JP2015073663A - Trocar, surgery support system, image processing method, and port - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a technology for easily performing simultaneous observations of visible light observation and ICG fluorescent observation in a thoracoscopic surgery.SOLUTION: A trocar 1 includes a pipe part 11, head part 12, side opening part 13, shaft 14, shaft bearing 15, switching mechanism 16, storage type infrared imaging device 17, cable 18, marker 19, and chip LED 23. A storage type infrared imaging mechanism 17, 23 is switched between a storage position and an expansion position by the switching mechanism 16. At the expansion position, the chip LED 23 irradiates near-infrared excitation light, and the infrared imaging device 17 detects ICG fluorescence. A surgery support system 101 includes a forceps trocar 1, a laparoscope trocar 3, forceps 4, a laparoscope 5 having a marker, an image processing device 6, a monitor 7, and an optical sensor 9. A visible light image and an ICG fluorescent image are combined and displayed in the monitor 7.

Description

  The present invention relates to a trocar for use in laparoscopic surgery. However, when used for thoracoscopic surgery, it is called a port. The present invention also relates to a surgery support system using the trocar as a core technology.

  Conventionally, open surgery has been a common surgical treatment for gastric cancer and the like.

  The lymph node where the tumor first metastasizes is called the sentinel lymph node (SN). In recent years, the SN theory has been attracting attention, assuming that if there is no metastasis in the sentinel lymph node, there is no metastasis in the regional lymph node. In addition, technologies related to early detection of cancer are also progressing, and the excision range of tumors tends to be reduced. Based on these backgrounds, application of minimally invasive surgery such as laparoscopic surgery is being studied.

  On the other hand, a technique related to ICG fluorescence observation is also attracting attention. ICG (Indocyanine Green) is a low-toxic water-soluble compound that binds to plasma proteins and fluoresces. In addition, the excitation wavelength and fluorescence wavelength of ICG do not overlap with the absorption regions of water and hemoglobin, which are the main absorbents in the body. That is, it is a near-infrared wave and penetrates the body tissue. Therefore, it is possible to identify the vascular running position inside the tissue and the lesion site.

  ICG fluorescence is weak and difficult to detect. In contrast, devices and systems related to ICG fluorescence observation have been developed (for example, Patent Document 1). However, these devices and systems are mainly intended for blood vessels near the body surface, and are relatively large in size and difficult to apply to laparoscopic surgery.

  Usually, an operator who performs laparoscopic surgery confirms the resection range before surgery. On the other hand, there were many requests to confirm the excision range during surgery. In addition, there has been a demand for confirming blood vessels around the excision object in order to prevent erroneous cutting of blood vessels leading to a serious medical accident. On the other hand, an endoscope capable of ICG fluorescence observation has been developed (for example, Patent Document 2).

  The endoscope of Patent Document 2 has a variable spectral optical element, and controls the spectral characteristics by controlling the distance and angle between two optical substrates facing each other in the variable spectral optical element. There is no transmission peak in the band, and at least the near-infrared fluorescence wavelength is transmitted. Thereby, the ICG fluorescence image in the abdominal cavity is acquired.

JP 2008-259595 A JP 2012-157383 A

  The technique described in Patent Document 2 always observes white light (visible light) and performs ICG fluorescence observation by ON / OFF control. As a result, simultaneous observation of white light and ICG fluorescence can be realized, but ON / OFF control may be a burden on the operator. In particular, two operations of ON / OFF of the light source and ON / OFF of the filter are necessary and complicated.

  Patent Document 2 describes that ICG fluorescence can always be observed by maintaining an always-on state. However, the technique described in Patent Document 2 is characterized in that ON / OFF control is the main operation, and maintaining the always ON state is only a secondary operation. There is no detailed description of its effects (mainly bad effects).

  If the ON state is always maintained, the operation burden on the operator is reduced, but the control and the corresponding configuration are still complicated. As a result, other problems such as an increased risk of failure and increased manufacturing costs arise.

  That is, the technique described in Patent Document 2 has a problem with practicality.

  The present invention solves the above-described problems, and an object thereof is to easily perform simultaneous observation of visible light observation and ICG fluorescence observation in thoracoscopic surgery.

