JP2020520691A - 生検装置およびシステム - Google Patents
生検装置およびシステム Download PDFInfo
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- JP2020520691A JP2020520691A JP2019562319A JP2019562319A JP2020520691A JP 2020520691 A JP2020520691 A JP 2020520691A JP 2019562319 A JP2019562319 A JP 2019562319A JP 2019562319 A JP2019562319 A JP 2019562319A JP 2020520691 A JP2020520691 A JP 2020520691A
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Abstract
Description
を実行させる。
カメラを有する。いくつかの実装では、前記一組の位置センサの少なくとも1つは、前記器具の遠位端に超音波トランスデューサを有する。いくつかの実装では、前記超音波トランスデューサは、ラジアルスキャンまたはリニアスキャントランスデューサを含む。いくつかの実装では、前記一組の位置センサの少なくとも1つは、前記器具の遠位端に電磁(EM)センサを有する。いくつかの実装では、前記一組の位置センサの少なくとも1つは、X線イメージインテンシファイアおよびX線撮像装置を有する。
命令を実行して前記装置に少なくとも前記組織部位から1つまたは複数の生検検体を取得するためのパターンであって、少なくとも2次元に配置された1つまたは複数の検体位置を有するパターンを決定すること、前記パターンに基づいて、ロボット医療システムの器具の遠位部分の動きの手技計画を決定すること、前記器具の前記遠位部分を、前記少なくとも2次元のパターンに対応する1つまたは複数の位置に誘導すること、を実行させる1つまたは複数のプロセッサと、を有する装置である。
では、前記生検パターンは円形状または格子状に配置された1つまたは複数の検体位置を有する。いくつかの実装では、前記生検パターンはさらに、前記1つまたは複数の検体位置に対応する、1つまたは複数の刺入深度、1つまたは複数の採取速度、1つまたは複数の採取間隔、あるいは1つまたは複数の採取力を有する。
を調整することを実行させる。
本開示の実施形態は、生検検体が収集される検体位置を含む生検パターンを受信することおよび/または生検パターン内の検体位置に基づいて医療器具の動きを計算することにより、種々の対象組織部位(例えば、肺の気管)における生検の検体位置に医療器具を案内するシステムおよび技術に関する。
図1Aは、開示された生検システムおよび技術の1つまたは複数の態様を実装する例示的な動作環境100を示している。動作環境100は、患者101、患者101を支持す
るプラットフォーム102、内視鏡115の動きを案内する手術ロボットシステム110、手術ロボットシステム110の動作を制御するコマンドセンタ105、電磁(EM)制御器135、電磁場発生器120、および電磁センサ125、130を含む。図1Aは、図1Bにより詳細に示される、患者101内の管腔網140のおおよその範囲も示している。
る。電磁場発生器120は、いくつかの実施形態では、電磁場発生ボードとすることができる。開示された生検ガイダンスシステムのいくつかの実施形態では、患者と患者を支持するプラットフォーム102との間に位置付けられた電磁場発生器ボードを使用することができ、電磁場発生器ボードは、その下に位置する導電性または磁性材料によって引き起こされる追跡歪みを最小限に抑える薄いバリアを組み込むことができる。他の実施形態では、電磁場発生器ボードは、例えば、患者の周りにおいて柔軟な設定オプションを提供することができる、手術ロボットシステム110に示されるものに類するロボットアームに取り付けることができる。
スプリングを含んでもよい。ブレーキ、例えば、フェールセーフブレーキは、機械的および/または電気的部品を含んでもよい。また、ロボットアーム175は、重力補助受動支持型ロボットアームであってもよい。
な例示的なコマンドコンソール200を示す。コマンドコンソール200は、コンソールベース201と、例えば、モニタなどのディスプレイモジュール202と、例えば、キーボード203およびジョイスティック204などの制御モジュールとを含む。いくつかの実施形態では、コマンドコンソール200機能のうちの1つ以上を、手術ロボットシステム110の基部180または手術ロボットシステム110に通信可能に連結された別のシステムに組み込んでもよい。医師などのユーザ205は、コマンドコンソール200を使用し、人間工学に基づいた位置から手術ロボットシステム110を遠隔制御する。
