JP6158246B2 - 低侵襲遠隔操作外科手術器具のための患者側外科医インターフェース - Google Patents
低侵襲遠隔操作外科手術器具のための患者側外科医インターフェース Download PDFInfo
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Description
本発明は、例えば、以下を提供する。
(項目1)
患者側外科医インターフェースであって、
a)手術室内に搭載された表示デバイスと、
b)マスタインターフェースであって、
該手術室内の滅菌外科手術野内に位置付けられた機械的に固定されていないマスタツールグリップと、
該機械的に固定されていないマスタツールグリップから分離され隔てられたハンド追跡送信機と、
を含み、該機械的に固定されていないマスタツールグリップは、該ハンド追跡送信機と共同して、感知された位置および配向情報を、該機械的に固定されていないマスタツールグリップを操作する人物と関連付けられた基準フレームで提供する、マスタインターフェースと
を備えている、患者側外科医インターフェースと、
該滅菌外科手術野内に位置付けられた外科手術エンドエフェクタを備えている遠隔操作スレーブ外科手術器具と、
該機械的に固定されていないマスタツールグリップと、該ハンド追跡送信機と、該表示デバイスと、該遠隔操作スレーブ外科手術器具とに連結された制御システムと
を備え、
該制御システムは、該基準フレームにおける該感知された位置および配向情報を受信し、該感知された位置および配向情報を使用して、制御コマンドを生成し、該制御コマンドを送信し、該表示デバイス上に表示される画像と関連付けられた基準フレームに対して、該外科手術エンドエフェクタを移動させる、
低侵襲外科手術システム。
(項目2)
制御ハンドルを含む、手動操作外科手術デバイスをさらに備え、該制御ハンドルは、上記機械的に固定されていないマスタツールグリップを動作する人物が、該手動操作外科手術デバイスの制御ハンドルもまた操作するように、上記滅菌外科手術野内に位置付けられる、項目1に記載の低侵襲外科手術システム。
(項目3)
上記患者側外科医インターフェースは、立体的画像ビューアをさらに備え、該立体的画像ビューアを通して上記表示デバイス上で画像を視認する際に、立体的画像が見られる、項目1に記載の低侵襲外科手術システム。
(項目4)
上記患者側外科医インターフェースは、表示デバイスモーションインターロックをさらに備え、該表示デバイスモーションインターロックは、上記マスタツールグリップの運動と上記スレーブ外科手術器具との間の追従を示す上記制御システムからの信号を受信すると、上記表示デバイスの移動を防止する、項目1に記載の低侵襲外科手術システム。
(項目5)
上記患者側外科医インターフェースは、表示デバイスベースのプレゼンスインターロックをさらに備え、該表示デバイスベースのプレゼンスインターロックは、外科医の存在または不在を示す信号を上記制御システムに提供する、項目1に記載の低侵襲外科手術システム。
(項目6)
上記患者側外科医インターフェースは、上記表示デバイスを搭載した可動ブームをさらに備え、該可動ブームは、上記手術室内の手術台の近くでの該表示デバイスの位置決めを可能にする、項目1に記載の低侵襲外科手術システム。
(項目7)
上記患者側外科医インターフェースは、可動安定化プラットホームをさらに備え、該安定化プラットホームは、外科医が上記マスタツールグリップを把持する間、該外科医の前腕を支持し、該安定化プラットホームは、上記表示デバイスのいかなる移動からも独立して移動されることができる、項目1に記載の低侵襲外科手術システム。
(項目8)
上記可動安定化プラットホームは、手術台の位置に対して該可動安定化プラットホームを移動させるために使用される複数の車輪を含む、項目7に記載の低侵襲外科手術システム。
(項目9)
上記可動安定化プラットホームは、手術台に搭載されている、項目7に記載の低侵襲外科手術システム。
(項目10)
上記可動安定化プラットホームは、ブームに搭載されている、項目7に記載の低侵襲外科手術システム。
(項目11)
上記患者側外科医インターフェースは、上記制御システムに連結された少なくとも1つのペダルを有するフットトレイをさらに備えている、項目1に記載の低侵襲外科手術システム。
