JP4047567B2 - Surgical system - Google Patents

Description

[0001]
BACKGROUND OF THE INVENTION
The present invention relates to a surgical system including an energy treatment device.
[0002]
[Prior art]
In recent years, in the medical field, a surgical operation system is configured by combining an observation apparatus and a surgical apparatus in accordance with a region to be operated or a procedure. As the observation device, an insertion portion inserted into the body cavity from the oral cavity or anus is a flexible endoscope, or an insertion portion disposed in the abdominal cavity via a trocar punctured in the abdominal wall is a rigid laparoscope (optical vision). Tube), and a microscope for operation that can observe fine nerves and blood vessels.
[0003]
On the other hand, as surgical devices, there are surgical devices driven by a power source in addition to surgical instruments such as grasping forceps and a scalpel. As a surgical apparatus driven by the power supplied from this power source, for example, a treatment tool is vibrated using ultrasonic vibration, and a living tissue as a target site is incised or coagulated by the vibration of the treatment tool, or crushed. There is an ultrasonic surgical device for suctioning, an electrosurgical device for incising and coagulating the target biological tissue by the thermal action of high-frequency power, a power treatment device for finely crushing the biological tissue with rotational force, etc. .
[0004]
As an example of a surgical system, in the field of neurosurgery, there is a surgical system under a microscope as a medical system in which a minute nerve or blood vessel is enlarged and observed under a microscope. In this surgical operation system under a microscope, treatment is performed by operating a handpiece or the like while observing an enlarged target portion through an eyepiece of a surgical microscope. For example, when performing treatment such as tumor crushing or excision, an energy treatment device such as an ultrasonic suction device is used. In this case, if the selection of the probe shape or output setting of the energy treatment tool to be used is not appropriate, there is a problem that the usability is reduced. In other words, experience was required to accurately select the probe shape and set the output.
[0005]
In order to solve the above-mentioned problems, the present applicant has proposed a surgical energy treatment system in Japanese Patent Application No. 2000-10920. In this surgical energy treatment system, the physical state of the tissue in the vicinity of the surgical site is automatically detected, and the setting of the energy treatment tool can be automatically performed from the detection result.
[0006]
[Problems to be solved by the invention]
However, inexperienced surgeons may make trial and error in selecting the probe shape of the energy treatment tool, setting the output, and the like, which has been a factor in lengthening the operation.
[0007]
The present invention has been made in view of the above circumstances, and an object thereof is to provide a surgical system capable of easily and accurately selecting a treatment tool and optimal settings even for an operator having little experience with a target case. .
[0008]
[Means for Solving the Problems]
  The surgical system of the present invention comprises:Treatment siteAn optical scanning probe for acquiring an optical diagnostic image at an arbitrary position ofTreatment siteIn a surgical system comprising an energy treatment tool for performing a treatment for, a recording unit for recording a diagnostic image acquired by the optical scanning probe;The predetermined acquired in advance by the optical scanning probeOf the treatment siteDiagnostic images and the relevantEnergy treatment device for treatmentAnd theTreatment toolofSetting stateincludingDiagnostic image database storing a plurality of treatment site images having treatment information, and the optical scanning probeAcquired byDiagnostic images and a plurality of diagnostic images stored in the diagnostic image databaseSaidTreatment site image andCompare operations by pattern matchingA comparison operation unit to perform,SaidComparison calculatorComparison by pattern matching inBased on the calculation result,A treatment site image most similar to the diagnostic image acquired by the optical scanning probe is selected from the treatment site images, and based on the treatment information related to the selected treatment site imageAn energy treatment instrument setting unit for setting conditions of the energy treatment instrument;It is characterized by comprising.
[0009]
In addition, the optical scanning probe includes a position detection unit that detects a position of the optical scanning probe with respect to the surgical site, and the comparison calculation unit includes the position information detected by the position detection unit and the position of the treatment site image accumulated in the diagnostic image database. Information is used as a parameter for calculation.
[0010]
Furthermore, a setting changing unit that changes the setting state of the energy treatment instrument to a desired state, and at least the setting value changed by the setting changing unit and the diagnostic image acquired by the optical scanning probe are stored in the diagnostic image database. Database registration means for registering as a treatment site image.
[0011]
According to this configuration, a treatment site image that most closely resembles the treatment site image is obtained from the diagnostic image database, and then, based on the treatment information of the treatment site image, the energy treatment tool is set via the energy treatment tool setting unit. Settings are made.
[0012]
In addition, the comparison operation unit compares the position data of the position detection unit and the position information of the treatment site image to obtain a treatment site image most similar to the treatment site image.
[0013]
Furthermore, the treatment information recorded in the treatment site image read from the diagnostic image database can be updated, and the treatment site image in which the updated treatment information is recorded is registered in the diagnostic image database.
[0014]
DETAILED DESCRIPTION OF THE INVENTION
Embodiments of the present invention will be described below with reference to the drawings.
1 to 7 relate to a first embodiment of the present invention, FIG. 1 is a diagram for explaining the configuration of a surgical microscope system, and FIG. 2 is a diagram for explaining the internal configuration of a binocular eyepiece tube portion that is a mirror body. 3 is a side view of FIG. 2, and is a diagram for explaining the configuration of the eyepiece optical system and the second observation optical system of the mirror body, FIG. 4 is a diagram for explaining the superposition unit, and FIG. FIG. 6 is a diagram illustrating an example of a treatment site image recorded in a database, and FIG. 7 is a diagram illustrating a microscope observation image and setting data displayed on a microscope.
[0015]
As shown in FIG. 1, the surgical system of the present embodiment is a surgical microscope system 1, which mainly includes a mirror body 2 attached to a gantry 3, and a measuring device 18 placed on, for example, a cart, An A / D converter 17, a workstation (hereinafter abbreviated as WS) 19, a monitor 16 and the like, and a digitizer (optical position detection device) 12 installed at a predetermined position in the operating room are mainly constituted. Yes. An endoscope camera control unit (not shown), an optical scanning probe, an observation device for the optical scanning probe, and the like are also installed.
The gantry 3 has a base 4 movable on the floor, a support column 5 standing on the base 4, and an end portion attached to the upper body portion of the support column 5 so as to be rotatable around an axis O1. A first arm 6 having a built-in illumination light source (not shown), a second arm 7 having one end mounted rotatably about an axis O2 provided at the other end of the first arm 6, and the second arm 7. The second arm 7 is mainly composed of a third arm 8 having one end portion pivoted about an axis O3 provided at the other end portion. The mirror body 2 is provided at the other end of the third arm 8. The mirror body 2 can be lifted in the front-rear direction with respect to the operator's observation direction around the axis O4 and can be lifted in the left-right direction around the axis O5.
[0016]
The second arm 7 is a pan-tilt farm including a link mechanism and a spring member for balance adjustment to perform an up / down movement operation. In addition, an electromagnetic brake (not shown) is provided at each of the rotating portions of the rotary shafts O1,..., O5 so that the mirror body 2 can be spatially freely adjusted and fixed. These electromagnetic brakes are connected to an electromagnetic brake power supply circuit (not shown) built in the column 5.
[0017]
The digitizer 12 includes two CCD cameras 13a and 13b that are receiving members, a camera holding member 14 that fixes the positions of the CCD cameras 13a and 13b, and a stand 15 that supports the camera holding member 14. ing.
[0018]
The CCD cameras 13a and 13b are connected to the measuring device 18, respectively. The measuring device 18 is connected to the WS 19 via the A / D converter 17, and the WS 19 is connected to the monitor 16.
[0019]
In the WS 19, tomographic image data obtained by an image diagnostic apparatus (not shown) such as CT and MRI, three-dimensional image data obtained by processing the tomographic image data and reconstructed into three dimensions are recorded in advance. .
[0020]
As shown in FIGS. 2 and 3, a pair of left and right imaging lenses 20 a and 20 b are arranged inside the fixed housing 20 constituting the mirror body 2. The imaging lenses 20a and 20b are optically connected to the observation optical system of the mirror 2 so that the left and right observation light beams emitted from the mirror 2 are incident.
[0021]
Reference numerals 21a and 21b are mirrors that respectively reflect the light beams through the imaging lenses 20a and 20b by 90 ° outward, and image rotator prisms 22a and 22b are arranged on the outgoing optical axes.
[0022]
Behind the image rotator prisms 22a and 22b are arranged prisms 23a and 23b that invert both observation light beams by 180 °. Triangular prisms 24a and 24b for reflecting the outgoing optical axis in the direction parallel to the observation optical axes OL and OR by an eyepiece optical system to be described later are arranged and fixed further behind the prisms 23a and 23b.
