JP3708147B2 - Surgical microscope - Google Patents

Description

[0001]
[Industrial application fields]
The present invention relates to a surgical microscope provided with observation means such as an endoscope capable of observing a blind spot.
[0002]
[Prior art]
In recent years, with the development of surgical techniques and surgical tools, microsurgery has been frequently performed. In this microsurgery, a surgical microscope is used to enlarge and observe the surgical site.
[0003]
In general, the surgical microscope includes a mirror having a binocular optical system for performing stereoscopic viewing, and the mirror can be held in a three-dimensional manner by an arm attached to a gantry. ing.
[0004]
By the way, in microsurgery in neurosurgery and otolaryngology, the surgical part (affected part) is often deep in the body cavity, and it is necessary to perform surgery with minimal invasiveness. The affected part is observed with the surgical microscope facing the incision hole. Since the affected part is observed through such a small incision hole, even if the observation direction of the surgical microscope is changed as much as possible, there are parts that are difficult to observe, that is, parts that become blind spots. Therefore, recently, in order to observe such a blind spot, a technique using a mirror and an endoscope is becoming widespread.
[0005]
In general, when using a mirror, an operator can visually observe a blind spot by inserting the mirror into a small incision hole while holding the mirror with one hand, or The reflected image is magnified and observed with a surgical microscope.
[0006]
In addition, when using an endoscope, an operator directly inserts the insertion portion of the endoscope into a minute incision hole while holding the endoscope with one hand, so that a part that becomes a blind spot is directly set. Observation is performed through an eyepiece of the endoscope, or an endoscope image captured by an imaging means built in or attached to the endoscope is observed by a TV monitor.
[0007]
By the way, when observing a blind spot using an endoscope in combination, particularly when using a fiberscope (flexible endoscope), the operation part of the endoscope is held with one hand and the other hand is used. Therefore, the distal end portion of the insertion portion of the endoscope must be held. Therefore, since both hands are closed, it is very difficult to perform an operation such as removing the surrounding tissue in order to reach the distal end portion of the endoscope to a part that becomes a blind spot.
[0008]
Even when a rigid endoscope is used, observation must be performed while holding the eyepiece of the rigid endoscope with one hand, so that workability is poor, operation time is prolonged, and operator fatigue is increased. In addition, there is a risk of damaging the surgical site with the tip of the rigid endoscope, and the surgeon has been forced to work very carefully.
[0009]
In this case, since an endoscope is used in addition to a surgical microscope, it is necessary to set many accessory devices such as a light source device for an endoscope and a TV monitor. As a result, the operating room becomes complicated, and the working efficiency of the surgeon, nurse, or the like for the operation deteriorates.
[0010]
Japanese Laid-Open Patent Publication No. 6-196 proposes a surgical microscope that has solved the above drawbacks. As shown in FIG. 10, this surgical microscope is constructed by attaching a rigid mirror 104 to a mirror body 102 of a surgical microscope supported by an arm 100 of a gantry via an adapter 103 for attaching an endoscope. This is very advantageous in that the operator does not need to hold the eyepiece 105 of the rigid endoscope 104. In this configuration, the endoscope attachment adapter 103 to which the rigid mirror 104 is attached can be rotated around the optical axis O of the mirror body 102. When observation is performed with the rigid mirror 104, the endoscope attachment adapter 103 is provided. The adapter 103 is rotated to place the rigid endoscope 104 at the observation position shown in the figure from the retracted position.
[0011]
Further, in the publication, as shown in FIG. 11, an endoscope insertion hole 120 is provided in a gripping arm 117 attached to a body 112 of a surgical microscope, and a fiber scope 118 is inserted into the hole 120. A configuration is shown in which the distal end portion of the fiberscope 118 is held by the endoscope distal end holding arm 119 and the endoscope distal end holding tool 110. This configuration is also very advantageous in that the operator does not need to hold the fiberscope 118 when observing a blind spot using the fiberscope 118.
[0012]
[Problems to be solved by the invention]
By the way, in the case of the conventional configuration shown in FIG. 10, since the rigid endoscope 104 needs to observe the blind spot in the observation visual field by the surgical microscope, the distal end of the rigid endoscope 104 is located on the surgical site side from the body 102 of the surgical microscope. It protrudes greatly. In addition, although the relative position between the mirror body 102 and the rigid mirror 104 is fixed, the observation optical axis O of the mirror body 102 and the observation optical axis of the rigid mirror 104 do not match. Therefore, when observing with the rigid endoscope 104, the operator operates the arm 101 of the gantry of the surgical microscope under the naked eye to move three-dimensionally, and be careful not to damage the surgical site with the rigid endoscope 104. While paying, the tip of the rigid endoscope 104 must be guided to a position where the blind spot of the surgical site can be observed.
[0013]
In the configuration of FIG. 10, when the rigid endoscope 104 is in the observation position, the distal end portion of the rigid endoscope 104 has a larger moment with respect to the rotation axis of the arm 101 than the mirror grip 106 held by the operator. Therefore, it is necessary for the operator to operate the lens grip 106 with great care. In particular, if the arm 101 is inadvertently moved while observing a blind spot using the rigid endoscope 104, the distal end of the rigid endoscope 104 may come into contact with the affected area and damage the affected area. Also, when changing the observation position of the rigid endoscope 104 or removing the rigid endoscope 104, the operator must pay close attention so as not to damage the surgical site at the distal end of the rigid endoscope 104.
[0014]
As described above, according to the configuration shown in FIG. 10, when the surgical site is observed with the rigid endoscope 104, the surgeon is required to pay close attention and a large burden, resulting in a long operation time.
