JP2009500086A - ロボットガイドカテーテルシステム - Google Patents
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Abstract
【解決手段】 本発明の一実施例の装置は、フレキシブルな鞘状器具と、フレキシブルなガイド器具(18)、及びツール(800、801等)で構成されている。フレキシブルな鞘状器具は、器具操作装置に取り外し可能に連結できる第1の器具ベースを具え、鞘状器具作業内腔を規定する。フレキシブルガイド器具は、器具操作装置に取り外し可能に連結することができ、鞘状器具の作業内腔を通ってねじ止めされている。ガイド器具は、ガイド器具作動内腔も規定し得いる。ツールは、ガイド器具作業内腔を通ってねじ止めされている第2の器具ベース(48)を具える。この装置の実施例では、鞘状器具とガイド器具は、互いに対して個別に制御可能である。
【選択図】 図1
Description
図1Aを参照すると、ロボットカテーテルシステム(32)の一実施例は、術台(22)から遠隔に配置されたオペレータ制御ステーション(2)を具える。このステーションには、器具操作装置(16)と器具(18)が器具操作装置装着ブレース(20)によって連結されている。通信リンク(14)は、オペレータ制御ステーション(2)と器具操作装置(16)との間で信号を送信する。図に示す実施例の器具操作装置装着ブレース(20)は、テーブル(22)の上に寝ている患者(図示せず)の情報に器具操作装置(16)を位置決めするように構成された比較的シンプルな、アーチ状構造部材である。
を導出し、この同次変換行列はカテーテル座標系Cのベクトルを、センサ測定が行なわれる固定グローバル座標系Gに変換する(下付き文字C0及び下付き文字G0を使用して0番目のステップ、または初期ステップを表わす)。登録ステップとして、カテーテルのコンピュータグラフィックビューを、マスター入力、及びカテーテル先端運動のコンピュータグラフィックビューを調整し、そしてグラフィックシーンのカメラビューと整合性がとれるまで回転させる。この初期ビューのカメラポジションに関する3軸座標系変換行列
を保存する(下付き文字Gref及び下付き文字Crefはグローバル「リファレンス」ビュー及びカメラ「リファレンス」ビューを表わす)。カテーテル座標に対応するカテーテル「リファレンスビュー」行列は次式のように得られる。
はコンピュータグラフィックソフトウェアから得られる。該当するカテーテル変換行列は、上述の方法と同様の方法で計算することにより次式のように表わされる。
への変換を行なう変換である。既に計算した上記量を使用して、この変換を計算により次式のように表わす。
を適用することにより変換される。コマンド入力が次式のように与えられると、
次式を計算により求めることができる。
Xc=wcos(θ)
Yc=Rsin(α)
Zc=wsin(θ)
上の式においては、次式のような関係がある。
w=R(1−cos(α))
α=[(φpitch)2+(φyaw)2]1/2 (曲がり合計)
(曲がり半径)
θ=atan2(φpitch,φyaw) (ロール角)
φpitch=αsin(θ)
φyaw=αcos(θ)
L=Rα
上の式においては、次式のような関係がある。
図196Aを参照すると、一の実施例に係るステアリング可能なガイド(18)器具とステアリング可能な鞘状器具(30)を、同軸で経膣的に子宮(875)に進める。図192A乃至Qに示すようなツール(図示せず)が、ガイド(18)内に同軸に連結されている。図196Bを参照すると、アッセンブリもステアリングされると、ガイドと鞘が前進する。蛍光透視法、経皮的超音波、及び器具搭載超音波などの撮像モダリティを用いて、子宮(875)へナビゲートする。膣(876)と、子宮(875)、ファロウピース管(872)および卵管(874)へステアリングして、卵巣(873)と腹膜(887)にアクセスすることができる。子宮(875)に、生理的食塩水あるいはその他の液体を注入して撮像を容易にすることができる。図196Cを参照すると、例えば、生理食塩水を入れた子宮(875)を、片側だき超音波アレイなどの、ガイド器具(30)に接続した超音波デバイス(863)で撮像して、対象の組織損傷(877)を観察することができる。図196Dを参照すると、別のシナリオにおいて、子宮(875)に通気を行って、図195に示すようなステアリング可能な内視鏡器具アッセンブリ(820)を、光撮像デバイスなどの前方監視画像捕捉デバイス(853)を用いて前進させる。このことは、ファロウピース管(872)の開口の位置を確認するのに役立つ。生理食塩水の注入、および関連する器具の遠位先端を用いた非外傷性組織処置も、ファロウピース管(872)の開口の位置を確認して、更に、撮像モダリティをここで述べたように前進させるのに役立つ。図196Eを参照すると、ファロウピース管(872)の開口に向けてステアリング可能に前進する鞘(30)とガイド(18)が記載されている。
