JP3339952B2 - Peeling treatment tool - Google Patents

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to an exfoliating treatment tool used for endoscopic surgery, and particularly for exfoliating body tissue.

[0002]

2. Description of the Related Art In a surgical operation under an endoscope, there are a method of using a so-called HI forceps, a method of using an ultrasonic crusher, and the like as means for performing peeling using a treatment tool. Unlike such a case in which a body tissue is cut with a scalpel or the like, only a required body tissue can be separated without cutting a blood vessel or the like in the body tissue.

[0003]

However, the exfoliation of the body tissue cannot be performed over a wide area at a time. Therefore, it is necessary to repeat the exfoliation treatment in a required range by repeating the exfoliation of a small area with care. is there. Such peeling requires a lot of time to repeatedly perform a monotonous operation, and requires a great deal of labor for the operator because it is necessary to always perform the operation with a constant peeling force. For this reason, automation of such a stripping operation has been eagerly desired.

SUMMARY OF THE INVENTION The present invention has been made in view of the above, and has been made in view of the fact that peeling in surgical operation can be performed while detecting the peeling force.
It is an object of the present invention to provide a peeling treatment tool capable of:

[0005]

According to the present invention, there is provided a peeling treatment instrument for achieving the above object , comprising: an insertion portion to be inserted into a body;
Peeling means provided at the tip of the entrance and capable of mechanical operation
Operating means for operating the mechanical operation of the peeling means,
On the surface of the exfoliating means so that it can contact body tissue
A pressing portion having a pressing surface formed on the pressing surface;
Peeling force provided on the pressing part to measure the force
And a detecting means .

[0006]

In this peeling treatment tool, the peeling means is arranged at a required site in the body. Then, the exfoliation site is pulled from both sides along the direction in which the exfoliation is to be exfoliated to tension the body tissue, and then exfoliation is started. The peeling means is mechanically operated by operating the operating means.
At this time, the pressing portion is formed on the surface of the peeling means.
The peeling is performed by bringing the pressed surface into contact with the body tissue in the body. Push
The force applied to the pressure surface is determined by a peeling force detecting means provided on the pressing portion.
Can be detected through.

[0007]

FIG. 1 shows a peeling treatment tool 1 according to an embodiment of the present invention. In this embodiment, the peeling means is formed by a peeling forceps tip 2, and this tip 2 is opened and closed by a pair of arms 2.
a, 2a, and a mechanical mechanism for opening and closing the arms 2a, 2a.
The desired body tissue is exfoliated by the operation .

[0008] Each arm portion 2a of the distal end portion 2, 2a has its tip portion 2 while being pivotally mounted to the distal end of the insertion portion 3 to be inserted into the body, pantograph-shaped link mechanism provided in the insertion portion 3 4 It is connected to. The insertion portion 3 is formed in a hollow tubular structure, and a housing 5 disposed outside the body as a grip portion or operation means is attached to the base end side, and a driving means 6 is housed in the housing 5. ing.

The driving means 6 of this embodiment includes a motor 7, a driving screw 9 connected to the motor 7 via a coupling 8, and a nut member 10 meshed with the driving screw 9. The nut member 10 is guided in the housing 5 along the axial direction of the drive screw 9 by appropriate guide means.
The rotary motion of the motor 7 and the drive screw 9 is converted into a linear motion along the axial direction. The rear end of the rod member 11 which is inserted into the insertion portion 3 and the leading end of which is connected to the link mechanism 4 is connected to the nut member 10, and the driving force of the driving means 6 is transmitted through the link mechanism 4. To the tip 2
The arms 2a of the tip 2 can be opened and closed. When the arms 2a, 2a open, the body tissue that comes into contact with the arms 2a is exfoliated. That is, the exfoliation of the body tissue will be described later.
Body tissues located on both sides of the separation line A
This is performed by pressing in directions separating from each other in 2a.
The arms 2a, 2a as these pressing portions are in contact with body tissue.
Formed on the surfaces of the arms 2a, 2a so that they can be touched.
Having a pressed surface. Reference numeral 12 is a microswitch that limits the amount of movement of the rod member 11.

