JP2018134151A - Endoscopic surgical operation support device and endoscopic surgical operation support method - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide an endoscopic surgical operation support device and an endoscopic surgical operation support method that can help prevent a scald of a tissue by causing an overheated part of an ultrasonic coagulation incision device to be recognized.SOLUTION: An endoscopic surgical operation support device 1 is a surgical imaging device used for a laparoscopic surgery, an endoscopic thoracoabdominal surgery, etc. The endoscopic surgical operation support device 1 includes first imaging means 2 for capturing an endoscopic image inside a body cavity, a second imaging means 3 for capturing a thermography image inside the body cavity, and image processing means 4 for extracting a range of a first preset temperature or higher from the thermography image, and displaying the range by superimposing it on the endoscopic image other than this range in display means 7.SELECTED DRAWING: Figure 1

Description

  The present invention relates to an endoscopic surgical operation support device and endoscopic surgical operation support for imaging a body cavity such as an abdominal cavity or a thoracic cavity during laparoscopic surgery or thoracoscopic surgery to assist an operator's operation. It is about the method.

  Laparoscopic surgery and thoracoscopic surgery are performed by inserting an endoscope, ultrasonic coagulation and incision device, automatic suturing device, forceps, etc. into a body cavity such as the abdominal cavity or chest cavity. Therefore, the surgical wound can be made minute, and the treatment period can be reduced to a short time.

  In laparoscopic surgery and thoracoscopic surgery, surgery is performed based on an endoscopic image obtained by imaging the body cavity with an endoscope. Regarding such an operation using an endoscope, Patent Document 1 discloses an apparatus that displays not only an endoscopic image but also a thermographic image and displays a temperature distribution of a mucosal surface or the like in a living body.

  Patent Document 1 discloses a thermographic image showing an endoscopic image formed by an objective optical system of an endoscope and a temperature distribution of a mucous membrane surface in a living body imaged by an objective optical system of a thermographic probe on a display screen of a monitor. There is described an endoscope thermography apparatus in which an enlargement ratio is set so as to be the same size as an image and displayed side by side.

JP 2000-79089 A

  In the endoscope thermography apparatus described in Patent Document 1, an endoscopic image and a thermographic image are displayed side by side. However, the thermographic image is described as being for knowing the temperature distribution on the mucous membrane surface and the like.

  However, in laparoscopic surgery and thoracoscopic surgery, when cutting tissue with an ultrasonic coagulation and incision device, the blade part of the ultrasonic coagulation and incision device is not only heated to frictional heat, carbonizing the tissue, but also supporting the blade The portion of the shaft that performs heat transfer from the blade also becomes high temperature.

For example, when the distal end portion of the shaft comes into contact with the pancreas near the stomach during a stomach operation and the pancreas is burned, a pancreatic fistula in which the pancreatic juice leaks in the abdominal cavity is generated, which can be a complication. At this time, even if the temperature distribution on the mucous membrane surface or the like is displayed on the thermographic image, the information by the thermographic image may not be useful for ensuring safety during the operation because of the low temperature.
In addition, since the surgeon concentrates on the operation, the operator gazes at an endoscopic image showing the surgical site. Therefore, even if the endoscopic image and the thermographic image are displayed side by side, the thermographic image is difficult to enter the operator's field of view.

  Accordingly, an object of the present invention is to provide an endoscopic surgical operation support device and an endoscopic surgical operation support method that can be used to prevent tissue burns by recognizing an overheated portion of an ultrasonic coagulation / cutting device. To do.

  The endoscopic surgery support apparatus according to the present invention includes a first imaging unit that captures an endoscopic image in a body cavity, a second imaging unit that captures a thermographic image in the abdominal cavity, and a first set temperature based on the thermographic image. An image processing unit is provided that extracts the above range and superimposes it on an endoscopic image outside the range and displays it on the display unit.

  The endoscopic surgery support method of the present invention includes a step of taking an endoscopic image in the abdominal cavity, a step of taking a thermographic image in the abdominal cavity, and extracting a range equal to or higher than a first set temperature from the thermographic image. And a step of superimposing with the endoscopic image outside the range and displaying on the display means.

