JPH07184929A - Surgical instrument - Google Patents

Abstract

PURPOSE:To provide the surgical instrument for reducing the working burden of a surgical operating person in the case of a stereotactic operation and safely, surely and exactly positioning surgical instruments in a short time. CONSTITUTION:This surgical instrument is composed of a stereotactic apparatus 2 for positioning a diseased part inside the head 1 from the position of the diseased part previously provided by a diagnostic imaging device while being fixed to the patient head 1, for example sheath 3 to be inserted to the diseased part corresponding to an inserting position and a direction due to the stereotactic apparatus 2, endoscope 4 to be freely attachably and detachably inserted to the sheath 3, treatment instruments, and plural driving motors for electrically three-dimensionally moving the sheath 3.

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to, for example, a surgical apparatus for remotely operating an intracranial surgery, and is particularly suitable for performing a remote operation by electrically driving the insertion / retraction of a sheath. Regarding surgical equipment.

[0002]

2. Description of the Related Art Generally, as a disorder requiring a surgical operation, for example, there is a disorder in the brain. Typical examples of the disorder include cerebral hemorrhage, subarachnoid hemorrhage, Parkinson's disease and the like. As a surgical method for improving these brain disorders, for example, "Cranial Neurosurgery" Vol. 14, No. 2, P.
123-133 (1986), computerized tomography (CT) guided stereotactic brain surgery is performed. Stereotaxic surgery is a procedure in which a stereotactic brain surgery device is fixed to the patient's head, and a positioning device provided in this stereotactic device positions the lesion in the brain, and a drainage tube, biopsy forceps, etc. Is inserted into an obstructed portion and an operation is performed. For example, Japanese Patent Publication No. 63-51701, USP. No. 4,350,159 and the like.

In such stereotactic surgery, X-ray CT,
By using an observation device such as MRI to detect and position an obstacle part from a tomographic image or a three-dimensional image, the positioning accuracy is improved and the invasion to the patient can be suppressed to a low level. Furthermore, for example, JP-A-1-146
In the stereotactic brain surgery device disclosed in Japanese Patent No. 522,
There has also been proposed an endoscopic stereotactic surgery apparatus that attempts to improve safety by performing a procedure such as biopsy and hematoma suction while observing in real time in combination with an endoscope.

[0004]

However, in the above-described conventional stereotactic surgery, for example, in the case of brain surgery, the positioning and fixing of the sheath with respect to the stereotaxic apparatus and the advancing / retreating operation of inserting / removing the sheath into / from the head are performed. Had to do it manually. That is, in order to change the insertion position of the sheath,
It was necessary to loosen the mounting screw of the fixing means for attaching the sheath to the localization device, move it to the position to be changed while reading the scale attached to the localization device, and tighten the screw of the fixing device again to fix it. This work is not only time-consuming and cumbersome, but also a pre-operative burden.

[0005] In addition, if the sheath may be attached to a wrong position due to an erroneous reading of the scales engraved on the orienting device of the operator, or if the fastening of the fixing means is insufficient, the sheath may be removed during the surgical operation. May fall off,
There was still room for improvement in order to improve safety. Therefore, an object of the present invention is to provide a surgical apparatus that reduces the work load on the operator in stereotactic surgery, and safely and reliably positions the surgical instrument accurately in a short time.

[0006]

In order to achieve the above object, the present invention is provided with a localization device fixed to a target site and recognizing a desired position within the target site three-dimensionally, and the localization system. A sheath provided with at least one of an endoscope and a treatment instrument that is detachable, and a insertion and retreat so that the sheath reaches a desired position recognized by the localization device so that the sheath reaches from the predetermined position. An image / process for electrically controlling and driving the device, and for driving one of at least the endoscope and the treatment instrument provided in the sheath to perform a desired image and a predetermined process by the treatment instrument. And a surgical device configured by means.

