JPH08215205A - Medical manipulator - Google Patents

Abstract

PURPOSE: To enable instructing of the position of an insertion hole to a manipulator controller by a handy means in an endoscope surgical operation using a manipulator. CONSTITUTION: A medical manipulator in which an insert body detachable through an insertion hole formed in an organism is driven by remote control to observe or treat a tissue part within the organism includes a positioning jig 2 having a pointer 36 for indicating the position of the insertion hole.

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a manipulator for medical use, and more particularly to a manipulator device for supporting a surgical operation used for grasping and moving an endoscope or a treatment tool when performing an endoscopic surgical operation. .

[0002]

2. Description of the Related Art Recently, surgical operations have been performed under an endoscope. In this endoscopic surgery, for example, an insertion hole is opened in a body wall such as an abdominal wall, and an endoscope and a treatment tool are percutaneously inserted into the body cavity through the insertion hole to observe and treat the body cavity. Is. In such an endoscopic surgery, the operation of the endoscope and the treatment tool introduced into the patient's body is performed by driving a manipulator installed outside the patient's body. A medical manipulator device of this kind is disclosed in US Pat. No. 5,217,003.

Further, Japanese Patent Laid-Open No. 6-30896 discloses an observing manipulator device for manipulating the movement of an endoscope in the body of a patient. Furthermore, Japanese Patent Application No. 6-1
No. 31809 discloses a medical manipulator having a detachable insert for observation and treatment. The movement of each of the above manipulators is controlled by the manipulator control device.

[0004]

In endoscopic surgery, a trocar is used to open an insertion hole in a body wall, and an endoscope or a treatment tool is inserted into a body cavity through the trocar. Since the endoscope and the treatment tool are operated in this state, the movements of the endoscope and the treatment tool are restricted by the position of the insertion hole formed in the body wall. As a result, the endoscope and the treatment tool are operated by the manipulator device in the above-mentioned US Pat. No. 5,217,003 and JP-A-6-3089.
Even in the medical manipulator device disclosed in Japanese Patent No. 6,
The movements of the endoscope and the treatment tool are restricted by the position of the insertion hole formed in the body wall.

Therefore, in order to control the positions of the endoscope and the treatment instrument in the body cavity by the manipulator, it is necessary to teach the position information of the insertion hole to the manipulator control device prior to the treatment work. However, inputting the position information of the insertion hole by keyboard operation is troublesome,
Further, in order to input the position of the insertion hole, another position detecting means for detecting the position of the insertion hole, for example, a position sensor using a magnetic or optical marker, position detection by image processing, or an articulated manipulator was used. Providing a position sensor or the like is conceivable, but it will be an expensive device with a considerably complicated configuration.

The medical manipulator of the present invention has been made by paying attention to such a problem, and its purpose is to determine the position of the insertion hole when performing endoscopic surgery using the manipulator. It is to provide a medical manipulator capable of teaching a manipulator control device by a simple means.

[0007]

In order to achieve the above-mentioned object, the medical manipulator of the present invention uses a remote operation to drive a removable insert body through an insertion hole formed in a living body. A medical manipulator for observing or treating a body tissue part includes a positioning means having a pointer for pointing the position of the insertion hole.

[0008]

Embodiments of the present invention will be described below in detail with reference to the drawings. First, a first embodiment of the present invention will be described with reference to FIGS. FIG. 1 is a diagram showing the configuration of the first embodiment. This configuration is composed of a treatment manipulator system 1 for performing a surgical operation inside a patient's body, and an observation manipulator system 2 for operating an endoscope 3 for observing the inside of the body according to the intention of the operator.

The treatment manipulator system 1 reads information on the position, posture, and grip of the operator's hand 5 by the operation input device 4, and the treatment manipulator control device 6 controls the treatment manipulator 7 based on the position and posture information. To drive. Tip treatment instrument 1 of treatment manipulator 7
5 is inserted through a tubular trocar 10 inserted into the body of a patient 9 fixed on an operating table 8 to treat the affected area.