が必要になる場合がある。
に沿って挿入することで、内視鏡の先端近くの領域にアクセスできるようにしてもよい。
上述の制御およびセンサ電子回路184および/またはコンソールベース201において、1つ以上のデータ記憶装置および1つ以上のハードウェアプロセッサとして実装され得る。生検ガイダンスシステム400は、いくつかの異なるソースからのデータを使用するものとして記載されているが、生検ガイダンスシステム400は、図4に示すものよりも多くの、少ない、および/または異なるデータソースを使用できることを理解されたい。
者の解剖学的構造内における手術ロボットシステム110による医療器具または医療器具の一部(例えば、器具の先端または遠位端)の物理的動きに関するデータである。ロボット位置データとしては、例えば、患者の解剖学的構造内において、特定の解剖学的部位に到達するかつ/またはその向き(例えば、内視鏡器具の始端および外装の一方または両方の特定のピッチ、ロール、ヨー、挿入、および後退)を変更するように器具の先端に対して指示するコマンドデータ、医療器具(例えば、器具先端または外装)の一部の挿入動作を表す挿入データ、IDMデータ(例えば、IDM 190からのデータ)、および、例えば解剖学的構造内で内視鏡を実際に動かす内視鏡の1つ以上のプルワイヤ、腱または軸の動きなど、医療器具の細長い部材の機械的な動きを表す機械的データが挙げられる。ロボット位置データは、医療器具(例えば、ロボットアーム175)の遠位端の1つ以上の制御器によって追跡されてもよい。
のデータを使用して、医療器具(例えば、内視鏡)の遠位端の位置および/または向きを決定するモジュールである。例えば、器具位置計算器420は、1つ以上の位置センサからのデータを医療器具の遠位端の3Dモデル座標および/または向きに変換するように構成されてもよい。
の位置および/または向きを特定するために、位置データリポジトリ415からのデータとともに使用されてもよい。
ール105またはコマンドコンソール200)を介してユーザに示されてもよく、および/またはユーザの入力によって調整されてもよい。医療器具の動きは、各調整後に1つ以上のコンピュータ可読メモリ(例えば、制御およびセンサ電子回路184のメモリ)に保存されてもよい。ユーザのコマンドで、器具動き計算器450は、器具の遠位端を案内するために、器具の動きに関するデータを、後述する器具制御器460に転送してもよい。別の例では、医療器具が1つまたは複数の生検検体を収集した後、器具動き計算器450は、医療器具の動きによって(例えば、上記の位置センサによって)検出される、生検検体を収集するために器具がとる実際の動きおよび/または器具が生検検体を収集する実際の位置に基づいて動きを調整するように構成されてもよい。いくつかの実施形態では、データは、器具の位置、向き、経路、姿勢などの変化を直接的または間接的に示してもよい。例えば、データは、生検パターン内の1つ以上の検体位置に到達するために医療器具がとる1つ以上の経路を含んでもよい。その代わりにまたはそれに加えて、データは、医療器具の遠位端の位置、向き、ピッチ、ロール、ヨー、挿入、後退、および/または偏向角を含んでもよい。
検体位置のそれぞれに器具を動かすために使用できる器具の動きを計算してもよい。いくつかの実施形態では、計算された器具の動きは、器具の位置、向き、経路、姿勢などの変化を直接的または間接的に示してもよい。例えば、計算された動きは、器具の遠位部分が生検パターン内の1つ以上の検体位置に到達するためにとる可能性がある1つ以上の経路から構成されてもよい。その代わりにまたはそれに加えて、データは、器具の遠位部分の位置、向き、ピッチ、ロール、ヨー、挿入、後退、および/または偏向角を含んでもよい。
のデータは、器具の遠位部分の位置および/または向きに関連しており、1つまたは複数の器具センサ(例えば、電磁センサ、撮像装置、X線装置、超音波トランスデューサ、または器具制御器)および/または位置センサデータリポジトリ415から導出されてもよい。いくつかの実施形態では、呼吸数および/または相特定器430からのデータは、呼吸による患者の解剖学的構造の動きに関連しており、1つまたは複数の呼吸センサおよび/または呼吸センサデータリポジトリ425から導出されてもよい。
示してもよい。パターン内の追加の採取位置に対して、上記のブロックうちの1つ以上を繰り返すことができる。