(項目12)
上記機械的に固定されていないマスタツールグリップは、上記制御システムに連結された少なくとも1つのスイッチをさらに備えている、項目1に記載の低侵襲外科手術システム。
(項目13)
上記少なくとも1つのスイッチは、外科医の存在または不在を示す信号を上記制御システムに提供する、項目12に記載の低侵襲外科手術システム。
(項目14)
上記少なくとも1つのスイッチは上記制御システムにマスタクラッチ信号を提供する、項目12に記載の低侵襲外科手術システム。
(項目15)
上記少なくとも1つのスイッチは、上記制御システムにカメラ制御信号を提供する、項目12に記載の低侵襲外科手術システム。
(項目16)
上記機械的に固定されていないマスタツールグリップは、グリップセンサをさらに備え、該グリップセンサは、上記制御システムにグリップ閉合情報を提供する、項目1に記載の低侵襲外科手術システム。
(項目17)
上記制御システムは、ラチェッティングシステムをさらに備えている、項目1に記載の低侵襲外科手術システム。
(項目18)
上記制御システムに連結された外科医のコンソールをさらに備え、該外科医のコンソールは、立体的表示デバイスおよび動力付きマスタインターフェースを含む、項目1に記載の低侵襲外科手術システム。
(項目19)
上記制御システムは、プロキシ視覚モジュールをさらに備え、該プロキシ視覚モジュールは、上記外科医のコンソールの立体的表示デバイスおよび上記患者側外科医インターフェースの表示デバイスに連結され、プロキシ視覚を提供し、上記プロキシ視覚は、上記機械的に固定されていないマスタツールグリップおよび該外科医のコンソールのマスタツールマニピュレータのうちの1つを移動させることによって移動される、項目18に記載の低侵襲外科手術システム。
(項目20)
滅菌外科手術野内に位置する機械的に固定されていないマスタツールグリップを移動させることによって、感知された位置および配向情報を生成することであって、該感知された位置および配向情報は、該滅菌外科手術野内で作業し、該機械的に固定されていないマスタツールグリップを操作する人物に関連付けられた基準フレームにおけるものである、ことと、
該感知された位置および配向情報に基づいて、低侵襲遠隔操作スレーブ外科手術器具のエンドエフェクタの移動を制御することであって、該エンドエフェクタは、該滅菌外科手術野内にある、ことと
を含む、方法。
(項目21)
上記手動操作外科手術器具の制御ハンドルを使用する人物によって、手動操作外科手術器具を制御することをさらに含み、該制御ハンドルは、上記滅菌外科手術野内にある、項目20に記載の方法。
(項目22)
(a)表示デバイスと、機械的に固定されていないマスタツールグリップと、ハンド追跡送信機とをさらに備える患者側外科医インターフェースと、(b)遠隔操作スレーブ外科手術器具と、(c)制御システムとを含む低侵襲外科手術システムにおいて、
該機械的に固定されていないマスタツールグリップが該ハンド追跡送信機からの視野内で移動され、かつ滅菌外科手術野内で移動された場合に、該機械的に固定されていないマスタツールグリップを操作する人物と関連付けられた基準フレームにおいて、該機械的に固定されていないマスタツールグリップの位置および配向を感知することと、
該制御システムによって、該基準フレームにおける感知された位置および配向を受信することと、
該制御システムによって、該感知された位置および配向を使用して、該表示デバイス上に表示される画像と関連付けられた基準フレームに対して、制御コマンドを生成することと、
該制御システムによって、該制御コマンドを該遠隔操作スレーブ外科手術器具に送信することと
を含む、方法。
(項目23)
上記制御システムが、上記機械的に固定されていないマスタツールグリップの運動と上記遠隔操作スレーブ外科手術器具との間の追従モードに入ると、上記表示デバイスの移動を防止することをさらに含む、項目22に記載の方法。
(項目24)
上記制御システムによって、外科医の存在または不在を示すプレゼンススイッチから、信号を受信することをさらに含む、項目22に記載の方法。
(項目25)
上記プレゼンススイッチは、上記機械的に固定されていないマスタツールグリップ上に含まれている、項目24に記載の方法。