[0015]
On the other hand, in the case of the conventional configuration shown in FIG. 11, it is necessary to move the endoscope distal end holding arm 119 in order to guide the distal end portion of the fiber scope 118 to the blind spot in the observation field of the operation microscope. Also, when the observation direction of the fiber scope 118 is changed, the endoscope tip holding arm 119 must be operated by holding the vicinity of the endoscope tip holding tool 110 by hand. In this case, since the endoscope distal end holding arm 119 and the fiberscope 118 held by the endoscope protrude greatly from the mirror body 112 toward the surgical site, the surgical site is not damaged by the distal end of the fiberscope 118 or the like. Therefore, it is necessary to pay sufficient attention to changing the alignment of the microscope and changing the observation position of the fiber scope 118. Such a careful operation results in interruption of the operation flow, which is not only very burdensome for the surgeon but also burdens the patient by extending the operation time.
[0016]
In addition, the situation described above has the same problem even in the case of a mirror regardless of only the endoscope.
The present invention has been made by paying attention to the above circumstances, and an object of the present invention is to provide a highly safe surgical microscope that does not damage the surgical site by observation means.
[0017]
[Means for Solving the Problems]
In order to solve the above problems, the present invention Surgical microscope Includes first observation means for observing the test object, second observation means for sharing at least one optical element of the optical system of the first observation means, and the first and second observation means. Holding means for movably holding the observation means in an arbitrary position and direction in the three-dimensional space, detection means for detecting that the second observation means is in an observable state, and detection information from the detection means On the basis of the Operation of the first or second observation means in a direction approaching an object to be rubbed Limiting means for limiting the above.
[0018]
[Action]
In the above configuration, the second observation means Is in an observable state The surgeon accidentally First or second observation means Even if you try to move it by mistake, etc. Operation of the first or second observation means in a direction approaching the object to be rubbed Is limited, First or The surgical site is not damaged by the second observation means.
[0019]
【Example】
Embodiments of the present invention will be described below with reference to the drawings. 1 to 5 show a first embodiment of the present invention.
FIG. 1 schematically shows an overall configuration of a surgical microscope 1 according to the present embodiment. As shown in the figure, the surgical microscope 1 has two observation means, that is, a mirror body 25 as a microscope main body and a rigid endoscope (endoscope) 32 attached thereto.
[0020]
One end of a horizontal arm 21 is attached to the upper end of the gantry 20 of the surgical microscope 1 so as to be rotatable about an axis a. One end of a pantograph arm 23 is rotatably attached to the other end of the horizontal arm 21 via a member 22. In this case, the pantograph arm 23 can be rotated around an axis b (vertical axis) and an axis c (horizontal axis) orthogonal to each other as shown in the figure.
[0021]
Further, one end of the mirror arm 24 is attached to the other end of the pantograph arm 23 so as to be rotatable about a vertical axis d. A mirror body 25 is supported on the mirror arm 24 so as to be rotatable and capable of being raised and lowered. In other words, the mirror body 25 can rotate around the axis e, which is the central axis of the mirror arm 24, and can rotate about the axis f orthogonal to the axis e to perform the elevation operation.
[0022]
Each rotating unit described above can be balanced by a balance adjusting unit (not shown). By rotating the arms 21, 23, 24 by these rotating portions, the observation position and the observation direction of the mirror body 25 can be set to a desired position and a desired direction in the three-dimensional space.
[0023]
As shown in FIG. 2, the mirror body 25 incorporates a binocular optical system (not shown) with the axis g as the center of the optical axis. Further, a microscope light guide 27 is attached to the mirror body 25. By supplying illumination light from a light source (not shown) to the mirror body 25 through the microscope light guide 27, the illumination light is supplied to the surgical unit. The stereoscopic observation image of the surgical part can be obtained through the eyepiece part of the mirror body 25.
[0024]
Further, an endoscope attachment adapter 28 is rotatably attached to the lower end of the mirror body 25. The adapter 28 can be rotated around the optical axis center g of the binocular optical system. Further, a stopper (not shown) is provided at the lower end of the mirror body 25 to position the adapter 28 at the storage position indicated by the solid line in FIG. 2 and the observation position indicated by the broken line in FIG. Therefore, the endoscope attachment adapter 28 can be rotated in the direction of the arrow shown in FIG. 2 between the storage position (solid line position) and the observation position (broken line position).
[0025]
FIG. 3 shows details of the endoscope mounting adapter 28. As shown in the figure, the endoscope mounting adapter 28 includes an adapter main body 28 a that rotates relative to the mirror body 25, and an endoscope guide that is rotatably connected to the adapter main body 28 a via a ball joint 30. 31. The endoscope guide 31 has an insertion hole 31a through which the insertion portion of the rigid endoscope 32 can be inserted, and the insertion portion of the rigid endoscope 32 can be inserted into the insertion hole 31a so that the rigid endoscope 32 can be supported. It has become. Further, a knob 33 is provided at the part of the ball joint 30 of the endoscope mounting adapter 28. By loosening the knob 33, the ball joint 30 is brought into a free state and attached to the endoscope guide 31. The rigid endoscope 32 can be directed in a desired direction. An operation weight adjustment handle 34 is attached to the endoscope guide 31, and the weight of sliding and rotating operations of the rigid endoscope 32 can be adjusted by this handle 34.
[0026]
Note that an endoscope light guide 35 is connected to the rigid endoscope 32 attached to the endoscope attachment adapter 28, and illumination light from a light source device (not shown) is transmitted to the rigid endoscope 32 via the light guide 35. By supplying the illuminating light to the surgical site, the observation image of the surgical site can be obtained through the eyepiece of the rigid endoscope 32.
[0027]
Next, the rotation mechanism of the pantograph arm 23 will be described with reference to FIGS. 4 and 5.
In FIG. 4, reference numeral 22 denotes a member for connecting the pantograph arm 23 and the horizontal arm 21. Arm shafts 40 and 40 (axis c) project in a direction orthogonal to the longitudinal direction of the pantograph arm 23 on both side surfaces of the base end portion of the pantograph arm 23 connected to the member 22. These arm shafts 40 and 40 projecting from both side surfaces of the pantograph arm 23 are separately fitted and supported in bearings 41 and 42 fixed to the left and right sides of the member 22, and rotate integrally with the pantograph arm 23. Can be done.