図7Aおよび図7Bは、本明細書に記載の手術ロボットシステム710の別の例示的なロボットアーム775および/または795を示し、手術ロボットシステム710は、生検検体を収集するように構成されたロボット制御収集装置717から構成される器具(例えば、内視鏡715)から構成される。場合によっては、ロボット制御収集装置717は、第2ロボットアーム(例えば、ロボットアーム1775)によって制御されてもよく、収集装置は、第1ロボットアーム(例えば、ロボットアーム775)によって制御される内視鏡715の作業チャネルを通して挿入される。さらに、ロボットシステム710で1つ以上の追加のアームを使用して、他の構成要素を制御できることを理解されたい。一例として、追加のアーム(例えば、アーム775および1775とは別のアーム)が外装を制御してもよい。外装は、内視鏡が通る作業チャネルを備えた関節運動可能な器具であってもよい。外装の目的は、内視鏡に追加の関節点を提供し、追加的または代替的に、内視鏡に追加の構造的支持を提供することであり得る。
備えてもよい。マーカ719は、放射線不透過性を有してもよく、マーカ719の放射線不透過性材料の例には、金、銀、タングステン、白金、タンタル、イリジウム、またはそれらの合金、または放射線不透過性高分子化合物が含まれるが、これらに限定されない。
によって実施されてもよい。上述のように、第1の検体位置への医療器具の動きは、いくつかの実施形態では、検体位置計算器(例えば、検体位置計算器410に類するもの)、器具位置計算器(例えば、器具位置計算器420に類するもの)、および/または呼吸数/相特定器(例えば、呼吸数および/または相特定器430に類するもの)からのデータに基づいて(例えば、器具動き計算器によって)計算されてもよい。
使用し、収集装置717の遠位端で放射線不透過性マーカ(例えば、マーカ719)を追跡することにより決定されてもよい。
本明細書で開示される実装は、組織検体の案内された生検のためのシステム、方法、および装置を提供する。
用されてもよい。例えば、当業者は、ツールコンポーネントを締結、取り付け、連結、または係合する同等の方法、また特定の作動運動を発生させる同等の機構など、複数の対応する代替および同等の構造詳細を使用できることを理解されたい。したがって、本発明は、本明細書に示される実装に限定されることを意図するものではなく、本明細書に開示される原理および新規の特徴に一致する最も広い範囲を与えられるべきである。
Claims (30)
- 組織部位から1つまたは複数の生検検体からなる一組の生検検体の取得を支援するシステムであって、
前記1つまたは複数の生検検体を収集可能な器具と、
前記器具の動きを制御するアクチュエータと、
実行可能な命令が格納された少なくとも1つのコンピュータ可読メモリと、
1つまたは複数のプロセッサであって、前記少なくとも1つのコンピュータ可読メモリと通信し、前記命令を実行して前記システムに少なくとも
前記組織部位内の1つまたは複数の検体位置を有する生検パターンにアクセスすること、
前記生検パターンに従って前記機器の動きを計算すること、
前記1つまたは複数の検体位置に対応する1つまたは複数の位置に前記器具を移動すること、
を実行させる1つまたは複数のプロセッサと、
を有することを特徴とするシステム。 - 前記生検パターン、前記生検パターンにアクセスするコマンド、または前記生検パターンに従って前記器具の動きを計算するコマンドを受信するユーザ入力装置をさらに有することを特徴とする請求項1に記載のシステム。
- 前記生検パターンを表示するユーザインターフェース画面をさらに有することを特徴とする請求項2に記載のシステム。
- 前記1つまたは複数のプロセッサは、前記命令を実行して前記システムに少なくとも、ユーザから受信した情報に基づいて、前記生検パターンを調整させる、または前記1つまたは複数の位置への前記器具の前記動きを表す経路を調整させることを特徴とする請求項1に記載のシステム。
- 1つまたは複数の位置センサからなる一組の位置センサをさらに有し、
前記1つまたは複数のプロセッサは、前記命令を実行して前記システムに少なくとも
前記一組の位置センサからのデータ信号に基づいて(1)前記一組の位置センサの少なくとも1つの位置または(2)前記器具の遠位端の位置を計算すること、
前記計算された位置に基づいて前記1つまたは複数の位置への動きを制御すること、を実行させること特徴とする請求項1に記載のシステム。 - 前記器具は、
前記組織部位に到達するスコープと、
(1)前記スコープ内に取り外し可能に配置される、または(2)前記スコープ内を通って延びる、前記1つまたは複数の生検検体を収集する収集装置と、
を有することを特徴とする請求項1に記載のシステム。 - 前記1つまたは複数のプロセッサはさらに、前記命令を実行して前記システムに少なくとも
前記スコープを第1の位置に配置すること、
第1の検体の収集を確認すること、
前記第1の検体の収集の確認に応じて前記スコープを第2の位置に配置すること、