[0023]
The first intermediate image forming points 25a and 25b formed by the image forming lenses 20a and 20b are located behind the triangular prisms 24a and 24b. Are provided so that the upper surface portions of prisms 26a and 26b serving as light guide means, which will be described later, substantially coincide with each other, and relay lenses 27a and 27a for relaying images behind the first intermediate imaging points 25a and 25b. 27b is fixed. The prisms 23a and 23b, the triangular prisms 24a and 24b, and the relay lenses 27a and 27b are built in the movable housing 28.
[0024]
The movable housing 28 is rotatable about the axis OP, that is, around the incident optical axis of the prisms 23a and 23b, via the connecting portions 28a and 28b. The rotator prisms 22a and 22b can be rotated about the axis OP by a half angle with respect to the rotation of the movable housing 28 with respect to the fixed housing 20 by a cam mechanism or the like (not shown).
[0025]
Reference numerals 29a and 29b are incident prisms 30a and 30b and exit reflectors 31a and 31b, and are parallel prisms as reflecting members built in the eye width adjustment housings 7a and 7b. The images transmitted from the first intermediate imaging points 25a and 25b by the relay lenses 27a and 27b are respectively transmitted from the output reflecting surfaces 31a and 31b of the parallel prisms 29a and 29b to the second intermediate imaging points 32a and 32b. Is imaged. Then, the light is guided to a pair of eyepiece optical systems 33a and 33b built in the eyepiece housings 8a and 8b, and constitutes observation optical axes OR and OL as microscope optical observation images.
[0026]
Here, the eye width adjustment housings 7a and 7b are rotatable about an axis substantially coincident with the optical axis (vertical direction in the figure) emitted from the triangular prisms 24a and 24b with respect to the movable housing 28, and As shown in FIG. 3, the retaining members 34a and 34b (only reference numeral 34a in the drawing) are supported so as not to move in the axial direction. This structure and the parallel prisms 29a and 29b constitute a so-called Giten top eye width adjustment mechanism.
[0027]
On the other hand, as shown in FIG. 3, a second eyepiece housing 9 that houses the second observation optical system is provided outside the first observation optical system. The second observation optical system is arranged on a small LCD monitor 38 that displays an image of an endoscope or the like as an electronic image under the control of a controller (not shown), and an output optical axis OL2 from the LCD monitor 38. Relay optical systems 39 and 41, a prism 40 that reflects the optical axis OL2 disposed inside the relay optical systems 39 and 41 by approximately 90 °, and an optical axis reflected by the prism 40 is the observation optical axis. The second eyepiece optical system 42 is optically arranged and connected on the outgoing optical axis OL2 so that the observation optical axes OL and OL2 have their exit pupils. Cross each other near the position.
[0028]
The small LCD monitor 38 is disposed and fixed between the movable housing 28 below the eye width adjustment housing 7a. In addition, only the left optical path is shown in the figure, but the right optical path has the same configuration.
[0029]
As shown in FIG. 4, the mirror body 2 includes an objective optical system 44, a variable magnification optical system 45, and an eyepiece optical system, and each forms a pair of left and right optical paths. The objective optical system 44 is provided with a variable focus mechanism and a focal length detection sensor. The zoom optical system 45 is provided with a zoom mechanism and a zoom detection sensor.
[0030]
The mirror body 2 is provided with an optical path insertion means 46 and an image insertion optical system 47 formed of a half mirror. The image insertion optical system 47 converts the light beam emitted from the image superimposing monitor 48 into an afocal light beam to the optical path insertion means 46. It is made to enter. Reference numeral 48a denotes a cable for sending an image signal to an image superposition monitor (also referred to as a superposition LCD) 48.
[0031]
As shown in FIG. 5, the present system 1 includes an optical scanning probe 78 for observing, for example, a cell image, which is a diagnostic image of an operation site in which an index 78a that can be detected by the digitizer 12 is disposed, and an observation device 79 thereof. An ultrasonic suction device 81 to which a handpiece 82 as an energy treatment tool is connected, and a second workstation (hereinafter abbreviated as 2WS) 73 for recording diagnostic images and performing image processing are provided.
[0032]
The 2WS 73 includes a diagnostic image database (hereinafter abbreviated as DB) 74 that stores treatment site images, an image memory 75 that is a recording unit, a comparison calculation unit 76, and a treatment tool setting that is an energy treatment tool setting unit. An information generation unit 77 is provided. The comparison calculation unit 76 is connected to the DB 74, the treatment instrument setting information generation unit 77, the ultrasonic suction device 81, the image memory 75, and the WS 19. The observation device 79 is connected to the image memory 75. Further, an image generation unit 87 and an ultrasonic suction device 81 are connected to the treatment instrument setting information generation unit 77, and the LCD 38 for displaying an image is connected to the image generation unit 87.
[0033]
For example, data 83 as shown in FIG. 6 is recorded in the DB 74 as one of the treatment site images. The data 83 stores various information such as information on the treatment site, information on the case, image data 84 on the case, various set values 85 when the treatment is performed, and the shape 86 of the handpiece 82. . That is, the image acquired by the optical scanning probe and the type and setting condition of the handpiece when the treatment is performed with the image are combined into one data.
[0034]
The operation of the surgical microscope system 1 configured as described above will be described.
It is assumed that an operator who uses the system 1 is an operator who has little experience with respect to the target case.
[0035]
First, the surgeon moves the lens body 2 and adjusts so that the surgical site can be observed. Then, the observation optical system of the microscope is operated with a foot switch or the like (not shown) to start observation of the surgical site. Then, the surgeon uses the optical scanning probe 78 to obtain a diagnostic image of the surgical site as shown in Japanese Patent Application No. 2000-151090, for example, in order to perform cytodiagnosis of the surgical site.
[0036]
Then, the digitizer 12 detects the tip position of the optical scanning probe 78 by detecting an index 78 a attached to the optical scanning probe 78. For this reason, when a diagnostic image is acquired by the optical scanning probe 78, tip position information of the optical scanning probe 78 is transmitted to the image memory 75 via the WS 19 and the comparison calculation unit 76 together with the diagnostic image. A diagnostic image acquired by the surgeon is also transmitted from the observation device 79 to the image memory 75.
[0037]
That is, in the image memory 75, the diagnostic image acquired by the observation device 79 and the tip position information of the optical scanning probe 78 when the diagnostic image is acquired are combined and recorded as diagnostic image data.
[0038]
Next, the comparison calculation unit 76 acquires diagnostic image data from the image memory 75, and performs comparison calculation with treatment site image data stored in the DB 74. That is, the comparison calculation unit 76 performs pattern matching between the image group data stored in the DB 74 and the diagnostic image data acquired from the image memory 75.
[0039]
Then, by this pattern matching, for example, the data 83 shown in FIG. 6 which is treatment site image data most similar to the diagnostic image data is selected from the image group data in the DB 74. Then, information related to the condition setting of the treatment instrument is transmitted from the information stored in the data 83 from the comparison calculation unit 76 to the treatment instrument setting information generation unit 77.
[0040]
Next, the treatment instrument setting information generation unit 77 displays information for condition setting on the LCD 38 via the image generation unit 87 and transfers the information for setting to the ultrasonic suction device 81. At this time, the microscope being observed by the operator displays setting data 89 including output setting information and probe type information to be used via the second observation optical system, together with the microscope observation image 88 shown in FIG. Is done.
[0041]
On the other hand, in the ultrasonic suction device 81 to which information for setting is transferred, information transmitted from the treatment instrument setting information generation unit 77 is acquired. Thus, the setting of the ultrasonic suction device 81 is completed. Thereafter, the surgeon connects the probe B displayed (instructed) on the second observation optical system to the ultrasonic suction device 81 and starts the treatment of the surgical site.
[0042]
As described above, after the acquired diagnostic image is transmitted to the image memory, the comparison calculation unit acquires the diagnostic image data transmitted to the image memory, while performing the comparison calculation with the treatment site image data stored in the DB. And obtaining treatment site image data most similar to the diagnostic image data, so that the treatment tool setting information generation unit can provide information related to condition setting of the treatment tool from information stored in the treatment site image data. The condition of the treatment tool can be set optimally by transferring to the treatment tool.
[0043]
As a result, even an operator who has little experience with the target case can quickly and reliably set the energy treatment tool without trial and error, thereby shortening the operation time.
[0044]
Hereinafter, the second embodiment will be described.