[0007]

In the surgical device having the above-described structure, the localization device fixes the target part to be an obstacle, positions the target part, and determines the insertion direction and position by the localization device. An operation for aligning the direction and position of the sheath with respect to the stereotactic surgery device by the control means by inserting the endoscope or the sheath equipped with the treatment tool,
The forward / backward movements of inserting and withdrawing the sheath into / from the target portion are performed by an electrically controlled drive unit.

[0008]

Embodiments of the present invention will now be described in detail with reference to the drawings. 1 and 2, the configuration of a surgical apparatus according to a first embodiment of the present invention will be described. In this first embodiment, a surgical apparatus for performing brain surgery is taken as an example.

In this surgical apparatus, a localization device 2 fixed to the head 1 of a patient for positioning a target lesion in the head 1, and an insertion position by the localization device 2
A sheath 3 whose direction is determined and which is inserted into a lesion portion, an endoscope 4 which is detachably inserted into this sheath 3, an ultrasonic aspirator 5 used as a treatment tool, and an ultrasonic aspirator 5 are driven. Ultrasonic aspirator main body 6 for performing the operation, an arm 7 for attaching and supporting the endoscope 4 and the ultrasonic aspirator 5 to the localization device 2, the arm 7 for the sheath 3, the endoscope 4, and the ultrasonic wave. An X motor 8 and a Z motor 9 for moving in the X axis direction and the Z axis direction with respect to the localization device 2 integrally with the suction device 5;
An α motor 10 for rotating about an axis, a β motor 11 for moving the sheath 3 integrally with the endoscope 4 and the ultrasonic aspirator 5 on the arm 7, and an advance / retreat with respect to the arm 7. 1 and a d motor 12 for controlling the operation of the motor, and further, in this device, a computer 13 for controlling the operation of each motor, as shown in FIG.
A driver 14 serving as a drive power source for each of the α, β and d motors 8 to 12 and a controller 15 for transmitting a drive command from the computer 13 to the driver 14 are provided. Although not shown, an encoder is attached to each motor.

The operation of the surgical operating apparatus thus constructed will be described. First, the patient's head 1 is inserted and attached to the ring portion of the orienting device 2 fixed on the operating table 16.

Then, after determining the insertion direction and the position of the sheath 3 into the head 1 based on the coordinates of the lesion portion in the patient's head 1 obtained by X-ray CT, MRI, etc. prepared in advance, X , Z, α, β values are determined and input to the computer 13. Each X, Z, α from the computer 13
The drive control signal to the β motor is the motor controller 15
Is transmitted to the driver 14 via. Driver 1
4 is supplied with a drive current for each motor based on the drive control signal to drive each motor.

An encoder attached to each motor detects whether or not the motor has moved to a value instructed by the computer 13. This detection signal is sent to the driver 14
Is fed back (F / B) to the motor control 15 and used for position control of each motor. In this way, the position and direction in which the sheath 3 moves back and forth are determined. Then, the d-motor 12 is driven to insert the sheath 3 into the head 1 in the same manner as the above-described operation.

FIG. 3 shows the vicinity of the distal end portion of the sheath 3 inserted into the head 1. Under observation by the endoscope 4 attached to the sheath 3, the ultrasonic aspirator (probe) 5 is remotely operated to suck and remove the hematoma 1c in the patient's brain 1b. According to the first embodiment as described above, the position of the sheath with respect to the orienting device, the insertion direction, and the insertion direction are controlled by a motor, so that the work load on the operator is reduced, and the surgical instrument is safe and reliable in a short time. Can be accurately positioned.

Further, as an example of using the localization device of the surgical operating apparatus of the first embodiment, as shown in FIG.
Alternatively, the position of a lesion (fault) portion 22 such as a tumor in the skull 20 of the patient is specified by an image diagnostic apparatus such as MRI. At the same time, the traveling position of the blood vessel 23 is also specified by image diagnosis, and the coordinate data thereof is stored in a storage device (not shown). The endoscope 4 is attached to the sheath 3 attached to the localization device 2 shown in FIG. 1, and the endoscope 4 is inserted toward the identified lesion 22.