[0028]
An armature 45 is positioned on the pantograph arm 23 side with respect to the bearing 41 and is slidably fitted and inserted into the arm shaft 40 protruding from one side surface of the pantograph arm 23. The armature 45 is non-rotatably attached to the arm shaft 40, and rotates integrally with the arm shaft 40 and the pantograph arm 23. Further, the armature 45 is supported on the pantograph arm 23 by a spring 44.
[0029]
Between the bearing 41 and the armature 45, an electromagnetic brake 43 fixed to the member 22 is disposed in a state of being fitted and inserted into the arm shaft 40, and is opposed to the armature 45 via a minute gap z.
[0030]
Such a structure is provided in all of the rotating portions that rotate about the axes a to f.
Here, the electromagnetic brake provided in each rotation part which rotates centering on the axis | shafts af will be demonstrated easily. The electromagnetic brakes (except for an electromagnetic clutch 46 described later) of each rotating unit are electromagnetically controlled by operating a switch (not shown) of a grip 26 (see FIG. 1) attached to the mirror body 25. That is, when the switch is in the OFF state, no current is supplied to the electromagnetic brakes of the rotating shafts a to f, so that the armature that rotates integrally with the arms 21, 23, 24 and the mirror body 25 is provided. It is electromagnetically attracted to the electromagnetic brake. Therefore, the rotation of the arms 21, 23, 24 and the mirror body 25 is prevented (locked). When the switch is turned on, current is supplied to the electromagnetic brakes of the rotation axes a to f, and the armatures that rotate integrally with the arms 21, 23, 24 and the mirror body 25 are moved from the electromagnetic brakes. Get away and free. Therefore, each of the arms 21, 23, 24 and the mirror body 25 can freely move to a desired position and direction, whereby the observation position and the observation direction of the mirror body 25 can be easily changed. The observation position and the observation direction of the mirror body 25 thus changed can be reliably held by turning the switch off again and locking the arms 21, 23, 24 and the mirror body 25.
[0031]
Such an operation will be specifically described below by taking the operations of the armature 45 and the electromagnetic brake 43 as an example. First, since the current is not supplied to the electromagnetic brake 43 when the switch of the grip 26 is in the OFF state, the armature 45 is electromagnetically attracted and locked to the electromagnetic brake 43 against the spring force of the spring 44. . Accordingly, the arm shaft 40 and the pantograph arm 23 that rotate integrally with the armature 45 are prevented from rotating, and the member 22 and the pantograph arm 23 are fixed.
[0032]
The locked state of the armature 45, that is, the electromagnetic adsorption action of the electromagnetic brake 43 is released by supplying current to the electromagnetic brake 43 by turning on the switch. When the armature 45 is unlocked, the armature 45 is slid by the distance z toward the pantograph arm 23 along the axial direction of the arm shaft 40 by the elastic force of the spring 44 and returned to its free initial position. It is. Therefore, the pantograph arm 23 can freely rotate around the axis c.
[0033]
The switch provided on the grip 26 is connected to a control unit (not shown) built in the gantry 20. Based on a control signal from the control unit, a current is supplied from a current supply source (not shown) to the electromagnetic brake via a cable (not shown). Further, the switch provided on the grip 26 is normally in an OFF state, and the electromagnetic brakes (except for an electromagnetic clutch 46 described later) provided on the respective rotation axes a to f are normally not supplied with current. Is in a state. Accordingly, the arms 21, 23, 24 and the mirror body 25 are normally in a locked state.
[0034]
Further, as shown in FIG. 4, an armature 47 is positioned on the pantograph arm 23 side of the bearing 42 on the arm shaft 40 protruding from the other side surface of the pantograph arm 23 and is slidably fitted and inserted. Yes.
[0035]
An electromagnetic clutch 46 fixed to the member 22 is disposed between the bearing 42 and the armature 47 in a state of being fitted and inserted into the arm shaft 40, and is opposed to the armature 47 via a minute gap y. As will be described later, when current is supplied to the electromagnetic clutch 46, the armature 47 is electromagnetically attracted to the electromagnetic clutch 46.
[0036]
The arm shaft 40 is inserted into a bearing 48 fixed to the member 22 at a position closer to the pantograph arm 23 than the armature 47. A gear 49 having teeth cut inside is rotatably attached to the inner surface of the bearing 48, and the arm shaft 40 is inserted inside the gear 49. In this configuration, the armature 47 is connected to the gear 49 through the spring 52.
[0037]
Details of the bearing 48 are shown in FIG. As illustrated, the arm shaft 40 is provided with a claw 50 that can swing around a shaft 55. The claw 50 rotates integrally with the arm shaft 40 and is abutted against the inner surface of the gear 49 by a spring 51 attached to the arm shaft 40 to mesh with the teeth of the gear 49. In this case, the claw 50 meshes with the gear 49 in such a manner that the gear 49 rotates only in one direction with the rotation of the arm shaft 40 and does not rotate in the opposite direction. That is, when the arm shaft 40 rotates in one direction (clockwise in the drawing), the gear 49 that meshes with the claw 50 rotates in the rotation direction along with this rotation, but the arm shaft 40 rotates in the opposite direction (see FIG. When it rotates counterclockwise, the meshing state of the claw 50 and the gear 49 is released, and only the claw 50 is rotated.
[0038]
When the arm shaft 40 rotates clockwise in the figure, the pantograph arm 23 rotates downward, and when the arm shaft 40 rotates counterclockwise in the figure, the pantograph arm 23 rotates upward.
[0039]
By the way, a micro switch 29 is provided at a storage position of the endoscope attachment adapter 28 (position indicated by a solid line in FIG. 2). The microswitch 29 is provided in the vicinity of a stopper (which has already been described) for positioning the adapter 28 at the storage position. The micro switch 29 is pressed by the adapter 28 only when the adapter 28 is located at the storage position. The current supply to the electromagnetic clutch 46 is controlled by the operating state of the microswitch 29.