Further, in the manipulator system 2 for observation, the operator has an FMD 11 for stereoscopically observing an endoscopic image.
(Face mounted display) is attached, the movement of the operator's head is detected by the three-dimensional digitizer 12 provided in the FMD 11, and observation is performed by the observation manipulator control device 13 based on the obtained position and orientation information. The manipulator 14 for driving is driven to orient the endoscope 3 at the distal end in the direction desired by the operator.

FIG. 2 shows the configuration of the manipulator 7 for treatment. The treatment manipulator 7 is a robot arm of three axes (A1 axis 16 (rotation), A2 axis 17 (up and down), A3 axis 18 (advance and retreat)) and A3 that perform vertical movement, rotation, and forward / backward movement based on a cylindrical coordinate system. A free joint A4 axis 19 that freely rotates with respect to the axis 18 and a free joint 20 (A5 axis) that is freely rotatable perpendicular to the A4 axis 19, and an insert 22 and an insert 22 that operate the distal treatment instrument 15 are free joints. 20 (A
It is composed of a holder 21 (A6 axis) that is rotated perpendicularly to (5 axes).

The insert 2 of the manipulator 2 for observation
3 has the same configuration as the treatment manipulator 7 except that the endoscope 3 is provided instead of the distal treatment instrument 15.

FIG. 3 shows the state of the treatment manipulator 7 during internal operation. The insert 22 is inserted into the body through the trocar 10. The position P0 24 of the insertion hole into the body can be considered to be a fixed point. The position Pe26 of the end effector section 25 is defined by the base of the bending section 57, and is positioned by the operation input device 4. The manipulator control device 6 for treatment inserts from the position of Pe26 and P0 24 and the insertion reference length 127 (the distance between the position Pe26 and the attachment body mounting position 28) in order to position it at the position Pe26 designated by the operation input device 4. Body mounting position P
m28 is calculated and the A1 axis 16, A2 axis 17, and A3 axis 18 are driven. For this purpose, it is necessary to know the position P0 24 of the insertion hole.

FIG. 4 shows a positioning jig 29 which is a positioning means for knowing the position P0 24 of the insertion hole. The positioning jig 29 can be inserted into the holder 21 instead of the insert 22, and by tightening the screw portion 56 with the tightening nut 30,
It can be detachably fixed to the holder 21. Positioning jig 29
Has a rotation stopper 31 for stopping the free rotation of the A4 shaft 19 and always positioning it at a fixed position, which is fitted into a hole 32 provided in the A3 shaft 18, and also stops the free rotation of the A5 shaft 20. It has a horizontal plate 33 capable of being held horizontally and a pointer 36 composed of a pipe 34 and a tip portion 35 for indicating the position 24 of the insertion hole.

The operation of the above configuration will be described below. In this embodiment, the following operation is performed to detect the position P0 24 of the insertion hole. First, the insertion body 22 of the treatment manipulator 7 is removed, and the positioning jig 29 is inserted into the holder 21 instead and fixed by the tightening nut 30.
A4 axis 19 and A5 axis 20 by the positioning jig 29
Is fixed at a fixed position, the position of the tip end portion 35 of the positioning jig 29 is set to A1 axis 16, A2 axis 17,
It is uniquely determined by the driving amount of the A3 axis 18. In this state, using the operation input device 4, the A1 axis 16, the A2 axis 17,
The A3 axis 18 is driven to position the tip end portion 35 of the positioning jig 29 at the insertion hole position P0 24, and the treatment manipulator control device 6 stores the position of the insertion hole P0 24.

As a means for operating the positioning jig 29 at this time, means other than the operation input device 4, for example, a joystick, a cursor input, a three-dimensional mouse or the like may be separately provided.

After memorizing the position P0 24 of the insertion hole, the positioning jig 29 is detached from the holder 21, and the insert 22 is attached instead. Since the position P0 24 of the insertion hole is known, the insertion member mounting position Pm2 is set with respect to the position Pe26 of the end effector unit 25 input by the operation input device 4.
8 can be calculated. A to position at position Pm28
By operating the 1-axis 16, the A2-axis 17, and the A3-axis 18, the end effector portion 25 is positioned at Pe 26.