を実行させることを特徴とする請求項1に記載のシステム。 - 前記器具は、前記1つまたは複数の生検検体を取得する収集装置を有し、
前記アクチュエータは、前記収集装置の動きを制御し、
前記収集装置はさらに、前記収集装置の遠位端にマーカを有し、
前記1つまたは複数のプロセッサは、前記命令を実行して前記システムに少なくとも
前記マーカの動きに応じて前記収集装置の動きを決定すること、
前記収集装置の前記動きに応じて前記1つまたは複数の検体位置を調整すること、
を実行させることを特徴とする請求項1に記載のシステム。 - 前記生検パターンは、少なくとも2次元に配置された1つまたは複数の検体位置を有することを特徴とする請求項1に記載のシステム。
- 前記生検パターンは、前記組織部位の形状に適合する形状に配置された1つまたは複数の検体位置を有することを特徴とする請求項9に記載のシステム。
- 前記生検パターンはさらに、前記1つまたは複数の検体位置に対応する、1つまたは複数の刺入深度、1つまたは複数の採取速度、1つまたは複数の採取間隔、あるいは1つまたは複数の採取力を有することを特徴とする請求項9に記載のシステム。
- 組織部位から1つまたは複数の生検検体の取得を支援する装置であって、
実行可能な命令が格納された少なくとも1つのコンピュータ可読メモリと、
1つまたは複数のプロセッサであって、前記少なくとも1つのコンピュータ可読メモリと通信し、前記命令を実行して前記装置に少なくとも
前記組織部位から1つまたは複数の生検検体を取得するためのパターンであって、少なくとも2次元に配置された1つまたは複数の検体位置を有するパターンを決定すること、
前記パターンに基づいて、ロボット医療システムの器具の遠位部分の動きの手技計画を決定すること、
前記器具の前記遠位部分を、前記少なくとも2次元のパターンに対応する1つまたは複数の位置に誘導すること、
を実行させる1つまたは複数のプロセッサと、
を有することを特徴とする装置。 - 前記1つまたは複数のプロセッサは、前記命令を実行して前記装置に少なくとも
一組の位置センサからのデータ信号に基づいて(1)前記一組の位置センサの少なくとも1つの位置または(2)前記器具の前記遠位部分の位置を計算すること、
前記計算された位置に基づいて前記器具の動きを制御すること、
を実行させることを特徴とする請求項12に記載の装置。 - 前記1つまたは複数のプロセッサは、前記命令を実行して前記装置に少なくとも
前記パターンに応じてスコープの動きを計算すること、
前記スコープの遠位部分を前記パターンに対応する前記1つまたは複数の位置に誘導すること、
を実行させることを特徴とする請求項12に記載の装置。 - 前記1つまたは複数のプロセッサは、前記命令を実行して前記装置に少なくとも
前記パターンに応じて収集装置の動きを計算すること、
前記収集装置の遠位部分を前記パターンに対応する前記1つまたは複数の位置に誘導すること、
前記収集装置による前記生検検体の収集に応じて、前記収集装置に配置されたマーカの動きに基づいて、前記収集装置が前記生検検体を取得した1つまたは複数の採取位置を計算すること、
前記1つまたは複数の採取位置と前記生検パターンの前記1つまたは複数の検体位置とを比較すること、
前記1つまたは複数の採取位置に基づいて、前記生検パターンの前記1つまたは複数の検体位置を調整すること、
を実行させることを特徴とする請求項12に記載の装置。 - 前記パターンは、前記組織部位の形状に適合する形状に配置された1つまたは複数の検体位置を有することを特徴とする請求項12に記載の装置。
- 患者の対象組織部位から1つまたは複数の検体を収集する方法であって、
ロボット医療システムのユーザインターフェースを介して、前記対象組織部位内の前記1つまたは複数の検体のパターンを選択するユーザ入力を受信することと、
前記ロボット医療システムの器具の遠位部分を、前記パターン内の第1の検体位置に対応する第1の位置に移動することと、
前記器具を、前記パターン内の前記第1の検体位置で第1の組織検体を取得するように誘導することと、
前記ロボット医療システムの前記器具の前記遠位部分を、前記パターン内の第2の検体位置に対応する第2の位置に移動することと、
前記器具を、前記パターン内の前記第2の検体位置で第2の組織検体を取得するように誘導することと、
を含むことを特徴とする方法。 - 前記ユーザ入力を受信して、前記1つまたは複数の検体の前記パターンを、前記第1の検体位置または前記第2の検体位置に調整すること、をさらに含むことを特徴とする請求項17に記載の方法。
- 前記パターンを調整することは、1つまたは複数の解剖学的特徴に基づくことを特徴とする請求項18に記載の方法。
- 前記パターンを調整することは、前記器具の前記遠位部分の初期位置を測定することと、前記器具の前記遠位部分の前記初期位置に基づいて、前記パターンを前記組織部位に適合させることを含むことを特徴とする請求項18に記載の方法。