[0040]
That is, the microswitch 29 is connected to the control unit built in the gantry 20 via a cable (not shown), and when the microswitch 29 is pressed by the adapter 28 (the adapter 28 is positioned at the storage position). In the ON state), no current is supplied to the electromagnetic clutch 46, but when the adapter 28 is removed from the storage position and the micro switch 29 is not pressed by the adapter 28 (OFF state), the control unit is used. Thus, an electric current is supplied to the electromagnetic clutch 46. That is, unlike the other electromagnetic brakes, the electromagnetic clutch 46 is electromagnetically controlled only by turning on / off the micro switch 29 regardless of turning on / off of the switch of the grip 26.
[0041]
When the micro switch 29 is in the OFF state (the adapter 28 is out of the storage position), the electromagnetic brakes of the rotating shafts a to f excluding the electromagnetic brake 43 regardless of whether the switch of the grip 26 is ON or OFF. No current is supplied to the.
[0042]
Next, the operation of the surgical microscope 1 having the above configuration will be described. First, the surgeon punctures the living body while stereoscopically observing the surgical site using a binocular optical system (not shown) built in the mirror body 25 with the adapter 28 placed in the storage position. The affected area P is approached through the micro incision hole H. At this time, the surgeon operates the switch (not shown) provided on the grip 26 to send a signal to the control unit (not shown) built in the gantry 20. When the switch is turned ON, the control unit is configured to release an electromagnetic brake (electromagnetic clutch 46) provided in the rotation unit so as to make the rotation unit of the shafts a to f normally locked. Current). As a result, the armature that has been electromagnetically attracted to the electromagnetic brake is in a free state, and the surgeon can freely rotate the rotating portions of the axes a to f, that is, the arms 21, 23, 24 and the mirror body 24. Thus, the observation position and the observation direction of the mirror body 25 can be changed, and a desired site of the surgical site can be observed.
[0043]
In this free state, the claw 50 attached to the arm shaft 40 rotates as the arm shaft 40 as the shaft c rotates. Further, in this state, since the adapter 28 is disposed at the storage position and the micro switch 29 is turned on, no current is supplied to the electromagnetic clutch 46 built in the shaft c, and therefore the armature 47 is moved to the electromagnetic clutch 46. Therefore, the gear 49 that meshes with the claw 50 can also rotate with the arm shaft 40 without being restricted by the armature 47.
[0044]
By the way, when the surgical field to be observed by the surgeon reaches the deep part of the body cavity, the inner surface and the inner side that are vignetted by the minute incision hole H even if the observation position and the observation direction are changed by operating the arms 21, 23, 24. A blind spot such as the back side of a blood vessel that cannot be observed with a microscope appears. In this case, the surgeon observes the blind spot using the rigid endoscope 32 in order to observe the remaining of the tumor or the clipping state of the aneurysm.
[0045]
When observing a blind spot using the rigid endoscope 32, first, the endoscope attachment adapter 28 is moved from the storage position to the observation position. When the endoscope mounting adapter 28 is moved from the storage position to the observation position, the microswitch 29 that has been pressed by the endoscope mounting adapter 28 is switched from the ON state to the OFF state, and the state is switched by a cable (not shown). 20 is transmitted to a control unit incorporated in the control unit 20.
[0046]
When the control unit detects that the micro switch 29 is in the OFF state, the control unit is provided in each of the rotation units of the axes a, b, and d to f regardless of the state of the switch (not shown) installed in the grip 26. The current supply to the electromagnetic brake is stopped, and the arms 21 and 24 and the mirror body 25 are locked. At this time, the electromagnetic brake 43 installed on the shaft c is electromagnetically controlled by the ON / OFF state of a switch (not shown) installed on the grip 26, regardless of whether the micro switch 29 is on or off. When the micro switch 29 is turned off in this way, current is supplied to the electromagnetic clutch 46 of the shaft c to which no current has been supplied, and the armature 47 that has been free until then is attracted to the electromagnetic clutch 46 and locked. Is done. Therefore, the gear 49 connected to the armor chair 47 via the spring 52 is also locked. As a result, the arm shaft 40 cannot rotate in the clockwise direction in which the claw 50 and the gear 49 are engaged, but can rotate only in the counterclockwise direction. That is, the pantograph arm 23 can rotate only in the upward direction and cannot rotate in the downward direction.
[0047]
In this state, the operator moves the endoscope attachment adapter 28 to the observation position, and then operates the knob 33 to release the ball joint 30 and adjust the observation direction of the rigid endoscope 32. Next, the operator operates the operation weight adjustment handle 34 attached to the guide 31, slides the rigid endoscope 32 up and down along the guide 31, and guides it to a desired observation position. Observe the blind spot.
[0048]
At this time, even if the operator / assistant or other observer mistakenly turns on the switch provided on the grip 26, as described above, the operations of the axes a, b, d to f are repeated. Since no current is supplied to the electromagnetic brake provided in the moving part, the arms 21 and 24 and the mirror body 25 hold the locked state. In this case, on the axis c, the current is supplied to the electromagnetic brake 43 by turning on the switch, and the armature 45 is in a free state. However, the armature 47 continues to supply current to the electromagnetic clutch 46. , It remains locked. Therefore, the gear 49 connected to the armor chair 47 via the spring 52 is also locked. That is, the pantograph arm 23 still rotates only upward, but cannot rotate downward.
[0049]
As described above, in the surgical microscope 1 of the present embodiment, when the endoscope attachment adapter 28 to which the rigid endoscope 32 is attached is arranged at the observation position, the arm (pantograph arm 23) that supports the mirror body 25 is rotated. Since the direction is limited only in the upward direction, the affected part P is caused at the distal end of the rigid endoscope 32 due to an erroneous operation of the surgical microscope 1 during endoscopic observation in which the rigid endoscope 32 protrudes from the mirror body 25 and when the endoscope is introduced. There is no risk of hurting.