According to the present invention, among the thermographic images in the body cavity imaged by the second imaging means, a thermographic image in a range equal to or higher than the first set temperature, and an endoscopic image in the body cavity imaged by the first imaging means, The endoscopic image in a range other than the range equal to or higher than one set temperature is displayed on the display unit by the image processing unit in a superimposed manner.
Therefore, the surgeon can perform the operation while observing the endoscopic image displayed on the display means for the range where the temperature in the thermographic image is lower than the first set temperature, and the range where the temperature is higher than the first set temperature is The thermographic image can be observed in the same field of view as the surgeon viewing the endoscopic image. Therefore, when the temperature in the body cavity is lower than the first set temperature, or if the range equal to or higher than the first set temperature is narrow, the surgeon can perform the operation without being disturbed by the thermographic image. In addition, the thermographic image is displayed so that the range of the first set temperature or higher is overlapped with the ultrasonic coagulation / cutting device by the endoscopic image, so that the surgeon can recognize the location where the ultrasonic coagulation / cutting device is at a high temperature. Because it is easy to recognize, it can be alerted.

In the endoscopic surgery support apparatus according to the present invention, when the image processing means detects a second set temperature that is equal to or higher than the first set temperature on the basis of the thermographic image, from the display of only the endoscopic image. The display can be switched to a display in which the range above the first set temperature and the endoscopic image outside the range are superimposed.
In the endoscopic surgery support method according to the present invention, when a third set temperature that is equal to or higher than the first set temperature is detected based on the thermographic image, the first endoscopic image is displayed. The method may include a step of switching to a display superimposed on a range above the set temperature and the endoscopic image outside the range.

  When the image processing means detects a temperature that is equal to or higher than the second set temperature, in order to superimpose a range that is equal to or higher than the first set temperature and an endoscopic image other than that range, Until the temperature is detected, the endoscopic image can be observed without being disturbed by the thermographic image.

In the endoscopic surgery support apparatus of the present invention, the image processing means has a function of detecting a temperature equal to or higher than a third preset temperature higher than the first preset temperature from the thermographic image, and the third preset temperature. An informing means for issuing a warning when the above temperature is detected can be provided.
In the endoscopic surgery support method of the present invention, a step of detecting a temperature equal to or higher than a third set temperature higher than the first set temperature from the thermographic image, and a temperature equal to or higher than the third set temperature are detected. And a step in which the notification means issues a warning.

  If the surgeon stops the operation and cools the ultrasonic coagulation / cutting device, a third set temperature higher than the first set temperature is set as the temperature at which the ultrasonic coagulation / cutting device is cooled. When detecting a temperature equal to or higher than the third set temperature, the notifying means issues a warning, so that the operator can be notified of the timing for cooling the ultrasonic coagulation / cutting device.

In the endoscopic surgery support apparatus according to the present invention, the image processing means has a function of notifying the maximum temperature in the range equal to or higher than the first set temperature from the thermographic image. Informing means for emitting a warning sound that changes in response can be provided.
The endoscopic surgical operation support method of the present invention may include a step of changing a warning sound from the thermographic image according to a maximum temperature in a range equal to or higher than the first set temperature.

  The warning sound is generated according to the highest temperature in the range of the first set temperature or higher, so that the surgeon is at the highest temperature that requires cooling of the ultrasonic coagulation / cutting device depending on the level of the warning sound. Or the degree of temperature rise of the ultrasonic coagulation / cutting device can be recognized by hearing.

The image processing means may be provided with operation means for instructing whether to select only the endoscopic image or to superimpose the thermographic image on the endoscopic image.
The surgeon can operate the operation means to instruct the image processing means to select only the endoscopic image or to superimpose the thermographic image on the endoscopic image. It is possible to select the display of only the endoscopic image and the superimposed display if the thermographic image is necessary by the operation of the operation means by the operator.