A force sensor 13 is attached to the arms 2a, 2a for peeling off the body tissue, as a peeling force detecting means for detecting a peeling force acting on the arms 2a, 2a.
The force sensor 13 of this embodiment is formed of a conductive sheet whose electric resistance changes according to pressure, and an output signal of the force sensor 13 is schematically shown in FIG. 2 via a signal line (not shown). It is sent to the control means 14.

As shown in FIG. 2, the control means 1 of this embodiment
4 includes a peeling force detection circuit 15 that processes an output signal from the force sensor 13 and outputs a peeling force signal relating to the magnitude and direction of the peeling force. The peeling force signal output from the peeling force detecting circuit 15 is sent to the comparing circuit 16. The comparing circuit 16 compares the peeling force with a preset allowable maximum force, and when the peeling force is larger than the allowable maximum force, controls the motor driving circuit 19 so that the motor driving force is immediately reduced. The motor drive circuit 19 has a line 20
A driving force control signal is sent to the motor 7 through the arm 2a,
The magnitude of the peeling force acting on 2a is controlled. By this control, an unnecessarily large peeling force is formed on the arms 2a, 2a to prevent damage to normal tissues.

A peeling force signal is also sent from the peeling force detecting circuit 15 to the smoothing circuit 17, and is converted into an average peeling force by the smoothing circuit 17 having a low-pass filter having a lower time constant for opening and closing. Sent. Subtraction circuit 18
Subtracts this average peeling force from the target peeling force set by the operator, and feeds it back to the motor drive circuit 19. Thereby, the average peeling force is controlled so that the target peeling force is always close.

The motor drive circuit 19 reverses the polarity of the current flowing through the motor 7 in response to a signal from the microswitch 9 sent via the line 21 and uses the subtraction circuit 18 and the comparison circuit 16 as control inputs to control the tip of the peeling forceps. The motor drive current for opening and closing the arms 2a of the section 2 is controlled.

According to the above processing flow, the arms 2a, 2
The peeling is automatically performed while controlling the peeling force acting on a substantially constant.

When the body tissue is peeled by such a peeling treatment tool 1, the following procedure is performed.

First, the insertion section 3 of the exfoliation treatment tool 1 under an endoscope
Is inserted into the body from the distal end, and the distal end portion 2 is brought close to the required body tissue. Then, after pulling the body tissue from both sides along the peeling line indicated by the symbol A in FIG. 2 to tension the body tissue,
Initiate peeling.

When the drive motor 7 is driven with the arms 2a, 2a of the tip 2 facing both sides of the peeling line A, the drive means 6 shown in FIG.
To convert the motion to a linear motion, and transmit this motion to the arms 2a, 2a via the rod member 11 and the link mechanism 4. Arm 2
a, 2a open and close, and the body tissue is peeled off by the peeling force received from the arms 2a, 2a. Thus, the arms 2a, 2
By moving the exfoliation treatment tool 1 along the exfoliation line A while opening and closing a, body tissues are exfoliated along the exfoliation line A in order.

The peeling force acting on the arms 2a, 2a is converted into an electric signal by the force sensor 13 and sent to the control means 14 via a signal line (not shown) inserted through the insertion section 3. As described above, the control means 14 controls the force sensor 13
, And controls the motor 7 via the line 20 to keep the peeling force within a predetermined range.

Thus, only a desired body tissue is always peeled off by a predetermined range of peeling force, and unintended tissue such as a blood vessel is prevented from being cut. Further, since the peeling force is automatically kept within the predetermined range, the operator's labor is greatly reduced.

Next, FIG. 3 shows a manipulator for polypectomy which is used for an endoscopic surgical operation and in which a flattened polyp is surely resected and extracted, similarly to the above embodiment.

This polypectomy manipulator
When using a conventional endoscopic method in which a polyp generated in a living body lumen is excised and removed by a snare, if the polyp is a flat polyp on a wall surface, a loop is not formed at the base of the polyp. This solves the problem that such a flat polyp cannot be resected.