Although the description has been made above centering on the treatment manipulator 7, the end effector section 25 is replaced with the endoscope 3 from the distal treatment instrument 15, and the operation input device 4 is changed to 3.
The same applies to the observation manipulator 14 except that it is replaced with the dimensional digitizer 12.

According to the first embodiment described above, the operator can observe the desired direction in endoscopic surgery, and the operability of the treatment tool can be improved. In order to operate such a medical manipulator used in endoscopic surgery, it is necessary to detect the position P0 24 of the insertion hole of the endoscope or the treatment tool, but as shown in this embodiment. By using the simple positioning jig 29, a separate device such as a position sensor using a magnetic or optical marker for detecting the position of the insertion hole, a position detection by image processing, and a position sensor using an articulated manipulator can be provided. It becomes unnecessary.

Further, in this embodiment, the positioning jig 29 is used as the insertion hole position detecting means and the free joints A4 axis 19 and A5 axis 2.
Since it also serves as a 0 restraint means, the attachment / detachment operation to / from the manipulator at the time of use becomes easy.

A second embodiment of the present invention will be described below with reference to FIGS. First, the configuration of the second embodiment will be described with reference to FIG. In the second embodiment, instead of the A4 ′ shaft 19 and the A5 shaft 20 shown in FIG. 2 of the first embodiment, a joint having a driving means, an A4 shaft 37 and an A5 shaft 38 are provided. In this embodiment, since the joint does not move passively, the A1 axis 16, the A2 axis 17, the A3 axis 18, and the A4 'axis are arranged so that the insert 22 passes through the position P0 24 of the insertion hole shown in FIG. 37, if you do not control the A5 'axis 38,
A strong force is applied to the skin near the insertion hole 24 or nearby tissues, which may cause damage.

FIG. 6 shows a positioning jig 39 in this embodiment.
Indicates. In this embodiment, the A4 ′ axis 37 and the A5 ′ axis 3
Since 8 has a driving means, the positioning jig 39 is composed of a fixing screw 40, a pipe 34, and a pointer 36 including a tip portion 35. Like the first embodiment, the insert 22
Is attached and detached, and the positioning jig 39 is attached to the holder 21 by the tightening nut 30 instead. Operation input device 4
(3D digitizer 1 for observation manipulators)
2) is used to operate the manipulator 7 to control the pointer tip portion 35 to indicate the position P 0 24 of the insertion hole, and the manipulator control device 6 to store the insertion point.
Further, in order to adjust the reference insertion length l'42 (the distance between the insertion body mounting position 28 and the pointer tip portion 35), the mounting position of the pipe 34 can be changed by the pipe mounting screw 41.

FIG. 7 shows different types of inserts. The insert A43 has the distal treatment tool 15, and the insert B44 has the endoscope 3. Insertion standard length of insert B44 LB 4
6 is longer than the insertion reference length 1A 45 of the insert A43. By changing the mounting position of the pipe 34 to l'A 47, l'B 48 corresponding to the insertion reference length of the insert, the insertion reference length l'of the positioning jig 39 is changed to the reference insertion length l of the insert.
Can be treated as the same length as.

According to the second embodiment described above, the A4 'shaft 3
7. Since there is a driving means on the A5 'axis 38, even if the position P0 24 of the insertion hole slightly changes due to the patient's breathing, intraoperative movement, changes in pneumoperitoneum, etc., the end effector portion 25 of the manipulator is changed. Does not affect positioning. Further, in this embodiment, the pointer tip portion 35 and the insert body mounting position Pm28
Since the length of the space between the manipulator and the jig around the insertion hole may interfere with the manipulator or the jig, it is easy to teach the position.

Further, the insertion reference length l'42 of the positioning jig
When the insertion reference length 127 of the insert body is set to be the same, it is not necessary to set a special constant for the insertion reference length l'42 of the positioning jig. As a result, one positioning jig 39 can be used for a plurality of insert bodies and manipulators.