[0050]
In this embodiment, the means (microswitch 29) for detecting the observation state by the rigid endoscope 32 is provided in the endoscope mounting adapter 28. However, the rigid endoscope 32 is inserted into the guide portion 31 for setting the rigid endoscope 32. Detection means for detecting the protrusion amount of the part may be provided, and the movement of the arm may be limited based on the detection result. That is, for example, as shown in FIG. 6, the photo interrupter 61 is provided in the guide 31 provided at the distal end portion of the endoscope mounting adapter 28, and the light shielding plate 60 is provided in the insertion portion of the rigid endoscope 32.
[0051]
In this case, the light shielding plate 60 does not block the photo interrupter 61 when the insertion portion of the rigid mirror 32 is sufficiently drawn (when the amount of protrusion from the mirror body 25 is small), and the insertion portion of the rigid mirror 32 is not a mirror. It is provided at a position where the photo interrupter 61 is blocked when it is located in an observation state that largely protrudes from the body 25. The photo interrupter 61 is connected to a control unit (not shown) built in the gantry 20.
[0052]
Therefore, in this configuration, when the rigid interrupter 32 is fully retracted and the photo interrupter 61 is not blocked by the light shielding plate 60, when a switch (not shown) provided on the grip 26 is pressed, the shaft Current is supplied to the electromagnetic brakes provided on the axes a to f, so that each arm is in a free state. Therefore, the mirror body 25 can be moved to a desired position.
[0053]
Further, when the rigid endoscope 32 is lowered along the guide 31 to be positioned in the observation state, the photo interrupter 61 is blocked by the light shielding plate 60, so that the control unit built in the gantry 20 blocks the photo interrupter 61 from light. This is detected, and the movement of the arm is limited only to the upward direction of the axis c as in the above-described embodiment.
[0054]
In this embodiment, a rigid mirror is used as an attached observation means. However, the same effect as in the above-described embodiment can be obtained even if a mirror is used instead of the rigid mirror.
Further, in the present embodiment, the detection of whether the rigid endoscope 32 is located at the observation position or the storage position is limited to drive the mirror 25 and the arm that supports the rigid endoscope 32. A proximity sensor or a contact sensor may be provided at the tip of 32, and the drive of the arm may be limited by the output. For example, an ultrasonic sensor is provided at the tip of the rigid endoscope 32, the distance between the rigid endoscope 32 and the affected part P is detected by the ultrasonic sensor, and the movement of the arm is limited when the value approaches a predetermined distance. . Alternatively, a touch sensor is provided at the distal end portion of the rigid endoscope 32, and when the distal end of the endoscope comes into contact with any object, the touch sensor detects it, and the movement of the arm is detected on the axis c as in the previous embodiment. Limit to direction only. It is obvious that the same effect as the above-described embodiment can be obtained by this method.
[0055]
As described above, when an ultrasonic sensor or a touch sensor is used, the work of rough orientation setting of the rigid endoscope 32 can be performed by driving the arm of the surgical microscope 1, thereby improving workability. There is an effect that the operation time can be shortened.
[0056]
In addition, when an ultrasonic sensor or a touch sensor is provided in this way, it is possible to easily detect the approaching direction or contact direction of the affected part, so that the direction of the affected part can be displayed in the microscope visual field or on the monitor. This makes it possible for the surgeon to recognize the danger in advance.
[0057]
Further, a display for notifying the operator that the movement of the arm is restricted may be performed in the microscope visual field or on the monitor. Further, the operator may be notified by sound that the movement of the arm is restricted. As a result, the surgeon can smoothly proceed with the operation and has the effect of reducing fatigue.
[0058]
7 and 8 show a second embodiment of the present invention.
In the conventional configuration of FIG. 11 introduced at the beginning of this specification, if the angle operation of the tip of the fiberscope 118 is performed by an operating means (not shown) such as an eyepiece of the fiberscope 72, both hands are blocked. It becomes difficult to perform treatment. Further, even if the fiberscope 118 having the electric angle mechanism is used, there is no change in operating the switch at hand, and there is a similar problem. In addition, even when the electric angle mechanism is operated by a foot switch or the like, it is a troublesome task to determine the one for the electric angle among many foot switches in addition to the foot switch of the surgical microscope. Moreover, when using an endoscope with an adjustment mechanism such as aiming, zooming, and dimming, it is necessary to adjust them in parallel with the observation of the surgical microscope, which is very troublesome. Is.
[0059]
Therefore, the purpose of this embodiment is to make the input means of the electric drive part of the surgical microscope 25 as the first observation means the same as the input means of the electric drive part of the fiberscope as the second observation means, It is to improve the operability of both.
[0060]
FIG. 7 is an overall configuration diagram of the surgical microscope 1 ′ according to the present embodiment, and FIG. 8 is a block diagram of a control unit provided in the gantry 20 of the surgical microscope 1 ′. The same members as those in the first embodiment are denoted by the same reference numerals and the description thereof is omitted.
[0061]
As shown in FIG. 7, one end of a horizontal arm 21 is attached to the upper end of the gantry 20 of the surgical microscope 1 ′ so as to be rotatable about an axis a. One end of a pantograph arm 23 is rotatably attached to the other end of the horizontal arm 21 via a member 22. In this case, the pantograph arm 23 can be rotated around an axis b (vertical axis) and an axis c (horizontal axis) orthogonal to each other as shown in the figure.
[0062]
A mirror body 25 is attached to the other end of the pantograph arm 23 via an XY driving device 80 so as to be rotatable about a vertical axis d. A grip 26 is attached to the side surface of the mirror body 25. When a switch (not shown) provided on the grip 26 is operated, an electromagnetic brake (not shown) built in the shafts a, b, c and d is activated. The mirror 25 can be arranged at a desired position in the three-dimensional space, as in the first embodiment described above.
[0063]
A grip arm 75 is attached to the lower end of the mirror body 25, and a fiber scope 72 is inserted into the endoscope insertion hole 75 a of the grip arm 75. The grip arm 75 is slidable between an observation position shown and a storage position not shown. Although not shown in FIG. 7, there is provided a micro switch 87 (see FIG. 8) that is pressed only when the gripping arm 75 is stored in the storage position.