The polypectomy manipulator that solves this problem includes a cylindrical hood 26 mounted on the outer periphery of the end of the endoscope 22 and suction means incorporated in the endoscope 22 to reduce the pressure inside the hood 26. , The surface of the loop 28 is arranged in parallel to the distal end surface of the endoscope 22 and has a binding means capable of moving in the axial direction in the hood 26, and an energization cutting means. The energization cutting operation is automatically performed as a series of operations.

More specifically, as shown in FIG.
Reference numeral 2 has an insertion portion to be inserted into a living body, and a light guide 23 for illuminating an observation site of a body wall is provided on an end surface of a tip portion of the insertion portion, and an observation image is obtained by light reflected from the body wall. The objective lens 24 is arranged so that a desired part in the living body can be observed while illuminating it. The endoscope 22 is provided with a channel 25 extending into the insertion portion and opening at the end face of the distal end.
Through this, the inside of the living body such as suction and water supply can be washed, and treatment using various treatment tools can be performed. This treatment is performed outside the body as required.

Further, a hood 26 made of a transparent material is mounted on the outer periphery of the distal end portion of the endoscope 22 so as to protrude forward.
By pressing 6, the diseased part B can be sealed in the hood 26 and placed under the observation of the endoscope 22.

The snare 27 projecting forward from the opening of the channel 25 has a loop 28 at its tip, and this loop 28 is formed so as to be parallel to the end face of the endoscope 22. A sheath 29 is provided on the shaft portion of the snare 27 so as to cover the wire portion forming the loop 28. By moving the sheath 29 and the wire portion of the loop 28 relatively in the front-rear direction. The diameter of the loop 28 can be expanded or reduced, and the affected part B can be tightened by such an operation of adjusting the diameter of the loop 28. The endoscope 22 is moved by moving the wire portion of the loop 28 and the sheath 29 back and forth integrally.
The amount of protrusion from the front end can be changed.

To move the sheath 29 back and forth, the snare 2
7 is provided with a first actuator 30 and a second actuator 31 for determining the relative positional relationship between the sheath 29 and the wire portion of the loop 28, that is, the diameter of the loop 28. In addition, a high-frequency ablation power source 32 is connected to a wire proximal end of the loop 28,
The affected part B can be cauterized by the loop 28 at the tip of the snare 27.

Further, an electromagnetically openable and closable valve 33 is arranged at the proximal end of the channel 25, and further at the base side of the valve 33, a suction pump 3 is connected via a reservoir 34.
5 is arranged. When the valve 33 is closed, the pump 35
The pressure in the hood 26 can be reduced by operating the pump 35. On the other hand, when the valve 33 is opened, the channel 25 is shut off from the reservoir 34 and communicates with the atmosphere, so that the pressure in the hood 26 can be returned to the atmospheric pressure.

These first and second actuators 3
The operations of 0, 31, the high-frequency ablation power supply 32, and the valve 33 are all independently controlled by the controller 36 . The operator C sends the controller 3 through the input device 37.
6 can be operated from outside the body through the system described above. This controller 3
The operator C operates the switches of the input device 37 in advance by programming the order of operation, time, etc.
The result, it is also possible to be continuously and automatically operating the entire system.

With such a polypectomy manipulator, a procedure such as excision and removal of a flat polyp on the wall surface of a living body lumen is performed as follows.

First, when the operator C operates a switch of the input device 37, a program in the controller 36 is started. Then, the hood 2 at the tip of the endoscope 22
6 is pressed against the wall of the living body lumen so as to be substantially perpendicular to the affected part B. Next, the valve 33 is closed and the channel 25 is closed.
, The pressure in the hood 26 is reduced, and the affected part B is raised toward the endoscope 22 by the negative pressure generated in the hood 26.

Then, the first and second actuators 1 are arranged so that the loop 28 surrounds the raised diseased part B.
By operating 0 and 11, the snare 27 is advanced. next,
By operating only the second actuator 11, loop 2
8, the affected part B is tied up, and the snare 27 is energized by the high-frequency ablation power source 32 to cauterize and cut off the affected part B.

Therefore, according to the manipulator for polypectomy, a series of troublesome resection operations of the affected part are automated, the burden on the operator is reduced, and the operation is performed by the operation programmed in advance. Accidents can be prevented beforehand, and safe and accurate surgery can be performed.

