JP2010000284A - Surgical procedure using ic tag - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a surgical procedure using IC tag capable of identifying a lesion correctly and performing an extirpative surgery accurately. <P>SOLUTION: An IC tag 4 is inserted into a human body and kept at a predetermined position, and a signal transmitted from a sensor is received and a signal transmitted from the IC tag is received. A sensor can display the sound or the light color to figure out the distance between the sensor and the IC tag, and the position of the IC tag is recognized by approximating the sensor and marked, and the lesion can be extirpated from the mark. <P>COPYRIGHT: (C)2010,JPO&INPIT

Description

  The present invention relates to a method for performing an operation by accurately confirming the position of a lesion site by inserting and placing an IC tag in a lesion (especially cancer cells) of a human body and receiving a signal transmitted from the IC tag. It is.

  In recent years, the development of endoscopic surgical instruments and surgical techniques has been remarkable, and as a result, the number of lesions to be operated becomes smaller, but the number of cases where it is difficult to identify the lesion is also increasing. Therefore, it is strongly desired to develop a means by which an operator can know the exact position of a lesion site during surgery.

Prior to the operation, a lesion site is confirmed by an image diagnostic device such as an endoscope or CT, and this is labeled by some method, and an excision operation can be performed while confirming this label. By the way, the following are known as conventional labeling methods.
(1) A method of injecting a dye into or near a lesion.
The “Surgery, Detection and Treatment of Tumors and Lesions in Endovascular Procedures or Endoscopic Procedures” according to Japanese Translation of PCT International Publication No. 8-500335 is a method for injecting an effective amount of a drug parenterally into a patient receiving the procedure, The label can be detected by an endoscope or intravascular catheter or by a light source supplied during a surgical procedure.
However, with this method, the injected dye diffuses over time, and it is not easy to grasp the exact lesion site.
(2) A method of inserting and leaving an indwelling needle in or near a lesion.
Japanese Patent Application Laid-Open No. 2008-100069 discloses an “ultrasonic system for displaying a composite image of an ultrasound image and an external medical image” on a composite image of the ultrasound image and the external medical image in real time during a catheter operation process. An ultrasound system that displays a needle.
The ultrasonic system includes an ultrasonic diagnostic unit including a probe for receiving an input of an ultrasonic signal reflected from a target body and a medical needle inserted into the target body, and positional information of the probe on the target body A probe position information providing unit for providing an image, a video signal providing unit for providing an external video signal obtained from an external video device and forming an external video of the object, and a position of a lesion in the external video from a user A user input unit for receiving an input of information, a video processing unit for forming a composite image of an ultrasound image and an external image based on the position information of the probe and the position information of the lesion, the ultrasound image, A display unit for displaying the external video and the composite video.
However, in this method, the medical needle inserted in the lesion or in the vicinity of the lesion is displaced, and the lesion site may not be specified, and sometimes the inserted medical needle may be lost.
(3) A method of leaving a clip in or near a lesion.
Japanese Patent Laid-Open No. 2005-218680 “Surgery lesion identification system” is an inexpensive and simple surgical lesion identification system that can identify a lesion in real time only by confirming an observation image of an endoscope It is.
That is, a light source clip is placed around the lesion. In this state, the LED of the light source clip is caused to emit light, and the light is imaged by a CCD element of a rigid endoscope disposed in the vicinity of the wall portion opposite to the wall portion of the lung where the light source clip is placed. The image picked up by the CCD element is subjected to image processing, and light having a wavelength in the near infrared region of the LED is superimposed on the image in the visible region and recognized by the operator on the monitor of the rigid endoscope to identify the lesioned part.
However, in this method, the clip left in the vicinity of the lesion or the lesion is displaced, and the lesion site may not be specified, and sometimes the remaining clip may be dropped. Furthermore, in the case of a non-tactable operation, it is difficult to grasp the exact position of the clip.
(4) A method of leaving a magnetic substance in or near a lesion.
The “in-body position detection system” according to Japanese Patent Application Laid-Open No. 2002-1113018 is a means for detecting the position of all lesions quickly, easily and at a low cost during surgery. Indwelling in advance at the lesion, the position of the clip placed by the detector is probed during subsequent surgery. The detector is provided with a magnetic sensor, and can output sound or light having a strength corresponding to the detected magnetic strength. The surgeon can recognize the position of the clip by sound or image output, and can remove the diseased tissue.
However, this method requires the installation of a three-dimensional sensor outside the body in order to determine the exact position of the magnetic material, and this sensor is a large-scale device for calculating the position of the magnetic material and displaying it to the operator. It becomes.
(5) A method in which 3 to 4 metal spheres are left in the lesion or the vicinity of the lesion and the position is determined by X-ray irradiation from two directions.
In this method, it is impossible to always irradiate X-rays in an endoscopic operation, so that it is difficult to grasp the position of a lesion site, and the apparatus becomes large.
"Detection and treatment of tumors and lesions in surgery, endovascular procedures or endoscopic procedures" according to Tokuhei Hei 8-500335 “Ultrasound system for displaying composite image of ultrasound image and external medical image” according to Japanese Patent Application Laid-Open No. 2008-100069 "Surgery lesion identification system" according to JP-A-2005-218680 “In-body position detection system” according to Japanese Patent Application Laid-Open No. 2002-1113018