At this time, the stored running state of the blood vessel is displayed as an image, and with reference to this, before contacting the blood vessel 23 or the nerve on the path through which the endoscope 4 reaches the lesion portion 22, The bending motor of the endoscope can bend the insertion portion to avoid damaging the blood vessel 23. Therefore, when the endoscope is inserted into the skull, stereotactic brain surgery can be safely performed without damaging the blood vessels in the brain, with minimal invasion.

Next, an example of using the localization device of the surgical operating apparatus according to the second embodiment of the present invention will be described. The second embodiment uses forceps that move in the same manner as the input manipulator by using the localization device of the surgical operating apparatus of the first embodiment. As shown in FIG. 5, the patient's head 31
The orienting device 32 fixed to the
A sheath 33 which is stereotactically inserted into a predetermined portion (lesion portion) in the skull by a drive motor (not shown), and this sheath 3
An endoscope 35 for observing a lesion 34 exposed from the opening by inserting the inside of the endoscope 3 up to the tip opening, and the endoscope 3 similarly.
A forceps 36 is provided which is inserted through the sheath 33 substantially in parallel with the probe 5 and works in the field of view of the endoscope 35.

The operation of these forceps 36 and the endoscope 35
The bending operation of (1) is driven by a motor 37 attached to the base of the sheath 33. Then, the image of the endoscope 35 is a CCU 49 connected to the endoscope 35 by a signal line 44.
Is displayed on the monitor 40 via. The operation of the forceps 36 is such that the operator pushes the manipulator 42 up and down by an input attached to the controller 41, the opening / closing operation is read by the concoder in the controller 41, the driver unit 43 is informed, and the driver unit 43 drives the motor 37. The signal is transmitted to the motor 37 via the motor signal line 44, and the forceps 36 can perform the same movement as the input manipulator 42.

In such a surgical apparatus, first, the position and size of a lesion 34 such as a tumor in a patient's skull is determined by X-ray CT and MR.
It is identified as a relative positional relationship with the localization device 32 by an image diagnostic device such as I. After that, the sheath 33 is punctured so that the distal end portion reaches the lesioned part 34 based on the positional information of the lesioned part 34.

Next, the endoscope 35 and the forceps 36 are attached to the sheath 33.
Inserted into the inside, the operator can see the lesion 40 on the monitor 40 screen.
The input manipulator 42 is operated while observing 4.
By operating the input manipulator 42, the forceps 36 perform a synchronized operation to treat the lesion portion 34.
The forceps 36 realizes a highly flexible movement in the sheath 33, similar to the input manipulator 42.

Therefore, according to the surgical operating apparatus of the second embodiment,
Since the forceps can be freely moved within the narrow sheath, the movement of the forceps is less restricted and treatment can be performed by free movement. Further, for this reason, even more complicated and difficult surgery can be performed by stereotactic brain surgery without craniotomy.

Further, by displaying a desired image on the monitor using the endoscope, the operator does not need to directly look at the sheath opening itself and can perform surgery in a comfortable posture. Further, since the operation and opening / closing of the forceps can be performed by the input manipulator, the fine movement at the tip of the forceps can be enlarged and operated, so that complicated surgical operation can be performed easily.

Next, referring to FIGS. 6 and 7, a third embodiment of the present invention will be described.
A configuration of an operation apparatus as an example will be shown and described. The third embodiment uses the localization device of the surgical operating apparatus of the first embodiment described above, and only the characteristic part will be described here. 6 shows a state in which the craniotomy is performed by the craniotomy drill attached to the localization device shown in FIG. 1, and FIG. 7 shows an example of a block configuration of the present embodiment.