A third embodiment of the present invention will be described below with reference to FIG. In the third embodiment, the tightening screw 51 of the positioning jig 49 is attached to the A3 shaft 18 shown in FIG. 2 of the first embodiment.
Therefore, the detaching mechanism 50 is provided. The positioning jig 49 is composed of a pipe 34 and a pointer tip portion 35. In the present embodiment, the position P0 24 of the insertion hole can be designated using the treatment manipulator 7 and the positioning jig 49 while the insert 22 is still attached.

According to the above-mentioned third embodiment, even if the position P0 24 of the insertion hole changes due to a change in the body position during the operation, and it is necessary to teach anew, the insert 22 is not removed. It has the effect of being able to teach.

A fourth embodiment of the present invention will be described below with reference to FIGS. 9 and 10. In the fourth embodiment, instead of the pointer tip portion 35 at the tip of the pipe 34 of the third embodiment, 2 is used.
The lasers 69 and 70 of the table are provided. The treatment manipulator 7 is operated so that the intersection point 71 of the two laser beams is an instruction point and the intersection point 71 of the insertion hole coincides with the intersection point 71 of the rays, and the position P0 24 of the insertion hole is taught.

Further, as shown in FIG. 10, one laser 6
9 is attached to a rotatable base 58, and an angle 52 formed by two laser beams can be changed by an angle changing mechanism 55 including a screw 53 and a spring 54. As a result, the position 71 of the intersection of the laser beams is also changed, so that the same effect as when the insertion reference length l'42 of the positioning jig in the second embodiment is changed is obtained.

According to the above-described embodiment, since the position of the insertion hole can be taught without contacting the living body, when the position of the insertion hole changes during the operation due to a change in the body position or the like, it interferes with devices around the insertion hole. Even if it is difficult to operate, the position of the insertion hole can be easily taught.

An additional description of the above embodiment will be given below. 2. Description of the Related Art There is known a manipulator for surgery in which a surgical instrument such as an endoscope can be inserted into a body cavity for observation and treatment inside the body cavity. In other words, the conventional endoscopic surgery is to perform various treatments in a body cavity by opening an insertion hole in a body wall such as an abdominal wall and inserting an endoscope or a treatment instrument into the body cavity through the insertion hole. Such a surgical procedure is widely performed as a minimally invasive procedure that does not require a large incision, such as a cholecystectomy and a surgery to remove a part of the lung.

In endoscopic surgery, generally, a first insertion hole is opened in the body wall and the endoscope is inserted into the body cavity, and the first operator holds it to secure the operative field. Then, the second and third insertion openings are opened in the body wall, and a surgical instrument such as forceps is inserted into the body cavity and the second
The surgeon performs surgery.

As described above, in endoscopic surgery, an operator who holds an endoscope which is unnecessary in general laparotomy is required. Therefore, Japanese Patent Application No. 4-221571 discloses a scope holder that holds the endoscope device so that the operative field can be secured even if there is no operator who holds the endoscope.

It is desirable to electrify such a scope holder so that the operator can directly operate it in order to save labor in endoscopic surgery. However, the endoscope inserted into the body cavity is restrained at the insertion hole. It is necessary to operate the manipulator so that unreasonable force is not applied to the living body.

Japanese Unexamined Patent Publication No. 6-30896 discloses a manipulator that holds an endoscope device and the like and can be operated electrically. Here, by positioning the insertion hole for inserting the endoscope into the body cavity and the operation center of the electric movable device attached to the tip of the manipulator, the endoscope is inserted even when the endoscope is operated. It has a structure that does not apply excessive force to the living body.

However, in the manipulator disclosed in Japanese Patent Laid-Open No. 6-30896, the movable device attached to the tip of the manipulator becomes large and the operability is deteriorated. Further, it does not describe any method for aligning the insertion hole and the operation center of the movable device.

In order to solve the above problems, the operation for determining the restriction point for restricting the movement of the endoscope can be accurately performed in a short time, and the operation of the surgical manipulator can be easily performed. The manipulator will be described.