The present embodiment is an embodiment in which the condition setting of the treatment section based on the treatment site image data obtained in the first embodiment is manually changed, and then the condition setting can be accumulated in a database. Further, in addition to the above contents, the display image position of the second observation optical system capable of displaying the condition setting of the treatment instrument can be changed.
[0045]
In this regard, the present applicant has proposed a surgical microscope in Japanese Patent Application No. 2000-193223. In this surgical microscope, the second observation optical system is provided as an observation optical system different from the observation optical system for the microscope, and the operator can set the energy treatment tool without taking his eyes off the microscope eyepiece. This is displayed on the second observation optical system so that it can be confirmed.
[0046]
However, if the display position of the second observation optical system is fixed in this surgical microscope, the image displayed on the second observation optical system is compared with the microscope observation image, or The display image of the second observation optical system does not need to be erased, but there is a problem that it cannot be used properly, for example, so as not to interfere with the observation of the microscope image.
[0047]
In the present embodiment, in addition to the first embodiment, the setting of the treatment instrument can be made manual, and the display position of the second observation optical system can be moved depending on the use state of the observation optical system. Yes.
[0048]
8 to 15 relate to the second embodiment of the present invention, FIG. 8 is a diagram for explaining another configuration of the surgical microscope system, and FIG. 9 is a side view for explaining the internal configuration of the binocular eyepiece tube. 10 is a diagram for explaining the relationship between the pinion gear and the rack, FIG. 11 is a view as seen from the direction of arrow A in FIG. 10, and FIG. 12 is a diagram for explaining a microscope observation image and a screen for changing the setting state of the ultrasonic suction device. FIG. 13 is a diagram illustrating a state in which the eyepiece housing is moved with respect to the movable housing, and FIG. 14 is a diagram illustrating a relationship between a microscope observation image and a screen by the second observation optical system before the eyepiece housing is moved. FIG. 15 is a diagram showing the relationship between the microscope observation image after the eyepiece housing moves and the screen by the second observation optical system.
Note that the surgical microscope system according to the present embodiment can manually set the conditions of the treatment tool, and the surgeon who uses the surgeon is experienced in the target case.
[0049]
As shown in FIG. 8, the surgical microscope system 1A of the present embodiment includes a superimposed image generation unit 80, a line-of-sight detection device 101, and a registration switch 102, and a DB information generation unit 100 is provided in 2WS73A.
In 2WS73A of the present embodiment, a DB information generation unit 100 is connected to the comparison calculation unit 76. The DB information generating unit 100 is connected to the DB 74, the registration switch 102, and the treatment instrument setting information generating unit 77.
[0050]
The treatment instrument setting information generation unit 77 is connected to a line-of-sight detection device 101 and a superimposed image generation unit 80. A superimposed LCD 48 is connected to the superimposed image generation unit 80. Other configurations are the same as those of the first embodiment, and the same members are denoted by the same reference numerals and description thereof is omitted.
[0051]
Further, as shown in FIG. 9, a pinion gear 104 is disposed in one surface 103 of the movable housing 28. Further, a knob (see reference numeral 200 in FIG. 11) for rotating the pinion gear 104 is provided at a predetermined position of the movable housing 28.
[0052]
On the other hand, on the eyepiece housing 9 side, a rack 106 formed in a predetermined curved shape that meshes with the pinion gear 104 is disposed. Further, the visual line detection device 101 is attached to the eyepiece portion of the eyepiece housing 9. As shown in FIG. 10, an elongated opening 107 is formed on the one surface 103, and a curved rack 106 protruding from the eyepiece housing 9 is engaged with the opening 107. That is, as shown in FIG. 11, the pinion gear 104 and the rack 106 are engaged with each other.
Other configurations are the same as those of the first embodiment, and the same members are denoted by the same reference numerals and description thereof is omitted.
[0053]
The operation of the surgical microscope system 1A configured as described above will be described.
Also in this embodiment, as in the first embodiment, first, the microscope is brought into an observation state. The diagnostic image obtained by the optical scanning probe 78 and the treatment site image data recorded in the DB 74 are compared and calculated by the comparison calculation unit 76 to set the ultrasonic suction device 81.
[0054]
When it is desired to change the setting of the ultrasonic suction device 81 before or during the treatment, the operator displays the setting state of the ultrasonic suction device 81 shown in FIG. 12 displayed on the second observation optical system. The user manually stares at the manual setting area 110 of the displayed screen 108.
[0055]
Then, the gaze detection device 101 provided in the eyepiece housing 9 detects that the operator is staring at the manual setting area 110. Then, the information is transmitted to the treatment tool setting information generation unit 77, and the treatment tool setting information generation unit 77 switches the setting state of the ultrasonic suction device 81 to a change mode in which manual change is possible.
[0056]
Then, the surgeon gazes at any of the setting change display areas 111, 112, 113, 114. Thereby, the setting condition of the ultrasonic suction device 81 can be changed by line-of-sight detection. Specifically, when the surgeon gazes at the setting change display area 111, the line-of-sight detection device 101 detects this and informs the treatment tool setting information generation unit 77 that the setting change display 111 is being viewed. introduce. Then, the treatment instrument setting information generation unit 77 transfers an instruction to raise the suction condition by 10% to the ultrasonic suction device 81, changes the setting of the ultrasonic suction device 81, and starts or restarts the treatment of the surgical part. The
As for detection by the visual line detection device 101, for example, there is an example as in Japanese Patent Publication No. 11-501403.
[0057]
On the other hand, the treatment instrument setting information generation unit 77 notifies the DB information generation unit 100 that the setting has been changed. Then, diagnostic image data compared with the treatment site image data is transmitted from the comparison operation unit 76 to the DB information generation unit 100.
[0058]
Here, when the surgeon determines that it is necessary to newly record the setting value whose setting has been changed, the registration switch 102 is pressed. Then, a set of information of diagnostic image data and setting conditions for the new ultrasonic suction device 81 corresponding to the diagnostic image data is transmitted to the DB 74 and newly registered as data in the form shown in FIG. .
[0059]
In this way, after an experienced surgeon changes the setting conditions by manual setting, the setting value and diagnostic image data are newly registered and stored, so that the treatment site image data registered in the database is upgraded. It can be performed.
[0060]
Note that when manual setting is performed by line-of-sight detection, it may be difficult to see the screen 108 by the second observation optical system. In this case, the knob 200 provided in the movable housing 28 is turned to rotate the pinion gear 104 in a predetermined direction. Then, by rotating the pinion gear 104, the rack 106 is moved, and the eyepiece housing 9 moves around the axis of the rack 106 while drawing an arc corresponding to the curved shape of the rack 106.
[0061]
As a result, the eyepiece housing 9 (dotted line in FIG. 13) arranged as shown in FIG. 9 before the movement of the eyepiece housing 9 moves away from the eyepiece optical system 33a as shown in FIG. 13 after the movement. Will be separated. Before and after the movement, the eye point between the microscope observation image and the image of the second observation optical system is always kept constant.
[0062]
For this reason, from the state (L) where the microscope observation image 88 and the screen 108 by the second observation optical system are separated as shown in FIG. 14, the microscope observation image as shown in FIG. 88 and the screen 108 by the second observation optical system come close to each other (l). Thus, the screen 108 by the second observation optical system does not interfere with the observation field of the microscope observation image 88.
[0063]
Therefore, when it is not anticipated that the setting conditions of the energy treatment tool are hardly changed, the microscope observation image 88 and the screen 108 are separated (L) as shown in FIG. Is expected, the microscope observation image 88 and the screen 108 are kept close to each other as shown in FIG. This reduces the operator's line of sight movement.
[0064]
Then, the energy treatment tool is set at the position of the second observation optical system in the state shown in FIG. 15, and then a preoperative image is secondly displayed on the observation optical system in order to confirm the position of the surgical site. After the display and the confirmation of the position, the second observation optical system is separated from the microscope observation image 88 (L) as shown in FIG. 14, and the observation of the microscope observation image 88 and the energy treatment are performed. Treat with tools.
[0065]
Thus, by changing the display position or angle of the second observation optical system, observation can be performed at a position desired by the operator.
[0066]
Hereinafter, a third embodiment will be described.
Japanese Examined Patent Publication No. 5-61612 discloses a drive control device that reduces the number of operation switches by using operation switches of a plurality of drive systems of a microscope. However, during the operation, it is desirable that the operator can perform treatment without taking his eyes off the eyepiece of the microscope, which can shorten the time.
[0067]
Further, when operating an energy treatment tool, an endoscope, etc. in addition to a microscope, if the number of operation switches such as a hand switch and a foot switch increases, naturally, the operator's switch operation becomes complicated. In particular, even if a foot switch is provided to switch the operation of the energy treatment tool and endoscope in addition to the microscope, the foot can be rubbed or the eye can be moved from the eyepiece to find a predetermined switch for switching. Must be released.
