JP4472080B2 - Microscopic surgery support system - Google Patents

Description

[0001]
BACKGROUND OF THE INVENTION
The present invention relates to a microscope operation support system that detects a three-dimensional position of a surgical instrument inserted into a microscope and an operation site and displays the detected position on an anatomical tomographic image of the operation site.
[0002]
[Prior art]
Conventionally, as a navigation system used in a microscope operation such as brain surgery, a system disclosed in Japanese Patent Application Laid-Open No. 5-305073 is known. In general, a signal device such as an LED provided on a surgical instrument such as a surgical microscope body, an endoscope, or a suction tube is recognized by a receiving device such as a large-sized CCD camera called a digitizer installed in an operating room. The operation is supported by calculating each three-dimensional position and displaying it on an image such as a CT image taken in advance.
[0003]
[Problems to be solved by the invention]
In general, a surgical operation under a microscope is a procedure in a narrow space, and an assistant and a nurse surround the surgeon as well as a surgeon. For this reason, the LED provided on the endoscope or the treatment tool may be hidden by the operator, and may not be recognized by a digitizer placed at a position away from the surgical site. In addition, when the digitizer is brought close to the bedside in order to enhance the recognition, the digitizer itself is large and may interfere with the surgeon.
[0004]
In addition, in the case of such a microscope support system, it is necessary to perform a so-called calibration operation in which information such as the position of the distal end of a surgical instrument such as an endoscope, the thickness of an insertion portion, and the direction of a visual field is registered on a workstation in advance. . When the surgical instrument is changed during the operation, it is necessary to redo calibration or to read and set calibration information registered in advance with a manual switch, which causes a problem that the procedure becomes complicated.
[0005]
The present invention has been made paying attention to the above circumstances, and the object of the present invention is not to obstruct the operator, and it is possible to reliably recognize the position of a surgical instrument such as an endoscope or a treatment instrument. It is to provide a surgical operation support system under a microscope.
[0006]
[Means for Solving the Problems]
In order to achieve the above-mentioned object, the present invention detects a three-dimensional position of a surgical instrument inserted into a microscope and a surgical site and displays it on an anatomical tomographic image of the surgical site. The first detection means for detecting the three-dimensional position of the microscope with respect to the surgical site, the second detection means for detecting the three-dimensional position of the surgical instrument with respect to the microscope, and the first and second detection means based on the detection result, and a calculator for calculating the three-dimensional position relative operative part of the surgical instrument consists of, said second detection means includes a signal member which is provided in the vicinity of the objective aperture of the microscope, the surgical And a receiving member that detects the signal member. The receiving member detects the signal member to calculate a three-dimensional position of the surgical instrument relative to the microscope .
[0007]
According to the said structure, the said receiving member can detect the signal from the said signal member, and can calculate the three-dimensional position of the microscope with respect to a surgical instrument.
[0008]
DETAILED DESCRIPTION OF THE INVENTION
Embodiments of the present invention will be described below with reference to the drawings.
[0009]
1 and 2 show a first embodiment, FIG. 1 is an overall schematic view of a surgical operation support system under a microscope, and FIG. 2 is an enlarged side view of a body part. The surgical microscope 1 includes a base 4 on which a pedestal 3 is movable on a floor surface, and a support column 5 standing on the base 4, and an illumination light source (not shown) is built in the upper end of the support column 5. One end of one arm 6 is attached to be rotatable about an axis O1.
[0010]
One end of the second arm 7 is attached to the other end of the first arm 6 so as to be rotatable about the axis O2. The second arm 7 is a pantograph arm composed of a link mechanism and a spring member for balance adjustment in order to perform a vertical movement operation. A third arm 8 is attached to the other end so as to be rotatable around an axis O3. It has been. The third arm 8 is an arm that enables the body 2 about the axis O4 to be lifted in the front-rear direction with respect to the observation direction of the operator and the operator to be lifted in the left-right direction about the axis O5. The mirror body 2 is provided at the other end of the third arm 8.
[0011]
Further, in order to adjust the position of the mirror body 2 freely and to fix the position, electromagnetic rotating brakes (not shown) are provided on the rotating portions of the rotating shafts O1 to O5. The electromagnetic brake is connected to an electromagnetic brake power supply circuit (not shown) built in the column 5, and the electromagnetic brake power supply circuit is a switch provided on a grip 9 integrally fixed to the mirror body 2 as shown in FIG. 10 is connected.