図205A乃至Bを参照すると、よりよく理解する目的で、一実施例を用いた腹腔鏡卵管切除術が記載されている。ガイド(18)及び鞘状(30)器具と、画像捕捉デバイスを具えるステアリング可能な内視鏡を、臍ポート(889)を通って通気式外科領域(888)に配置し、これをステアリングして、例えば焼灼ハサミあるいは把持器を具えるステアリング可能な器具アッセンブリの操作を容易にする視野を作る。図204.5A乃至Bを参照すると、追加の鞘/ガイド対(818、819)などの一又はそれ以上の器具を臍(889)またはその他のポート(890)を通して導入して、後腹膜的に、下腹膜的に、その他で、腹膜内に位置する組織にアクセスする。15mmHgでの通気と、トレンデルンブルグ身体位置が、腹腔鏡検査ツールのアクセスと操作を容易にしている。図205A乃至Bに示すように、切除した組織片(883)を卵管(874)から切り離して、外科的に作ったサイドポート(890)を通して取り出す。
図218Aを参照すると、一の実施例によるステアリング可能な器具アッセンブリを尿道(912)を介して膀胱(910)へ進めている。ここでは、画像捕捉デバイス(853)を用いて、注入した生理的食塩水によって容易にして、対象となる損傷(933)の細胞検査と潜在的な観察を行う。画像捕捉デバイスを接続するロボットガイド及び/又は鞘の全方向的ステアリング性と正確さが、膀胱(910)内部の画像の収集を容易にしている。この画像を互いに貼り付けて、3次元画像を形成する。器具アッセンブリ(901)も、明らかな出血や、組織の不規則な部分などの欠陥に向けて画像捕捉デバイスを進め、これを拡大するのに使用することができる。図218Bを参照すると、器具アッセンブリ(30、18、881)は、代替的に、あるいは、追加で、膀胱(910)内の腫瘍またはその他の損傷(933)を切除する切除ツール(881)などの介入ツールを具えていても良い。図218C乃至Dを参照すると、器具アッセンブリの一部分(例えば、鞘状遠位先端を尿道の入り口において膀胱に位置させ、より細いガイド18を、腎臓(932)に向けてその中へ入れる)を、腎臓へ向けて進めて、腎臓(932)の中へステアリング可能に入れることができる。ここでは、把持器またはその他のツールで結石(936)を捕捉するか、あるいは、図218C−Dに記載するように、化学薬剤、クライオ、RF、あるいはレーザ切除ツール(935)、又は、超音波などのその他の照射性技術を用いて、結石を破壊することができる。
内部内腔によるアプローチから、ここに述べた実施例にあるようなステアリング可能なツールアッセンブリ(30、18)を用いて、LES(924)をバルーン(851)で拡大することができる。図220A乃至Cを参照すると、拡張可能なバルーン(851)を具えるステアリング可能な器具アッセンブリが、LES(924)内に精密に配置され、拡張され、除去されており、少なくとも一過性にLES(924)を拡大あるいは拡張させる。図221A乃至Cを参照すると、RF、レーザ、クライオ、超音波、その他を用いた切除ツール(881)をガイド/鞘状アッセンブリ(18、30)に連結して、過度に締まったLES(924)を具える組織を、結果として拡大したLESへ組織を内部から切除するのに用いることができる。切除特性を有する拡張可能なバルーン内で、切除と拡大を組み合わせることができる。一の実施例では、切除ツール(881)は、従来のRF切除カテーテルの遠位先端にある分散切除ゾーンに対向する周方向を向いた切除ゾーンを有しており、切除動作の特定の仕事が行われる間に、周辺のLES(924)の組織に、より広がった切除が行われる。