As shown in FIG. 7, in this surgical apparatus, an acceleration sensor 54, a force sensor 55 attached to a craniotomy drill 51, a motor 58 for rotating the drill 53, a drill advancing / retreating actuator 57, and a control unit 59. Connected to.

In this surgical apparatus, as shown in FIG. 6, a drill blade 53 is provided at the tip of a craniotomy drill 51, and an acceleration sensor 54 and a force sensor 55 are attached to the operator's hand side. Further, the craniotomy drill 51 is fixed by a holder 56, and a drill advancing / retreating actuator 57 is built in the holder 56. The acceleration sensor 54 is a displacement detection type sensor having a piezoelectric element or a micro cantilever, and the force sensor 55 is a force sensor having a load cell or a beam structure. Further, the drill advancing / retreating actuator 57 is composed of a motor with gears or the like.

Using the surgical apparatus configured as described above,
When cutting the cranial bone with the cranial drill 51, first, the drill blade 53 is rotated by the motor 58, and the claw drill 51 is advanced by the drill advancing / retreating actuator 57. At this time, the force sensor 55 detects the reaction force received from the skull by the force sensor 55 so that an unreasonable force is not applied.
Controls the speed at which the drill blade 53 is advanced. Then, when the head bone is about to penetrate, the reaction force received from the head bone becomes weaker. Therefore, this is detected and the speed at which the drill blade 53 is advanced or the rotation speed of the motor 58 is reduced.

Then, at the moment when the drill blade penetrates, the reaction force from the skull bone disappears suddenly, but the acceleration increases because the drill blade 53 tries to continue to move as it is due to the inertial force. By detecting the abrupt changes in the reaction force and the acceleration, the rotation of the motor 58 is stopped, and at the same time, the drill advancing / retreating actuator 57 reverses the drill advancing / retreating direction in order to stop the advance of the drill blade 53. Alternatively, a brake member (not shown), such as a brake drum, may be used to turn off the power of the drill advancing / retreating actuator 57 and simultaneously apply a brake to stop the movement of the craniotomy drill 51.

With the surgical apparatus according to the third embodiment,
A force sensor that detects the reaction force from the cranial bone received by the craniotomy drill at the time of craniotomy and an acceleration sensor that detects the acceleration of the craniotomy drill are installed in the craniotomy drill, and the signals are used to control the rotation and advance / retreat of the drill. Compared with, it is possible to prevent damage to the brain parenchyma at the time of craniotomy. Next, FIGS. 8 and 9 show and explain a surgical apparatus as a fourth embodiment according to the present invention.

In this embodiment, the craniotomy drill in the surgical device of the third embodiment is removed from the stereotactic device, and the actuator for advancing and retracting the drill is replaced with a joint actuator having a joint that can be flexibly bent. Instead, it can be used for other, for example, vertebral arch cuts. That is, as shown in FIG. 8, the drill 62 is fixed to the localization device via the articulated holder 60 for holding the drill.

The adjusting portion of the articulated holder 60 has a joint fixing actuator 61 for locking the movement of the joint.
Is built in. The actuator 61 includes, for example, a pneumatic brake that stops the adjustment movement by air pressure,
By increasing the hardness by applying an electric field, magnetic fluid or the like that stops the movement of joints can be used.

When the object to be treated in this apparatus is, for example, vertebral arch cutting, the drill 62 having a shape suitable for vertebral arch cutting and the vertebral arch drill blade 63 are replaced. That is, the surgeon holds the drill 62 for vertebral arch in his or her hand and performs it while directly looking at the vertebral arch to be cut. The joint portion of the multi-joint holder 60 is in the free state, and the drill blade 6 for the lamina is provided.
3 can be moved freely.

In such a case, in the surgical operating apparatus according to the present embodiment, the force sensor 65 and the acceleration are generated when the surgeon suddenly moves the laminar drill blade 63 or when the vertebral arch is cut. The sensor 64 detects the movement, makes a judgment that is considered dangerous, automatically stops the rotation of the motor, and locks the joint of the joint actuator, so that safety can be achieved.