[0064]
Further, the distal end portion of the fiber scope 72 excluding the angle portion 73 is held by an endoscope distal end holding arm 71 and an endoscope distal end holding tool 74 provided on the grasping arm 75. The fiberscope 72 has an electric angle mechanism (not shown), and a control unit 91 (see FIG. 8) of the electric angle mechanism is built in the gantry 20.
[0065]
A foot switch 81 is connected to the gantry 20. The foot switch 81 is provided with seesaw switches 83 and 84 for operating a focus mechanism (not shown) and a zoom mechanism (not shown) provided on the mirror body 25 and a joystick switch 85 for operating the XY drive device 80. ing. Control units 88, 89, and 90 that control the focus mechanism, the zoom mechanism, and the XY drive device 80 are built in the gantry 20 (see FIG. 8).
[0066]
As shown in FIG. 8, the seesaw switch 83 for operating the focus mechanism is directly connected to a focus mechanism control unit 88 built in the gantry 20, and the seesaw switch 83 for operating the zoom mechanism. Are also directly connected to a zoom mechanism control unit 89 built in the gantry 20.
[0067]
A joystick switch 85 for operating the XY driving device 80 is connected to a switching circuit 86 built in the gantry 20, and an XY driving device controller 90 is connected to a normally closed terminal of the switching circuit 86. Yes. The electric angle mechanism control unit 91 is connected to a terminal on the normally open side of the switching circuit 86. Further, the signal output of the micro switch 87 provided in the mirror body 25 is input to the switching circuit 86.
[0068]
Next, the operation of the surgical microscope 1 ′ having the above configuration will be described. First, the surgeon approaches the affected area using the surgical microscope 1 '. At that time, the surgeon grasps the grip 26 provided on the lens body 25 and further operates a switch (not shown) provided on the grip 26 to make the axes a to d free so as to be the observation point of the affected part. Rough alignment of the mirror body 25 is performed. This is the same as in the first embodiment. Furthermore, the surgeon uses the seesaw switches 83 and 84 provided on the foot switch 81 to change the focusing and observation magnification.
[0069]
When performing a delicate movement of the visual field, a joystick switch 85 provided on the foot switch 81 is operated. At this time, since the grip arm 75 holding the fiber scope 72 is in the storage position, the micro switch 87 is pressed, and the signal is input to the switching circuit 86 built in the gantry 20. In this state, since the contact of the switching circuit 86 is connected to the normally closed side, the joystick switch 85 is connected to the XY drive device controller 90. Accordingly, when the surgeon operates the joystick switch 85, a control signal is sent to the XY drive device control unit 90, and the XY drive device 80 is driven in a direction desired by the surgeon. Become.
[0070]
A blind spot portion (such as a deep part in the body cavity) that cannot be observed by the microscope 25 is observed by the fiberscope 72. In this case, first, the gripping arm 75 is moved from the storage position to the illustrated observation position. At this time, the microswitch 87 installed in the mirror body 25 is opened, and the switching circuit in which the signal is built in the gantry 20 is opened. 86. When the switching circuit 86 receives this input signal, the contact is switched to the normally open side. Therefore, the joystick switch 85 is connected to the electric angle mechanism control unit 91.
[0071]
In this state, the operator operates the endoscope distal end holding arm 71 to insert the distal end portion of the fiberscope into the body cavity and observe the blind spot site. When the operator wants to change the observation direction of the fiberscope 72, the operator operates the joystick switch 85 to send a control signal to the electric angle mechanism control unit 91. As a result, the angle portion 73 of the fiber scope 72 is driven in a direction desired by the operator, and the observation direction is changed.
[0072]
When the gripping arm 75 is arranged at the observation position as described above, the driving of the horizontal arm 21 and the pantograph arm 23 is restricted in the same manner as in the first embodiment, and in addition, the XY driving device 80. Driving is also prohibited.
[0073]
As described above, the surgical microscope 1 ′ of the present embodiment has the XY drive device 80 because the XY drive device 80 is disconnected from the joystick switch 85 during observation by the fiberscope 72 in addition to the effects of the first embodiment. There is no risk of erroneous operation of the 80, and the safety is further improved.
[0074]
Further, the surgical microscope 1 ′ of the present embodiment includes a microscope body 25 that is a first observation means, and a fiberscope that is a second observation means for observing a blind spot portion that cannot be observed by the microscope body 25. 72, and a control unit 90 of an XY driving device 80 that is an electric visual field moving device of the microscope body 25, an electric angle control unit 91 that is an electric visual field moving device of the fiberscope 72, and an XY driving device. A joystick switch 85 which is a common input means for outputting an operation signal to the control unit 90 and the electric angle control unit 91, and for selectively outputting the operation signal to the XY drive device control unit 90 or the electric angle control unit 91. And a selection means 86, so that it can be operated as compared with a configuration in which a switch provided on the eyepiece of the fiberscope 72 is operated. Sex is much better.
[0075]
Further, the operating means 85 for operating the XY driving device 80 of the microscope body 25 and the electric angle of the fiber scope 72 having the same function in terms of the visual field moving mechanism is integrated into one switch, that is, the joystick switch 85. Since one of them can be operated by one, the surgeon can operate without a sense of incongruity. Further, when the fiberscope 72 is used, there is no need to newly provide a switch, so that the system can be configured at a low cost. Furthermore, such a method of sharing the same function by one switch is not limited to the visual field moving mechanism, but is applied to a magnification changing mechanism, a focusing mechanism, an exposure mechanism of a photographing apparatus, a dimming mechanism of an illumination apparatus, and the like. Also good.
[0076]
Further, if the seesaw switch 83 and the seesaw switch 84 also perform operations such as air supply / water supply / suction of the fiber scope 72 by the same method, more efficient observation can be performed.
[0077]
FIG. 9 shows a third embodiment of the present invention. In addition, the same code | symbol is attached | subjected about the member same as a 1st Example and a 2nd Example, and the description is abbreviate | omitted.