図225A乃至Fを参照すると、ステアリング可能な器具アッセンブリを用いて、直腸(955)を通って大腸(900)へナビゲートし、ポリープなどの組織欠陥あるいは形成異常(954)を生検し、溶解し、及び/又は除去する介入を行うことができる。図225Aを参照すると、CCDカメラあるいはファイバカメラなどの前方画像捕捉デバイス(853)と共に、ステアリング可能な器具アッセンブリ(901)をステアリング可能に大腸(900)にナビゲートしている状態が記載されている。この器具アッセンブリの高度なステアリング可能性によって、図225Bに記載されているように、全方向における組織欠陥(954)の検査を容易にしている。図225Cを参照すると、器具アッセンブリは、複数の器具サブアセンブリを具えていても良く、このうちの一つが、ポリープ除去焼灼スネアデバイス(957)を具えていても良い。図225D及び225Eに示すように、この焼灼スネアデバイス(957)は、適所に正確にナビゲートされて、ポリープなどの組織欠陥(954)を焼灼して除去するのに使用される。図225Fを参照すると、器具アッセンブリをその他の欠陥(954)に再度方向付けることができ、ここで、同じ手順を繰り返しても良い。代替的にステアリング可能な器具アッセンブリから生検針(図示せず)を展開させて、大腸の組織欠陥を正確にサンプリングすることができる。
図226A乃至229Dを参照すると、一又はそれ以上のステアリング可能な器具アッセンブリを用いて、気管(958)、気管支(959)、及び肺(964)にナビゲートし、これらを診断あるいは治療することができる。図226A乃至Cを参照すると、拡張可能なバルーン(851)を具えるステアリング可能な器具アッセンブリ(30、18)を、気管支(959)まで進めて、一方向弁を収納するように構成したステント構造などの拡張可能な人工気管(960)を展開させるのに使用することができる。肺気腫などの疾患を治療する場合、活性肺気量、薬剤溶出ポリマ、その他を減らすことが望ましい。別の実施例では、ステントを展開させて、特定の気道セクションの開存性を維持することができる。図227A乃至Dを参照すると、ある気管支(959)を、クライオ、RF、超音波、その他を用いて切除して(881)、気管支の壁にある喘息に関連する平滑筋の狭窄(961)を防ぐことができる。この平滑筋自体を切除する(881)、あるいはこの筋肉に続く運動神経を切除して、気道(962)をより広げることができる。
本発明のいくつかの実施例に係るステアリング可能なツールアッセンブリを用いて、ヒトの膝滑膜性関節の側部ポートから、同じ関節の後側局面へ正確に針を通して、前側あるいは側部から後側へ縫合し、半月板の損傷を縫合によって修復することができる。入り乱れた滑膜性関節(腰関節など)は、入り乱れた、好ましくは、灌水した腰関節などの関節スペースにナビゲートするように構成した細いステアリング可能な器具アッセンブリの端部に配置した小さなステアリング可能な器具で調べることができる。
本発明の実施例によって提供されるステアリング可能なプラットフォームを用いて、例えば、石灰化した組織と神経の周囲に入れることによって、椎間板スペースにステアリング/ナビゲートすることができる。脊椎穿刺を行って、非常に細いステアリング可能なデバイスをCSFチャネルに挿入して硬膜下の脳へ折り返して、硬膜下血腫を吸引する、脳組織を生検する、調査する、及び、脳の領域にナビゲートすることができる。
また、本発明のいくつかの実施例によるステアリング可能な器具と器具アッセンブリを用いてIMAの分解と、一方の肺(好ましくは左肺)を落とした後関連する小さな管の焼灼を行うことができ、次いで、一又はそれ以上のIMAsの遠位端吻合によってバイパスを作ることができる。縦隔鏡検査は、胸骨上のアクセスルートから行うことができる。心膜外スペースへは、剣状突起の下のアクセスルートからアクセスして、心外膜の切除、あるいはぺーシングリードの配置を行うことができる。肺の楔状切除術は、好ましくは、腫瘍などの組織欠陥への案内を助けるCT/MRデータを用いて、経胸郭アプローチから行うことができる。迷走神経あるいは内蔵神経ぺーシングリードは、経胸郭検査法によって非常に正確に配置することができる。上述したとおり、ヘラーの筋切開術を経胸郭的アプローチによって行うことができる。
図230A乃至Fの実施例に記載されているように、本発明の実施例によるステアリング可能な器具アッセンブリ(30、18)を用いて、鼻/洞経路にナビゲートして、診断を行い、治療を行うことができる。一の実施例では、経鼻経路(967)を通過させて、上顎洞へエントリするための約2.5mm以下の全断面寸法を有するステアリング可能な器具を用いて、上顎洞にナビゲートし、灌水し、投薬することができる。更に、この上顎洞へのエントリは、図230Gに示すように、石灰化した関連柔組織を高精度に、少なくとも部分的に切開するように構成されたバー、ドリルあるいはその他の拡大ツール(966)によって増加する。その他の実施例では、前頭洞、篩骨洞、および蝶形骨洞にアクセスし、診断し、治療することができる。