The first imaging unit and the second imaging unit may capture the same imaging range at the same magnification.
When the endoscopic image from the first imaging unit and the thermographic image from the second imaging unit are superimposed, the endoscopic image and the thermographic image are captured in the same imaging range at the same magnification. Or superimposing without adjusting the imaging direction, it is easy to superimpose.

  According to the present invention, since it is easy for the operator to recognize a high-temperature portion of the ultrasonic coagulation / cutting device, it is possible to alert the operator. Therefore, the present invention can be used for prevention of tissue burn by recognizing the overheated portion of the ultrasonic coagulation / cutting device.

It is a figure which shows the structure of the endoscopic surgery assistance apparatus which concerns on embodiment of this invention. It is an example of the endoscopic image imaged by the endoscopic surgery support apparatus shown in FIG. It is an example of the thermography image imaged by the endoscopic surgery support apparatus shown in FIG. It is the extraction image which extracted the range of the 1st preset temperature from the thermography image shown in FIG. 5 is a composite image obtained by combining the endoscopic image shown in FIG. 2 and the extracted image shown in FIG. 4.

An endoscopic surgery support apparatus according to an embodiment of the present invention will be described with reference to the drawings.
An endoscopic surgery support apparatus 1 according to the present embodiment shown in FIG. 1 is a surgical imaging apparatus used for laparoscopic surgery, thoracoscopic surgery, and the like. The endoscopic surgery support apparatus 1 includes first imaging means 2, second imaging means 3, image processing means 4, notification means 5, operation means 6, and display means 7.

The first imaging means 2 has a function of outputting an endoscopic image (see FIG. 2) that is a color moving image.
The imaging unit of the first imaging means 2 is inserted into the body cavity as a laparoscopic device or a thoracoscopic device. The imaging unit of the first imaging unit 2 includes an objective lens disposed at the distal end of the laparoscopic device, and an imaging element that converts an image formed by the objective lens into an electrical signal.
The video processing unit of the first imaging means 2 is installed around the operating table as a control unit connected to the laparoscopic device or thoracoscopic device by a cable. The video processing unit of the first imaging unit 2 has a function of converting an analog signal from the imaging element into a digital signal so that the image processing unit 4 can perform image processing to obtain an endoscopic image.

The second imaging means 3 has a function of outputting a moving image colored in blue, green, yellow, red, and white as a thermographic image (see FIG. 3) as the temperature increases.
The imaging unit of the second imaging unit 3 is inserted into the body cavity as a laparoscopic device or a thoracoscopic device together with the imaging unit of the first imaging unit 2. The imaging unit of the second imaging means 3 includes a germanium lens serving as an objective lens disposed at the distal end of the laparoscopic device or the thoracoscopic device, and an infrared detection element that converts an image formed by the germanium lens into an electrical signal. .
The video processing unit of the second imaging unit 3 converts the analog signal from the infrared detection element into a digital signal so that the image processing unit 4 can perform image processing, and performs a coloring process according to the temperature level. It has.

The image processing means 4 has the following first to fourth functions.
The first function extracts a range that is equal to or higher than the first set temperature from the thermographic image, and displays the range on the display unit 7 so as to be superimposed on an endoscopic image outside this range.
The second function displays the superimposed composite image on the display unit 7 when a temperature equal to or higher than the second set temperature higher than the first set temperature is detected from the thermographic image.
The third function detects a temperature equal to or higher than the third set temperature higher than the first set temperature from the thermographic image and notifies the notification means 5 of the detected temperature.
The fourth function notifies the notification means 5 of the maximum temperature in the range equal to or higher than the first set temperature from the thermographic image.

The notification unit 5 has a function of emitting a warning sound or instructing the image processing unit 4 to display a warning.
The operation unit 6 is an input device that instructs the image processing unit 4 and inputs set values. The display unit 7 is a color monitor device that displays a color moving image from the image processing unit 4. The display means 7 can be an LCD or an organic EL display.

  The operation and use state of the endoscopic surgery support apparatus 1 according to the embodiment of the present invention configured as described above will be described.