As illustrated, the mirror body 25 includes an objective lens 64, a pair of zoom optical systems 62, 62, a pair of half mirrors 79, 79, a pair of imaging lenses 78, 78, and a pair of eyepieces 77, 77, and these constitute a stereoscopic optical system. A TV adapter 96 is connected to an arbitrary side surface of the mirror body 25, and the TV adapter 96 receives reflected light from the half mirrors 79 and 79 built in the mirror body 25.
[0078]
A mirror 76 is built in the TV adapter 96. The mirror 76 is normally set at a position where the reflected light from the half mirrors 79, 79 is reflected upward in the TV adapter 96. An imaging lens 65 and a TV camera 98 are attached to the upper surface of the TV adapter 96, and an imaging element (not shown) of the TV camera 98 is positioned at the imaging position of the imaging lens 65.
[0079]
The mirror 76 built in the TV adapter 96 is operated by operating a mirror operation knob 97 fixed to the mirror 76 between a normal position indicated by a solid line in the figure and an endoscope observation position indicated by a broken line in the figure. The shaft 99 can be rotated as a fulcrum. A micro switch 95 is attached inside the TV adapter 96. The microswitch 95 is positioned so as to be pressed only when the mirror 76 is set at the endoscope observation position.
[0080]
A fiberscope 72 is attached to the lower surface of the TV adapter 96, and an observation optical axis (not shown) of the fiberscope 72 coincides with an optical axis (not shown) of the imaging lens 65. The distal end portion of the fiber scope 72 is held by an endoscope tip holding arm 71 and an endoscope tip holding tool 74.
[0081]
A pump 93 is connected to the fiber scope 72, and a physiological saline container 94 is attached to the pump 93. The pump 93 is controlled by a pump control unit 92.
[0082]
A half mirror 66 is provided in front of the light source 67. The half mirror 66 can be positioned on the optical axis of the light source 67 (shown by a solid line in the figure), and can be moved to a position off the optical axis (shown by a broken line in the figure). That is, it can move substantially perpendicular to the optical axis of the light source 67. Therefore, the half mirror 66 is connected to a half mirror control unit 59 that controls the moving operation.
[0083]
Part of the light from the light source 67 passes through the half mirror 66, enters the light guide 63, and is guided to the affected part (not shown) through the mirror body 25. The light from the light source 67 reflected by the half mirror 66 is input to a light guide (not shown) of the fiber scope 72 through the aperture 68 and guided to the tip of the fiber scope 72. The diaphragm 68 is connected to the diaphragm control unit 69.
[0084]
The foot switch 81 is connected to the switching circuit 86. The normally closed terminal of the switching circuit 86 is connected to the focus mechanism control unit 88, the zoom mechanism control unit 89, and the XY drive device control unit 90 built in the gantry 20. Further, the normally open terminal of the switching circuit 86 is connected to the electric angle control unit 91, the pump control unit 92, the half mirror control unit 59, and the aperture control unit 69. Further, the microswitch 95 is connected to the switching circuit 86 and an arm control unit (not shown) built in the gantry 20. The arm control unit controls the driving of the rotating unit of the arm (each arm shown in the first and second embodiments) that supports the mirror body 25.
[0085]
Next, the operation of the surgical microscope having the above configuration will be described. First, the surgeon observes the affected area through the microscope body 25. At this time, all of the observation light emitted from the light source 67 enters the light guide 63 and is guided to the mirror body 25, and is projected from the mirror body 25 to an affected area (not shown). The reflected light from the affected part enters the mirror body 25 through the objective lens 64 and reaches the half mirror 79 through the zoom optical system 62. 50% of the incident light incident on the half mirror 79 is transmitted upward as it is, and the remaining 50% is reflected in the side surface direction of the mirror body 25. The observation light transmitted above the half mirror 79 is imaged by the imaging lens 78. Therefore, the surgeon can observe the image as a stereoscopic image by enlarging the image with the eyepiece 77.
[0086]
The observation light reflected to the side of the half mirror 79 is incident on the TV adapter 96 and then reflected by the mirror 76 to form an image on the imaging lens 65, that is, on an image pickup device (not shown) built in the TV camera 98. To do. That is, the same image as the microscopic image observed by the operator is projected onto a monitor (not shown). At this time, since the micro switch 95 built in the TV adapter 96 is in an open state, this signal is input to the switching circuit 86. In this state, since the contact point of the switching circuit 86 remains connected to the normally closed side, the foot switch 81 includes a focus mechanism control unit 88, a zoom mechanism control unit 89, and an XY drive device control unit 90 built in the gantry 20. The surgeon can operate a focus drive unit, a zoom drive unit, and an XY drive unit 80 (not shown) using the foot switch 81. Furthermore, an arm (not shown) that supports the mirror body 25 can also be moved to an arbitrary position in the three-dimensional space.
[0087]
Next, when the operator uses the fiberscope 72 to observe the blind spot of the microscope, the endoscope tip holding arm 71 is operated to position the tip of the fiberscope 72 at a desired observation position. Next, the mirror operation knob 97 provided in the TV adapter 96 is operated to set the mirror 76 to the endoscope observation position (position indicated by a broken line in the figure). As a result, the micro switch 95 built in the TV adapter 96 is pressed, and the signal is input to the switching circuit 86. When the switching circuit 86 receives the signal that the microswitch 95 is pressed, the switching circuit 86 switches the contact to the normally open side. As a result, the foot switch 81 is disconnected from the control units 88, 89, 90 of the microscope, and is connected to the electric angle control unit 91, the pump control unit 92, the half mirror control unit 59, and the aperture control unit 69, respectively.
[0088]
When the half mirror control unit 59 is connected to the foot switch 81, the half mirror 66 is moved on the optical axis. Therefore, the observation light incident on the mirror body 25 becomes 50%, and the remaining illumination light is incident on the fiberscope 72. The illumination light incident on the fiberscope 72 is emitted from the tip of the fiberscope 72 by a light guide means (not shown), and can be observed with the fiberscope 72.