本実施例では、図2Aに示されるように、患者側外科医インターフェース150は、第1のマスタツールグリップ170Aおよび第2のマスタツールグリップ170Bを含む。マスタツールグリップ170Aおよび170Bは、例証にすぎず、マスタツールグリップを本具体的構成に限定することを意図するものではない。本開示に照らして、種々のマスタツールグリップは、滅菌外科手術野内から、器具110、111(図1Aおよび1B)等の遠隔操作スレーブ外科手術器具を制御するために使用することができる。
図3Aは、例えば、液晶表示(LCD)デバイスである、表示デバイス160上に画像を提供する、システムの一態様のより詳細なブロック図である。従来の立体的内視鏡112は、患者102の組織ならびに立体的内視鏡112の視野内の外科手術器具110および111の任意のエンドエフェクタの左右チャネル画像を提供する。
患者側外科医インターフェース150は、追従モード(スレーブ外科手術器具が、マスタツールグリップの移動に追従する)、マスタクラッチモード(マスタ移動からスレーブ作動を係脱する)、カメラ制御モード(内視鏡の移動を有効化する)、エネルギーツールモード(外科手術エネルギーツール制御を有効化する(例えば、電気焼灼ツール))、カメラフォーカスモード(カメラフォーカス制御を有効化する)、アームスワッピング(種々のマスタおよびスレーブアーム制御の組み合わせを可能にする)、ならびにTileProスワッピングモード(外科医の表示内の種々の写真表示の制御を有効化する、例えば、フル画面表示と、外科医が2つ以上の別個の画像またはデータ画面を視認する表示との間のスワッピング)等のシステムモードを制御するためのインターフェースを含む。システムモードを制御するためのインターフェースは、外科医101によって、容易にアクセス可能であって、種々の動作モードのオン/オフ作動およびトリガされた起動の両方に対応する。
図1Aおよび1Bに例証されるように、患者側外科医インターフェース150は、外科医101の前腕または肘のためのベンチアームとして機能する、可動人間工学的前腕支持180を含む。前腕支持180は、マスタツールグリップ170、170A、170Bの微細な運動のための安定性を提供する。前腕支持180はまた、連携タスクのために、ハンド間の固有感覚関係を維持する。
前述のように、制御システム190、190A(図1A、1B、3A、および7)は、種々の機能を果たす。制御システム190A(図7)は、動作モードのうちの1つにおける動作と関連付けられた情報と、動作すべきモードを示す情報の両方を受信する。例えば、マスタインターフェース入力/出力モジュール702を使用して、制御システム190Aは、感知された空間情報721、感知された配向情報722、およびグリップ閉合情報723、ならびに制御スイッチ724(例えば、表示およびマスタツールグリッププレゼンススイッチ)の状態に関する情報を受信する。制御システム190Aはまた、患者側外科医インターフェース(PSSI)150からモード制御コマンド725を受信する。種々の制御スイッチからの状態情報およびモード制御コマンドに応答して、制御システム190Aによって講じられる措置は、前述されており、したがって、ここでは反復されない。
Surgical Apparatus」)(参照することによって、全体として本明細書に組み込まれる)を参照されたい。
前述のように、患者側外科医インターフェース150によって、表示デバイス660は、外科医601に対して、可変方向に位置付けおよび配向可能となる。前述の従来の併置マッピングは、外科医601が、立体的表示660を見る方向に沿って自身の手を移動させて、内視鏡下ビュー方向Zsに沿って、器具を移動させる必要があることを示唆する。このアプローチは、外科医が表示デバイス160Bを覗き込む、図3Cに例証されるもの等の立体的表示デバイスにとっては容認可能である場合があるが、外科医のビューがより水平である表示デバイスの場合、容認可能ではない。