When performing a laminectomy method, which is a treatment method for a disease such as spinal paralysis due to pressure inside the spinal canal, with such an operating device, the reaction force received by the drill for laminectomy and the acceleration of the drill To detect the sudden movement of the drill, and in that case stop the rotation of the drill,
By fixing the movement of the multi-joint holder, safer laminectomy can be performed.

Next, FIG. 10 shows and describes a surgical apparatus according to a fifth embodiment of the present invention. The present embodiment is an example in which a surgical knife is attached instead of the laminectomy drill of the surgical operating apparatus according to the fourth embodiment. In this surgical apparatus, a surgical instrument holder 66 having a surgical knife 70 mounted on the distal end thereof is fixed to a frame or the like of the stereotaxic apparatus via the multi-joint holder 10. This articulated holder 60
In place of the joint fixing actuator, the joint actuator 82 for moving the scalpel 70
Have been replaced respectively. The controller 9 is also provided with a teaching input section 83.

The joint actuator 82 is composed of an AC motor or the like, and can detect components in a plurality of directions together with the acceleration sensor 71 and the force sensor 72 attached to the surgical instrument holder 66. The acceleration sensor 7
1 is composed of, for example, a gyro capable of detecting acceleration components in three directions, in which piezoelectric elements are provided in one package in the X, Y, and Z directions, and the force sensor 72 arranges a strain gauge on the strain beam. Distortion due to the applied force is detected, and X, Y,
A 6-axis force sensor that can detect the force in the Z direction and the moments of roll, pitch, and yaw can be considered.

In the surgical apparatus configured as described above,
First, when the operator treats a certain range, for example, when performing a midline incision with a scalpel, the treatment target portion is taught before the treatment. That is, when incising with the surgical knife 70, the surgical knife 70 is positioned at the starting point and the end point, and at that time, the teaching button of the teaching input section 83 is pressed at each position,
Enter the position as a seat.

At the time of actual treatment, the operator holds the surgical treatment instrument holder 66 by hand and performs the treatment. During the actual treatment, the surgical treatment instrument holder 66 is moved in a direction deviating from the treatment target portion (incision line in this case) taught during that period. When trying to move, the direction is detected by the acceleration sensor 71 and the force sensor 72, and the movement of the multi-joint holder 66 is controlled so as to move the surgical treatment instrument holder 66 in the teaching direction input in advance.

Further, the force sensor 7 of the surgical treatment instrument holder 66.
2 detects the reaction force received from the living body by the surgical knife 70 during the procedure, and controls the movement of the multi-joint holder 66 so that the reaction force is maintained in the range of the applied force necessary for the incision set by the signal thereof. . The surgical instrument at the tip of the surgical instrument holder 66 is replaceable. For example, if the surgical instrument is a needle device, suture / anastomosis etc. in the body cavity can be safely performed by teaching the robot in advance. be able to.

From the above, according to the surgical operating apparatus of the fifth embodiment, the acceleration sensor and the force sensor capable of detecting the multi-axis component can detect the deviation of the movement between the portion to be treated and the portion which the operator taught in advance. The articulated holder is controlled so that it is detected and the surgical treatment tool is moved according to the detected signal so that a safer treatment can be performed. Next, FIG. 11 and FIG.
The configuration of a surgical apparatus according to a sixth embodiment of the present invention will be shown and described in the following. This embodiment is a master-slave system for performing remote surgical procedures.

In this system, the master arm 101 operated by the operator has a position sensor 96 (for example, potentiometer, encoder, resolver, etc.) for detecting the shape of the master arm 101, and the master arm 101.
Has a built-in joint actuator 97 (for example, a motor, a brake, etc.) for restricting its movement. The slave arm 98 that actually performs the treatment includes a position sensor 93 (potentiometer, encoder, resolver, etc.) for detecting the shape of the slave arm 98, and a joint actuator 94 for driving the slave arm 98.
(Motor etc.) is built in.