[0068]
Therefore, there has been a demand for a surgical microscope system capable of easily and surely switching by selecting a predetermined switch from among the operation switches without keeping an eye on the eyepiece.
[0069]
16 to 19 relate to the third embodiment of the present invention, FIG. 16 is a diagram for explaining another configuration of the surgical microscope system, and FIG. 17 is a diagram for explaining the relationship between the operation switch of the foot switch and the sensor. 18 is a diagram for explaining an endoscope switch position notification image displayed on a microscope image, and FIG. 19 is a diagram for explaining an ultrasonic switch position notification image displayed on a microscope image.
[0070]
As shown in FIG. 16, the operation control unit 122 of the surgical microscope system 1B of the present embodiment includes a microscope control unit 121 that performs drive control (zoom, focus, etc.) of a microscope optical system, and a microscope foot switch 125. A foot switch arrangement change setting unit (described as FS arrangement change setting unit in the figure) 123 that changes the function arrangement, an optical sensor detection unit 124, a superimposed image generation 80, and an ultrasonic suction device 81 are connected. . The optical sensor detection unit 124 is connected to an optical sensor A 126, an optical sensor B 127, an optical sensor C 128, and an optical sensor D 129 provided on the foot switch 125.
[0071]
On the other hand, a handpiece 120 having a switch 134 is connected to the ultrasonic suction device 81. The switch 134 is connected to the operation control unit 122 via the ultrasonic suction device 81. Note that a superimposed LCD 28 is connected to the superimposed image generation unit 80.
[0072]
As shown in FIG. 17, an optical sensor A 126 is installed in the operation switch 130 provided in the foot switch 125 of the surgical microscope. Similarly, the operation switch 131 is provided with an optical sensor B127, the operation switch 132 is provided with an optical sensor C128, and the operation switch 133 is provided with an optical sensor D129.
[0073]
When switching the setting state of the foot switch 125 to a state desired by the surgeon, for example, by switching a function switch (not shown) of the foot switch arrangement change setting unit 123, the operation switches 130, 131, 132, and 133 are switched. You can set the function.
[0074]
Specifically, in the case of microscope operation, four functions of focus up / down and zoom up / down can be arranged at arbitrary positions of the operation switches 130, 131, 132, 133, respectively.
[0075]
In the case of the ultrasonic suction device, four functions of water supply up / down and suction pressure up / down can be arranged at arbitrary positions of the operation switches 130, 131, 132, 133, respectively. Furthermore, in the case of an ultrasonic suction device, some switches can be assigned to focus up / down of the microscope, and the remaining switches can be assigned to suction pressure up / down of the ultrasonic suction device.
[0076]
Then, the set content is detected by the operation control unit 122 and transmitted to the superimposed image generation unit 80. Further, when the ultrasonic suction device is gripped, the switch 134 is operated so that the operation control unit 122 detects that, and the operation switches 130, 131, 132, 133 provided on the foot switch 125 are detected. At least a part of the controlled object is changed from the microscope side to the surgical instrument side.
[0077]
Thus, the superimposed image generation unit 80 generates a switch position notification image that notifies the function of the operation switch of the foot switch 125 according to the detection state of the operation control unit 122.
[0078]
The operation of the surgical microscope system 1B configured as described above will be described.
Similar to the above-described embodiment, first, the operator sets the microscope in the observation state. Then, the operator places his / her foot on the foot switch 125 in order to operate the observation optical system of the microscope. At this time, for example, when the operator's foot is placed on the operation switch 130 of the foot switch 125, the optical sensor 126 corresponding to the operation switch 130 reacts. As a result, the optical sensor detection unit 124 detects that the foot has been placed on the operation switch 130.
[0079]
Then, the optical sensor detection unit 124 transmits the detected position to the operation control unit 122 and transmits it to the superimposed image generation unit 80. In the superimposed image generation unit 80, the arrangement of the operation target switch of the foot switch 125 is transmitted to the superposition LCD 48, and the endoscope switch position notification image 137 is superimposed on the microscope observation image 88 as shown in FIG.
[0080]
At this time, the operation switch on which the foot is placed is displayed, for example, with a darker edge. Then, after confirming the operation target of the operation switch on which the foot is currently placed among the foot switches 125, the observation state of the microscope is changed.
[0081]
In addition, when using the ultrasonic suction device 81 and the handpiece 120 to treat the surgical site, the switch 134 installed on the handpiece 120 is operated. Then, the instruction signal at that time is transmitted to the operation control unit 122 via the ultrasonic suction device 81. Then, the operation control unit 122 switches the operation target of the foot switch 125 from the microscope side to the ultrasonic suction device 81 side, and sends an instruction signal to the superimposed image generation unit 80 to switch the superimposed image to be superimposed on the microscope observation image 88. The superimposed image is switched from the endoscope switch position notification image 137 to the ultrasonic switch position notification image 138 in the ultrasonic suction mode shown in FIG. In the ultrasonic switch position notification image 138, an operation assignment 138a of the foot switch 125 and a setting state 138b of the ultrasonic suction device are displayed.
[0082]
The edge of the display portion corresponding to the operation switch on which the operator's foot is placed is displayed darkly.
[0083]
As a result, the operator can know the positional relationship of the operation switches of the foot switch and the position of the operation switch currently operated and the operation switch to be switched without taking his eyes off the microscope eyepiece. The set value of the sonic suction device can be known.
[0084]
In this way, by confirming the positional relationship of multiple operation switches provided on the foot switch on the microscope image, it is possible to check the setting state of the operation switches provided on the foot switch without taking your eyes off. Can do.
[0085]
Further, even when the assignment of each operation switch of the foot switch is changed, the surgeon can confirm the operation target of the foot switch with a microscope image without taking his eyes off the eyepiece.
[0086]
Furthermore, the operator can easily confirm the desired switch operation in which direction the foot can be moved by checking the functional arrangement of the operation switches displayed in the surgical microscope field of view. Incorrect operation of the operation switch is reliably prevented.
[0087]
In addition, when the surgical instrument is gripped, the control unit switches at least a part of the control object of the foot switch from the microscope to the surgical instrument by performing a switch operation. It can be performed.
[0088]
In the present embodiment, the setting of the treatment instrument has been described. However, the present invention may be applied to setting changes (focus, zoom, image rotation, etc.) of the endoscope and the ultrasonic observation apparatus. In addition, this time, the switch between the microscope and the treatment tool is shown by the switch provided on the treatment tool, but the same effect can be obtained even if the use state of the probe is detected by the acceleration sensor provided on the probe. it can.
[0089]
By the way, the fifth and sixth embodiments of Japanese Patent Application No. 2000-194807 presented by the present applicant show a form in which endoscopic observation and ultrasonic observation are performed simultaneously with observation with a surgical microscope. Observation can be performed by displaying an endoscopic observation image in the visual field and an ultrasonic observation image in the second observation optical system.
[0090]
However, when using an observation device such as a surgical microscope, an endoscope, an ultrasonic device, etc. during surgery, if each image is displayed without correlation between the devices, each image is displayed by another device. It is hard to understand which position corresponds from the viewpoint.
[0091]
For this reason, there has been a demand for a surgical microscope system that displays correlation between observation images in an easy-to-understand manner by correlating the positional relationship between images obtained by the respective observation apparatuses.
[0092]
Hereinafter, a fourth embodiment will be described.
In the present embodiment, attention is focused on the following objects.
[0093]
For observation of the surgical site, various observation devices such as an operation microscope, an endoscope for observing the blind spot of the operation microscope, and an ultrasonic observation device are used. When various observation devices are used in this way, it is difficult for an operator to understand the correspondence between the observation positions. In this embodiment, the surgeon clearly shows the correlation between the observation position of the surgical microscope, the observation image of the endoscope used for blind spot observation of the surgical microscope, and the ultrasonic image obtained by the ultrasonic observation apparatus. Is aimed at.
