JP2008017997A - Surgery support navigation system - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide an operator with necessary navigation functions according to the state of a surgery based on knowledge database of surgical technique protocol. <P>SOLUTION: This surgery support navigation system functionally integrating an endoscope apparatus insertable into a patient body, surgical instruments accompanying thereto and a medical diagnostic apparatus 5a is provided with: a surgical technique protocol input device 2b for inputting the surgical technique protocol consisting of operator information, disease information of patients, surgical environment, surgical techniques and a surgical technique workflow; a means for segmenting and storing the surgical technique workflow based on the surgical technique protocol; and a means for constructing the knowledge database consisting of the segmented surgical technique workflow, the operator information and the disease information of the patient. <P>COPYRIGHT: (C)2008,JPO&INPIT

Description

  The present invention relates to an operation support navigation system that integrates the functions of an endoscope apparatus that can be inserted into a patient's body and a surgical instrument accompanying the endoscope apparatus and a medical image diagnostic apparatus such as a magnetic resonance imaging apparatus, an X-ray CT apparatus, and an ultrasonic apparatus. Further, the present invention relates to a technique for presenting a surgeon with necessary navigation functions according to surgical conditions based on surgical procedure protocols such as surgeon information, patient disease information, surgical environment, surgical procedure, and surgical procedure workflow.

As described in [Patent Document 1], a conventional surgical assistance navigation system supports a plurality of surgical operations.
JP 2003-79637 A

However, when viewed from the apparatus side, the operation management becomes complicated and the operation rate increases. Further, when viewed from the user side, the navigation operation becomes complicated, and the number of operations of the navigation function increases. In other words, no matter how much the navigation function is enhanced, a burden is placed on the device itself and the user who operates it, and eventually the user adjusts his / her operation to the navigation system. Furthermore, when using a surgery-supporting navigation system when urgency is required in the operating field environment, the operator may be in a situation where both hands are blocked and the navigation system cannot be operated directly. In addition, since surgery is performed while patient information, a plurality of image information, and monitoring are performed, it is necessary to have a function that allows necessary information to be easily retrieved and analyzed / viewed when necessary. Furthermore, even if the surgical technique is the same, the navigation function required by the surgeon differs depending on the progress of the surgery, so a user interface that is unique to the surgeon and that is most easily handled by the surgeon is required.
An object of the present invention is to present a necessary navigation function to an operator according to a surgical situation based on a knowledge database based on a surgical procedure protocol.

  The above object is to provide a surgical support navigation system that integrates the functions of an endoscopic device that can be inserted into a patient's body and an associated surgical tool and a medical diagnostic device. Surgical technique protocol input means for inputting a surgical technique protocol comprising a surgical technique workflow, means for subdividing and storing the surgical technique workflow based on the surgical means protocol, the subdivided surgical technique workflow, operator information and patient A means for constructing a knowledge database of disease information, a means for reconstructing the surgical procedure workflow for each user on the basis of the knowledge database, and a time course in operation based on the reconstructed surgical procedure workflow Surgical Assistance Navigation with the necessary navigation function It is achieved by the emissions system.

  According to the present invention, based on a knowledge database based on a surgical technique protocol, a necessary navigation function can be presented to an operator according to the surgical situation.

  Embodiments of the present invention will be described below with reference to the accompanying drawings. Note that components having the same function are denoted by the same reference symbols throughout the drawings for describing the embodiment of the invention, and the repetitive description thereof is omitted.

  FIG. 1 is a configuration diagram of a surgery support navigation system according to a preferred embodiment of the present invention. The operation support navigation system 1 uses a navigation operation input device 2b such as a mouse, a touch screen, and a voice to select a navigation function, display the result on the monitor 2a, and analyze / browse the navigation device 2 and magnetic type A position acquisition device 4 that transmits position information acquired from various position detection devices 4a such as sensors and optical sensors to the navigation device 2, and a medical image diagnostic device 5a such as a magnetic resonance imaging device, an X-ray CT device, and an ultrasonic device The image acquisition device 5 for transmitting the patient management information and the actual image information monitored from the patient monitor 5b such as a medical diagnostic image, anesthesia machine and endoscope device acquired from the navigation device 2 and the operation tool operation input device 6a. Sends operation input information to the navigation device 2 when operating the endoscopic device and associated surgical tool 6b (including surgical robot forceps). That the surgical instrument information acquisition apparatus 6 is configured to have a knowledge database 3 in which information about the operation protocol for each device are stored. The knowledge database 3 may be arranged in each device as described above, or may be centrally managed as shown in FIG. As a communication means, the network 7 may take a form of connecting PCs with an optical interface via an optical switch, or a form of connecting PCs using a network. Moreover, the form which connects between PCs using a dedicated cable by shared buses, such as a PCI bus, and the form which connects between PCs using a PCI-to-PCI bridge function by a switched fabric technique may be sufficient.