FIGS. 4 to 8 are used in a surgical operation, in particular, by making the posture of a patient variable, the influence of the weight of the organ is reduced, and the operation of the organ can be easily performed even with a surgical manipulator having a small driving force. Fig. 2 shows a possible powered operating table system.

In the power operating table system, the driving force of the manipulator is inevitably reduced in order to reduce the size of the surgical manipulator used for the operation under the endoscope. An object of the present invention is to solve the problem that the driving force is insufficient due to the weight of an organ, which makes it difficult to downsize a surgical manipulator.

This powered operating table system includes operating table attitude control means for changing the attitude of a patient, organ moving means, a force sensor provided in the organ moving means, and attitude detecting means for the organ moving means. The posture of the operating table is automatically changed using the output from the force sensor and the posture detecting means.

FIGS. 4 to 6 show a specific example of the configuration of the power operating table system. As shown in FIG. 4, the power operating table system includes a 6-DOF vertical articulated manipulator 40 having both an organ moving unit and a posture detecting unit of the organ moving unit, and a distal end of the manipulator 40. The treatment tool 41 includes an attached treatment tool 41, a force sensor 42 provided on the treatment tool 41, and a power operating table 43.

As shown in FIG. 5, the power operating table 43 is provided with a rotating mechanism 45 for rotating the bed section 44 below the bed section 44. The rotation mechanism 45 is formed by a support section by a curved guide 46 and a rotation drive device having a motor 47 and a gear mechanism 48.

An elevating / tilting mechanism 49 for changing the posture and height of the bed 44 is provided below the rotating mechanism 45. The elevating / tilting mechanism of the present embodiment is formed by three linear actuators 50, and each linear actuator 50 is constituted by a motor assembled in a piston and a screw / nut mechanism for converting the rotation of the motor into a linear motion. ing.

A translation mechanism 51 for two-dimensionally translating the bed section 44 is provided below the elevating / tilting mechanism 49, and is installed on the operating room floor. This parallel moving mechanism 5
Reference numeral 1 denotes an X-axis moving mechanism and a Y-axis moving mechanism. The Y-axis mechanism is formed by a support section by a linear guide 52 and a ball screw mechanism 54 for converting the rotational movement of the motor 53 into a linear movement. . The X-axis mechanism is formed in the same structure as the Y-axis mechanism, and is arranged below the Y-axis mechanism at right angles to the Y-axis mechanism. The bed unit 44 is constituted by the rotating mechanism 45, the elevating / tilting mechanism 49, and the parallel moving mechanism 51.
Three-dimensional translation (x, y, z) and posture transformation (dx,
dy, dz) and rotational movement (θ).

FIG. 6 shows the structure of the force sensor 42. FIG.
(B) shows a cross section in the x-axis direction of (A). As is apparent from this figure, the force sensor 42 is formed of an elastic body having a projection at the center. The three-axis components Fx, Fy, Fz in the x, y, z-axis directions of the force acting on the part are detected. The force sensor 42 is provided with piezoresistive elements indicated by reference numerals ah. Each piezo element ah
Changes the resistance of the piezo element. Fz is
Fx and Fy are detected by subtracting the outputs of the symmetrical elements of the projections from the outputs of the piezo elements ah. That is, Fx is a piezo element c,
Fy is detected by subtracting the sum of the outputs of piezo elements g and h from the sum of the outputs of piezo elements e and f, and Fy is detected by subtraction of the sum of the outputs of piezo elements a and b.