咽頭は、従来の硬い咽頭鏡とは対照的に、いくつかの実施例で提供されているフレキシブル/ステアリング可能なプラットフォームを用いて、口(968)を介して生検を行い、修正し、切除することができる。図231Aを参照すると、好ましくは、CCDまたはファイバデバイスといった直接的な視覚化手段などの画像捕捉デバイスを具えるステアリング可能な器具アッセンブリは、口(968)を介してステアリング可能におよびフレキシブルにナビゲートすることができ、咽頭(969)領域へ降りてゆく。図231Bを参照すると、患者の特定の生体構造によって、ステアリング可能な器具アッセンブリの遠位端を咽頭にナビゲートするには、有意な転回と、ステアリング能力が必要とされる。図231C乃至Eは、ステアリング可能な器具の遠位端に連結することができ、咽頭で使用されるツールの様々な実施例を示す。
図232A乃至Cを参照すると、様々な実施例による一又はそれ以上のステアリング可能な器具アッセンブリを、鎖骨の上の経皮的アクセスポイントから、甲状腺(971)及び副甲状腺(972)領域へナビゲートすることができる。甲状腺(971)領域に入ると、CCD又はファイバデバイスなどの直接視覚化手段といった、画像捕捉デバイスを好ましくは具えるステアリング可能な器具(896、820、901)を用いて、甲状腺(971)及び/又は副甲状腺(972)を調べ、生検を行い、切除し(RF、クライオ、レーザ、超音波、その他)、部分的に溶解し、注入を行い、あるいは、これらのいずれかの一部を切除して除去することができる。図232Aを参照すると、甲状腺及び/又は副甲状腺の上に焦点を合わせた前方監視ステアリング可能な内視鏡(820、901)を用いて、いくつかの実施例によって構成した一又はそれいじょうのステアリング可能な器具アッセンブリ(896)を用いて、甲状腺及び/又は副甲状腺を処理することができる。図232Cを参照すると、副甲状腺(972)の一又はそれ以上の節が、甲状腺(971)近傍の正常位置にない場合に、このような位置に副甲状腺(972)のあるべきところにない節が位置していることを期待して、操作可能な器具を縦隔領域(973)に戻すようにステアリングすることができる。
ステント及びステントグラフトなどの拡張可能な人工器官を、小さな、ニチノールまたはステンレス製のトグルボルトタイプのステープルクリップを円周状に留めて展開させることによって、「端部漏れ」のリスクを低減させて、適所に展開させて係止させることができる。また、本発明の様々な実施例の対象のステアリング可能な器具システムを用いて、ステントまたはステントグラフトの縦軸を内側から外へ縦方向に下げることができる。図233A乃至Cを参照すると、対象のステアリング可能な器具プラットフォームを用いて、上行大動脈全体を通じて、クリップ、またはステープル適用器、後退可能な針、その他などの遠位側で展開するツールを用いて、ナビゲート、診断、治療、及び介入することができる。図233Aを参照すると、ステアリング可能なガイド(18)及び鞘状(30)のアセンブリが腎動脈(975)をナビゲートしている。図233Bを参照すると、ステアリング可能な器具が腹腔動脈(977)をナビゲートしている。図233Cを参照すると、ステアリング可能な器具が大動脈弓(976)をナビゲートして、これを用いて、大動脈流出路を介した逆方向のアプローチから、心臓(974)の左心室へ入っている。
本発明の実施例によって提供されるステアリング可能な器具は、伏在静脈を採取するGuidant社の「VasoView」手順と同等の手順であるが、対象の器具のステアリング可能性故に有意に改善された手順(剛性のある、ストレートなVasoViewと異なり、経皮性クロッシングの後直ちに鋭角にターンさせることができる)を提供することができる。
Claims (24)
- 器具操作装置に取り外し可能に連結することができる第1のフレキシブル鞘状器具であって、当該鞘状器具が鞘状器具の作動内腔を規定しているフレキシブル鞘状器具と;
前記器具操作装置に取り外し可能に連結することができる第2の器具ベースを具えるフレキシブルガイド器具であって、当該ガイド器具が前記鞘状器具の作動内腔内に配置されており、ガイド器具の作動内腔を規定しているフレキシブルガイド器具と;