[0094]
20 to 31 are related to a fourth embodiment of the present invention. FIG. 20 is a diagram showing the external appearance of a microscope body part and an endoscope connecting / holding device. FIG. 21 is a view showing a microscope body part and an endoscope. FIG. 22 is a view for explaining the connection in the vicinity of the sterilization adapter, FIG. 23 is a view for explaining the endoscope inserted into the sterilization adapter, and FIG. FIG. 25 is a diagram for explaining a configuration of a main part of the ultrasonic observation system, FIG. 25 is a diagram for explaining a scope holder of the ultrasonic observation system, FIG. 26 is a diagram for explaining a system including an ultrasonic probe and its peripheral devices, and FIG. FIG. 28 is a diagram illustrating another configuration of the surgical microscope system, FIG. 28 is a diagram illustrating a state in which the ultrasound probe is moved up and down, and FIG. 29 is a diagram illustrating a state in which the probe holding portion of the ultrasound probe is disposed upward. FIG. 30 shows an example of a display screen. Description figures, FIG. 31 is a diagram for explaining another example of the display screen.
[0095]
As shown in FIGS. 20 to 22, an endoscope connecting / holding device 55 is pivotally supported on the microscope body 2 so as to be rotatable about an axis B as a displacement means. The flange 142a arranged in the microscope body part 2 prevents the endoscope connection / holding device 55 from coming out of the microscope body part 2. Thereby, the endoscope connecting / holding device 55 is rotatable around the axis B with respect to the microscope body part 2.
[0096]
In FIG. 21, the endoscope connecting / holding device 55 is provided with a casing 55 a that houses a fixing screw 56 for fixing the endoscope connecting / holding device 55 to the microscope body part 2. The fixing screw 56 is provided with a flange 56 a for preventing it from coming off, and is biased toward the microscope body part 2 by a compression spring 57. The microscope body 2 is provided with female screws 21a and 21b that face the fixing screw 56 when the endoscope connecting / holding device 55 is in a horizontal state.
[0097]
Here, a camera head is disposed on the axis B in the microscope body 2, and an optical element such as a lens or a prism is disposed on the axis B in the endoscope connection / holding device 55 in a direction facing the camera head. An observation optical system 58 (shown by a thick solid line) is arranged.
[0098]
Since the observation optical system 58 and the camera head are both coaxially arranged on the axis B, the endoscope connection / holding device 55 rotates (on the axis B) with respect to the microscope body 2. However, it is possible to rotate only the image without decentering. The direction of the observation optical system 58 is changed by an optical element such as a prism (not shown) and guided to the tip C of the endoscope connection / holding device 55.
[0099]
In FIG. 21, a light guide fiber 53 is arranged on the left side of the axis B in the microscope body 2. In the endoscope connecting / holding device 55 facing the light guide fiber 53, a first illumination light transmission unit 59 is provided. A second illumination light transmission unit 60 is provided at a position point-symmetric to the first illumination light transmission unit 59 with respect to the axis B. For these illumination light transmission parts 59, 60, for example, plastic single fibers are used. These are also guided to the distal end of the endoscope connecting / holding device 55, and the first illumination light transmission unit 59 is disposed on the front side with respect to the paper surface, and the second illumination light transmission unit 60 is disposed on the back side with respect to the paper surface. . That is, in FIG. 20, the 1st illumination light transmission part 59 is located in the upper side, and the 2nd illumination light transmission part 60 is located in the lower side.
[0100]
On the other hand, when the endoscope connection / holding device 55 is set on the opposite side of the position shown in FIGS. 20 and 21 with respect to the microscope body 2, the endoscope connection / holding device 55 is rotated 180 degrees around the axis B. The light guide fiber 53 is opposed to the second illumination light transmission unit 60, the second illumination light transmission unit 60 is disposed on the upper side, and the first illumination light transmission unit 59 is disposed on the lower side. Become. That is, the illumination transmission part facing the light guide fiber 53 is always located on the upper side.
[0101]
Returning to FIG. 20, reference numeral 61 denotes an image rotation ring for rotating the transmission image of the observation optical system 58. The image rotation ring 61 rotates an image rotator (not shown) in the observation optical system. Reference numeral 62 denotes a zoom ring, which enlarges or reduces an image by moving a zoom lens (not shown) in the observation optical system 58 in the axial direction.
[0102]
On the other hand, reference numeral 50 denotes an eccentricity adjustment knob, which has an X adjustment knob 50a, a Y adjustment knob 50b, and a Z adjustment knob 50c. The Y adjustment knob 50b is provided so as to penetrate in the vertical direction so that the knob can be operated from the upper side even when it is turned to the opposite side around the axis B. The X adjustment knob 50a and the Y adjustment knob 50b correct the eccentricity of the transmission image between the endoscope and the observation optical system 58 by moving an adjustment lens (not shown) in the observation optical system 58 in the X and Y directions. The adjustment knob 50c adjusts the focus between the endoscope and the observation optical system 58 by moving a focus lens (not shown) in the observation optical system 58 in the axial direction.
[0103]
These knobs 50a, 50b, and 50c are provided in the arrangement shown in FIG. 20 so that the operator can confirm the operation direction with a sense, and the lens is moved by an internal mechanism such as a link (not shown). It has a structure. Reference numeral 51 denotes a sterilization adapter as a connection portion.
[0104]
As shown in FIG. 22, a sterilization adapter connection 63 is formed at the distal end of the endoscope connection / holding device 55. The sterilization adapter connecting portion 63 is provided with a rectangular recess 64, and an observation light incident portion 63a, a first illumination light emitting portion 64b, and a second illumination light emitting portion 64c are provided in the rectangular recess 64. It has been. On the rear end side, an observation optical system 58, a first illumination light transmission unit 59, and a second illumination light transmission unit 60 are provided. A protrusion 63 a is provided on the outer periphery of the sterilization adapter connection portion 63.
[0105]
Reference numeral 65 denotes a sterilized drape that covers the microscope body 2 and the endoscope connection / holding device 55. An attachment ring 66 made of an elastic material attached to the sterilization adapter connection portion 63 is provided, and a groove 66 a is formed on the inner surface of the ring 66.
[0106]
The sterilization adapter 51 is made of a material that can withstand high-pressure steam sterilization such as stainless steel or EOG (ethylene oxide gas) sterilization, and is provided with a rectangular convex portion 67, a U-shaped concave portion 68, and a hook 69. An observation light exit end 68 a and an illumination light exit end 68 b are disposed in the U-shaped recess 68. The observation light exit end 68a and the illumination light exit end 68b are provided with a cover glass (not shown) and cannot be sterilized, and therefore, the observation light entrance 64a, the first illumination light exit 64b, and the second Are separated from the observation system connection portion and the illumination light connection portion of the endoscope connector which need to be sterilized and kept clean, which will be described later.
[0107]
Reference numeral 71d is an endoscope connector. It has a shape that fits into the U-shaped recess 68 of the sterilization adapter 51, and includes an observation system connection part 72a and an illumination system connection part 72b. Here, the endoscope connector 71d of the endoscope has a shape that can be fitted in the U-shaped recess 68 only in one direction, but the rectangular protrusion 67 of the sterilization adapter 51 is the rectangular recess 64 of the sterilization adapter connection part 63. It is designed to fit in two directions.
[0108]
When performing an operation, first, it is determined which side the endoscope connecting / holding device 55 is to be arranged with respect to the mirror body. Here, it is assumed that it is determined to be arranged on the side shown in FIG. Here, as shown in FIG. 21, when the endoscope connecting / holding device 55 is rotated horizontally, the tip of the fixing screw 56 enters the inside by the urging force of the compression spring 57 at the female screw 21a. . In this state, the endoscope connecting / holding device 55 is fixed to the microscope body part 2 by screwing the fixing screw 56.
[0109]
In this state, as shown in FIG. 21, the first illumination light transmission unit 59 is opposed to the light guide fiber 53, and is connected to the first illumination light emitting unit 64 b. That is, the illumination light is emitted from the illumination emission part 64b.
[0110]
Next, the sterilization drape 54 shown in FIG. The groove 66a in the mounting ring 66 is fixed by fitting it into the protrusion 52a.
[0111]
In this state, the sterilized adapter 51 that has been sterilized is attached to the sterilization adapter connection portion 63 so that the hook 69 faces upward.
[0112]
Thereby, the illumination light emission end 68b provided in the U-shaped recess 68 and the illumination light emission part 64b are electrically connected. By connecting the endoscope connector 71d in accordance with the U-shaped recess 68 of the sterilization adapter 51, the illumination system connection portion 72b and the illumination light emitting end 68b are electrically connected. Thereby, the illumination light from the light guide fiber 53 is guided to the illumination system connection portion 72b, and illumination is performed from the distal end of the endoscope. The endoscope cable is hooked on the hook 69 as necessary.
[0113]
In another operation, when the endoscope connection / holding device 55 is set on the opposite side of FIG. 20 with respect to the microscope body part 2, the following operation is performed before sterilizing drape.