  Various labeling methods for identifying a lesion site are known, but there are problems as described above. The problems to be solved by the present invention are these problems. An IC tag can be inserted and placed in order to accurately mark a lesion site, and an operator can perform it based on a signal transmitted from the IC tag. Provide surgical methods.

  The surgical method according to the present invention is a method in which an IC tag is inserted and placed in the body by some means, a signal transmitted from the IC tag is captured to specify a region of a lesioned part, and this part is excised. In the present invention, an IC tag is used as means for allowing an operator to recognize a lesion, but the form and internal structure of the IC tag itself are not limited.

  By the way, although the IC tag is pushed out and inserted into a predetermined lesioned part or near the lesioned part, an indwelling function may be provided so as not to be displaced at a predetermined position. For example, by attaching one or more locking pieces to the IC tag, the locking pieces can be caught in the body and placed at a predetermined position. Moreover, in order to make the IC tag itself have a shape having a locking piece function, for example, a rough V shape, a rough triangle, or the like can be formed.

  There are various sizes of IC tags ranging from small ones of about 0.3 mm to those of about 2 to 3 cm. In the present invention, the size of the IC tag is not limited. Actually, a relatively small IC tag is preferable, but it may be properly used depending on the application. For example, in the case of a brain tumor, a small IC tag that can enter a thin cerebral blood vessel is used. In addition, there are two types of IC tags, namely, an electromagnetic induction method (magnetic field type tag) and a radio wave communication method (electric field type tag), and an active type and a passing type.

  When inserting an IC tag in or near a lesioned part, when using an endoscope to recognize the lesioned part, when confirming a lesioned part using CT, a lesioned part using X-rays In some cases, an echo may be used, and an IC tag set on a catheter or a cylindrical applicator can be pushed out by a pusher and placed in or near the lesion.

  By the way, at the time of surgery, the position of the IC tag placed in the lesioned part or in the vicinity of the lesioned part is confirmed by bringing the sensor closer. That is, a signal transmitted from the IC tag is received in response to a signal transmitted from the sensor, but can be displayed with sound or light color so that the distance between the sensor and the IC tag can be understood. For example, a high tone is emitted when approaching the IC tag, and a low tone is emitted when leaving the IC tag, so that the exact position of the placed IC tag, that is, the lesion site can be known. In the case of color, the color can be displayed on the monitor, or the intensity of the signal transmitted from the IC tag can be directly converted into a distance and represented by an actual numerical value.

  As described above, if the position of the IC tag is determined, a mark for specifying the position may be attached. For example, it becomes a kind of landmark by baking with an electric knife. If the lesion is a small lesion, only one IC tag may be placed. However, if the lesion is spread over a certain area, a plurality of IC tags are placed so as to surround the lesion. Accordingly, the position of each IC tag is confirmed and marked in the operation. Or it is also possible to perform an excision operation while confirming with a sensor without attaching a mark.