[0012]
The mirror body 2 has an objective lens 11. The objective lens 11 is connected to a motor and a position sensor (not shown) and is movable in the optical axis direction so that the lens position can be detected by the position sensor. It is configured.
[0013]
Reference numeral 12 denotes a signal plate for a digitizer described later to detect the three-dimensional coordinates of the mirror body 2. Two or more LEDs 13a are integrally fixed to the signal plate 12 as signal members. Similarly, around the objective lens 11, two or more LEDs 13b as signal members are provided. The LEDs 13a and 13b are connected to the LED control device 14, respectively. The LED control device 14 is connected to the measurement device 15.
[0014]
Reference numeral 16 denotes a digitizer (optical position detection device) for detecting the position of the LED 13a in the three-dimensional coordinates. The digitizer 16 includes two CCD cameras 17a and 17b as receiving members, a camera support member 18 that fixes the positions of the CCD cameras 17a and 17b, and a stand 19, and is installed at a position away from the bed in the operating room. Has been. The CCD cameras 17 a and 17 b are each connected to a measuring device 15, and the measuring device 15 is connected to a workstation 21 via an A / D converter 20.
[0015]
Two CCD cameras 17c and 17d are provided as receiving members on the outer surface of the surgical instrument 22 such as an endoscope or an ultrasonic suction probe at a position facing the objective lens 11 of the microscope 1. The CCD cameras 17 c and 17 d are each connected to a measuring device 15, and the measuring device 15 is connected to a workstation 21 via an A / D converter 20.
[0016]
A monitor 23 for displaying processed information is connected to the workstation 21. Mark members 25a, 25b, and 25c are fixed around the surgical site of the patient 24 to be treated.
[0017]
Next, the operation of the operation support system under the microscope will be described.
[0018]
A tomographic image of a CT, MRI apparatus, etc., taken in advance before surgery is reconstructed into three-dimensional image data and recorded in the workstation 21. When starting the operation, calibration is performed using the mark members 25a, 25b, and 25c in order to correlate the tomographic image data in the workstation 21 and the coordinates of the surgical site.
[0019]
The operator holds the grip 9 and presses the switch 10 to release the lock by the electromagnetic brake built in the shafts O1 to O5, and moves the lens body 2 to position the focal position at the observation site of the surgical site.
[0020]
The digitizer 16 detects a plurality of LEDs 13a on the signal plate 12 provided on the mirror body 2, and based on this, signals emitted from the digitizer 16 are processed by the measuring device 15 and the A / D converter 20, and further the workstation. 21 calculates the position and orientation of the mirror body 2 in the living body coordinate system.
[0021]
Further, the position information of the objective lens 11 is transmitted to the workstation 21 by the position sensor. The workstation 21 calculates the relative position of the focal point with respect to the mirror body 2 from the position information of the objective lens 11.
[0022]
The two CCD cameras 17c and 17d provided in the surgical instrument 22 always detect the LED 13b provided around the objective lens 11 of the mirror body 2 facing the surgical part, and based on this, the CCD cameras 17c and 17d The emitted signal is processed by the measuring device 15 and the A / D converter 20, and the workstation 21 calculates the relative position and posture of the surgical instrument 22 and the mirror body 2. Further, this information is integrated with the position and orientation information of the mirror body 2 in the previous biological coordinate system on the workstation 21 to calculate the position and orientation of the surgical instrument 22 in the biological coordinate system.
[0023]
The position, posture, focus, and position and posture information of the surgical instrument 22 in the biological coordinate system obtained as described above are displayed on the monitor 23 by the workstation 21 so as to be superimposed on the in-vivo three-dimensional image data. The
[0024]
Instead of the digitizer 16 in the first embodiment, as a second embodiment, the surgical microscope 1 is provided with encoders (not shown) on the rotation axes O1 to O5, and the output from each encoder is the A / D. It may be sent to the workstation 21 via the converter 20.
[0025]
If comprised in this way, the position and attitude | position of the mirror 2 will be calculated in a workstation based on the output from each encoder provided in each rotating shaft O1-O5 of the surgical microscope 1. FIG. Therefore, since it is not necessary to install a large digitizer in the operating room, the operator and assistant can move safely and freely.