Next, the operation of detecting the force acting on the manipulator 40 through the force sensor 42 and moving the bed 44 will be described with reference to FIGS.
As shown in this processing flow in FIG. 8, first, the outputs of Fx, Fy, and Fz are detected by the force sensor 42 (step S1). The outputs of Fx, Fy, and Fz are shown in FIG.
As shown in FIG. 3, there are three axial components of the force F acting on the manipulator 40 or the treatment tool 41 in the x, y, and z-axis directions, and these three axial components Fx, Fy, and Fz are, as described above, the respective piezoelectric elements a- It is calculated by the output of h. Then, the force vector F applied to the treatment tool 41 from each component of the posture of the manipulator 40 or the treatment tool 41 and the output of the force sensor.
Can be calculated (step S2). As a result, the gravity component F
g is calculated (step S3). By rotating the gravitational component Fg in the direction of movement of the treatment tool 41 in the direction of the vector D, an angle θ is calculated such that the operation force of the manipulator in the direction of the vector D falls within the range of the maximum operation force (step S4). By rotating the posture of the power operating table by −θ with respect to the movement direction vector D of the manipulator (step S5), the direction of gravity apparently changes to Fg ′, and the organ is manipulated with a smaller driving force than before the posture change. Can be moved in the direction of the moving direction vector D.

FIGS. 9 to 12 show a radiation operating power operating table system for controlling the direction of irradiation of a radiation irradiation site and enabling easy and accurate positioning of the irradiation site.

This powered operating table system for radiation therapy
In recent years, radiotherapy for cancer using accelerators such as heavy particles has been put into practical use. However, in such radiotherapy devices, the irradiation direction of radiation is usually limited to one direction, and positioning of an affected part is difficult. In view of the problem that it is not easy, such a problem is solved.

This powered operating table system for radiation therapy
It comprises a tomographic or three-dimensional image capturing means, a radiation treatment means, and an operating table having control means for controlling the position and posture of the patient.

More specifically, as shown in FIGS. 9 to 11, an X-ray CT 61 or MRI image diagnostic device 62 for obtaining a tomographic image of an affected part, a heavy particle irradiation device 63, a power operating table 64 The whole is formed from an image processing device 66 for specifying the position of the affected part from the image information of 1 or 2 and an operating table driving device 67 for controlling the position and posture of the operating table 64 based on the positional information of the affected part. Is done.

As shown in FIG. 10, the heavy particle beam irradiation unit 68 of the heavy particle irradiation device 63 is mounted above the irradiation chamber. The patient P is placed on a power operating table 64 capable of automatically converting three-dimensional translation and posture / rotation, and the affected part is fixed to the operating table 64 by a fixing device 70 having a coordinate marker 65 attached thereto. I have.

FIG. 11 shows the structure of the power operating table 64. A rotating mechanism 72 for rotating the bed is provided below the bed 71 of the power operating table 64. The rotation mechanism 72
It consists of a support by a curved guide 73 and a rotary drive by a motor 74 and a helical gear 75. An elevating / tilting mechanism 76 that changes the posture and height of the bed 71 is provided below the rotating mechanism. Lifting / tilting mechanism is 3
The linear actuator 77 is provided. The linear actuator 77 is composed of a motor assembled in a piston and a screw / nut mechanism that converts the rotation of the motor into a linear motion. A translation mechanism 78 for two-dimensionally translating the bed is provided below the lifting / tilting mechanism 76, and is installed on the operating room floor. The parallel moving mechanism includes an X-axis moving mechanism and a Y-axis moving mechanism. The Y-axis mechanism includes a support by a linear guide 79 and a ball screw mechanism 81 that converts the rotation of the motor 80 into linear motion. The X-axis mechanism has the same structure as the Y-axis mechanism, and is arranged below the Y-axis mechanism at right angles to the Y-axis mechanism. With these rotation mechanism, elevating / tilting mechanism, and parallel movement mechanism, the bed unit can perform three-dimensional parallel movement (x, y, z) and posture change (dx, d).
y, dz) and rotational movement θ in total of six degrees of freedom.

FIG. 12 shows a processing flow of the radiation operating power operating table system. The X-ray CT and MRI images of the affected part are projected with the coordinate markers attached to the patient by the fixing device (step T1). An irradiation target position is determined from a tomographic image or a three-dimensional image of the affected part (step T).
2). As shown in FIG. 13, the three-dimensional coordinates of the irradiation target Pt are determined from the position of the coordinate marker 65 imprinted simultaneously with the trunk. Next, the patient is moved to the irradiation room, and is fixed to the powered operating table by a fixing device. Assuming that the relationship between the fixator and the operating table is known, three-dimensional coordinates on the operating table at the target site are determined. The position, inclination and rotation of the bed are calculated from the determined irradiation target position and the irradiation direction specified by the operator. Each motor of the power operating table is driven based on the calculation result.