[0114]
The fixing screw 56 shown in FIG. 21 is loosened and extracted from the female screw 21a. The endoscope connecting / holding device 55 is rotated about the axis B. The fixing screw 56 enters at the female screw 21b, and is similarly fixed by tightening the fixing screw 56. The second illumination light transmission unit 60 is opposed to the light guide fiber 53 by rotating 180 degrees. In addition, the second illumination light transmission unit 60 and the illumination light emitting end 64c are positioned on the upper side by rotating 180 degrees. In this state, the sterilization drape 65 is covered, the sterilization adapter 51 is attached with the cable hook facing upward, and the endoscope connector 71d is connected.
[0115]
Illumination light from the light guide fiber 53 is guided to the illumination system connection part 72b via the second illumination light transmission part 60, the second illumination light emission end 64c, and the illumination light emission end 68b, and the distal end of the endoscope Illuminated from.
[0116]
Next, it is confirmed whether or not the observation image of the endoscope has eccentricity. If there is eccentricity, the X adjustment knob 50a and the Y adjustment knob 50b of the eccentricity adjustment knob 50 are turned to move a lens (not shown), Adjust the observation image so that it is in the center of the monitor. Next, it is confirmed whether or not the focus is appropriate. If there is a blur, the Z adjustment knob 50c is used for adjustment. After the adjustment so far, take the scope and observe the surgical site.
[0117]
Here, when the image on the monitor is rotated with respect to the viewing direction, the image rotation ring 61 is rotated to adjust the direction. If the magnification is not appropriate, the zoom ring 62 is turned to make the magnification appropriate.
[0118]
When the endoscope is not used, the endoscope is held by the holder. When the endoscope is replaced with an endoscope having a different visual field direction, the endoscope connector 71d is pulled out and an endoscope connector of another endoscope is connected. The endoscope connector is easily sterilized by being connected to the endoscope connection / holding device 55 in a sterilizable and unclean area through a sterilizable and clean area sterilization adapter 51 so that the endoscope connector is always kept clean. It is.
[0119]
Further, since the endoscope connecting / holding device 55 can be largely moved to both sides of the microscope body part 2 around the axis B, the endoscope can be preferably connected / held on the side of the operator's dominant arm. . In addition, by using the sterilization adapter 51, it is possible to replace the endoscope during the operation.
[0120]
As shown in FIG. 23, the endoscope 71 includes an insertion portion 71a and a main body portion 71b. An endoscope cable 71c extends from the main body portion 71b, and the observation system connection portion 72a is provided at an end thereof. Is provided. The endoscope connector 71d of the endoscope 71 is provided with an observation system connection portion 72a and an illumination system connection portion 72b. A predetermined index 71e for position detection is installed on the main body 71b of the endoscope 71.
[0121]
A configuration for acquiring a three-dimensional ultrasonic observation image of the surgical site will be described with reference to FIGS.
The ultrasonic observation system 201 of the present embodiment is provided with a scope holder (arm mechanism) 202 that can be moved spatially and freely, and an ultrasonic probe holder 202 that is detachably connected to the scope holder 202. It has been.
[0122]
In addition, the scope holder 202 is provided with an attachment portion 204 that is detachably attached to a side rail (not shown) of the surgical bed, and an arm main body 205. Here, the attachment portion 204 of the scope holder 202 is provided with an attachment portion main body 206 and a base 207 extending from the attachment portion main body 206. Further, the attachment portion main body 206 is provided with a hook-like engagement portion 208 that is attached by being hooked on the side rail of the surgical bed.
[0123]
Further, the attachment portion main body 206 is provided with a fixing knob 209 for fixing the attachment portion main body 206 to the bedside rail at a position facing the engaging portion 208. The fixing knob 209 is attached by being screwed into the attachment portion main body 206 and has a screw portion extending toward the engagement portion 208. In addition, a pressing member that is in pressure contact with the mounting surface of the bedside rail is provided at the end of the screw portion of the fixed knob 209.
[0124]
Therefore, if the fixing knob 209 is tightened in a state where the engaging portion 208 is hooked on the bedside rail and the pressing member of the fixing knob 209 is pressed against the mounting surface of the bedside rail, the mounting portion main body 206 is moved to the bedside rail. Can be fixed to.
[0125]
Further, a vertical arm 211 constituting the arm body 205 is rotatably attached to the base 207 of the attachment portion 204. The vertical arm 211 extends vertically upward from the base 207, and is supported so as to be rotatable about a vertical first axis O6 coinciding with the longitudinal axis.
[0126]
Further, an adjustment knob 212 for adjusting the amount of rotation force of the vertical arm 211 around the first axis O6 is screwed to the base 207. The adjustment knob 212 is provided with a thread portion that extends in a direction orthogonal to the first axis O 6 and extends in the direction of the vertical arm 211. A pressing member that is pressed against the outer peripheral surface of the vertical arm 211 is provided at the end of the screw portion. Accordingly, the amount of rotational force of the vertical arm 211 is determined by the tightening amount of the adjustment knob 212 with respect to the base 207, that is, the degree of pressure contact of the pressing member with respect to the vertical arm 211.
[0127]
Also, at the upper end of the vertical arm 211, one end of the first link arm 213 constituting the arm body 205 is pivoted about the second axis O7 orthogonal to the first axis O6 via the joint 214. It is attached as possible. At the other end of the first link arm 213, a third axis O8 parallel to the second axis O7 is provided at one end of the second link arm 215 constituting the arm body 205 via the joint 216. It is pivotally attached to the center.
[0128]
Further, one end portion of the second link arm 215 is rotatable about a fourth axis O9 extending in a direction orthogonal to the third axis O8 (axial direction of the second link arm 215). It is supported by.
[0129]
Further, at the other end portion of the second link arm 215, a connecting shaft portion (attachment mounting portion) 217 is rotatable about a fifth axis O10 orthogonal to the fourth axis O9 via a joint portion 218. It is supported by. As shown in FIG. 2B, the connection shaft portion 217 is formed with two notches 219a and 219b on the outer peripheral surface of the tip portion.
[0130]
In addition, a rotational force amount adjusting mechanism (not shown) is provided in each joint portion 214, 216, 218. As a result, the link arms 213 and 215 naturally rotate around the axes O7 to O10 by the dead weight of the ultrasonic probe 203 detachably connected to the scope holder 202 and the arm main body 205 holding the ultrasonic probe 203. To prevent this.
[0131]
Further, the first ultrasonic probe holder (attachment) for connecting the ultrasonic probe 203 to the connecting shaft portion 217 of the scope holder 202 in a detachable manner, or the second ultrasonic probe holder (attachment). Etc. can be selectively attached as necessary.
[0132]
Here, the first ultrasonic probe holder is formed by, for example, a radial scan ultrasonic probe holder. The first ultrasonic probe holder is provided with a holder main body and an attachment portion for detachably attaching the holder main body to the connecting shaft portion of the scope holder.
[0133]
Further, the holder main body is provided with a fixed portion and a movable portion. The fixed portion of the holder body incorporates a linear direction driving mechanism that moves the movable portion b along the vertical direction. The linear drive mechanism includes a drive motor 225a, a first gear 226 driven by the motor 225a, a second gear 227 engaged with the first gear 226, and the second gear 226. A third gear 228 meshed with the gear 227 and an encoder 229 that operates in accordance with the rotation of the third gear 228 are provided.
[0134]
The movable portion 224b of the holder main body 222 is provided with a probe mounting hole 230 for inserting and fixing the ultrasonic probe 203, and a rack 231 engaged with the second gear 227 of the fixing portion 224a. . The rack 231 extends in the vertical direction. As the second gear 227 rotates, the rack 231 is moved in the vertical direction, whereby the movable portion 224b is supported so as to be movable up and down with respect to the fixed portion 224a. Note that stoppers (not shown) are provided at the upper and lower ends of the rack 231 of the movable portion 224b so as not to move further. Further, an inclined portion 230a for releasably locking the ultrasonic probe 203 at the upper end portion of the probe mounting hole portion 230 is formed in the movable portion 224b.
[0135]
In addition, a pair of pin holding plates 232 a and 232 b are provided on the attachment portion 223 of the first ultrasonic probe holder 202 so as to protrude from the fixing portion 224 a of the holder main body 222. Here, an engaging pin 233a is attached to one pin holding plate 232a, and an engaging pin 233b is attached to the other pin holding plate 232b. The engaging pins 233a and 233b are supported so as to be movable in and out of the pin holding plates 232a and 232b. Then, the engaging pin 233a of the pin holding plate 232a and the engaging pin 233b of the pin holding plate 232a are always urged in a direction protruding inward by a spring member (not shown), and the connecting shaft of the scope holder 202 is connected. Respectively detachably engaged with the cut portions 219a and 219b of the portion 217.