  The present invention for solving the above-mentioned problems is a trocar provided on the abdominal wall for surgery, a pipe part for inserting a medical instrument into the body, a head part provided continuously above the pipe part, Switching between a side opening provided at a position where the pipe part is inserted into the body, a storage position that passes through the side opening and is stored in the pipe part, and a deployment position that is developed to be photographed outside the pipe part. A retractable infrared imaging device that rotates as possible, and a near-infrared excitation light source that irradiates near-infrared excitation light.

  Preferably, the near-infrared excitation light source is a chip LED disposed around a lens of the retractable infrared imaging device.

  Thereby, an ICG fluorescence image can be acquired at the development position.

  The present invention that solves the above problems is a surgery support system, including a trocar having a retractable infrared imaging mechanism, an ICG fluorescence image acquisition means for acquiring an ICG fluorescence image, and a visible light image corresponding to the ICG fluorescence image And a visible light image acquisition means.

  Preferably, the visible light image acquisition means includes a laparoscope.

  An ICG fluorescence image is acquired by a retractable infrared imaging mechanism. A visible light image is acquired with a laparoscope. Thereby, simultaneous observation with visible light observation and ICG fluorescence observation can be easily performed.

  Preferably, the visible light image acquisition means passes through the pipe part, the head part, a side opening provided at a position where the pipe part is inserted into the body, and the side opening. A trocar having a retractable camera that can be switched between a retracted position stored in the camera and a deployed position that can be photographed out of the pipe.

  That is, visible light observation is performed using a trocar having a retractable camera instead of a laparoscope. Thereby, minimally invasiveness improves.

  More preferably, the surgery support system further includes image processing means for performing a synthesis process on the ICG fluorescence image and the visible light image.

  That is, the ICG fluorescence image and the visible light image are superimposed and displayed. Thereby, the surgeon can confirm the excision range and blood vessels around the excision object during the operation. As a result, the burden on the operator can be reduced and the safety of the operation can be increased.

  More preferably, the surgery support system includes a first marker provided on a head portion of a trocar included in the ICG fluorescence image acquisition unit, a second marker provided on a laparoscope included in the visible light image acquisition unit, The ICG fluorescence image and the visible light based on the positional relationship between the first marker and the second marker detected by the position detection sensor and the position detection sensor that detects the positions of the first marker and the second marker. Image processing means for synthesizing the image is further provided.

  That is, image composition processing is performed based on the positional relationship between the markers. Thereby, even if there is no common reference point, image composition processing can be performed with high accuracy.

  More preferably, the surgery support system includes a first marker provided on a trocar head part included in the ICG fluorescence image acquisition unit and a third marker provided on a trocar head part included in the visible light image acquisition unit. A position detection sensor that detects positions of the first marker and the third marker, and a positional relationship between the first marker and the second marker detected by the position detection sensor, and the ICG fluorescence image and the Image processing means for synthesizing the visible light image is further provided.

  In the case of using a trocar having a retractable camera instead of a laparoscope, an image composition process can be performed with high accuracy without a common reference point.

  More preferably, the surgery support system is included in the ICG fluorescence image acquisition means, and includes a plurality of trocars including a first trocar and a fourth trocar, a first marker provided on a head portion of the first trocar, and a fourth The positional relationship between the 4th marker provided in the head part of a trocar, the position detection sensor which detects the position of the 1st marker and the 4th marker, and the 1st marker and the 4th marker which the position detection sensor detects The image processing means for acquiring the three-dimensional information of the ICG fluorescence image is further provided.

  Thereby, the three-dimensional information of the ICG fluorescence image can be obtained with high accuracy.

  More preferably, the surgery support system further includes a three-dimensional projector that is provided above the operating table and projects a three-dimensional image onto a patient's abdomen based on the three-dimensional information.

  Thereby, the information in the depth direction of the observation target can be expressed so as to appeal to the operator's intuition.

  The present invention for solving the above problems is an image processing method, comprising a pipe portion, a head portion, a side opening provided at a position where the pipe portion is inserted into the body, and the pipe passing through the side opening. A retractable infrared imaging device that can be switched between a retracted position stored in the unit and a deployed position that can be photographed outside the pipe, and a near-infrared excitation light source that emits near-infrared excitation light The ICG fluorescence image is acquired by a trocar having a first marker provided in the head part, the visible light image is acquired by the visible light image acquiring means having the second marker, and the first marker and the second marker , And the ICG fluorescence image and the visible light image are combined based on the positional relationship between the first marker and the second marker.