In this powered operating table system for radiation therapy, the irradiation direction can be automatically controlled, so that irradiation can be performed while changing the angle with respect to the irradiation target Pt, as shown in FIG. Thus, the radiation exposure of the tissue other than the irradiation target can be reduced. FIG.
As shown in FIG. 5, even when the irradiation target Pt is scattered in a plurality of sites, the irradiation position can be automatically changed, so that irradiation can be performed simultaneously in one treatment, and the treatment time can be reduced. Shortening can be done.

FIGS. 16 and 17 relate to tweezers capable of automatically distinguishing nerves from other tissues, particularly to an extracerebral tweezers system.

The extracerebral tweezers system is used for conventional microsurgery, that is, tweezers for pinching nerves and blood vessels or separating tissues, since there is no means for distinguishing nerves from other tissues. This is based on the fact that it takes a great deal of time and effort to distinguish nerves from other tissues, and a mechanism that stimulates nerves at the tip of tweezers and this stimulation And a mechanism for detecting an electroencephalogram that changes due to the change.

More specifically, the external tweezers system 83 includes bipolar tweezers 84, a stimulator 86 connected to the bipolar tweezers 84 through a lead wire 85, and an electroencephalogram connected to a patient via electrodes 88. 87 in total.

According to this tweezers system 83 for external use, when a weaker electrical stimulus is applied than the bipolar tweezers 84 and the nerve N touches the tip of the bipolar tweezers 84 when the brain tissue R is dissected, the electroencephalogram changes. appear. The change of the brain wave is transmitted to the electroencephalograph 8 through the electrode 88.
7 is detected.

As a result, when the nerve N touches the tweezers 84, it is immediately detected, and especially when the brain tissue is dissected,
The burden on the operator can be greatly reduced and the treatment time can be shortened.

FIG. 18 shows a tweezers system 83a for external use according to the modification, in which a film battery 89 is directly attached to the tweezers.

An electric current flows from the film battery 89 to the tweezers, and the nerve can be stimulated by the electric current, so that there is no need to provide a separate stimulating device. For this reason, the movement of the tweezers is not restricted by the lead wire or the like, and the operation becomes extremely simple.

FIGS. 19 and 20 show a nerve block system. This nerve block system requires a long time and burdens the surgeon because the nerve block that has been used for the treatment of nervous stomach ulcers in the past was searching for the nerve and blocking it one by one. This is to improve the situation that it was large, and it can be done in a short time and lighten the burden on the operator.

The nerve block system comprises a laparoscope,
It is characterized by comprising a nerve identification probe, a nerve block treatment tool, and one or more forceps, and automating nerve identification and nerve block.

That is, as shown in FIG. 19, a bed 90 for accommodating a patient P is provided with a laparoscope 91, a nerve identification probe 92, forceps 93 and a treatment tool 94, respectively.
The posture or position of each treatment tool is controlled by a main controller 98 that controls the rotation of the joints of the holders 95. Code 96
Denotes a high-frequency power supply, and reference numeral 97 denotes an observation device. The high-frequency power supply 96 and the observation device 97 are similarly controlled by the main controller 98.

The nerve block by this nerve block system is performed as follows.

As shown in FIG. 20, the hardness of the stomach tissue is measured along the stomach surface by the nerve identification probe 92 while observing the treatment area through the laparoscope 91 by the observation device 97. Nerve cells are identified because their axon sheaths are harder than normal cells. Then, the nerve identified by the treatment tool 94 is burned and blocked. The forceps 93 grips the stomach to facilitate a series of operations.

FIGS. 21 and 22 show a lymph node separation system, particularly a lymph node separation system which can be performed in a short time and has a small burden on the operator.

Conventionally, since the surgeon carefully searched for and removed lymph nodes (where the cancer had metastasized), it took a very long time, and the burden on the surgeon was great.