- 前記パターンを適合させることは、前記第1の検体位置または前記第2の検体位置における前記器具の、1つまたは複数の刺入深度、1つまたは複数の採取速度、1つまたは複数の採取間隔、あるいは1つまたは複数の採取力を調整することを含むことを特徴とする請求項20に記載の方法。
- 前記器具を、前記第1の組織検体または前記第2の組織検体を取得するように誘導するときに、前記患者の呼吸数に基づいて前記器具の前記遠位部分の動きを調整することをさらに含むことを特徴とする請求項17に記載の方法。
- 前記ロボット医療システムの前記器具の前記遠位部分を前記第2の位置に移動することは、前記第1の検体位置における前記第1の組織検体の収集の通知を受信した後に行われることを特徴とする請求項17に記載の方法。
- 前記ロボット医療システムの前記器具の前記遠位部分を前記第1の位置または前記第2の位置に移動することは、
一組の位置センサからのデータ信号に基づいて、前記器具の前記遠位部分少なくとも1つの位置を計算することと、
前記計算された少なくとも1つの位置に基づいて、前記器具の動きを制御することと、
を含むことを特徴とする請求項17に記載の方法。 - 命令が格納されている非一時的なコンピュータ可読媒体であって、命令が実行されると少なくとも1つの計算装置に少なくとも
1つまたは複数の生検検体のパターンを受信することであって、前記パターンは患者の対象組織部位内の少なくとも2次元に配置された1つまたは複数の生検位置を有する、こと、
前記ロボット医療システムの器具の遠位部分を、前記少なくとも2次元のパターン内に配置された前記1つまたは複数の生検位置に対応する1つまたは複数の採取位置に移動すること、
を実行させることを特徴とする非一時的なコンピュータ可読媒体。 - 前記命令が実行されると前記少なくとも1つの計算装置に少なくとも
一組の位置センサからのデータ信号に基づいて、前記器具の前記遠位部分の少なくとも1つの位置を計算すること、
前記計算された少なくとも1つの位置に基づいて、前記器具の動きを制御すること、を実行させることを特徴とする請求項25に記載の非一時的なコンピュータ可読媒体。 - 前記命令が実行されると前記少なくとも1つの計算装置に少なくとも、前記患者の前記組織部位の1つまたは複数の解剖学的特徴または前記患者の呼吸数に基づいて、前記1つまたは複数の生検検体の前記パターンを調整することを実行させることを特徴とする請求項25に記載の非一時的なコンピュータ可読媒体。
- 前記命令が実行されると前記少なくとも1つの計算装置に少なくとも、前記組織部位内の1つまたは複数の血管に基づいて、前記1つまたは複数の生検検体の前記パターンを調整することを実行させることを特徴とする請求項27に記載の非一時的なコンピュータ可読媒体。
- 前記命令が実行されると前記少なくとも1つの計算装置に少なくとも、前記パターンを前記組織部位の形状に適合させることを実行させることを特徴とする請求項25に記載の非一時的なコンピュータ可読媒体。
- 前記命令が実行されると前記少なくとも1つの計算装置に少なくとも
前記器具が前記1つまたは複数の生検検体を取得した1つまたは複数の収集位置を受信すること、
前記1つまたは複数の収集位置に基づいて前記パターンを調整すること、
を実行させることを特徴とする請求項25に記載の非一時的なコンピュータ可読媒体。
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US20180325499A1 (en) | 2018-11-15 |
CN110831498B (zh) | 2022-08-12 |
EP3621520A1 (en) | 2020-03-18 |
KR102643758B1 (ko) | 2024-03-08 |
US11529129B2 (en) | 2022-12-20 |
JP2023171877A (ja) | 2023-12-05 |
KR20200007896A (ko) | 2020-01-22 |
CN110831498A (zh) | 2020-02-21 |
AU2018265018A1 (en) | 2019-11-28 |
KR20240035632A (ko) | 2024-03-15 |
US20230190244A1 (en) | 2023-06-22 |
EP3621520A4 (en) | 2021-02-17 |
AU2018265018B2 (en) | 2024-03-07 |
WO2018208994A1 (en) | 2018-11-15 |
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