  The present invention for solving the above problems is a port provided in the chest wall for surgery, a pipe part for inserting a medical instrument into the body, a head part provided continuously above the pipe part, Switching between a side opening provided at a position where the pipe part is inserted into the body, a storage position that passes through the side opening and is stored in the pipe part, and a deployment position that is developed to be photographed outside the pipe part. A retractable infrared imaging device that rotates as possible, and a near-infrared excitation light source that irradiates near-infrared excitation light.

  According to the present invention, simultaneous observation of visible light observation and ICG fluorescence observation can be easily performed in thoracoscopic surgery. Thereby, the surgeon can confirm the excision range and blood vessels around the excision object during the operation. As a result, the burden on the operator can be reduced and the safety of the operation can be increased.

Trocar with retractable infrared imaging mechanism Detailed plan view of infrared imaging mechanism Trocar with retractable infrared imaging mechanism (modification) Surgery support system (first embodiment) System variants Conceptual diagram of image composition processing Conceptual diagram related to scattering Conceptual diagram of 3D observation Basic principles of 3D observation Surgery support system (second embodiment) Surgery support system (third embodiment)

<Trocar with retractable infrared imaging mechanism>
~Constitution~
A configuration of a trocar having a retractable infrared imaging mechanism will be described. FIG. 1 is a perspective view of a trocar having a retractable infrared imaging mechanism. FIG. 1A and FIG. 1B have different viewpoints.

  The trocar 1 includes a pipe portion 11 and a head portion 12. Most of the pipe portion 11 is inserted into the hole in the abdominal wall. The head part 12 is continuously provided on the upper part of the pipe part 11. The head portion 12 is hollow, and forceps can be inserted from the top thereof. Although not described in detail, the head unit 12 includes a sealing mechanism that prevents air leakage when the forceps are inserted and removed, and an air supply mechanism that sends air into the abdominal cavity.

  Side opening 13 is provided at a position where pipe 11 is surely inserted into the body. A shaft 14 is disposed in the axial direction of the pipe portion and along one end of the side opening 13. A plurality of bearings 15 are fixed to the inner wall of the pipe portion 11, and the bearings 15 fix the shaft 14 so as to be rotatable. The end of the shaft 14 extends outside the trocar. A switching mechanism 16 is provided at the end of the shaft 14. The switching mechanism 16 can be switched between a storage position and a deployment position.

  A retractable infrared imaging device 17 is integrally joined to the shaft 14 at a position corresponding to the side opening 13. Thereby, with the rotation of the switching mechanism 16 and the shaft 14, the retractable infrared imaging device 17 can pass through the side opening 13 and can be photographed at the storage position stored in the pipe portion and outside the pipe portion. It rotates so that it can be switched to the deployed position. A cable 18 is connected to the retractable infrared imaging device 17, and the cable 18 passes through the trocar 1 and is connected to an external image processing apparatus 6.

  It is more preferable to arrange the cable 18 along the shaft 14 or to make the shaft 14 hollow and arrange the cable 18 in the shaft 14 because there is no risk of cutting the cable 18 when inserting forceps.

  A marker 19 is provided on the head unit 12. In the present embodiment, a checkered flag pattern composed of white and black is shown as an example, but the present invention is not limited to this as long as the optical sensor 9 can be recognized as a marker.

  The switching mechanism 16 is provided with a torsion spring 22. The torsion spring 22 may be embedded in the switching mechanism 16. One end of the torsion spring 22 is fixed to the inner wall of the head portion 12, and the other end of the torsion spring 22 is fixed to the switching mechanism 16. Usually, the elastic force of the torsion spring 22 biases the retractable infrared imaging device 17 to be deployed via the shaft 14. That is, the switching mechanism 16 and the retractable infrared imaging device 17 maintain the deployed position. When the switching mechanism 16 is operated to rotate, the retractable infrared imaging device 17 is stored through the side opening 13 against the elastic force of the torsion spring 22.

  A chip LED 23 is disposed around the lens of the infrared imaging device 17. The chip LED 23 emits excitation light having a wavelength of, for example, 800 nm as a near infrared excitation light source. FIG. 2 shows a detailed configuration of the infrared imaging mechanisms 17 and 23.

  The near-infrared excitation light source may be disposed on the trocar end face.