  In the surgical method according to the present invention, an IC tag is placed in advance at or near a lesioned part, and the operator confirms the IC tag with a sensor and marks the position where the IC tag is placed. Based on this, the lesion can be removed. By placing the IC tag accurately, the operator can remove the lesion without leaving the lesion, and even with a very small lesion, the position of the IC tag placed at the lesion can be accurately determined by bringing the sensor closer. I can grasp.

  In the case of a lesion that has spread over a certain area, it is necessary to place a plurality of IC tags. At this time, by assigning a number to each IC tag, it is possible to grasp the position in the case of an operation and extract it without leaving a lesion site. Here, if the IC tag has an indwelling function, the IC tag is pushed out from the needle and inserted into the lesioned part or the vicinity of the lesioned part, so that the position does not change. After confirming the lesion using an endoscope or CT, an IC tag is inserted at a predetermined position, and the IC tag is left without being displaced.

  The IC tag is smaller than a conventional label, and in the case of a brain tumor, a very small IC tag can be inserted into a cerebral blood vessel and can be placed at a predetermined position in the blood vessel via a locking piece. In addition, since the marker is highly reliable and a cancer that has been enlarged widely, a plurality of IC tags can be driven and placed, so that there is no unremoved residue during surgery. Further, since the IC tag responds to a signal transmitted from the sensor and can accurately grasp the distance between the sensor and the IC tag, the position of the lesion site can also be accurately grasped.

  FIG. 1 shows a case where cancer cells 2 are generated in the large intestine 1. The cancer cell 2 can be confirmed by an endoscope 3 as shown in the figure. In the present invention, an IC tag 4 is placed on the cancer cell 2. If the endoscope 3 is inserted from the anus and examined, even very small cancer cells 2 generated on the inner wall surface 5 of the large intestine 1 can be confirmed. When the cancer cell 2 is confirmed, the IC tag 4 is inserted into the center of the cancer cell 2. (B) of the figure is a case where the IC tag 4 is inserted into the cancer cell 2.

In the present invention, the method of inserting the IC tag 4 is not particularly limited, but can be inserted into the cancer cell 2 by using the endoscope 3 as shown in FIG.
FIG. 2 is a schematic view showing the distal end portion of the endoscope 3. The distal end has an observation window 6, an illumination window 7, and a forceps channel 8, and an illumination light guide fiber 9 extends from the illumination window 7. The light source 10 is guided to the light source 10 and the light from the light source 10 can be irradiated from the illumination window 7 to illuminate the inner wall surface 5 of the large intestine 1.

  An objective lens 11 is provided in the observation window 6, and red, green, and blue color filters 12 and a CCD 13 are provided behind the objective lens 11. Therefore, the cancer cell 2 is illuminated with light irradiated from the illumination window 7, and this image is passed through the objective lens 11 from the observation window 6, converted into an electrical signal by the CCD 13, and projected on the TV monitor 15 via the cable 14. I can do it.

  Even if the cancer cell 2 generated on the inner wall surface 5 of the large intestine 1 is very small, it can be discovered without being overlooked by using the endoscope 3, and the IC tag 4 is driven into the found cancer cell 2. Similarly, the endoscope 3 is used to drive the IC tag 4, but a catheter is inserted into the forceps channel 8, and the IC tag 4 is pushed out by a pusher from a needle 16 connected to the distal end of the catheter. The surgeon inserts the needle 16 into the cancer cell 2 while looking at the TV monitor 15, pushes out the IC tag 1 in this state, and places the IC tag 4 at a predetermined position.

  FIG. 3 shows the needle 16 on which the IC tag 4 is set. The needle 16 is connected to the distal end of a tube extending to the operator's hand, and is fitted into the forceps channel 8 of the endoscope 3 so that it can be inserted and removed. If it moves to the front end side, the IC tag 4 is pushed out by being pushed by the pusher 18. The pushed IC tag 4 is inserted into the cancer cell 2 and placed at a predetermined position.

  By the way, the IC tag 4 is pushed out from the needle hole 17, but when the needle 16 is pulled out, the IC tag 4 must not be reversed. That is, the IC tag 4 is a label for specifying the position of the cancer cell 2 generated on the inner wall surface 5 of the large intestine 1, and the position of this label must not change. Therefore, it is convenient that the IC tag 4 has an indwelling function. Here, the indwelling function is a function for preventing the IC tag 4 inserted in the cancer cell 2 or the vicinity thereof from being misaligned, and may basically have a shape having a protrusion.