Further, both the master arm 101 and the slave arm 98 are provided with a tissue gripping portion at their tip ends.
A force sensor 91 (for example, a small load cell, a strain gauge, etc.) for detecting the tissue gripping force is provided in the slave side tissue gripping portion, and an acceleration sensor 92 is provided near the tip of the slave arm 98. In addition, the master arm 101
Similarly, a force sensor 100 is provided at the tip of the.

In the surgical apparatus constructed as described above, when the operator moves the master arm 101 for treatment, a signal from the position sensor 96 is input to the control apparatus 95 so as to follow the shape of the master arm. The slave arm 98 is driven. If the surgeon mistakenly makes a sudden movement on the master arm side, the slave side acceleration sensor 9
2, it is detected that the movement is not a normal operation. Based on the detection signal, the control device 95 locks the joint actuator 94 on the slave arm side and stops the movement of the slave arm 98 so as not to follow the movement of the master arm.

The reaction force signal from the living body detected by the force sensor 91 of the tissue gripping portion on the slave arm side is input to the control device 95 and then to the joint actuator 97 on the master arm side, and the master side. The joint actuator 97 is driven so as to present the reaction force detected by the slave side. When the detected reaction force is an excessive value that damages the tissue, the movement of the joint actuator 94 on the slave side of the control device 95 causes the master arm 10 to move.
Regardless of the movement of 1, control is performed so that the preset value is not exceeded.

The joint actuator 94 may be drive-controlled so as to stop the movement of the master arm 101 when an excessive acceleration or force on the tissue is detected. The treatment tool at the tip of the arm can be replaced with other forceps or the like.

The surgical apparatus according to the sixth embodiment described above detects the excessive acceleration of the slave manipulator and the excessive force on the tissue, and drives and controls the slave arm or the master arm in accordance with the information, so that The operation by the master-slave surgical operation system that approaches a minimally invasive deep organ that could not be achieved by the treatment tool can be safely performed while covering mistakes on the part of the operator.

Next, FIG. 13 shows the structure of a surgical operating apparatus as a seventh embodiment of the invention. In this surgical device,
The computer 111 stores the CT image data 116 of the affected area.
And a patient information memory 112 composed of patient-specific information data 117 and a knee ligament reconstruction surgery database 113
A display 114, a surgical robot 118,
A surgical robot controller 115 that drives and controls the surgical robot 118, and a reference position detection sensor 1 that detects a reference position for the surgical robot controller 115 to control.
It is composed of 19 and.

This surgical device inputs signals read from the patient information memory 112 and the knee ligament reconstruction surgery database 113, and outputs the signals to the display 114 and the surgical robot controller 115. The surgical robot controller 115 controls the operation of the surgical robot 118 based on the signal from the reference position detection sensor 119.

FIG. 15 shows the use of such a surgical device.
It shows a state when a knee ligament reconstruction operation is performed. A drill 13 for bone cutting at the tip of the surgical robot 118.
1 is attached. On the bed 130 on which the patient to be treated is placed, the patient knee fixing base 120 is provided together with the surgical robot 132.

The reference position detection sensor 119 is clearly recognizable in the CT image, and the surgical robot 118 is used.
For detecting a reference position indicating member with respect to, for example, the reference position indicating member includes a plurality of CT-impermeable metal pieces,
It is a triaxial magnetic source with a core of high permeability as a core material,
It is attached to a patient knee fixing base 120 made of a body surface or an X-ray transparent material.