[0026]
FIG. 3 shows a third embodiment, and shows, for example, a rigid endoscope as the surgical instrument 22. A reception adapter 30 is provided on the proximal end side of the surgical instrument 22. The receiving adapter 30 includes a grip part 31 and a camera support part 32. The grip portion 31 has a cylindrical shape made of an elastic resin material having a longitudinal opening 33 in a part thereof. The opening 33 is narrower than the diameter on the proximal end side of the surgical instrument 22, and the inner diameter of the grasping portion 31 is formed substantially equal to the diameter on the proximal end side of the surgical instrument 22.
[0027]
The camera support section 32 is provided with CCD cameras 34a and 34b at positions separated in the longitudinal direction. A cable 37 is provided on the base end side of the camera support portion 32. Signals from the CCD cameras 34a and 34b communicate with the measuring device 15 via the cable 37.
[0028]
According to the present embodiment, the operator presses the opening 33 of the receiving adapter 30 against the surgical instrument 22 such as an endoscope or an ultrasonic probe to be used before the operation. Since the opening 33 is an elastic member, the opening 33 is mounted so as to expand to a necessary width. After the operation, the receiving adapter 30 can be removed from the surgical instrument 22 by pulling it in the direction opposite to that at the time of wearing.
[0029]
Therefore, since the receiving adapter 30 can be freely attached to and detached from the surgical instrument 22 to be used, it is not necessary to prepare the surgical instrument 22 dedicated to the operation under the microscope, and it is economical because the conventional instrument can be used.
[0030]
According to the first to third embodiments, an operator, an assistant, or the like does not interfere between the signal member on the microscope and the reception member on the surgical instrument, and the signal-reception of both is reliably performed. A relationship is established. Therefore, since the three-dimensional data of the microscope and the surgical instrument are always obtained in a stable state, and the first detection means only needs to recognize the microscope, it can be installed at a position away from the surgical site. There is an effect that the surgeon can concentrate on the technique with peace of mind without impairing the movement of the operator or assistant.
[0031]
4 and 5 show a fourth embodiment, and the same components as those of the first embodiment are denoted by the same reference numerals and description thereof is omitted. A signal adapter 35 is detachably fixed to the proximal end side of the surgical instrument 22 such as an endoscope or an ultrasonic suction probe. The signal adapter 35 is provided with at least two LEDs 36. The LED 36 is connected to the measuring device 15 via the cable 37 and the LED control device 14.
[0032]
As shown in FIG. 5, the inside of the mirror body 2 is a half body in which a part of the light beam is arranged 90 degrees horizontally between the variable magnification optical system 40 and the pair of imaging lenses 41a and 41b to polarize the mirror body 2. A mirror 42 is provided. Further, a mirror 43 that reflects the polarized light beam upward again is provided. Reference numerals 44a and 44b denote a pair of imaging lenses for imaging the polarized light beam. A magnification detecting means (not shown) is connected to the variable magnification optical system 40 and is further connected to the workstation 21 so that magnification information can be displayed on the monitor 23. The imaging lenses 41a and 41b are provided at positions where light beams are imaged at the focal positions of the eyepiece lenses 45a and 45b.
[0033]
A camera box 46 is attached to a predetermined position of the mirror body 2, and CCD cameras 47a and 47b are built therein. The CCD cameras 47a and 47b are fixed at predetermined positions of the camera box 46 so as to be arranged on the image forming planes by the image forming lenses 44a and 44b, respectively.
[0034]
The CCD cameras 47a and 47b are connected to the measuring device 15 and further to the workstation 21 via a CCU (camera control unit) (not shown).
[0035]
FIG. 6 shows a fifth embodiment, and shows an endoscope 48 as a surgical instrument. The endoscope 48 includes an insertion part 49, a grip part 50, and an eyepiece part 51. The eyepiece 51 has a shape to which a known CCD camera (not shown) can be connected. The grip portion 50 has a cylindrical shape to which the signal adapter 35 can be attached and detached, and a base portion 52 to which a known light guide cable (not shown) can be attached and detached is provided in the radial direction.
[0036]
The insertion portion 49 has a cylindrical shape, and a barcode 53 indicating the function of the endoscope 48 is provided on the outer peripheral surface on the distal end side. The functions of the endoscope 48 mentioned here are an angle of view, a visual field direction, an outer diameter of the insertion portion 49, an axial length, and the like. The bar code 53 is not limited to a part of the insertion portion 49 in the circumferential direction, and may be provided on the entire circumference.