患者側外科医インターフェース150については、表示デバイス160は、常時、コンソール立体ビューアのように60度だけ下方に角度付けられていない。表示デバイス160が、3次元画像とマスタツールグリップとの間の従来の構成を再現するように、垂直に配向されすぎる(すなわち、外科医のビューが、表示画面に垂直であって、本質的に、水平である)場合、外科医101は、図5Aに描写されるように、快適ではない姿勢へと、自身の手首515A、515Bを後方に屈曲させるか、または別様に前腕を快適ではない姿勢に保持する必要があるであろう。そのような位置において、スレーブ外科手術器具を操作することは可能であるが、外科医101は、人間工学的に望ましくない不自然な位置を見つけることになるであろう。
従来の低侵襲遠隔操作外科手術システムは、突然の望ましくないスレーブ運動を生じさせることなく、追従モードに入ることができるように、マスタツールグリップおよびスレーブ外科手術器具エンドエフェクタの配向が位置付けられるまで、外科医が待機することを要求していた。しかしながら、制御システム190Aでは、遠隔操作サーボ制御ループモジュール760内のラチェッティングシステムモジュール730(図7)が、外科医101がマスタツールグリップ170の移動を開始すると、起動され、例えば、プロセッサモジュール701上で実行される。ラチェッティングシステムモジュール730ならびにモジュール760は、メモリ780内に格納される。マスタツールグリップ170とスレーブ外科手術器具110のエンドエフェクタとの間の配向誤差に関係なく、遠隔操作サーボ制御ループシステムは、マスタツールグリップ170と、外科手術器具エンドエフェクタ(時として、スレーブ外科手術器具先端661と呼ばれる)との間の追従モードに入る。
a Teleoperated Minimally−Invasive Surgical Instrument」)により詳細に説明されており、参照することによって、全体として本明細書に組み込まれる。
前述のように、プロキシ視覚は、外科医によって、別の外科医を監督するために使用することができる。本実施例では、外科医195(図1B)は、患者側外科医インターフェース150を使用して、外科医101によって監督される。しかしながら、本構成は、例証にすぎない。例えば、外科医101は、マスタツールグリップ170A(図2)を使用して、プロキシ視覚を制御する一方、外科医195は、マスタツールグリップ170Bを使用して、遠隔操作スレーブ外科手術器具110を制御し得る。任意のマスタツールグリップがプロキシ視覚に割り当てられることができ、外科医は、そのマスタツールグリップを使用して、異なるマスタツールグリップを使用する別の外科医を監督することができる。患者側外科医インターフェース150は、第2の外科医のコンソールまたは第1の外科医のコンソールさえ必要とすることなく、そのような監督を促進する。
図9は、可動表示デバイス160、マスタツールグリップ170、ハンド追跡送信機175、および遠隔操作スレーブ外科手術器具110を含む、低侵襲外科手術システム100において、制御システム190、190Aに実装される方法900の一態様のためのプロセスフロー図である。新しく感知されたマスタ運動データの受信動作901では、新しく感知された空間データ、新しく感知された配向データ、または両方が、制御システム190によって受信される。動作901は、処理を安全インターロックチェック動作902に移行する。
患者側外科医インターフェースであって、
a)手術室内に搭載された表示デバイスと、
b)マスタインターフェースであって、
手術室内に位置付けられた機械的に固定されていないマスタツールグリップと、
機械的に固定されていないマスタツールグリップから分離および隔てられたハンド追跡送信機であって、機械的に固定されていないマスタツールグリップは、ハンド追跡送信機と共同して、機械的に固定されていないマスタツールグリップを操作する人物と関連付けられた基準フレームで感知された位置および配向情報を提供する、ハンド追跡送信機と、
を含む、マスタインターフェースと
を備えている患者側外科医インターフェースと、
外科手術エンドエフェクタを備えている、遠隔操作スレーブ外科手術器具と、
機械的に固定されていないマスタツールグリップ、ハンド追跡送信機、表示デバイス、および遠隔操作スレーブ外科手術器具に連結された制御システムと、
を含み、前記制御システムは、基準フレーム内で感知された位置および配向情報を受信し、感知された位置および配向情報を使用して、制御コマンドを生成し、制御コマンドを送信し、表示デバイス上に表示された画像と関連付けられた基準フレームに対して、外科手術エンドエフェクタを移動させる。