[0136]
Further, operation knobs 234a and 234b for pulling the engaging pins 233a and 233b toward the outer side of the obtaining portion 223 are provided on the outer surface sides of the pin holding plates 232a and 232b, respectively. The probe 203 is provided with an index (not shown) for position detection.
[0137]
In FIG. 26, reference numeral 269 denotes an ultrasonic driving device that drives the ultrasonic probe 203. The ultrasonic drive device 269 is provided with a motor 270 for driving an ultrasonic transducer (not shown) and an encoder 271 for detecting the position. In addition, the ultrasonic drive device 269 includes an ultrasonic observation device that drives the motor 270 built in the ultrasonic drive device 269 and detects the encoder 271 or acquires a two-dimensional image obtained by an ultrasonic transducer. A device 272 is connected. A foot switch 273 and a three-dimensional image generation device 274 are connected to the ultrasonic observation device 272.
[0138]
A motor driving device 275 for driving a motor 225a built in the first ultrasonic probe holder 202 for radial scanning (not shown) is connected to the foot switch 273. The foot switch 273 is provided with an ultrasonic observation switch (not shown) for controlling on / off of the ultrasonic observation device 272 and a motor drive switch (not shown) for operating the motor drive device 275.
[0139]
A movement amount detection device 276 for detecting the value of the encoder 229 is connected to the encoder 229 built in the first ultrasonic probe holder 202. The movement amount detection device 276 is connected to the ultrasonic observation device 272 and the three-dimensional image generation device 274. Further, a monitor 277 is connected to the three-dimensional image generation device 274.
[0140]
Each output signal from the ultrasonic observation device 272 and the movement amount detection device 276 is input to the three-dimensional image generation device 274, and the three-dimensional image generated by the three-dimensional image generation device 274 based on the input information. Is displayed on the monitor 277.
[0141]
The same applies to the case where the second ultrasonic probe holder 202 for front scanning (not shown) is connected to the connecting shaft portion 217 of the scope holder 202.
[0142]
As shown in FIG. 27, the surgical microscope system 1C according to the present embodiment includes the digitizer 12, the measurement device 18, the A / D converter 17, and the WS 19 as in the first embodiment, and includes the WS 19 and the superimposed image generation unit 80. Are connected to each other, and the superimposed image generating unit 80 and the superimposing LCD 48 are connected. The WS 19 is connected to a mirror control unit 304 that detects focus and zoom information of the microscope. A WS 19 is connected to the three-dimensional image generation apparatus 274.
[0143]
The endoscope television camera 140 is connected to an image generation unit 87 and a visual field image generation unit 305. An LCD 36a for displaying an image in the field of view of the microscope is connected to the in-field image generating unit 305. An LCD 38 that displays an image of the second observation optical system is connected to the image generation unit 87.
[0144]
In observing, first, the endoscope 71 is attached to the side surface of the body part, and then the operation part is observed with the endoscope 71 in an observation state. In addition, ultrasonic observation is performed to obtain an image inside the surgical site. At this time, in order to acquire the above-described three-dimensional ultrasonic observation image, the ultrasonic observation system is used to observe the ultrasonic image in the radial direction of the surgical site.
[0145]
As shown in FIGS. 28 and 29, a radial scan ultrasonic probe 203 provided with an index (not shown) that can be detected by the digitizer 12 is moved in a direction perpendicular to the radial direction (arrow direction in the figure), and a plurality of ultrasonic waves are moved. Get an image. The ultrasonic image acquired at this time is transmitted to the three-dimensional image generation device 274. On the other hand, the spatial position information of the ultrasonic probe 203 detected by the digitizer 12 during ultrasonic observation is transmitted from the WS 19 to the three-dimensional image generation device 274.
[0146]
That is, the spatial position information and the ultrasound image are paired and recorded in the 3D image generation device 274, and the data is accumulated to generate a 3D ultrasound image having a correlation with the surgical site position space. , Transmitted to WS19 and recorded.
[0147]
The surgeon observes the surgical site with the endoscope 71 in order to confirm the blind spot of the microscope body 2 of the microscope. At this time, when it is desired to check information inside the tissue in the observation direction of the endoscope 71, an image changeover switch (not shown) is pressed. As a result, an ultrasonic image is displayed on the second observation optical system.
[0148]
The observation image observed by the endoscope 71 is displayed as an endoscopic image on the LCD 36 a that displays the in-field display image 306 from the endoscope TV camera 140 via the in-field image generation unit 305. The Further, the distal end position observation direction of the endoscope 71 is detected by the digitizer 12, and the detection result is transmitted to the WS 19.
[0149]
That is, the WS 19 re-images the three-dimensional ultrasonic image 144 that matches the observation direction of the endoscope 71 from the previously recorded three-dimensional ultrasonic image based on the transmitted information on the endoscope observation direction. To construct.
[0150]
The generated three-dimensional ultrasonic image 144 is transmitted to the image generation unit 87 and displayed on the LCD 38 as shown in FIG. Thus, the operator can observe the three-dimensional ultrasonic image 144 through the second observation optical system.
[0151]
The surgeon confirms the presence of a tumor and the like by confirming internal information of the surgical part in the observation direction of the endoscope 71. When an image changeover switch (not shown) is pressed, an ultrasonic cross-sectional image at the microscope focal position is displayed on the second observation optical system, and a three-dimensional ultrasonic image in the endoscope observation direction is superimposed on the microscope observation field. Switch to mode.
[0152]
At this time, the observation position of the microscope is calculated from the position information of the microscope body 2 sent from the digitizer 12 to the WS 19 and the focus and magnification information sent from the body control unit 304 to the WS 19.
[0153]
Based on this observation position, a two-dimensional ultrasonic image 147 perpendicular to the observation optical axis direction of the mirror body 2 is reconstructed from the three-dimensional ultrasonic image 144 recorded in the WS 19, and the image generation unit 87 and the LCD 38 are used. Then, the second observation optical system is displayed as shown in FIG.
[0154]
Further, the focal position information 145 of the microscope body 2 and the three-dimensional ultrasonic image 146 in the observation direction of the endoscope 71 are transmitted from the WS 19 to the superimposed image generating unit 80 and the superimposing LCD 48, as shown in FIG. Is displayed. Then, by comparing the focal position 145 of the microscope body 2 with the ultrasonic image 147 at that position, information inside the surgical site is confirmed.
[0155]
That is, with the ultrasonic observation apparatus, the observation image in the front or radial direction of the surgical site is captured, and the observation image information is recorded together with the position information detected by the position detection means. Detecting the endoscope observation position and correlating the observation position of the microscope focus position and the ultrasonic image, and the observation position of the endoscopic image and the ultrasonic image, thereby matching the observation position of the ultrasonic observation image. Is displayed on the visual field display means.
[0156]
In this way, internal tissue information in the observation direction of the endoscope, for example, blood vessels and tumors can be confirmed by ultrasonic observation images, and the internal conditions of the tissue can be reliably confirmed in advance even for the blind spots of the surgical microscope. You can grasp and proceed with the treatment. This reliably prevents the tumor from being left behind.
[0157]
It should be noted that the present invention is not limited to the embodiments described above, and various modifications can be made without departing from the spirit of the invention.
[0158]
[Appendix]
According to the embodiment of the present invention as described above in detail, the following configuration can be obtained.
[0159]
(1) In a surgical system including an optical scanning probe that acquires an optical diagnostic image at an arbitrary position of a surgical site, and an energy treatment tool that performs a procedure on the surgical site.
A recording unit for recording a diagnostic image acquired by the optical scanning probe;
A diagnostic image database in which a plurality of treatment site images having treatment information such as treatment site images and treatment information such as energy treatment tools and treatment tool setting states related to the treatment,
A comparison operation unit for comparing the diagnostic image of the optical scanning probe with a plurality of treatment site images stored in the diagnostic image database;
Based on the calculation result of the comparison calculation unit, an energy treatment tool setting unit for setting conditions of the energy treatment tool,
A surgical system comprising:
[0160]
(2) It has a position detection means for detecting the position of the optical scanning probe with respect to the surgical site, and the comparison calculation section is configured to detect the position information detected by the position detection means and the position information accumulated in the diagnostic image database. The microscope system according to appendix 1, which is used as a parameter for calculation.