In the surgical apparatus configured as described above,
The computer 111 stores CT image data 116 of the knee, which is imaged preoperatively and is stored in the patient information memory 112.
Then, patient-specific information (softness of body, movement of knee, etc.) 117 quantified by the preoperative examination is input. In addition to these data, the strength data of the reconstructed ligament stored in the knee ligament reconstruction surgery database 113 and the knee movement data computer 111 for various skeletal and ligament shapes are input to the reconstruction ligament fixation set by the operator. Simulation of knee dynamics after performing ligament reconstruction surgery depending on the hole position and reconstruction ligament material.

The result is displayed on the display 114 as a 3D graphic. In this way, a simulation is performed to determine the position of the ligament fixation hole where the post-operative knee dynamics are good (no catching, no concentration of application on the reconstructed ligament, etc.). Information on the optimum position is input to the surgical robot controller 115. Here, the surgical robot control device receives the signal from the reference position detection sensor 119 and recognizes the positional relationship between the treatment target portion and the surgical robot 118.

The optimum hole position data for fixing the reconstructed ligament is
The position of the reference position indicating member in the CT image captured before the operation is used as a reference, and the hole position information based on this CT image is used as data for actual treatment using the same reference position. As shown in FIG. 14A, when the reference position indicating member is a plurality of X-ray opaque metal pieces 123, the reference position detection sensor 119 is the TV camera 121, and the reference position is detected by image processing. , And the bone is cut by the surgical robot 118 so as to match the reference position of the CT image. Further, as shown in FIG. 14B, when the reference position indicating member is a triaxial magnetic source 124, the reference position detection sensor 119 is a triaxial magnetic sensor 125 having a similar structure.
Becomes

The present embodiment is not limited to knee ligament reconstruction surgery, but can be applied to artificial knee joint replacement surgery and artificial hip joint replacement surgery. However, in this case, it is necessary to create a reconstructed surgery database for surgery.

With the operation apparatus of the seventh embodiment as described above, in the knee ligament reconstruction operation, the CT image data of the affected area and the patient's individual are preoperatively determined in order to determine the bone cutting position for the optimum fixation of the reconstructed ligament. Based on the available information and the respective data from the knee ligament reconstruction surgery database, the postoperative dynamics are simulated, and accurate bone cutting can be performed by the surgical robot based on the determined bone cutting position data. It is possible to determine bone cutting position determination that was largely based on the experience and intuition of a doctor at the present time, and by performing a procedure by a robot, it is possible to perform highly accurate bone cutting and to expect a sufficient recovery of function. .

Next, FIG. 16 shows the structure of a surgical operating apparatus as an eighth embodiment of the invention. In this surgical apparatus, the CT image data 140 of the patient's head is stored in the computer 1.
41, the computer 141 is connected to the input device 14
3, display 142, and robot controller for surgery 14
4 is connected. This surgical robot controller 14
4 is a surgical robot 146 and a reference position detection sensor 14
Connected to 5.

In the surgical apparatus thus constructed, the computer 141 constructs a skull image of a stereoscopic image (3D) from the CT image 140 of the head before the operation, and displays it in 3D on the display 142. This display image is moved or changed in shape by the input device 143 to carry out a simulation for determining a surgical plan for deformity of the cranial bone. The bone cutting site determined by this simulation is input to the surgical robot 146 as cutting position data, and the site exactly as simulated is cut.

From the above, the surgical apparatus according to the present embodiment can accurately perform a surgery for shaping a deformity of the skull with a surgical robot based on the data determined by the preoperative simulation. Therefore, as compared with the conventional case where the cutting is performed manually by the doctor based on the simulation data, it is more accurate and the burden on the doctor can be reduced.

As described above, the surgical apparatus of the present invention is
By using the localization device, the positioning accuracy can be improved, human error can be eliminated, and the invasion to the patient can be further suppressed. In addition, a safe operation can be secured without causing damage to the blood vessel or nerve when the probe is inserted. Furthermore, by using a multi-degree-of-freedom manipulator capable of remotely operating a treatment tool such as forceps provided in the probe, complicated operation of the treatment tool can be easily operated from the outside,
Safe and advanced surgery can be performed.