First, the operator or the administrator of the endoscopic surgery support apparatus 1 sets the first set temperature, the second set temperature, and the third set temperature in the image processing unit 4 by operating the operation unit 6.
The first preset temperature may be a temperature that requires attention when contacting a different tissue different from the treatment site. The second set temperature can be a temperature at which the operator wants to concentrate on the endoscopic image without being disturbed by the thermographic image. The third preset temperature may be a temperature that requires cooling of the ultrasonic coagulation / cutting device that has been overheated after the treatment is stopped.

  For example, the first set temperature can be 200 degrees at which the tissue is carbonized. The second preset temperature can be 250 degrees assumed by the surgeon that a thermographic image is unnecessary. In the scissors-type ultrasonic coagulation / cutting device, the third preset temperature can be set to 300 degrees close to the melting point (326.8 degrees) of the fluororesin layer formed on the surface of the pad portion that is paired with the blade.

A plurality of types of the first set temperature to the third set temperature may be set for each, and may be selected by the operation means 6. For example, when mode 1 is 200 degrees, mode 2 is 250 degrees, and mode 3 is 300 degrees as the first set temperature, mode 1 is 225 degrees, mode 2 is 275 degrees, and mode 2 is the second set temperature. 3 can be 325 degrees, and the third set temperature can be 250 degrees for mode 1, 300 degrees for mode 2, and 350 degrees for mode 3.
Further, when these temperatures from the first set temperature to the third set temperature are used with the factory shipment settings, resetting by the operator and the administrator is not necessary.

For example, when the endoscopic surgery support device 1 set in this way is used in laparoscopic surgery, the endoscopic image in the abdominal cavity is inserted from the first imaging means 2 by inserting the laparoscopic device into the abdominal cavity. Is output (see FIG. 2). A thermographic image is output from the second imaging means 3 (see FIG. 3).
The endoscopic image from the first imaging unit 2 and the thermographic image from the second imaging unit 3 are input to the image processing unit 4.

(Description of the first function)
In the image processing means 4, first, a temperature extraction image is generated by extracting a range equal to or higher than the first set temperature from the thermographic image. Next, the image processing means 4 superimposes the endoscope image corresponding to a range other than the range not lower than the first set temperature.
Regarding this superposition, first, in a temperature extraction image obtained by extracting a range equal to or higher than the first set temperature from the thermographic image, the range below the first set temperature is black, and the range above the first set temperature is a colored range corresponding to the temperature distribution. (See FIG. 4).
Next, the display priority of the black range is set lower than that of the endoscopic image, and the display priority of the colored range (a range equal to or higher than the first set temperature) is set higher than that of the endoscopic image. Then, the endoscopic image and the temperature extraction image are superimposed based on the priority.
By doing so, it is possible to obtain a composite image in which the remaining range is an endoscopic image while the range of the thermographic image is equal to or higher than the first set temperature (see FIG. 5).

At this time, the first imaging unit 2 and the second imaging unit 3 image the same imaging range at the same magnification.
When the endoscopic image from the first imaging unit 2 and the thermographic image from the second imaging unit 3 are superimposed, the endoscopic image and the thermographic image are captured in the same imaging range at the same magnification. If the superimposition is performed without adjusting the image capturing direction or the imaging direction, the temperature distribution of the thermographic image is displayed on the ultrasonic coagulation / cutting device based on the endoscopic image, so that the superimposition is easy.

  As described above, the image processing means 4 uses the first function to generate a composite image and display it on the display means 7, so that the temperature in the thermographic image is less than the first set temperature. Since the endoscopic image is displayed, the surgeon can perform the operation while observing the endoscopic image. And the range which became high temperature more than 1st preset temperature can be made into the colored thermography image according to temperature distribution. Therefore, the surgeon can observe the extracted thermographic image in the same field of view as the surgeon viewing the endoscopic image.

  Thus, when the temperature in the body cavity is lower than the first set temperature, or if the range equal to or higher than the first set temperature is narrow, the operator can perform the operation without being disturbed by the thermographic image. In addition, the thermographic image is displayed so that the range of the first set temperature or higher is overlapped with the ultrasonic coagulation / cutting device by the endoscopic image, so that the surgeon can recognize the location where the ultrasonic coagulation / cutting device becomes hot. Because it is easy to recognize, it can be alerted.