  FIG. 4 shows an embodiment showing an IC tag having an indwelling function. 4 in the figure represents an IC tag, 19a and 19b represent locking pieces, and the IC tag 4 has two locking pieces 19a and 19b. Here, the IC tag 4 is a chip composed of an antenna and an LSI, and the outer surface is covered with a resin, and thin spring-like locking pieces 19a and 19b are connected to the IC tag 4 and extend. Therefore, when the IC tag 4 is inserted into the body, both the locking pieces 19a and 19b bend inward and contract each other. However, if the IC tag 4 is inserted into a predetermined cancer cell 2 and stops, the IC tag 4 spreads outward. Is placed in that position.

  FIG. 5 shows a case where the IC tag 4 has an inverted V shape. That is, the tip of the inverted V shape is thin and sharp, so that it can be easily inserted into the cancer cell 2, and if pushed out into the cancer cell 2, it is placed without returning. The shape of the IC tag itself having a placement function is not limited to the inverted V shape shown in FIG. 5, but may be a triangle. Further, the locking pieces 19a and 19b are combined with the inverted V shape or the triangular IC tag 4. It is also possible to adopt a different form.

  FIG. 6 shows still another form of the IC tag 4 having an indwelling function. The IC tag 4 is provided with a spring 20, and the IC tag 4 inserted into a predetermined cancer cell 2 is left without moving by the spring spring 20. If, for example, a shape memory alloy is used as the spring spring material, the spring spring 20 extends straight when set in the needle hole 17 as shown in FIG. When it reaches a predetermined temperature (about 36 ° C.), it can be deformed and restored to its original shape. That is, by restoring the shape of the mainspring 20, the position of the inserted IC tag 4 is left unchanged.

By the way, the use of the IC tag as a label is not particularly limited. Basically, it is used as a labeling means for an operator to recognize a lesion during surgery, and can be applied specifically to the next lesion.
(1) Colorectal cancer Colorectal cancer occurs on the inner wall surface of the large intestine. The cancer generated on the inner wall is found by an endoscope, and an IC tag is inserted and placed in the vicinity of the colon cancer or the colon cancer using the endoscope.
(2) Breast cancer Although breast cancer occurs in soft tissues, it can be used as a label for inserting and placing an IC tag and extracting cancer cells while confirming breast cancer by CT, echo, or the like.
(3) Lung cancer In the case of lung cancer, a needle is inserted from the body surface using CT, or an endoscope or a catheter is inserted from the bronchus, and an IC tag is inserted and placed at a predetermined lesion site.
(4) Liver cancer In the case of liver cancer, a thin catheter is inserted from a blood vessel, a predetermined lesion site is identified using, for example, an echo, and an IC tag is inserted and placed at this position. Alternatively, the IC tag can be inserted and placed by inserting a needle from the body surface.
(5) Brain tumor A very thin catheter can be inserted into a blood vessel, a lesion can be identified using CT, and an IC tag can be pushed out of the tube and placed.

  FIG. 1 shows a state in which the needle 16 extends from the distal end of the endoscope 3 to some extent. If the needle 16 is inserted into the cancer cell 2 and pressed by the pusher 18 in this state, the IC tag 4 It is extruded from the tip of the needle 16 and is embedded and placed in the cancer cell 2. The locking pieces 19 a and 19 b of the IC tag 4 shown in FIG. 4 extend straight in both outward directions, but are bent along the side of the IC tag 4 in the needle hole 17. Then, while being pushed out from the needle hole 17, the locking pieces 19 a and 19 b are restored and extend straight outward, and the locking pieces 19 a and 19 b are locked to the cancer cell 2. There is nothing.

  Here, a thin spring material is used for the locking pieces 19a and 19b. Alternatively, a shape memory alloy can be used. That is, as the temperature rises to around 36 ° C. at the same time as it is inserted into the cancer cell 2, the locking pieces 19 a and 19 b bent along the side of the IC tag 4 are restored to the original shape and both Can extend straight outward.