On the other hand, the illustrated lymph node separation system comprises a laparoscope, a lymph node identification probe, and a processing device for lymph node isolation, and identifies lymph nodes (cancer) and identifies lymph nodes. This is an automated quarantine.

As specifically shown in FIG. 21, a bed 90 for accommodating a patient P has a laparoscope 91 and an ultrasonic probe 9.
2A, the forceps 93 and the treatment tool 94 are held by holders 95, respectively, and the posture or position of each treatment tool is controlled by the main controller 98 that controls the rotation of the joint of each holder 95. Reference numeral 96 denotes a high-frequency power supply, and reference numeral 97 denotes an observation device. The high-frequency power supply 96 and the observation device 97 are similarly controlled by the main controller 98. Reference numeral 92B in FIG. 21 denotes an ultrasonic observation apparatus, reference numeral L in FIG. 22 denotes a lymph vessel , and reference numeral m denotes a lymph node.

The nerve block by this nerve block system is performed as follows. Laparoscope 9 by observation device 97
While observing the affected part through 1, the lymph node that has become cancerous is identified by the ultrasonic probe 92A. Then, the lymph vessels L are clipped so as to isolate the cancerous lymph nodes. The lymph vessels are cauterized and resected with the treatment tool 94 to remove the cancerous lymph nodes.

According to the lymph node separation system, it is extremely easy to identify cancerous lymph nodes, it is possible to perform treatment in a short time, and the burden on the operator can be reduced.

FIG. 23 relates to a nerve identification system, particularly a nerve identification system used for brain surgery.

In conventional brain tumor surgery, it is difficult to identify the facial nerve, which requires time for treatment.
Because of the heavy burden on the surgeon, there was a great demand for improvement.

A nerve identification system that meets such a demand provides a system that can easily identify facial nerves, particularly during surgery for brain tumors, and monitors the facial expressions of patients during surgery. It is characterized by the provision of a device that can be used.

That is, in this nerve identification system, a patient's head is fixed with a head fixing device 100, and treatment is performed with a treatment manipulator 102 while observing the inside with a rigid endoscope 101. The treatment manipulator 102 is a master 103
The operator performs a required treatment through the treatment manipulator 102 while operating the handle of the master 103. And the video camera 104 is placed on the ceiling,
Image processing device 105 together with an image signal from rigid endoscope 101
Is displayed on the head mount display 106.

When the operator operates the computer on the master 103 side, the expression of the patient photographed by the video camera 104 is displayed on the window 107 of the head mount display 106.
It is projected to. The surgeon performs an operation while looking at the image of the affected part from the rigid endoscope 101 and the facial expression of the patient displayed on the window 107. When the treatment manipulator 102 touches the patient's facial nerve, a check symptom appears on the patient's face, which is recognized as the facial nerve.

Thus, it is possible to efficiently perform an operation on a required site.

[0074]

As is apparent from the above, according to the present invention,
By performing the exfoliation in the surgical operation while detecting the exfoliation force, the required part can be exfoliated accurately and reliably, and the burden on the operator can be greatly reduced.

[Brief description of the drawings]

FIG. 1 is an explanatory view schematically showing the entire structure of a peeling treatment tool according to an embodiment of the present invention.

FIG. 2 is an explanatory view showing the operation of the peeling treatment tool of FIG. 1;

FIG. 3 is an explanatory diagram of a polypectomy manipulator.

FIG. 4 is an explanatory view showing the overall structure of the power surgery system.

FIG. 5 is a view schematically showing an internal structure of a power operating table.

FIG. 6 is an explanatory diagram of a force sensor used in the power surgery system in FIG. 4;

FIG. 7 is an explanatory view of a force acting on the manipulator on the power operating table of FIG. 5;

FIG. 8 is a flowchart showing the operation of the power surgical system of FIG. 4;

FIG. 9 is an explanatory view showing an outline of a powered operating table system for radiation therapy.