  Further, as shown in FIG. 5, the surgeon not only has a high temperature in the blade B portion, but also the portion of the shaft S that supports the blade transfers heat from the blade B to a high temperature not lower than the first set temperature. In the scissors-type ultrasonic coagulation / cutting device, it can be recognized that the pad P portion that is paired with the blade B is also at a high temperature.

  Therefore, the surgeon can recognize the overheated portion of the ultrasonic coagulation / cutting device by performing the operation using the endoscopic surgery support device 1, and can help to prevent the burn of the tissue.

(Description of second function)
Even if the ultrasonic coagulation / cutting device is at or above the first set temperature, the surgeon may proceed with the procedure without any problem as long as it is below the second set temperature. In such a case, the surgeon operates the operation means 6 to designate the second function to the image processing means 4.

In this function, only the endoscopic image is displayed on the display unit 7 until the second set temperature is detected based on the thermographic image. However, when the second set temperature is detected, only the endoscopic image is displayed. Then, the display is switched to a display in which the range above the first set temperature and the endoscopic image outside the range are superimposed.
That is, when the first preset temperature is 200 degrees and the second preset temperature is 250 degrees, if the thermographic image does not have a range of 250 degrees, only the endoscopic image is displayed on the display means 7. Therefore, the surgeon can observe the endoscopic image without being disturbed by the thermographic image.
In addition, when a range of 250 degrees that is the second set temperature is detected in the thermographic image, the range including the range of 200 degrees or more that is the first set temperature is also displayed. In addition to this range, the temperature distribution around the 250 degree range can be widely recognized.

  In the second function, depending on the second set temperature, it is determined whether only the endoscopic image or a combined image in which the thermographic image is superimposed on the endoscopic image, but the operator operates the operation means 6. Thus, the image processing unit 4 may be instructed to select only the endoscopic image or to superimpose the thermographic image on the endoscopic image. By doing so, when the thermographic image is obstructive and unnecessary, only the endoscopic image is displayed, and if the thermographic image is necessary, the superimposed display is selected by the operation of the operation means 6 by the operator. Can do.

(Explanation of third function)
Next, a third function in which the image processing unit 4 detects a temperature equal to or higher than the third set temperature from the thermographic image will be described.
When the notification means 5 receives from the image processing means 4 a notification that the temperature equal to or higher than the third set temperature has been detected based on the thermographic image, the notifying means 5 cools the ultrasonic coagulation / cutting device to the surgeon. Issue a warning to request. This warning can be a sound, displayed on the display means 7, or light such as Patlite (registered trademark).

When the warning is a sound, a continuous sound or intermittent sound can be generated from the speaker provided in the notification means 5.
When displaying a warning on the display means 7, the notification means 5 that has received a notification from the image processing means 4 that a temperature equal to or higher than the third set temperature has been detected from the image processing means 4 causes the warning display to be further superimposed. The processing means 4 is instructed. By doing so, the image processing means 4 not only superimposes the extracted image from the thermographic image on the endoscopic image but also superimposes a warning display.
This warning display can be a symbol, a character, or a mark. Further, the warning display may be blinked.

  As described above, in the third function, the image processing unit 4 can detect the third set temperature higher than the first set temperature in the temperature distribution displayed as the thermographic image. By the detection of the third set temperature, the notification means 5 issues a warning. Therefore, even if it is difficult for the operator to concentrate on the operation and recognize the overheated ultrasonic coagulation / cutting device only with the thermography image, the notification means 5 sets the timing for cooling the ultrasonic coagulation / cutting device. The surgeon can be notified. Further, if the third preset temperature is set to 300 degrees, in the scissors-type ultrasonic coagulation / cutting device, before the fluororesin layer formed on the pad part surface paired with the blade melts and spreads by overheating, Since the ultrasonic coagulation / cutting device can be cooled, the ultrasonic coagulation / cutting device can be used in a safe state.