  The IC tag 4 shown in FIG. 5 is also set in the needle hole 17 and pushed out by the pusher 18. The inverted V-shaped IC tag 4 is set by being fitted into the needle hole 17 with the whole or both sides curved in an arc shape. Therefore, when the pusher 18 is pushed out from the tip of the needle, the curved shape is restored to a flat shape, and even if the needle 16 is retracted, both ends are locked and do not return and remain in that position. Is done.

  The IC tag 4 having the spring 20 shown in FIG. 6 is similarly set in the needle hole 17. In this case, the mainspring 20 is in a state of extending straight, and is restored to the mainspring 20 at the same time as being inserted into a blood vessel in the body, for example. That is, a shape memory alloy is used for the mainspring 20, and when the temperature reaches around 36 ° C., the mainspring 20 can be restored to the shape of the mainspring and is left at the inserted position.

  By the way, the IC tag 4 is placed in the lesioned part or in the vicinity of the lesioned part using the endoscope 3 or other means as described above, and the surgeon performs an extraction operation using the IC tag 4 as a marker. If the sensor approaches the IC tag 4 placed on the cancer cell 2, it reacts to the signal from the sensor. That is, if a sensor (not shown) is brought close to the IC tag 4, a reaction corresponding to the distance from the IC tag 4 can be exhibited. For example, control is performed so that a reaction sound is generated, and a high sound is generated as the distance approaches. Alternatively, the color of light can be changed, and the color can be controlled to become darker as the distance from the IC tag 4 approaches.

  If the position of the IC tag 4 embedded prior to the operation is confirmed by the sensor, the position is marked. For example, it becomes a mark by baking with an electric knife. An electric knife can be attached to the sensor, and the position of the IC tag 4 can be confirmed by the sensor, and at the same time a mark can be attached with the electric knife, and a cancer removal operation is performed based on the mark.

  By the way, laparoscopic surgery and laparoscopic surgery are known as surgical methods for extracting cancer cells generated in the large intestine and stomach, and any surgical method is targeted in the present invention. In particular, in the case of laparoscopic surgery, since a camera is inserted into the body and displayed on a TV monitor, it is not easy to confirm small cancer cells, and the position is specified by the IC tag 4 for this purpose. Therefore, even minute cancer cells can be completely removed without leaving them behind.

  FIG. 7 shows a relatively large cancer cell 21 generated on the inner wall of the stomach. In the case of the cancer cell 21 having a certain spread as described above, the area cannot be specified by one IC tag 4 as shown in FIG. Therefore, a plurality of IC tags 4 a, 4 b, 4 c... Are placed so as to surround the cancer cell 21. As for the placement method of the IC tags 4a, 4b, 4c,..., The IC tags 4a, 4b, 4c,.

  With the IC tags 4a, 4b, 4c... Driven and placed, the cancer cells 21 can be removed by laparoscopic surgery or laparoscopic surgery. At this time, the position of each IC tag 4a, 4b, 4c,... Placed in the sensor is confirmed before the extraction, and the stomach surface is marked by burning with an electric knife, and extraction is performed based on the mark. . When attaching the mark, it is necessary to confirm the region of the cancer cell 21 by confirming that the number of the placed IC tags 4a, 4b, 4c,... Matches the mark.

  Then, after the excision operation is completed, it is necessary to confirm that there is no IC tag remaining in order to prevent the cancer cells 21 from being left behind. This means that the operator can be informed of the presence of an IC tag that remains by reapproaching the sensor by light or sound with a sound or color in response to the sensor. Therefore, by using the IC tags 4a, 4b, 4c,..., Even a few cancer cells 21 can be completely removed without leaving them. In particular, in the case where cancer cells 21, 21,... Exist in a plurality of locations instead of cancer cells 21 generated with a region in one location, by placing a large number of IC tags 4 a, 4 b, 4 c. The removal of all cancer cells is completed in one operation.

  By the way, the sensor serves as both a transmission antenna and a reception antenna. With respect to the transmission antenna, the position accuracy of the IC tag 4 can be increased by narrowing the radio wave irradiation range. For example, as shown in FIG. 8A, the size of the irradiation range can be adjusted by narrowing the width of the beam 23 from the antenna 22a, and the required positional accuracy can be obtained. That is, as shown in FIG. 8B, the required position accuracy can be increased by arranging a radio wave absorber or a waveguide 24 in the antenna, or by narrowing the reception range depending on the shape of the antenna.