[0161]
(3) Setting changing means for changing the setting state of the energy treatment instrument to a desired state;
Database registration means for registering at least the setting value changed by the setting changing means and the diagnostic image acquired by the optical scanning probe as a treatment site image in the diagnostic image database;
The surgical system according to Supplementary Note 1 or Supplementary Note 2, comprising:
[0162]
(4) The surgical operation system according to appendix 3, wherein the setting change unit is a line-of-sight detection unit provided in a surgical microscope.
[0163]
(5) A microscope which is a first observation means having an observation optical system for magnifying and observing the surgical site, and an in-field image display means for displaying an image different from the observation image obtained by this microscope in the observation field of the microscope. When,
A second observation means for observing the surgical site;
Position detection means for detecting the observation position of the microscope and the observation position of the second observation means, and correlating those positions;
A recording means for recording a diagnostic image of the surgical site;
In a surgical microscope system having
Based on the detection result of the position detection means,
An image processing unit for reconstructing an image that matches the observation direction of the microscope or the second observation unit from a plurality of diagnostic images recorded in the recording unit;
A display control unit for displaying the output image from the image processing unit on the in-field image display unit;
Surgical microscope system.
[0164]
(6) The surgical microscope system according to appendix 5, wherein the in-field image display unit is an image superimposing unit that superimposes an image on an optical image of a microscope.
[0165]
(7) The surgical microscope system according to appendix 6, wherein the display control unit displays an output image from the image processing unit in correlation with an optical image of the microscope.
[0166]
(8) The surgical microscope system according to one of appendix 5 to appendix 7, wherein the image processing unit constructs a diagnostic image in a direction perpendicular to the observation optical axis of the microscope.
[0167]
(9) The surgical microscope system according to one of appendix 5 to appendix 7, wherein the image processing unit constructs a diagnostic image corresponding to an observation direction of the second observation unit.
[0168]
(10) a surgical microscope having a plurality of electric drive mechanisms;
In-field image display means for displaying an image in the observation field of view of this surgical microscope,
A foot switch for operating the electric drive mechanism;
A setting changing unit for appropriately changing the position of the operation unit of the foot switch;
A detection unit for detecting that a foot is placed on the foot switch;
Display control means for visually notifying the switch position of the operation part on which the foot is placed on the in-field image display means according to the detection result of the detection part;
A surgical microscope system comprising:
[0169]
(11) a surgical microscope;
A foot switch for operating a plurality of electric drive units of the surgical microscope;
A surgical instrument having a setting unit for performing a predetermined setting;
A sensor for detecting the use state of the surgical instrument;
According to the detection result of this sensor, a control unit that assigns at least a part of the function of the foot switch to the surgical instrument,
A surgical microscope system comprising:
[0170]
(12) The surgical microscope system according to appendix 11, wherein the setting unit of the surgical instrument is an output setting unit of an energy treatment tool that is a surgical instrument.
[0171]
(13) The surgical microscope system according to appendix 11, wherein the setting unit of the surgical instrument is a setting unit that performs at least one of focusing, zooming, and image rotation of the endoscope.
[0172]
(14) The surgical microscope system according to appendix 11, wherein the setting unit of the surgical instrument is a setting unit that performs at least one of image size change and image rotation of the ultrasonic observation apparatus.
[0173]
(15) The surgical microscope system according to appendix 11, wherein the sensor is a switch provided in a grip portion of the surgical instrument.
[0174]
(16) The surgical microscope system according to appendix 11, wherein the sensor is an acceleration sensor provided in a grip portion of the surgical instrument.
[0175]
【The invention's effect】
As described above, according to the present invention, even an operator who has little experience with a target case can easily and accurately select a treatment tool and make an optimal setting, and adjust the second observation optical system according to the observation state. A surgical system capable of moving the display image position can be provided.
[Brief description of the drawings]
FIG. 1 to FIG. 7 relate to a first embodiment of the present invention, and FIG. 1 is a diagram for explaining the configuration of a surgical microscope system.
FIG. 2 is a diagram for explaining an internal configuration of a binocular eyepiece tube portion that is a mirror body;
FIG. 3 is a side view of FIG. 2, illustrating the configuration of the eyepiece optical system and the second observation optical system of the mirror body;
FIG. 4 is a diagram illustrating a superposition unit.
FIG. 5 is a diagram for explaining a configuration of a main part of a surgical microscope system.
FIG. 6 is a diagram showing an example of a treatment site image recorded in a database
FIG. 7 is a view showing a microscope observation image and setting data displayed on a microscope.
8 to 15 are related to a second embodiment of the present invention, and FIG. 8 is a diagram for explaining another configuration of a surgical microscope system.
FIG. 9 is a side view for explaining the internal configuration of the binocular eyepiece tube.
FIG. 10 is a diagram for explaining the relationship between a pinion gear and a rack;
11 is an arrow view from the direction of arrow A in FIG.
FIG. 12 is a diagram for explaining a microscope observation image and a screen for changing the setting state of the ultrasonic suction device.
FIG. 13 is a diagram illustrating a state in which the eyepiece housing is moved with respect to the movable housing.
FIG. 14 is a diagram showing a relationship between a microscope observation image before the eyepiece housing moves and a screen by the second observation optical system.
FIG. 15 is a diagram showing a relationship between a microscope observation image after the eyepiece housing moves and a screen by the second observation optical system.
FIG. 16 to FIG. 19 relate to a third embodiment of the present invention, and FIG. 16 is a diagram for explaining another configuration of a surgical microscope system.
FIG. 17 is a diagram for explaining a relationship between an operation switch of a foot switch and a sensor.
FIG. 18 is a diagram for explaining an endoscope switch position notification image displayed on a microscope image;
FIG. 19 is a diagram for explaining an ultrasonic switch position notification image displayed on a microscope image;
FIGS. 20 to 31 are related to a fourth embodiment of the present invention, and FIG. 20 is a diagram showing the external appearance of a microscope body and an endoscope connecting / holding device.
FIG. 21 is a cross-sectional view of an optical and mechanical connection state between a microscope body part and an endoscope as viewed from above.
FIG. 22 is a diagram for explaining the connection near the sterilization adapter
FIG. 23 is a diagram for explaining an endoscope inserted into a sterilization adapter;
FIG. 24 is a diagram for explaining the main configuration of an ultrasonic observation system.
FIG. 25 is a diagram for explaining a scope holder of an ultrasonic observation system
FIG. 26 is a diagram illustrating a system including an ultrasonic probe and its peripheral devices.
FIG. 27 is a diagram for explaining another configuration of a surgical microscope system;
FIG. 28 is a diagram showing a state in which the ultrasonic probe is moved up and down.
FIG. 29 is a diagram illustrating a state in which the probe holding portion of the ultrasonic probe is disposed above.
FIG. 30 is a diagram illustrating an example of a display screen
FIG. 31 is a diagram for explaining another example of the display screen;
[Explanation of symbols]
1. Surgery microscope system
12 ... Digitizer
18 ... Measuring device
19 ... Workstation
73 ... Second workstation
74 ... Diagnostic image database (DB)
75 ... Image memory
76 ... Comparison calculation section
77. Treatment instrument setting information generation unit
78 ... Optical scanning probe
79 ... Observation equipment
87. Image generation unit

Claims (3)

In a surgical system comprising an optical scanning probe that acquires an optical diagnostic image at an arbitrary position of a treatment site , and an energy treatment device that performs a treatment on the treatment site .
A recording unit for recording a diagnostic image acquired by the optical scanning probe;
Diagnostic image database in which a plurality accumulated treatment site image having a treatment information including the setting state of the energy treatment instrument and the treatment instrument on the diagnosis image and the treatment of pre-acquired predetermined treatment site by the optical scanning probe,
Diagnostic image acquired by the optical scanning probe, a comparison operation unit for performing a comparison operation by pattern matching a plurality of said treatment site image stored in the diagnostic image database,
Based on the comparison calculation result by the pattern matching in the comparison operation unit selects the most similar treatment site image diagnostic images acquired by the optical scanning probe from the treatment site image, according to the treatment site image the selected An energy treatment tool setting unit configured to set conditions of the energy treatment tool based on the treatment information ;
A surgical system comprising: A position detecting means for detecting the position of the optical scanning probe relative to the surgical site;
The said comparison calculating part utilizes the positional information detected by the said position detection means, and the positional information on the treatment site | part image accumulate | stored in the said diagnostic image database as a parameter at the time of a calculation. Microscope system. Setting changing means for changing the setting state of the energy treatment instrument to a desired state;
Database registration means for registering at least the setting value changed by the setting changing means and the diagnostic image acquired by the optical scanning probe as a treatment site image in the diagnostic image database;
The surgical system according to claim 1 or 2, further comprising:

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