11 to 16 show the first embodiment, in which a slave manipulator is operated by operating a master manipulator in a surgical manipulator for inserting a surgical instrument into a body cavity and observing and / or treating the inside of the body. When operating, the slave manipulator's surgical instrument's insertion part is configured to match the position and orientation of the master manipulator with the position and orientation of the slave manipulator so that excessive force is not applied to the insertion hole in the body wall. It was done.

That is, as shown in FIG. 11, in the manipulator for surgery, the slave manipulator 101 as a manipulator has its distal end portion a body wall a of the patient.
From a surgical instrument 103 having an insertion portion 102 to be inserted into the body cavity c through the insertion hole b of the same, and a robot 104 having a plurality of axes having linear and rotational degrees of freedom for supporting the surgical instrument 103 It is configured. Insertion part 102
The tip part of is equipped with a three-dimensional (three-dimensional) scope 105 and a pair of treatment tools 106 and 107. Three-dimensional (three-dimensional)
The distal end of the scope 105 and the pair of treatment tools 106, 1
No. 07 can be bent with multiple degrees of freedom.

On the other hand, as an operation procedure, there is a master manipulator 111 as an operation means having a multi-joint structure, and an HMD (head mounted display) 11 is provided at the tip of the master manipulator 111.
2 and a pair of treatment tool operating arms 113 and 114 are provided.

The slave manipulator 101 and the master manipulator 111 are connected to the control device 121. The position of the tip end of the master manipulator 111 corresponds to the position of the slap manipulator 101, and the position of the rotating part of the HMD 112 is 3. It is controlled so as to correspond to the bending angle of the three-dimensional (three-dimensional) scope 105 and further operate the treatment operation operation arms 113 and 114 in accordance with the positions of the treatment tools 106 and 107.

The axis of the slave manipulator 101 has an actuator (not shown), an encoder 118 for detecting its rotational position, and a speed reducer (not shown).
Is provided. An encoder 120 is provided at the joint portion of the master manipulator 111, the rotating portion of the HMD 112, and the joint portion of the treatment operation arm.

Although FIG. 11 shows the insertion portion in which the three-dimensional (three-dimensional) scope 105 as an endoscope and the treatment instrument 167 are integrated, only the endoscope or only the treatment instrument is configured. But it doesn't matter. Also, as an endoscope,
Although an embodiment having a bending mechanism at the tip is shown, a rigid endoscope may be used. FIG. 13 is a diagram showing the link mechanism in the above configuration in an easy-to-understand manner.

FIG. 12 shows the structure of the system for controlling the operation of the surgical manipulator. That is, the slave manipulator 101 and the slave manipulator 101
A control device 121 for controlling the, a manipulation means 122 and a manipulation switch 124 are provided. The control device 121 includes an MPU 125, an actuator drive circuit 120, and an input / output interface (I / F) 127, and the operating unit 122, the slave manipulator 101, and an operating switch 124 are connected to each.

Next, the operation of the surgical manipulator configured as described above will be described. In the above configuration, in order not to apply an unreasonable force to the insertion hole b of the body wall a,
The operation called point lock is performed. In this surgical manipulator, the operator operates the master manipulator 111 to operate the slave manipulator 101, but at this time, since the slave manipulator 101 operates following the movement of the master manipulator 111, for example, When the operator mistakenly operates the master manipulator 111, the insertion hole by performing the slave operation even though the operation instrument 103 inserted into the body cavity c of the patient is restrained in movement by the insertion hole b. It happens that an unreasonable force is applied to b.

Therefore, the above-mentioned problems can be solved by limiting the operation of the slave manipulator 101 so that the surgical instrument 103 can be controlled to operate with the insertion hole b as a fulcrum. Here, this operation restriction will be referred to as a point lock.

The operation limiting method by the point lock will be described. FIG. 14A shows the slave manipulator 10.
1 shows the distal end portion 128 of the insertion portion 102 of FIG.
Shows the tip 129 of the master manipulator 111.

The operation relationship between the master manipulator 111 and the slave manipulator 101 in the master-slave mode is as follows.
The relative movement amount of the coordinate system 9 is the slave manipulator 10
The coordinate system of the tip portion 128 of No. 1 is reflected in the operation.