As shown in FIG. 2, the navigation device 2, the position acquisition device 4, the image acquisition device 5, and the surgical instrument information acquisition device 6 each have a communication interface (hereinafter referred to as communication I / F), a CPU, a memory, and a database. The navigation device 2 transmits processing instructions to each processing device by the CPU 2c using input information from the navigation operation input device. If the processing content is image processing, go to navigation device 2; if it acquires position information, it goes to position acquisition device 4; if it acquires image information, it goes to image acquisition device 5; The processing command is transferred to the information acquisition device 6 via the communication I / F, and the processing result is displayed on the monitor 2a via the display interface (hereinafter referred to as display I / F) 2e. The memory 2d stores the acquired image information, position information, and surgical tool control information. The CPU (2c) is in charge of information read / write control. The monitor 2a displays information obtained by performing image processing on the actual endoscopic image, the medical diagnostic image, and the medical diagnostic image by switching the display I / F (2e).
The database 3a stores DICOM information such as medical diagnostic images and patient information acquired before surgery, and intraoperative medical diagnostic images and image processing / processed images in accordance with a schedule of a knowledge database and a surgical procedure protocol.

The position acquisition device 4 serves to receive a command from the navigation device, acquire position information, and transfer it to the navigation device. The CPU (4c) determines the type of the position detection device 4a, connects / disconnects communication with an external position detection device, and controls read / write of the position information to the memory 4d and the database 3b. As the position detection device 4a, one or a plurality of optical position detection devices 4a-1 and magnetic position detection devices 4a-2 are connected to the position acquisition device.
The database 3b stores intraoperative position information according to the schedule of the knowledge database and the surgical procedure protocol.

  The image acquisition device 5 receives a command from the navigation device, acquires image information, and transfers it to the navigation device. The CPU (5c) determines the type of the medical image diagnostic apparatus 5a, performs communication connection / disconnection with an external medical image diagnostic apparatus, and controls reading / writing of medical image information to the memory 5d and the database 3c. Further, the type of the patient monitor 5b is determined, connection / disconnection to / from an external patient monitor, and read / write control of the patient information to the memory 5d and the database 3c are performed. The medical image diagnostic apparatus corresponds to a medical image diagnostic apparatus that can be imaged during surgery, and includes an ultrasonic apparatus 5a-1, an XR apparatus 5a-2, an X-ray CT apparatus 5a-3, and a magnetic resonance imaging apparatus 5a-4. The patient monitor includes an anesthesia machine 5b-1, an endoscope apparatus 5b-2, and a surgical field monitor 5b-3 for monitoring the surgical field conditions of the operator, patient, and staff. The database 3c stores intraoperative image information according to the schedule of the knowledge database and the surgical procedure protocol.

  The surgical instrument information acquisition device 6 serves to receive a command from the navigation apparatus, acquire control information (driving direction information, internal sensor information, etc.) from an actuator that drives the surgical instrument, and transfer it to the navigation apparatus. The CPU (6c) determines the type of the surgical tool 6b, performs communication connection / disconnection with the actuator, and controls read / write of the surgical tool control information to the memory 6d and the database 3d. The surgical instrument 6b includes a robot surgical instrument driven by an actuator, but does not include a surgical instrument that is operated manually. The database 3d stores control information from the actuator during the operation according to the knowledge database and the schedule of the operation protocol.

  FIG. 3 shows a navigation screen 8 displayed on the monitor 2a. The navigation screen 8 is based on the surgical protocol set on the surgical technique protocol screen 8a, and establishes a connection between the data management unit 8b responsible for reading / writing patient image information and navigation setting information, and the surgical support navigation system and external devices. Self-diagnosis unit 8c responsible for cutting and cutting requests, Surgery planning unit 8d responsible for surgical planning using preoperative images or the latest intraoperative images, and intraoperative responsible for surgical support through image analysis and image display using intraoperative images The screen transitions to the operation unit 8e.