(Explanation of the fourth function)
Next, the 4th function which notifies the alerting | reporting means 5 of the highest temperature in the range beyond 1st setting temperature from a thermographic image is demonstrated.
As a second alarm function, the notification unit 5 receives a maximum temperature in a range equal to or higher than the first set temperature based on the thermographic image, which is notified by the image processing unit 4, and changes the warning sound according to the maximum temperature. To emit.
For example, the warning sound can be made higher as the maximum temperature becomes higher. In addition, the warning sound can be configured such that the interval between the intermittent sounds becomes shorter as the maximum temperature becomes higher.
In this way, the notification means 5 emits a warning sound, so that the surgeon can determine whether the ultrasonic coagulation / cutting device is at the highest temperature that requires cooling, depending on the level of the warning sound or the interval between intermittent sounds. The degree of temperature rise of the sonic coagulation / cutting device can be recognized by hearing.

  The first alarm function and the second alarm function can be switched by operating the operation means 6.

  As described above, the endoscopic surgery support apparatus 1 according to the embodiment of the present invention can monitor the tip temperature of a surgical instrument that is at a high temperature, such as an ultrasonic coagulation and incision apparatus. Complications due to injury may be avoided and can assist the operator in completing safe surgery.

  The present invention is suitable for performing laparoscopic surgery and thoracoscopic surgery, and is also suitable as a device for improving and nurturing the techniques of an operator who performs laparoscopic surgery and thoracoscopic surgery.

DESCRIPTION OF SYMBOLS 1 Endoscopic surgery support apparatus 2 1st imaging means 3 2nd imaging means 4 Image processing means 5 Notification means 6 Operation means 7 Display means

Claims (10)

First imaging means for imaging an endoscopic image in a body cavity;
Second imaging means for imaging a thermographic image in the body cavity;
An endoscopic surgery support apparatus comprising: an image processing unit that extracts a range that is equal to or higher than a first set temperature from the thermographic image and superimposes it on an endoscopic image outside the range and displays the image on a display unit.   When the image processing means detects a second set temperature that is equal to or higher than the first set temperature based on the thermographic image, from the display of only the endoscopic image, a range that is equal to or higher than the first set temperature and other than the range The endoscopic surgery support apparatus according to claim 1, wherein the display is switched to a display in which the endoscopic image is superimposed. The image processing means has a function of detecting a temperature equal to or higher than a third set temperature higher than the first set temperature from the thermographic image,
The endoscopic surgery support apparatus according to claim 1, further comprising a notification unit that issues a warning when a temperature equal to or higher than the third set temperature is detected. The image processing means has a function of notifying a maximum temperature in a range equal to or higher than the first set temperature from the thermographic image,
The endoscopic surgery support apparatus according to claim 1, further comprising a notification unit that emits a warning sound that changes according to the maximum temperature.   5. The operation unit according to claim 1, further comprising an operation unit that instructs the image processing unit to select only the endoscopic image or to superimpose the thermographic image on the endoscopic image. 6. Endoscopic surgery support device.   The endoscopic surgery support apparatus according to any one of claims 1 to 5, wherein the first imaging unit and the second imaging unit are configured to image the same imaging range at the same magnification. Capturing an endoscopic image in a body cavity;
Capturing a thermographic image in the body cavity;
An endoscopic surgery support method comprising the steps of: extracting a range that is equal to or higher than a first set temperature from the thermographic image, superimposing the range on the endoscopic image outside the range, and displaying it on a display means.   When a third set temperature that is equal to or higher than the first set temperature is detected based on the thermographic image, from a display of only the endoscopic image, a range that is equal to or higher than the first set temperature and the endoscopic image that is outside the range The endoscopic surgery support method according to claim 7, further comprising a step of switching to a superimposed display. Detecting a temperature equal to or higher than a third set temperature higher than the first set temperature from the thermographic image;
The endoscopic surgery support method according to claim 7 or 8, further comprising a step of notifying a warning when a temperature equal to or higher than the third set temperature is detected.   The endoscopic surgery support method according to claim 7 or 8, further comprising a step of changing a warning sound from the thermographic image according to a maximum temperature in a range equal to or higher than the first set temperature.