[0089]
At this time, the surgeon operates the foot switch 81 to send a signal to the diaphragm control unit 69, and controls the diaphragm 68 provided on the illumination optical path of the fiberscope 72 according to the observation site, the operator's preference, and the like. Is possible. As in the second embodiment, the angle angle of the fiber scope 72 can be changed using the foot switch 81 via the electric angle control unit 91. Further, it is possible to send a signal to the pump control unit 92 by a foot switch to perform operations such as water supply and suction. Also in this embodiment, when the fiberscope 72 is in the observation state, the movement of the arm is limited as in the first embodiment.
[0090]
As described above, the surgical microscope according to the present embodiment has the same effects as those of the first and second embodiments, and the image of the microscope 25 serving as the first observation unit and the second observation unit. Therefore, the arm can be easily locked in accordance with the output of the detecting means 95.
[0091]
Further, the surgical microscope according to the present embodiment includes a switching unit 86 that is operated by the detection unit 95 and that can perform all operations related to the endoscope, such as light amount adjustment, water supply, and suction, with the foot switch 81 of the microscope. Therefore, the operator does not need to hold the fiberscope 72 even during endoscopic observation, and can devote both hands to the operation, which greatly improves the efficiency of the operation. In addition, even when the fiberscope 72 is not used for observation, it is possible to perform water supply and suction using the foot switch 81 by a simple operation.
[0092]
In addition, according to the aspect demonstrated above, the various structure shown by the following items is obtained.
1. First observation means for observing the test object, second observation means for sharing at least one optical element of the optical system of the first observation means, and first and second observations In a surgical microscope having holding means for holding the means movably in an arbitrary position and direction in a three-dimensional space,
Surgery comprising: detection means for detecting that the second observation means is in an observable state; and restriction means for restricting movement of the holding means based on detection information from the detection means. Microscope.
[0093]
2. 2. The surgical microscope according to claim 1, wherein the second observation means is used by projecting toward the test object side from the first observation means when observing the test object.
[0094]
3. The restricting means restricts the movement of the holding means so that when the second observing means is in an observable state, the second observing means can move only in a direction substantially opposite to the protruding direction. The surgical microscope according to item 2, characterized in that:
[0095]
4). In a surgical microscope having a first observation means for observing an object to be examined and a second observation means capable of observing a blind spot portion that cannot be observed by the first observation means,
A first control unit that controls the electric drive unit of the first observation unit; a second control unit that controls the electric drive unit of the second observation unit; the first control unit and the second control unit; An operation signal output means for outputting an operation signal to the control section; and an output selection means for selectively outputting the operation signal to the first control section or the second control section. Surgical microscope.
[0096]
In the configuration of the fourth aspect, when the first observation unit is used, the operation signal output unit is connected to the first control unit, and when the second observation unit is used. The operation signal output means is connected to the second control means.
[0097]
5. The surgical microscope according to item 4, wherein the electric drive unit of the first observation unit and the electric drive unit of the second observation unit have the same function.
6). The electric drive unit of the first observation unit and the electric drive unit of the second observation unit include a visual field moving mechanism, a zooming mechanism, a focusing mechanism, an exposure mechanism of the photographing apparatus, and a dimming mechanism of the illumination apparatus. 5. The surgical microscope according to item 4, which is any one of the above.
[0098]
7. A detection means for detecting which of the first observation means and the second observation means is in an observation state, and wherein the output selection means outputs the operation signal based on detection information from the detection means The surgical microscope according to item 5 or 6, wherein an output destination of an operation signal from the means is selected.
[0099]
According to the above configuration, since the first and second observation means can be controlled by the same input means, not only can the system be configured at low cost, but also the efficiency of the operation can be greatly increased.
[0100]
【The invention's effect】
As described above, in the surgical microscope of the present invention, when the second observation unit is in an observable state, the movement of the holding unit that holds the second observation unit is limited. The risk of damaging the patient by a simple microscope operation can be avoided. In addition, this greatly improves the safety of the operation, so that the operator can concentrate on the operation work, and the operation efficiency is greatly improved.
[Brief description of the drawings]
FIG. 1 is an overall configuration diagram of a surgical microscope according to a first embodiment of the present invention.
2 is an enlarged perspective view of a body part of the surgical microscope of FIG. 1. FIG.
3 is a perspective view showing details of an adapter provided at the lower part of the body of the surgical microscope of FIG. 1. FIG.
4 is a perspective view showing a rotation mechanism of a pantograph arm of the surgical microscope shown in FIG. 1. FIG.
5 is a front view of a bearing provided in the rotation mechanism of FIG. 4;
FIG. 6 is a schematic view showing detection means for detecting the protruding state of the rigid endoscope.
FIG. 7 is an overall configuration diagram of a surgical microscope according to a second embodiment of the present invention.
8 is a block diagram of a control unit provided in the gantry 20 of the surgical microscope of FIG.
FIG. 9 is an overall configuration diagram of a surgical microscope according to a third embodiment of the present invention.
FIG. 10 is a main part configuration diagram showing a conventional example of a surgical microscope.
FIG. 11 is a main part configuration diagram showing another conventional example of a surgical microscope.
[Explanation of symbols]
DESCRIPTION OF SYMBOLS 1 ... Surgical microscope, 21, 23, 24 ... Arm (holding means), 25 ... Mirror body (1st observation means), 29 ... Micro switch (detection means), 32 ... Rigid endoscope (2nd observation means) .

Claims (1)

A first observation means for observing the test object;
A second observing means that does not share at least one optical element of the optical system of the first observing means;
Holding means for holding the first and second observation means movably in an arbitrary position and direction in a three-dimensional space;
Detecting means for detecting that the second observing means is in an observable state;
Limiting means for limiting the movement of the first or second observing means in the direction approaching the object to be protected based on the detection information from the detecting means;
A surgical microscope characterized by comprising:

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