  The infrared imaging device 17 detects, for example, ICG fluorescence having a wavelength of 840 nm. The excitation wavelength and fluorescence wavelength are appropriately selected as appropriate.

-Store-deployment switching operation-
The switching operation of the retractable infrared imaging mechanisms 17 and 23 will be described. The surgeon operates the switching mechanism 16.

  In a state where the switching mechanism 16 is not operated, the retractable infrared imaging device 17 maintains the deployed position by the biasing of the torsion spring 22. When inserting the pipe portion 11 into the hole in the abdominal wall, the switching mechanism 16 is operated to the storage position, and the storage position is maintained. The retractable infrared imaging device 17 is in the retracted position via the shaft 14. Thereby, the pipe part 11 can be inserted into the hole of the abdominal wall without the retractable infrared imaging device 17 becoming an obstacle (trocar insertion: deployment position → storage position).

  When the operation of the switching mechanism 16 is released after the pipe portion 11 is inserted, the retractable infrared imaging device 17 is in the deployed position via the shaft 14. ICG fluorescence observation is performed in this state (imaging: storage position → deployment position).

  When the pipe part 11 is extracted after the operation, the switching mechanism 16 is operated again to the storage position, and the storage position is maintained. The retractable infrared imaging device 17 is in the retracted position via the shaft 14. Thereby, the pipe part 11 can be extracted from the abdominal wall without obstructing the infrared imaging device 17 (trocar extraction: deployment position → storage position).

-Modification of retractable infrared imaging mechanism-
The retractable infrared imaging mechanism is not limited to the above configuration. FIG. 3 is a perspective view of a trocar 2 according to a modification. FIG. 3A is a state diagram in which the retractable infrared imaging device 17 is deployed at the deployment position, and FIG. 3B is a state diagram in which the retractable infrared imaging device 17 is stored in the storage position. The same code | symbol is attached | subjected to the same structure as FIG. The trocar 2 has a pipe portion 11 and a head portion 12. Side opening 13 is provided at a position where pipe 11 is inserted into the body.

  A pivotable hinge mechanism 31 is provided at one end of the opening in the pipe portion axial direction, and the retractable infrared imaging device 17 is connected to the pipe portion 11 via the hinge mechanism 31. The hinge mechanism 31 is provided with a torsion spring 32, and the elastic force of the torsion spring 32 normally urges the retractable infrared imaging device 17 to be deployed.

  On the other hand, the retractable infrared imaging device 17 is connected with a tension cable 33 extending to the outside of the trocar. When the tension cable 33 is pulled, the retractable infrared imaging device opposes the elastic force of the torsion spring 32. The device 17 is stored through the side opening 13. A cable 18 is connected to the retractable infrared imaging device 17. The marker 19 is fixed to the head unit 12.

  The tension cable 33 is protected by a guide so as to reduce the risk of cutting the tension cable 33 when the forceps 4 are inserted or pulled out.

  When the pipe portion 11 is inserted into the hole in the abdominal wall, the tension cable 33 is pulled and the retractable infrared imaging device 17 is set to the retracted position. After the pipe portion 11 is inserted, the tension of the tension cable 33 is released and the retractable infrared imaging is performed. The device 17 is set as a deployment position. When ICG fluorescence observation is performed in this state and the pipe part 11 is extracted after the operation, the pulling cable 33 is pulled and the retractable infrared imaging device 17 is set to the retracted position again.

  Although the torsion spring 22 and the torsion spring 32 are shown as an example of the urging means, a plate spring or the like may be used.

  <Surgery support system>

-First embodiment-
~ Basic configuration ~
The surgery support system 101 using a three-dimensional real-time image will be described. FIG. 4 is a schematic configuration of the surgery support system 101.

  The surgical operation support system 101 includes retractable infrared imaging mechanisms 17a, 17b, 23a, 23b, forceps trocars 1a, 1b having markers 19a, 19b, laparoscopic trocars 3, forceps 4a, 4b, and markers 19d. The image obtained from the laparoscope 5 and the retractable infrared imaging devices 17a and 17b and the image obtained from the laparoscope 5 are input, and these are processed by the image processing device 6 and the image processing device 6 A monitor 7 for outputting the obtained image and an optical sensor 9 are provided.

  The forceps 4a and 4b are a kind of surgical instrument, and are used for grasping, suppressing, pulling, and cutting blood vessels and organs. Generally, it has a bowl shape, and the tip is actuated via a fulcrum by the rotation of the handle. The handle portion is closed and inserted into the forceps trocars 1a and 1b.