Then, by providing an acceleration sensor, a force sensor, etc. on the treatment instrument attached to the localization device, the movement of the treatment instrument in the surgery performed by the operator is monitored, and the occurrence of erroneous operation is limited.
Dangerous situations can be prevented in advance. Further, the present invention is not limited to the above-described embodiments, and it goes without saying that various modifications and applications can be made without departing from the scope of the invention.

[0059]

As described above in detail, according to the present invention, there is provided a surgical apparatus which reduces the work burden on the operator in stereotactic surgery, and positions the surgical instrument accurately, safely, reliably and in a short time. can do.

[Brief description of drawings]

FIG. 1 is a diagram showing a configuration of each member of a surgical operating apparatus according to a first embodiment of the present invention.

FIG. 2 is a block diagram showing the configuration of the surgical operating apparatus according to the first embodiment.

FIG. 3 is a view showing the vicinity of the distal end portion of the sheath inserted into the head by the surgical operating apparatus according to the first embodiment.

FIG. 4 is a diagram showing a relationship between a lesion part of a brain in a skull and a traveling position of a defect.

FIG. 5 is a view showing a state in which the surgical apparatus of the first embodiment is used to perform an operation with forceps inserted into the head by a manipulator.

FIG. 6 is a diagram showing, as a third embodiment, a state in which craniotomy is performed by a craniotomy drill attached to the localization apparatus of the first embodiment.

FIG. 7 is a block diagram showing the configuration of a surgical operating apparatus according to a third embodiment of the present invention.

FIG. 8 is a diagram showing, as a fourth embodiment, a state in which vertebral arch cutting is performed by a craniotomy drill attached to a joint actuator attached to the localization device of the first embodiment.

FIG. 9 is a block diagram showing the configuration of a surgical operating apparatus as a fourth embodiment according to the present invention.

FIG. 10 is a diagram showing a member structure and a block structure of a surgical operating apparatus as a fifth embodiment according to the present invention.

FIG. 11 is a block diagram showing a configuration of a master-slave system as a sixth embodiment according to the present invention.

FIG. 12 is a diagram showing a member configuration of a master-slave system of a sixth embodiment.

FIG. 13 is a block diagram showing a configuration of a surgical operating apparatus as a seventh embodiment according to the present invention.

FIG. 14 is a diagram showing an example of a reference position indicating member in the surgical operating apparatus according to the seventh embodiment.

FIG. 15 is a diagram showing a state when performing a knee ligament reconstruction operation using the surgical operating apparatus according to the seventh embodiment.

FIG. 16 is a block diagram showing the configuration of a surgical operating apparatus as a seventh embodiment according to the present invention.

[Explanation of symbols]

1 ... Head, 2 ... Localization device, 3 ... Sheath, 4 ... Endoscope, 5
... Ultrasonic aspirator, 6 ... Ultrasonic aspirator body, 7 ... Arm,
8 ... X motor, 9 ... Z motor, 10 ... α motor, 11 ...
β motor, 12 ... d motor, 13 ... Computer, 14
… Driver, 15… Controller, 16… Operating table.

 ─────────────────────────────────────────────────── ─── Continuation of the front page (72) Inventor Yoshihiro Kosaka 2-43-2 Hatagaya, Shibuya-ku, Tokyo Inside Olympus Optical Co., Ltd.

Claims (1)

[Claims] 1. A localization device fixed to a target site and recognizing a desired position in the target region three-dimensionally, and at least one of an endoscope and a treatment instrument which are detachably mounted on the localization device. A sheath; a control drive unit that electrically controls and drives insertion and retraction so that the sheath reaches a desired position recognized by the localization device and a predetermined position; and the sheath. 2. A surgical apparatus, comprising: a video / processing unit that drives at least one of the endoscope and the treatment instrument provided in the above to perform a desired image and a predetermined process by the treatment instrument.