FIG. 4D shows a diagram in which the position of the tip of the flexible endoscope (flexible outer cylinder) 4 is estimated from the length of insertion of the flexible endoscope (flexible outer cylinder) 4. The uppermost end of the flexible endoscope (flexible outer cylinder) 4 in FIG. 4D shows the return position of the contrast agent 5A.

  FIG. 5 shows operation correction when the flexible endoscope (flexible outer tube) 4 is twisted by contrast image measurement. FIG. 5 shows a case where a 180 ° twist occurs in the flexible endoscope (flexible outer cylinder) 4. That is, the operation correction for the twist of the flexible endoscope (flexible outer cylinder) 4 is made so that the insertion direction and the moving direction of the distal end coincide with the twist amount θ of the flexible endoscope (flexible outer cylinder) 4. It is corrected by converting the operation input coordinates.

  Specifically, this correction is performed when the torsion amount θ of the flexible endoscope (flexible outer tube) 4 is 0 ° (360 °) in the clockwise direction, when the operation input direction is right, “right”. In addition, if the operation input direction is left, it will be operated as `` Left '', if the operation input direction is up, it will be operated as `` Up '', and if the operation input direction is down, it will be operated as `` Down ''. There is no need to convert operation input coordinates.

  Further, when the twist amount θ of the flexible endoscope (flexible outer tube) 4 is 90 ° clockwise, when the operation input direction is right, it is “up” and when the operation input direction is operated left. It is necessary to operate “down”, “left” when the operation input direction is up, and “right” when the operation input direction is down. Therefore, in this case, when the operation input direction is operated to the right, it is “up”, when the operation input direction is operated to the left, “down”, and when the operation input direction is operated upward, it is “left”. When the operation input direction is operated downward, it is necessary to convert the operation input coordinates so as to be operated “right”.

  When the twist amount θ of the flexible endoscope (flexible outer tube) 4 is 180 ° clockwise, the operation input direction is “left” when the operation input direction is right, and “right” when the operation input direction is left. ", It is necessary to operate" down "when the operation input direction is up, and" up "when the operation input direction is down. Therefore, in this case, when the operation input direction is operated to the right, it is “left”, when the operation input direction is operated to the left, “right”, and when the operation input direction is operated upward, it is “down”. When the operation input direction is operated downward, the operation input coordinates need to be converted so that the operation input direction is operated “up”.

  Further, when the twist amount θ of the flexible endoscope (flexible outer tube) 4 is 270 ° clockwise, “down” is indicated when the operation input direction is right, and “up” when the operation input direction is left. ”, It is necessary to operate“ right ”when the operation input direction is up, and“ left ”when the operation input direction is down. Therefore, in this case, if the operation input direction is operated to the right, it is “down”, if the operation input direction is operated to the left, it is “up”, and if the operation input direction is operated up, it is set to “right”. When the operation input direction is operated downward, it is necessary to convert the operation input coordinates so as to be operated “left”.

  As described above, by converting the operation input coordinates according to the twist amount (angle) θ and correcting the operation input coordinates, when the operation input direction in FIG. The tip of the outer tube 4 can be moved in the same direction as the operation direction arrow A in the operation input direction.

  Here, when the twist amount θ of the flexible endoscope (flexible outer tube) 4 is 0 ° (360 °) clockwise (when the endoscope body is placed straight and is not twisted), An operation when the twist amount θ of the endoscope (flexible outer cylinder) 4 is 90 ° clockwise (when twisted by 90 degrees) will be described.

  First, the case where the amount of twist θ of the flexible endoscope (flexible outer cylinder) 4 is 0 ° (360 °) in the clockwise direction (when the endoscope body is placed straight and is not twisted) will be described. When the flexible endoscope (flexible outer cylinder) 4 is moved from the center to the left on the screen of the monitor 29, it is on the left side of the monitor 29 as viewed from the operator, so the dial for operating in the left-right direction is turned. Since the dial operated in the left-right direction is connected to a wire that moves the distal end portion of the flexible endoscope 4 in the left-right direction, the distal end portion of the flexible endoscope 4 moves leftward. Here, the dial is turned counterclockwise. Thus, when the twist amount θ of the flexible endoscope (flexible outer tube) 4 is 0 ° (360 °) clockwise (when the endoscope body is placed straight and there is no twist), the screen The direction of movement of the operation dial is the same as the direction of the operation dial.