  In laparoscopic surgery, it is common to use a plurality of forceps (for example, 3 to 5). In this system, a trocar having at least one retractable infrared imaging mechanism may be used, and a general trocar (without a retractable infrared imaging mechanism) may be used for others.

  The laparoscope 5 is a kind of endoscopic instrument, and has a light source and a camera. The laparoscope 5 is inserted into the body through the trocar 3 for laparoscope. The marker 19d is provided at a position where it is not inserted into the body of the laparoscope 5. In this system, a commercially available laparoscope 5 may be used.

  The optical sensor 9 measures the three-dimensional positions of the markers 19 a, 19 b, 19 d and outputs the measurement result to the image processing device 6. In the present embodiment, the optical sensor 9 recognizes white and black of the marker as visible light, but may transmit infrared and receive infrared reflected by the marker. The sensor is not limited to an optical sensor, and may be a magnetic sensor as long as a three-dimensional position can be measured.

~basic action~
Visible light observation is performed with the laparoscope 5 to obtain a visible light image.

  Prior to the ICG fluorescence observation, the fluorescent dye ICG is injected into the observation object in advance. And near infrared excitation light is irradiated by chip | tip LED23. The irradiated excitation light passes through the surface of the living body and is irradiated onto the observation target, and excites the fluorescent dye injected into the observation target to generate fluorescence. ICG fluorescence is detected by the retractable infrared imaging device 17. In this way, an ICG fluorescence image is acquired.

  As shown in FIG. 5, the ICG fluorescence image and the visible light image may be output to separate monitors 7a and 7b.

  The ICG fluorescence image and the visible light image are combined (details will be described later) and superimposed. FIG. 6 is a conceptual diagram of image composition processing.

~effect~
By using the surgery support system 101, simultaneous observation of visible light observation and ICG fluorescence observation can be easily performed in thoracoscopic surgery.

  Thereby, the surgeon can confirm the excision range and blood vessels around the excision object during the operation. As a result, the burden on the operator can be reduced and the safety of the operation can be increased.

  Laparoscopic surgery using the surgery support system 101 is based on general laparoscopic surgery, and there is no major change in the surgical method. You can save it.

  Further, the surgery support system 101 has a simple configuration using the trocar 1 having a retractable infrared imaging mechanism, and the existing surgery support system can be reused with a simple improvement.

  The trocar 1 having a retractable infrared imaging mechanism is an improvement of a general trocar, has a simple configuration, has a low risk of failure, and has a low manufacturing cost. In other words, this system is highly practical.

  In addition, since the surgery support system 101 uses a trocar for inserting forceps, it is not necessary to make a new hole in the abdominal wall. Thereby, minimally invasiveness can be maintained.

  In addition, although the basic structure and basic operation | movement of the surgery assistance system were demonstrated above, you may have the following structure further.

~ Image composition ~
In general, when two images are combined, a common reference point is set on each image, and the images are combined based on the reference point. However, while the visible light image is an image of the tissue surface, the ICG fluorescence image is an image inside the tissue, and it is difficult to set a common reference point on the image.

  In addition, although there exists description regarding the superimposed display of an ICG fluorescence image and a visible light image in the prior art (patent document 2), there is no description regarding a specific synthesis method. In the prior art, since the ICG fluorescence image and the visible light image are acquired by the same imaging means, it is presumed that the problem of positional deviation does not occur. On the other hand, in this embodiment, since it acquires by the separate imaging means 5 and 17, alignment is difficult.

  In the present embodiment, the trocar 1a has a marker 19a, and the laparoscope 5 has a marker 19d. The optical sensor 9 measures the three-dimensional positions of the markers 19a and 19d.

  The positional relationship between the marker 19a and the infrared imaging device 17a at the development position is unchanged. Therefore, the three-dimensional position of the infrared imaging device 17a can be accurately estimated based on the position of the marker 19a. The marker 19d is provided on the laparoscope 5, and the three-dimensional position of the laparoscope 5 camera can be accurately estimated based on the position of the marker 19d.

  Thereby, the image processing apparatus 6 estimates the positions of the ICG fluorescence image and the visible light image. That is, the ICG fluorescence image and the visible light image are combined based on the positional relationship between the markers 19a and 19d.