機械的に固定されていないマスタツールグリップを移動させることによって、感知された位置および配向情報を生成することであって、
感知された位置および配向情報は、機械的に固定されていないマスタツールグリップを操作する人物と関連付けられた基準フレームにおけるものである、ことと、感知された位置および配向情報に基づいて、低侵襲遠隔操作スレーブ外科手術器具のエンドエフェクタの移動を制御することと、
を含む。
Claims (14)
- 外科手術システムであって、前記外科手術システムは、
機械的に固定されていないマスタツールグリップとハンド追跡送信機と表示デバイスとを含む外科医インターフェースであって、前記機械的に固定されていないマスタツールグリップは、前記ハンド追跡送信機との組み合わせで、前記機械的に固定されていないマスタツールグリップの位置および配向情報を、前記機械的に固定されていないマスタツールグリップを操作する人物に対して定義された身体中心の基準フレームで感知するように構成されている、外科医インターフェースと、
外科手術エンドエフェクタを含む遠隔操作スレーブ外科手術器具と、
前記機械的に固定されていないマスタツールグリップと前記ハンド追跡送信機と前記表示デバイスと前記遠隔操作スレーブ外科手術器具とに結合された制御システムであって、前記制御システムは、前記感知された位置および配向情報を受信することと、前記感知された位置および配向情報を用いて、前記表示デバイス上に表示された画像に関連付けられた基準フレームに対して前記外科手術エンドエフェクタを移動させることとを行うように構成されている、制御システムと、
手動で操作される外科手術デバイスと
を備え、
前記手動で操作される外科手術デバイスは、前記機械的に固定されていないマスタツールグリップを操作する前記人物によって操作されるように位置決めされている、外科手術システム。 - 前記外科医インターフェースは、前記表示デバイスから一定の距離のブーム上に搭載されている立体的画像ビューアをさらに備え、
前記立体的画像ビューアを通して前記表示デバイス上で画像を視認する際に、立体的画像が見られる、請求項1に記載の外科手術システム。 - 前記外科医インターフェースは、表示デバイスモーションインターロックをさらに備え、
前記表示デバイスモーションインターロックは、前記スレーブ外科手術器具の運動が前記機械的に固定されていないマスタツールグリップの追従運動であることを示す信号を前記制御システムからを受信すると、前記表示デバイスの移動を防止するように構成されている、請求項1に記載の外科手術システム。 - 前記外科医インターフェースは、表示デバイスベースのプレゼンスインターロックをさらに備え、
前記表示デバイスベースのプレゼンスインターロックは、前記機械的に固定されていないマスタツールグリップを操作する前記人物の存在または不在を示す信号を前記制御システムに提供するように構成されている、請求項1に記載の外科手術システム。 - 前記外科医インターフェースは、可動ブームをさらに備え、
前記表示デバイスは、前記可動ブーム上に搭載され、
前記可動ブームは、手術室内の手術台の近くでの前記表示デバイスの位置決めを可能にするように構成されている、請求項1に記載の外科手術システム。 - 前記外科医インターフェースは、手術台の位置に対して可動であるように構成されている安定化プラットホームをさらに備え、
前記安定化プラットホームは、前記機械的に固定されていないマスタツールグリップを操作する前記人物の前腕を支持するように構成されており、
前記安定化プラットホームは、前記表示デバイスのいかなる移動からも独立して移動されるように構成されている、請求項1に記載の外科手術システム。 - 前記安定化プラットホームは、複数の車輪を含み、前記複数の車輪は、手術台の前記位置に対して前記安定化プラットホームを移動させるように構成されている、請求項6に記載の外科手術システム。
- 前記安定化プラットホームは、前記手術台に搭載されている、請求項6に記載の外科手術システム。
- 前記安定化プラットホームは、ブームに搭載されている、請求項6に記載の外科手術システム。
- 前記機械的に固定されていないマスタツールグリップは、前記制御システムに結合された1つ以上のスイッチをさらに備え、