  FIG. 9 shows a case where minute cancer cells A are generated in the stomach, and a plurality of IC tags 4a, 4b, 4c are placed around the cancer cell A, and the IC tag placed by the sensor 22 of FIG. 8 inserted into the body. 4a, 4b, 4c can be confirmed accurately. Moreover, the positional accuracy is high. Further, by attaching the laser beam emitting device 25 to the tip of the antenna 22a shown in FIG. 10, the direction of the antenna beam can be instructed to the operator.

  On the other hand, FIG. 11 shows a signal transmission / reception system. By adopting the array antenna 26, position accuracy information of the IC tag 4 can be obtained three-dimensionally. Thus, the operator can know the position of the IC tag 4 and use it for the operation. In this system, the position of the IC tags 4a, 4b, 4c,.

Cancer cells that have developed on the inner wall of the large intestine. Schematic which shows the front-end | tip part of an endoscope. When the IC tag is set in the needle hole. An example of an IC tag having an indwelling function. Another embodiment of IC tag with indwelling function Another embodiment of IC tag with indwelling function When multiple IC tags are placed around cancer cells that have developed on the inner wall of the stomach. (a) is an antenna whose beam width is adjusted, and (b) is an antenna provided with a radio wave absorber and a waveguide. When using a sensor to check multiple IC tags placed around a small cancer cell that has developed in the stomach. An antenna with a laser light emitting device attached to the tip. A signal transmission / reception system with an array antenna.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 Large intestine 2 Cancer cell 3 Endoscope 4 IC tag 5 Inner wall surface 6 Observation window 7 Illumination window 8 Forceps channel 9 Light guide fiber for illumination
10 Light source
11 Objective lens
12 Color filter
13 CCD
14 Cable
15 TV monitor
16 needles
17 Needle hole
18 Pusher
19 Locking piece
20 Wind-up spring
21 Cancer cells
22 sensors
23 beam
24 Wave absorber or waveguide
25 Laser beam irradiation device
26 Array antenna
27 Monitor

Claims (12)

In order to identify a lesioned part, an IC tag is inserted into a human body, placed at a predetermined position, and the position of the placed IC tag is confirmed by bringing a sensor closer thereto, and the lesioned part is removed. Surgical method using tags. In order to identify the lesioned part, the IC tag is inserted into the human body and placed at a predetermined position, and the position of the placed IC tag is confirmed by bringing the sensor close to it. A surgical method using an IC tag characterized by extracting The surgical method using the IC tag according to claim 1 or 2, wherein a plurality of IC tags are placed around the lesioned part. The operation method using the IC tag according to claim 1, wherein the IC tag is provided with a locking piece. The surgical method using the IC tag according to claim 1, wherein the IC tag has a substantially V shape or a substantially triangular shape. The first, second, third, fourth, or fourth, wherein when the sensor is brought close to the IC tag in which it is placed, the distance is approached to change the sound and notify the operator. A surgical method using the IC tag according to claim 5. When the sensor is brought close to an indwelling IC tag, the distance is approached so that the color of light is changed to notify the operator. A surgical method using the IC tag according to claim 5. The IC according to claim 1, 2, 3, 4, 5, 6, or 7 provided with a special antenna for receiving and responding to a weak signal from a sensor. Surgical method using tags. The claim 1, the claim 2, the claim 3, the claim 4, the claim 6, or the claim 7 having an adjustable function so that the beam width irradiated from the antenna can be narrowed down. Surgical method using IC tag. A surgical method using the IC tag according to claim 1, 2, 3, 4, 4, 5, or 7, wherein a radio wave absorber or a waveguide is provided in the antenna. A surgical method using an IC tag according to claim 1, 2, 3, 4, 4, 5, or 7, wherein a laser beam emitting device is attached to the tip of the antenna. The operation method using the IC tag according to claim 1, 2, 3, 4, 5, 6, or 7, wherein a signal transmission / reception system including an array antenna is used as a sensor. .

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