  Furthermore, the ICG fluorescence image and the visible light image can be synthesized more accurately by estimating the depth direction information and the accurate plane direction information related to the ICG fluorescence image by the later-described ICG fluorescence three-dimensional observation.

-Three-dimensional observation of ICG fluorescence-
The ICG fluorescence image is an image inside the tissue, and information in the depth direction cannot be obtained. On the other hand, when confirming the excision range from an ICG fluorescence image or when confirming surrounding blood vessels, information in the depth direction is very useful.

  ICG fluorescence is transmitted through the tissue and appears on the tissue surface. Therefore, it looks larger as the observation object becomes deeper. As a result, the ICG fluorescent image has a problem related to scattering. FIG. 7 shows a conceptual diagram related to scattering. That is, a deep and thin observation object (left figure) and a shallow and thick observation object (right figure) may be observed in the same manner. In other words, when information on the depth direction cannot be obtained, accurate information on the width direction (plane direction) cannot be obtained.

  Therefore, the existing ICG fluorescent image has a problem that the accuracy of the position information is lacking.

  In this embodiment, the surgery support system 101 includes markers 19a and 19b corresponding to the two infrared imaging mechanisms 17a, 17b, 23a, and 23b. The optical sensor 9 measures the three-dimensional positions of the markers 19a and 19b. Thereby, the three-dimensional positions of the infrared imaging devices 17a and 17b can be accurately estimated based on the positions of the markers 19a and 19b. The image processing apparatus 6 estimates the positions of the ICG fluorescence image by the infrared imaging device 17a and the ICG fluorescence image by the infrared imaging device 17b.

  FIG. 8 shows a conceptual diagram of three-dimensional observation. That is, information on the depth direction and the plane direction is estimated based on the positional relationship between the markers 19a and 19b. Further, the two ICG fluorescence images are synthesized and a three-dimensional image is output to the monitor 7.

  Note that accurate plane direction information may be output to the monitor 7 as an ICG fluorescence image (two-dimensional) and depth direction information as numerical values.

  As a result, depth direction information and accurate plane direction information relating to the ICG fluorescence image can be obtained.

  In the above description, two infrared imaging mechanisms have been described as examples. However, since a plurality of (for example, about 3 to 5) forceps are used in general laparoscopic surgery, three or more infrared imaging mechanisms are used. A mechanism may be used. For example, three virtual triangles (details will be described later) are formed by three infrared imaging mechanisms, and the estimation accuracy is improved.

  By the way, in general laparoscopic surgery, a plurality of forceps trocars 1 are arranged almost evenly on the abdominal wall. In other words, there is almost no possibility that the trocars 1 are densely arranged. Thereby, a sufficiently wide distance between observation points can be secured, and the estimation accuracy is improved.

~ Three-dimensional observation of visible light ~
Although the three-dimensional observation of ICG fluorescence has been described above, naturally, the three-dimensional observation can also be performed for visible light.

  In the schematic configuration diagram of the surgical operation support system 101 shown in FIG. 4, only two forceps trocars 1a and 1b are shown from the viewpoint of easy viewing. On the other hand, in general laparoscopic surgery, a plurality of forceps (for example, about 3 to 5) are used. Here, a forceps trocar 1e (not shown) is used.

  The trocar 1e includes a pipe portion 11, a head portion 12, a side opening 13, a shaft 14, a bearing 15, a switching mechanism 16, a retractable camera 17e, a cable 18, and a marker 19e. That is, in the trocar shown in FIG. 1, the infrared imaging device is replaced with a visible light camera.

  FIG. 9 shows the basic principle of three-dimensional observation. In the virtual triangle formed by the two cameras and the target point, the distance L between the two cameras, the angle α formed by one camera line of sight between the camera base line, and the angle β formed by the camera base line and another camera line of sight Based on this, the depth D can be estimated. By increasing the number of cameras, more virtual triangles are formed, and the depth D can be estimated by the number of virtual triangles. Therefore, taking the average improves the estimation accuracy.

  In this embodiment, the positional relationship between the marker 19e and the visible light camera 17e at the unfolded position is unchanged. Therefore, the three-dimensional position of the visible light camera 17e can be accurately estimated based on the position of the marker 19e. The marker 19d is provided on the laparoscope 5, and the three-dimensional position of the laparoscope 5 camera can be accurately estimated based on the position of the marker 19d. That is, the inter-camera distance L can be estimated.