[0037]
The barcode 53 is not limited to the distal end side of the insertion portion 49 but may be provided on the proximal end side or on the outer surface of the grip portion 50. Moreover, you may provide in multiple places. A monitor 23 for displaying processed information is connected to the workstation 21. Mark members 25a, 25b, and 25c are fixed around the surgical site of the patient 24 to be treated.
[0038]
The position and inclination of the endoscope 48 can be made the same as that of the mirror body 2 when the digitizer 16 detects the LED 36 provided in the signal adapter 35.
[0039]
The light beam from the surgical site enters the mirror body 2 from the objective lens 11, passes through the variable magnification optical system 40, passes through the half mirror 42, and travels straight, and is reflected by the half mirror 42 and polarized by 90 degrees. It is distributed to the luminous flux. The light beam traveling straight is imaged by the imaging lenses 41a and 41b, and is observed through the eyepiece lenses 45a and 45b. On the other hand, the light beam reflected by the half mirror 42 is reflected upward by the mirror 43, is imaged by the pair of imaging lenses 44a and 44b, and is projected onto the CCD cameras 47a and 47b, respectively. The captured image is displayed on the monitor 23 and is output to the workstation 21 via the measuring device 15.
[0040]
When the barcode 53 is under the microscope and displayed on the CCD cameras 47a and 47b, the measuring device 15 and the workstation 21 recognize the information of the barcode 53, and accordingly, the display content setting is switched and the image information ( The angle of view, the viewing direction, the outer diameter of the insertion portion 49, the length in the axial direction, etc.) are superimposed on the monitor 23 and displayed together with the tomographic images already recorded.
[0041]
During the operation, when the surgeon replaces the endoscope with a different visual field direction or outer diameter of the insertion portion, the setting is switched to the information according to the barcode 53 provided in the replaced endoscope as described above, and the monitor 23 Displayed above.
[0042]
When the barcode 53 is on the entire circumference, it can be recognized no matter what position the endoscope 48 rotates about the longitudinal axis.
[0043]
FIG. 7 shows a sixth embodiment, in which the measuring device 15 and the workstation 21 have a program for recognizing characters on an image. The endoscope 48 has a model number 54 displayed in at least one place on the outer surface.
[0044]
Then, the operator registers in advance the type number and function of the endoscope (view angle, visual field direction, outer diameter of the insertion portion 49, axial length, etc.) that will be used during the operation on the workstation. deep.
[0045]
When the model number 54 provided on the outer surface of the endoscope 48 is under microscope observation and is displayed on the CCD cameras 47a and 47b, the measuring device 15 and the workstation 21 recognize the model number 54 and Read the information (view angle, viewing direction, outer diameter of the insertion portion 49, axial length, etc.) associated with the registered model number and superimpose it on the monitor 23 together with already recorded tomographic images, indicate.
[0046]
Therefore, since the medical instrument can be used if a model number is provided on the outer surface, it is not necessary to newly prepare a dedicated one and is economical.
[0047]
FIG. 8 shows a seventh embodiment. On the outer surface of the endoscope 48, marker portions 55 having different reflectivities and intervals for each model are provided.
[0048]
Then, the surgeon causes the digitizer 16 to recognize the endoscope marker portion 55 that will be used during the operation in advance, and at the same time, the functions (view angle, visual field direction, outer diameter of the insertion portion 49, axial length, etc.). Register on the workstation and correlate with the marker.
[0049]
When the endoscope is replaced during the operation, when the digitizer 16 recognizes the marker portion 55 on the outer surface of the endoscope 48, the measuring device 15 and the workstation 21 read out the function information registered in advance, and the monitor 23 The image is superimposed and displayed together with the already recorded tomographic image and the like.
[0050]
Accordingly, since the digitizer recognizes the type / function of the surgical instrument, it is not necessary to provide a CCD camera in the microscope, and the system becomes simple. Further, even if the surgeon replaces the surgical instrument during the operation, the setting is automatically switched to the setting associated with the instrument, and the operator's hand is not bothered, so that the operator can concentrate on the operation with confidence.
[0051]
According to each of the embodiments, the following configuration is obtained.