前記ガイド器具の作動内腔内に配置されたツールと;を具え、
前記鞘状器具の各々と、ガイド器具と、ツールが、互いに対して独立して制御可能であることを特徴とする装置。 - 請求項1に記載の装置において、前記ツールが前記ガイド器具に対して独立して移動可能であり、前記ツールの遠位端が前記ガイド器具内腔の遠位側部分から延在することができ、当該遠位側へ後退して戻ることができることを特徴とする装置。
- 請求項1に記載の装置において、前記ツールが電極を具えることを特徴とする装置。
- 請求項3に記載の装置において、前記電極が切除電極であることを特徴とする装置。
- 請求項1に記載の装置において、前記ツールが把持器を具えることを特徴とする装置。
- 請求項1に記載の装置において、前記ツールがハサミを具えることを特徴とする装置。
- 請求項1に記載の装置において、前記ツールが針を具えることを特徴とする装置。
- 請求項7に記載の装置において、前記針が後退可能であることを特徴とする装置。
- 請求項1に記載の装置において、前記ツールが折りたたみ可能なバスケットを具えることを特徴とする装置。
- 請求項1に記載の装置において、前記ツールが拡張可能なバルーンを具えることを特徴とする装置。
- 請求項1に記載の装置において、前記ツールがステープル適用器を具えることを特徴とする装置。
- 請求項1に記載の装置において、前記ツールがレーザ発光素子を具えることを特徴とする装置。
- 請求項1に記載の装置において、前記ツールが超音波トランスデューサを具えることを特徴とする装置。
- 請求項1に記載の装置において、前記ツールが低温冷却素子を具えることを特徴とする装置。
- 請求項1乃至14のいずれか1項に記載の装置において、前記ツールが介入手順部位において、内部身体組を機械的に操作するように作動できることを特徴とする装置。
- 請求項1に記載の装置において、前記ツールが手動で近位側で作動することを特徴とする装置。
- 請求項1に記載の装置において、前記ツールが電子機械的に近位側で作動することを特徴とする装置。
- 請求項1に記載の装置において、前記鞘状器具の遠位先端が、位置確認センサを具えることを特徴とする装置。
- 請求項1に記載の装置において、前記ガイド器具の遠位先端が、位置確認センサを具えることを特徴とする装置。
- 請求項1に記載の装置において、前記鞘状器具が当該器具の遠位部分に位置確認センサを担持しており、前記ガイド器具が当該器具の遠位部分に位置確認センサを担持していることを特徴とする装置。
- 請求項1に記載の装置において、前記鞘状器具が前記第1の器具ベースを介して器具操作装置によってロボット制御されることを特徴とする装置。
- 請求項1に記載の装置において、前記ガイド器具が前記第2の器具ベースを介して器具操作装置によってロボット制御されることを特徴とする装置。
- 請求項21に記載の装置において、前記器具操作装置が、前記ガイド器具の遠位側部分が患者の身体内の介入手順部位に配置されるように前記ガイド器具を操作するよう構成されていることを特徴とする装置。
- 請求項1に記載の装置において、単一の器具操作装置が、前記鞘状器具と、前記ガイド器具の双方をロボット制御することを特徴とする装置。
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US8617102B2 (en) | 2013-12-31 |
US20120065467A1 (en) | 2012-03-15 |
US20140081292A1 (en) | 2014-03-20 |
US20190350660A1 (en) | 2019-11-21 |
WO2007005976A1 (en) | 2007-01-11 |
US8801661B2 (en) | 2014-08-12 |
US20110238083A1 (en) | 2011-09-29 |
US20140296875A1 (en) | 2014-10-02 |
EP1906858B1 (en) | 2016-11-16 |
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US20170086929A1 (en) | 2017-03-30 |
US9457168B2 (en) | 2016-10-04 |
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