  Next, a case where the twist amount θ of the flexible endoscope (flexible outer cylinder) 4 is 90 ° clockwise (when twisted by 90 degrees) will be described. When the flexible endoscope (flexible outer cylinder) 4 is moved from the center to the left on the screen of the monitor 29, it is on the left side of the monitor 29 as viewed from the operator, so the dial for operating in the left / right direction is turned to the left. . However, since the distal end portion of the flexible endoscope 4 is rotated by 90 degrees, the left and right sides of the distal end portion of the flexible endoscope 4 correspond to the vertical direction and are rotated 90 degrees counterclockwise. When the dial operated in the left-right direction is turned counterclockwise, the distal end portion of the flexible endoscope 4 moves downward. As described above, when the twist amount θ of the flexible endoscope (flexible outer tube) 4 is 90 ° clockwise (when twisted by 90 °), the moving direction when viewed on the screen and the operation dial The directions will not match.

  Therefore, for example, a crosshair is put on the lens surface or the like of the flexible endoscope 4, the dial that operates in the left-right direction is moved in a state where the body of the flexible endoscope 4 is not twisted, and the marker is moved in the direction to move left Think about putting in. In this case, when the endoscope is rotated 90 degrees, the marker is also rotated, and the marker is positioned on the lower side and observed on the monitor, so that it can be seen that the endoscope is twisted.

  And until now, when the surgeon moved from the center to the left on the monitor screen, it was on the left side of the monitor as viewed from the surgeon, so it was only necessary to turn the dial in the left-right direction. In this case, the marker indicates Thus, when the left and right dials are moved, it can be seen that the marker moves downward so that the marker can be seen on the lower side on the monitor. Therefore, the operator may switch the operation so as to move the dial in the vertical direction from the dial in the horizontal direction and rotate the dial so that the endoscope moves in the upward direction. In this way, the surgeon can always perform an operation if the operation is intentionally switched while always looking at the position of the marker.

1 is an overall system configuration diagram of an endoscopic surgery support system showing an embodiment of the present invention. It is a figure which shows the flow path of the contrast agent formed in the longitudinal direction on the wall surface of the flexible endoscope shown in FIG. FIG. 3 is a diagram showing a state where the flexible endoscope shown in FIG. 2 is twisted. FIG. 3 is a diagram showing the amount of twist in the contrast agent flow path when the flexible endoscope shown in FIG. 2 is not twisted or twisted. FIG. 3 is a diagram illustrating a dial operation direction and a moving direction of the distal end portion of the flexible endoscope when the operation input coordinate conversion correction is performed when the flexible endoscope illustrated in FIG. 2 is twisted.

Explanation of symbols

1 ……………… CT gantry 2 ……………… X-ray tube 3 ……………… Detector 4 ……………… Soft endoscope 4A ……………… Soft endoscope Front end 5 ……………… Flow path 5A …………… Contrast agent 6, 7 ………… Open / close valve 8 ……………… Pump 9 ……………… Tank 10 …………… Control device 11... Rotation drive device 12... Right drive device 13... Vertical drive device 14. 100 ………… Endoscopic surgery support system

Claims (2)

A flexible surgical tool that protrudes from the distal end of the endoscope formed in the body of the flexible endoscope and performs a treatment; and a wire that controls the direction of the distal end of the camera and the endoscope. In an endoscopic surgery support system including a flexible endoscope for surgery in which control of the direction of the endoscope tip and manipulation of the distal surgical tool are performed by hand operating means,
A flow path through which a contrast agent flows is formed in the longitudinal direction of the flexible endoscope body on the wall surface of the flexible endoscope body, and a tomographic image in the vicinity of the distal end of the flexible endoscope including the formed flow path is captured. , A torsion detection means for detecting a twist state of the tip of the flexible endoscope from the captured tomographic image;
An endoscopic surgery support system comprising means for correcting an operation amount of the hand operating means according to the detected twisted state of the flexible endoscope tip.   The endoscopic surgery support system according to claim 1, wherein the tomographic image is formed by an MR apparatus or a CT apparatus.

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