[0052]
(Supplementary note 1) In a surgical operation support system under a microscope that detects the three-dimensional position of a surgical instrument inserted into a microscope and an operation part and displays it on an anatomical tomographic image of the operation part, the three-dimensional position of the microscope with respect to the operation part Based on detection results of the first detection means for detecting, the second detection means for detecting the three-dimensional position of the surgical instrument relative to the microscope, and the detection results of the first and second detection means, The second detection means comprises a signal member provided in the vicinity of the objective opening of the microscope and a receiving member provided in the surgical instrument. Surgery support system.
[0053]
(Supplementary note 2) The surgical operation support system under a microscope according to Supplementary note 1, wherein the receiving member is detachable from a surgical instrument.
[0054]
(Supplementary note 3) The microscope operation support system according to supplementary note 1 or 2, wherein the receiving member is a CCD.
[0055]
(Additional remark 4) In the operation support system under a microscope which detects the three-dimensional position of the surgical instrument inserted in a microscope and an operation part, and displays it on the anatomical tomographic image of an operation part, the three-dimensional position of the microscope with respect to an operation part is shown. A first detection means for detecting, an index portion indicating the form information of the surgical instrument provided on the outer surface of the surgical instrument, and a second detection means for recognizing the index portion, and automatically based on this recognition The microscope operation support system characterized in that the display setting is switched automatically (Appendix 5) The first detection means and the second detection means are the same. Surgery support system.
[0056]
(Appendix 6) Microscopic surgery support system according to appendix 4, wherein the second detection means is provided in an optical member of a microscope (Appendix 7), wherein the indicator section is a barcode. Additional support system for microscope operation according to appendix 4 or 6.
[0057]
(Supplementary note 8) The microscopic surgery support system according to Supplementary note 4 or 6, wherein the indicator portion is a character, and the second detection means has a character recognition function.
[0058]
【The invention's effect】
As described above, according to the present invention, an operator, an assistant, or the like does not interfere between the signal member on the microscope and the reception member on the surgical instrument, and the signal-reception relationship between the two is ensured. Is established. Therefore, since the three-dimensional data of the microscope and the surgical instrument are always obtained in a stable state, and the first detection means only needs to recognize the microscope, it can be installed at a position away from the surgical site. There is an effect that the surgeon can concentrate on the technique with peace of mind without impairing the movement of the operator or assistant.
[Brief description of the drawings]
FIG. 1 is a configuration diagram of an entire operation support system under a microscope showing a first embodiment of the present invention.
FIG. 2 is a side view of the mirror body showing the embodiment.
FIG. 3 is a perspective view of a rigid endoscope showing a third embodiment of the present invention.
FIG. 4 is a side view of a mirror body showing a fourth embodiment of the present invention.
FIG. 5 is a configuration diagram showing an internal structure of the mirror body according to the embodiment.
FIG. 6 is a perspective view of a rigid endoscope showing a fifth embodiment of the present invention.
FIG. 7 is a perspective view of a rigid endoscope showing a sixth embodiment of the present invention.
FIG. 8 is a perspective view of a rigid endoscope showing a seventh embodiment of the present invention.
[Explanation of symbols]
DESCRIPTION OF SYMBOLS 1 ... Operation microscope 2 ... Mirror body 13a, 13b ... LED (signal member)
16: Digitizers 17c, 17d: CCD camera (receiving member)

Claims (2)

In a surgical operation support system under a microscope in which a three-dimensional position of a surgical instrument inserted into a microscope and an operation part is detected and displayed on an anatomical tomographic image of the operation part.
First detection means for detecting the three-dimensional position of the microscope with respect to the surgical site;
Second detection means for detecting a three-dimensional position of the surgical instrument relative to the microscope;
Based on the detection results of the first and second detection means, and a calculation unit that calculates a three-dimensional position relative to the surgical part of the surgical instrument,
The second detection means includes
A signal member which is provided in the vicinity of the objective aperture of the microscope,
Provided in the surgical instrument, a receiving member for detecting the signal member,
Consists of
A three-dimensional position of the surgical instrument relative to the microscope is calculated by detecting the signal member with the receiving member, and a surgical operation support system under a microscope. The microscope operation support system according to claim 1, wherein the receiving member is provided in a receiving adapter that is detachably attached to the surgical instrument.

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