FIG. 10 is an explanatory view of an irradiation room of the powered operating table for radiation treatment in FIG. 9;

FIG. 11 is an explanatory diagram showing the internal structure of a power operating table used in the radiotherapy power surgery second system in FIG. 9;

FIG. 12 is a flowchart of a process in the radiation operating power operating table system of FIG. 9;

13 is an explanatory diagram of a state in which a position of an irradiation target is determined in the powered operating table for radiation treatment system of FIG. 9;

FIG. 14 is an explanatory diagram when irradiating another irradiation target.

FIG. 15 is an explanatory diagram in the case of irradiating another irradiation target.

FIG. 16 is an explanatory diagram of an extracerebral tweezers system.

FIG. 17 is an explanatory diagram of a case where a treatment is performed by the extracerebral tweezers system of FIG. 16;

FIG. 18 is a diagram showing a modification of the extracerebral tweezers system of FIG. 16;

FIG. 19 is a schematic diagram of a nerve block system.

FIG. 20 is an explanatory diagram showing an example of a treatment using the nerve block system of FIG. 19;

FIG. 21 is a schematic diagram of a lymph node separation system.

FIG. 22 is an explanatory diagram of a treatment example by the lymph node separation system of FIG. 21;

FIG. 23 is a schematic explanatory diagram of a nerve identification system.

[Explanation of symbols]

DESCRIPTION OF SYMBOLS 1 ... Peeling treatment tool, 2 ... Tip part, 2a ... Arm part, 3 ... Insertion part, 4 ... Link mechanism, 5 ... Housing, 6 ... Driving means,
7 ... motor, 8 ... coupling, 9 ... drive screw, 10 ...
Nut member, 11 rod member, 12 micro switch, 13 force sensor, 14 control means, 15 peeling force detection circuit, 16 comparison circuit, 17 smoothing circuit, 18 subtraction circuit, 19 motor drive circuit.

──────────────────────────────────────────────────続 き Continuing on the front page (72) Naoki Uchiyama 2-43-2 Hatagaya, Shibuya-ku, Tokyo O-limpus Optical Co., Ltd. (72) Yasuhiro Ueda 2-43-2 Hatagaya, Shibuya-ku, Tokyo Inside the Olympus Optical Co., Ltd. (72) Inventor Sakae Takehata 2-43-2 Hatagaya, Shibuya-ku, Tokyo Inside the Olympus Optical Co., Ltd. (72) Koichi Umeyama 2-43-2, Hatagaya, Shibuya-ku, Tokyo No. Within Olympus Optical Co., Ltd. (72) Inventor Yuichi Ikeda 2-43-2 Hatagaya, Shibuya-ku, Tokyo Inside Olympus Optical Co., Ltd. (72) Inventor Akihiro Horii 2-43-2, Hatagaya, Shibuya-ku, Tokyo No. Olympus Optical Co., Ltd. (56) References JP-A-5-208014 (JP, A) JP-A-62-19379 (JP, A) JP-A-5-168584 (JP, A) JP-A-5-38327 (JP, A) JP-A-63-147449 (JP, A) JP-A-4-231943 (JP, A) (58) (Int.Cl. ⁷ , DB name) A61B 17/28 A61B 1/00 334 G02B 23/24

Claims (4)

(57) [Claims] An insertion portion to be inserted into a body, and a peeling member provided at a distal end of the insertion portion and capable of performing a mechanical operation.
Separating means, operating means for operating the mechanical operation of the peeling means, and a surface of the peeling means so as to be capable of contacting the body tissue in the body.
A pressing portion having a pressing surface formed on the pressing portion; and a pressing portion provided on the pressing portion for measuring a force applied to the pressing surface.
And a peeling force detecting means . 2. The operating means according to claim 1 , further comprising:
The operating force of the operating means by moving
2. The method according to claim 1, further comprising an operating force transmitting means for transmitting the operating force to the peeling means.
The stripping treatment tool according to the above. 3. A method according to claim 1, wherein said measurement is based on a force measured by said peeling force measuring means.
Operating the operating means, and mechanically operating the peeling means.
2. The peeling process according to claim 1, further comprising control means capable of controlling the peeling.
Fixture. 4. The method according to claim 1, wherein the peeling means is operated by the operating means.
And a pair of arms that relatively open and close in response to each other.
Or the peeling treatment tool according to 2.