  Furthermore, the angles α and β are measured for each target point, and the depth position of the target point can be estimated based on the basic principle. The three-dimensional shape in the abdominal cavity can be measured by moving the target point and repeating the depth position estimation.

  Thereby, the image processing apparatus 6 estimates the position of the visible light image by the visible light camera 17e and the visible light image by the camera of the laparoscope 5. That is, three-dimensional information is estimated based on the positional relationship between the markers 19d and 19e. Further, the two visible light fluorescent images are synthesized and a three-dimensional image is output to the monitor 7.

  Note that accurate plane direction information may be output to the monitor 7 as a visible light image (two-dimensional) and depth direction information as a numerical value.

  Further, the ICG fluorescence image has three-dimensional information, and the visible light image has three-dimensional information. The image processing device 6 synthesizes the ICG fluorescence image and the visible light image with high accuracy based on the three-dimensional information.

-Second embodiment-
FIG. 10 is a schematic configuration diagram of the surgery support system 102. The surgery support system 102 includes forceps trocars 1a and 1b having retractable infrared imaging mechanisms 17a, 17b, 23a and 23b and markers 19a and 19b, a forceps trocar 1c having a visible light camera 17c and a marker 19c, and forceps. 4 a, 4 b, 4 c, an image obtained from the retractable infrared imaging devices 17 a, 17 b and an image obtained from the visible light camera 17 c, an image processing device 6 for image processing these, and an image processing device 6 Is provided with a monitor 7 for outputting an image created by the optical sensor 9 and an optical sensor 9.

  That is, the trocar 3 for laparoscope, the laparoscope 5 and the marker 19d in the surgery support system 101 are not provided, but the trocar 1c for forceps having the visible light camera 17c, the forceps 4c and the marker 19c are added. In other words, the visible light observation is performed by the visible light camera 17c instead of the laparoscope.

  In general, a plurality of forceps are used in laparoscopic surgery. In this system, at least two forceps trocars for ICG fluorescence observation and visible light observation are sufficient. Although a laparoscope is not used, laparoscopic surgery is used for convenience.

  When the laparoscope 5 is used as in the surgery support system 101, the operator needs to operate the direction of the laparoscope 5 to search for a cutting site and the like, whereas the visible light camera 17c reliably secures the distal end of the forceps 4c. Therefore, important images such as cut portions can be obtained with certainty. Therefore, on the assumption that the performance of the visible light camera 17c is high (preferably at least close to that of the laparoscope 5), it is possible to reliably obtain a higher quality image than the laparoscope 5.

  However, to make the laparoscope 5 unnecessary, it is necessary to provide an alternative light source to the retractable camera 17.

  On the other hand, since the trocar 3 for laparoscope and the laparoscope 5 become unnecessary, it is not necessary to make a corresponding hole in the abdominal wall, and the low invasiveness is improved.

  -Third embodiment-

  FIG. 11 is a schematic configuration diagram of a surgery support system 103 which is another modified example. The surgery support system 103 is a modification of the surgery support systems 101 and 102. Configurations common to the surgery support systems 101 and 102 are omitted as appropriate.

  In the surgery support systems 101 and 102, the surgeon operates the forceps 4 and the laparoscope 5 while looking at the monitor 7, but the surgeon's line of sight and the actual surgical field are inconsistent. It gives a sense of incongruity and is a burden. In particular, an operator who is experienced in laparotomy may not be accustomed to laparoscopic surgery.

  The surgery support system 103 includes a three-dimensional projector 8 instead of or in addition to the three-dimensional monitor 7. The three-dimensional projector 8 is provided above the operating table and directly projects a three-dimensional image created by the image processing device 6 onto the abdomen of the patient.

  As a result, the operator's line of sight matches the direction of the surgical field, and a realistic feeling similar to that in open surgery can be expressed. That is, the burden on the operator can be reduced.

<Port with retractable infrared imaging mechanism>
The above description is based on the assumption of laparoscopic surgery, but the present invention may be applied to thoracoscopic surgery. However, a surgical instrument called a trocar in laparoscopic surgery is called a port in thoracoscopic surgery. That is, the trocar and the port are almost the same.