First, as shown in FIG. 14B, the state of TCP (tool tip point) of the tip portion 129 of the master manipulator 111 is defined as TCPm130, and FIG.
The TCP state of the tip portion 128 of the slave manipulator 101 shown in (a) is TCPs 131.

TC of the master manipulator 111
In the process of obtaining P, obtaining the TCP of the slave manipulator 101, and operating the slave, first, the joint variables are obtained from the movement amount from the encoders arranged on each axis of the master manipulator 111, and the forward coordinates for obtaining the position / orientation of the TCP are obtained. Perform conversion processing. With this, the TCP of the master manipulator 111 is obtained. After that, it is configured to perform inverse coordinate transformation for obtaining the control amount of each axis of the slave manipulator 101 from the obtained TCP value.

From the above-mentioned state, as shown in FIG. 14B, the operator manipulates the tip portion 12 of the master manipulator 111.
It is assumed that the position / orientation of TCPm 130 of No. 9 is moved to the state of TCPm 132. At this time, TCPm130 to T
The vector indicating the position / orientation moved to CPm132 is A
And At the same time, the master manipulator 111
It is assumed that the tip portion 129 of is rotated by θ as shown in the figure.

The control device 121 sets the homogeneous coordinate transformation matrix A '(FIG. 14 (a) shown in FIG. 14 (a) so that the positional relation (the homogeneous coordinate transformation matrix A) of the master manipulator 111 is the same. ) TCPs 131 to TCPs 1
33) is calculated. At the same time, TCP
The line segment connecting s131 and the point lock position 134 is defined as the O axis, and the point lock position 134 and TCPs1 are defined.
The line segment connected to 33 is defined as the P-axis. Further, the angle α forming the O axis and the P axis and the vector Q perpendicular to the plane formed by the two straight lines of the O axis and the P axis are calculated.

Tip portion 1 of slave manipulator 101
In order to make 28 follow the tip 129 of the master manipulator 111, it moves from TCPs 131 of the tip 128 of the slave manipulator 101 to TCPs 133. At this time, the axis of the tip 128 of the slave manipulator 101 passes through the point lock position 134. Since the condition must be satisfied, the tip end portion 128 of the slave manipulator 101 is moved to the TCPs 133, and at the same time, the tip end portion 128 of the slave manipulator 101 is moved while being rotated around the Q vector by the angle α formed by the O-axis and the P-axis obtained above.

Since the tip portion 129 of the master manipulator 111 is rotated by θ in FIG. 14B, the axis (P of the tip portion 128 of the slave manipulator 101 (P
Rotate θ about the axis.

The above operation is performed in the control device 121.
Calculation is performed at regular intervals. By repeating this calculation, the master-slave mode with a point lock operation in real time is realized.

The above is the slave manipulator 1
In the case of inserting 01 into the body cavity of the patient,
A countermeasure against a singular point that occurs when the slave manipulator 101 is inserted into or removed from the insertion hole b will be described.

Tip part 1 of slave manipulator 101
The singular point generated when inserting 28 is the position obtained when the position of the insertion hole b and the TCP of the slave manipulator 101 match, but since there are innumerable postures to insert, the robot 104 has It is not possible to determine the posture. Further, even when the position of the insertion hole b and the TCP of the slave manipulator 101 do not coincide with each other, there is a problem in calculation accuracy in the vicinity, so that the posture cannot be determined in some cases.

Therefore, with respect to the posture at the portion where the TCP of the tip end portion 128 of the slave manipulator 101 and the insertion hole b coincide with each other, this posture is solved by determining the inserted posture.

However, since it is necessary to determine in advance from which part the above-described previous posture is adopted, by providing a certain range of dead zone near the insertion hole b, the singular point of the robot 104 is Even if it happens, it is designed so that it can move smoothly.

On the other hand, as an operating means, force sensors 153a and 153b are provided on a grip portion 154 provided on the slave manipulator 101 as shown in FIG. Slave manipulator 101 and force sensor 1
53a and 153b are connected to the control device 121 and operate so that the position and orientation determined by the force sensors 153a and 153b correspond to the position and orientation of the slave manipulator 101.