前記1つ以上のスイッチのうちの少なくとも1つは、前記機械的に固定されていないマスタツールグリップを操作する前記人物の存在または不在を示す信号を前記制御システムに提供するように構成されている、請求項1に記載の外科手術システム。 - 前記機械的に固定されていないマスタツールグリップは、前記制御システムに結合された1つ以上のスイッチをさらに備え、
前記1つ以上のスイッチのうちの少なくとも1つは、マスタクラッチモードを起動するための起動信号を前記制御システムに提供するように構成されており、前記マスタクラッチモードでは、前記遠隔操作スレーブ外科手術器具の移動は、前記機械的に固定されていないマスタツールグリップの移動によって制御されない、請求項1に記載の外科手術システム。 - 前記制御システムは、ラチェッティングシステムをさらに備え、前記ラチェッティングシステムは、前記機械的に固定されていないマスタツールグリップが移動させられた際に、前記外科手術エンドエフェクタの配向に対する前記機械的に固定されていないマスタツールグリップの配向を継続的に改善するように構成されている、請求項1に記載の外科手術システム。
- 前記制御システムに結合された外科医のコンソールをさらに備え、
前記外科医のコンソールは、第2の表示デバイスおよびマスタツールマニピュレータを含む、請求項1に記載の外科手術システム。 - 前記制御システムは、前記外科医インターフェースの前記表示デバイスと前記第2の表示デバイスとに結合されたプロキシ視覚モジュールをさらに備え、前記プロキシ視覚モジュールは、前記表示デバイスと前記第2の表示デバイスとにプロキシ視覚を提供するように構成されており、前記プロキシ視覚は、前記遠隔操作スレーブ外科手術器具の仮想的な画像であり、
前記プロキシ視覚モジュールは、前記機械的に固定されていないマスタツールグリップ、または、前記外科医のコンソールの前記マスタツールマニピュレータのいずれかを移動させることによって移動される、請求項13に記載の外科手術システム。
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US8521331B2 (en) | 2013-08-27 |
KR101825712B1 (ko) | 2018-02-06 |
BR112012011324A2 (pt) | 2016-04-19 |
WO2011060139A2 (en) | 2011-05-19 |
JP2013510671A (ja) | 2013-03-28 |
US8831782B2 (en) | 2014-09-09 |
EP3092968B1 (en) | 2019-07-24 |
US20140018960A1 (en) | 2014-01-16 |
EP3092968A3 (en) | 2017-02-22 |
US20110118748A1 (en) | 2011-05-19 |
EP3574860A1 (en) | 2019-12-04 |
KR20120115484A (ko) | 2012-10-18 |
JP2017119168A (ja) | 2017-07-06 |
KR101772958B1 (ko) | 2017-08-31 |
KR20170100677A (ko) | 2017-09-04 |
EP3574860B1 (en) | 2023-08-30 |
WO2011060139A3 (en) | 2012-04-19 |
JP6373440B2 (ja) | 2018-08-15 |
EP2467082B1 (en) | 2016-04-27 |
JP5757955B2 (ja) | 2015-08-05 |
BR112012011324B1 (pt) | 2020-04-14 |
EP2467082A2 (en) | 2012-06-27 |
JP2015128681A (ja) | 2015-07-16 |
CN102665589A (zh) | 2012-09-12 |
EP3092968A2 (en) | 2016-11-16 |
CN102665589B (zh) | 2015-09-30 |
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