  FIG. 4 is an example of a surgical technique protocol screen 8a. The upper part of the screen shows the time schedule for the entire operation. Along with this time schedule, the function module schedule for each screen shown in FIG. 3 is determined. Schedule management of each function is realized by a form at the center of the surgical procedure protocol screen. In the upper right part of the screen, determination items (decision information) of the surgical technique before the operation, such as an operation method, a target part, operator information, and patient information, are shown. This decision item can be changed, and the matter related to the changed part is organically changed by a knowledge database described later. For example, when a part of a surgical technique is changed immediately before an operation or when an operator is forced to change, functions and schedules related to the matter are organically changed. On the left side of the screen, functional module icons of surgical protocols for the surgical procedure are arranged, and time schedules, milestones, and the like can be set by combining the functional module icons. The right center part of the screen shows the properties of the functional module icons that are currently used or will be used. For example, in the property of the alignment function module, information to be changed depending on the operation status such as which tool is used for alignment, which image is used, and what is used for the marker is shown. The explanation so far is mainly about how to use the surgical technique protocol screen at the time of surgical planning. In the lower right part of the screen, the operation status on the operation technique protocol screen during the operation progress is shown. Thereby, the operation situation several minutes ago can be played back on the screen.

  Figures 5 and 6 show the schema of the knowledge database. The knowledge database schema S1 includes a plurality of relational tables consisting of user interface icons and tasks associated with functional modules. Table relationships are represented by lines connecting the tables. The indexes of the values FK1, FK2, and FK3 are foreign keys to the related table, and indicate that the related table needs to be specified. Otherwise, the database returns an error. In order to characterize the various functional modules incorporated in the knowledge database as a whole, a brief description of the table is given.

  The surgical procedure table S2 includes the surgical procedure name, target site ID, body position, doctor ID, patient ID, anesthesia ID, religion, modality, total operation time as a record, and information on the surgical technique and operation staff / patient. Can have.

  The plan table S3 includes concept IDs, schedule IDs, importance levels, urgency levels, relevance levels, and dependency levels as records, mainly the relationship between the technique and the image, the relationship between the technique and the position information, the technique and the technique. Describes the relationship between the tool, the technique and the functional module, and the relationship between them and the schedule.

  The software structured model has functions such as searching for necessary information and services on behalf of the user and flexibly correcting the behavior according to the situation. The software structured model determines and executes its own behavior toward the goal given by the user according to the behavioral rules of behavior. If execution fails, re-planning is performed and the goal is achieved by another method. When executing the plan, the user moves to the device having the functional module, executes the processing according to the planning, and returns the processing result to the navigation device. In addition, it is possible to have a knowledge database based on a surgical procedure protocol that is indispensable in planning for each device on which the software structured model moves. Planning is performed based on operation rules included in these surgical technique protocol databases. The action rule defines an action plan for solving a goal in a situation against a surgical schedule. The software structured model takes an appropriate action according to the situation on the spot and at that time, and generates an action plan. As an evaluation method for taking an appropriate action, there is a neural network or the like.

  According to the present embodiment, it is possible to present a navigation function corresponding to a user's behavior (motion) pattern according to the state of surgery, and the navigation system can adjust the operation according to the user. In other words, when necessary, the necessary information can be easily extracted and analyzed / viewed, so that the operator can concentrate on the operation.

Surgery support navigation system configuration diagram. The operation assistance navigation system block diagram. Surgery support navigation screen transition diagram. Surgical technique protocol setting screen. Knowledge base schema 1. Knowledge base schema 2. State transition diagram of software structured model. Example 1.

Explanation of symbols

  2 navigation device, 2a monitor, 2b navigation operation input device, 3 knowledge database, 4 position acquisition device, 4a position detection device, 5 image acquisition device, 5a medical image diagnostic device, 6 surgical tool information acquisition device, 6a surgical tool operation input apparatus,

Claims (1)

  In a surgical support navigation system that integrates the functions of an endoscopic device that can be inserted into a patient's body and a surgical instrument and medical diagnostic device that accompanies it, from surgeon information, patient disease information, surgical environment, surgical technique, and surgical technique workflow Surgical technique protocol input means for inputting the surgical technique protocol, means for subdividing and storing the surgical technique workflow based on the surgical means protocol, and the subdivided surgical technique workflow, operator information, and patient disease information A means for constructing a knowledge database, a means for reconstructing the surgical technique workflow into a surgical technique workflow for each user based on the knowledge database, and a time-dependent need for surgery based on the reconstructed surgical technique workflow Surgical support navigation system characterized by having a navigation function

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