1 Trocar 2 Trocar (Modification)
3 Trocar (for laparoscope)
DESCRIPTION OF SYMBOLS 4 Forceps 5 Laparoscope 6 Image processing apparatus 7 Monitor 8 Three-dimensional projector 9 Optical sensor 11 Pipe part 12 Head part 13 Opening part 14 Shaft 15 Bearing 16 Switching mechanism 17 Infrared imaging device (camera)
18 Cable 19 Marker 22 Torsion spring 23 Chip LED
25 switching sensor 31 hinge mechanism 32 torsion spring 33 tension cable 101 to 103 surgery support system

Claims (12)

A trocar provided on the abdominal wall for surgery,
A pipe for inserting a medical device into the body;
A head portion continuously provided on the upper portion of the pipe portion;
A side opening provided at a position to be inserted into the body of the pipe part;
A retractable infrared imaging device that passes through the side opening and pivotably switches between a storage position stored in the pipe portion and a deployment position deployed so as to be photographed outside the pipe portion;
A trocar comprising: a near-infrared excitation light source that emits near-infrared excitation light. The trocar according to claim 1, wherein the near-infrared excitation light source is a chip LED disposed around a lens of the retractable infrared imaging device. ICG fluorescence image acquisition means for acquiring an ICG fluorescence image, comprising the trocar according to claim 1 or 2;
A surgical support system comprising: a visible light image acquiring unit that acquires a visible light image corresponding to the ICG fluorescence image. The surgery support system according to claim 3, wherein the visible light image acquisition means includes a laparoscope. The visible light image acquisition means includes
A pipe part, a head part, a side opening provided at a position to be inserted into the body of the pipe part, and a storage position stored in the pipe part through the side opening and photographing outside the pipe part The surgical support system according to claim 3, further comprising a trocar having a retractable camera that can be switched to a deployment position that is deployed to a position. The surgery support system according to any one of claims 3 to 5, further comprising an image processing means for combining the ICG fluorescence image and the visible light image. A first marker provided on a head portion of a trocar included in the ICG fluorescence image acquisition means;
A second marker provided on a laparoscope included in the visible light image acquisition means;
A position detection sensor for detecting positions of the first marker and the second marker;
The image processing means for synthesizing the ICG fluorescence image and the visible light image based on a positional relationship between the first marker and the second marker detected by the position detection sensor. 4. The surgical operation support system according to 4. A first marker provided on a head portion of a trocar included in the ICG fluorescence image acquisition means;
A third marker provided on the head portion of the trocar included in the visible light image acquisition means;
A position detection sensor for detecting positions of the first marker and the third marker;
The image processing means for synthesizing the ICG fluorescence image and the visible light image based on the positional relationship between the first marker and the third marker detected by the position detection sensor. 5. The surgical operation support system according to 5. A plurality of trocars included in the ICG fluorescence image acquisition means, including a first trocar and a fourth trocar;
A first marker provided on the head portion of the first trocar;
A fourth marker provided on the head portion of the fourth trocar;
A position detection sensor for detecting positions of the first marker and the fourth marker;
The image processing means for acquiring three-dimensional information of the ICG fluorescence image based on a positional relationship between the first marker and the fourth marker detected by the position detection sensor. The surgical operation system described. The surgery support system according to claim 9, further comprising a three-dimensional projector provided above the operating table and projecting a three-dimensional image onto the patient's abdomen based on the three-dimensional information. A pipe part, a head part, a side opening provided at a position to be inserted into the body of the pipe part, and a storage position stored in the pipe part through the side opening and photographing outside the pipe part By a trocar having a retractable infrared imaging device that can be switched to a deployment position to be deployed, a near-infrared excitation light source that irradiates near-infrared excitation light, and a first marker provided in the head unit, ICG fluorescence image is acquired,
A visible light image is acquired by the visible light image acquisition means having the second marker,
Detecting the position of the first marker and the second marker;
An image processing method comprising: combining the ICG fluorescence image and the visible light image based on a positional relationship between the first marker and the second marker. A port on the chest wall for surgery,
A pipe for inserting a medical device into the body;
A head portion continuously provided on the upper portion of the pipe portion;
A side opening provided at a position to be inserted into the body of the pipe part;
A retractable infrared imaging device that passes through the side opening and pivotably switches between a storage position stored in the pipe portion and a deployment position deployed so as to be photographed outside the pipe portion;
A port comprising: a near-infrared excitation light source that irradiates near-infrared excitation light.

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