The force sensor 153a uses three force direction vectors (B1, B2, B3), and the force sensor 153b uses two force direction vectors (B4, B5) and one rotation (B).
A strain gauge is mounted inside so that 6) can be detected. The position and orientation determined by the force sensors 153a and 153b are the force sensor 153 in FIG.
a, 153b components B1, B2, B3, B4, B5, B
6 means that, when the constraint condition such that the long axis of the endoscope 105 intersects the insertion hole b is not set, A1, A2, A3, A of the slave manipulator 101 is set.
4, A5, A6 are controlled respectively, but in the case of point lock, the position and the insertion of the tip of the slave manipulator 101 are determined by the position of the point of interest of the insertion section 102 determined by B1 to B5. The inclination of the insertion portion 102 so that the long axis of the insertion portion 102 passes through the insertion hole b is determined, and the insertion portion 1 is determined by the rotation angle of the insertion portion 102 by B6.
Control the rotation of 02's point of interest and position.

That is, the operator holds the robot's grip 154.
When gripping and moving in the direction of the arrow, the TCP at the distal end portion of the endoscope 105 becomes like the vector A as in the first embodiment so that the constraint condition shown in the first embodiment is satisfied. Try to move. Force center 153a, 153b
Since independent position / orientation information of B1 to B6 is detected, the TCP position of the master manipulator 111 is obtained from the information of the encoder 120 arranged at each joint of the master manipulator 111 performed in the first embodiment. The forward coordinate conversion for calculating the posture and calculating the component of the moving vector A on the master manipulator 111 side is not necessary, and the information of the force sensors 153a and 153b is used as it is to perform the slave operation according to the control amount of each joint. good.

Now, a series of flow of the operation method of the present embodiment described above will be shown. First, in order to obtain the position of the insertion hole b of the patient on the bed, for example, the slave manipulator 10
1, the surgical instrument 103 is attached, and the position of the insertion hole b and the TCP position of the surgical instrument 103 are determined by the force sensors 153a, 1
It is adjusted by operating 53b (the posture may be in any state). TC when aligning
The position of P is based on the output of the encoder attached to each axis of the slave manipulator 101.
It can be calculated by The TCP coordinates are stored in the storage means inside the control device 121 as the position of the insertion hole b. As a result, the insertion hole b
The relative position between the slave manipulator 101 and the slave manipulator 101 is obtained. Since the position of the slave manipulator 101 is fixed, the position of the insertion hole b is obtained.

Next, the master manipulator 111 is operated by the operation of the operator. As shown in FIG. 16, on the control device 121 side, the position and rotation at the tip of the master manipulator 111 are read as operation commands. The position / orientation information obtained from the master manipulator 111 is coordinate-converted into the position or attitude of the slave manipulator 101.

When the coordinate conversion process is completed, the surgical instrument 1
It is determined whether or not the operation target part 03 (the tip TCP of the slave manipulator 101) is near the insertion hole b. Here, it is determined whether the tip TCP of the slave manipulator 101 is inside the body cavity c. If it is outside the body cavity c, immediately before the position of the operation target portion of the surgical instrument 103 (the tip TCP of the slave manipulator 101) enters the vicinity of the insertion hole b as the value of the inclination of the long axis of the insertion portion 102. Value is used to further cause the rotation of the insertion portion 102 about the long axis to match the rotation command of the slave manipulator 101. If the position of the tip TCP of the slave manipulator 101 is the body cavity c of the patient.
In the case of being located inside, the insertion portion 102 passes through the position of the insertion hole b, and the position of the operation target portion of the surgical instrument 103 (the tip TCP of the slave manipulator 101) matches the command position determined by the master manipulator 111. Further, the rotation of the insertion portion 102 about the long axis is operated so as to match the rotation command of the master manipulator 111.

Therefore, the master manipulator 11
Even when the position and orientation determined by the operation 1 do not satisfy the constraint condition of passing through the insertion hole b of the surgical instrument 103 of the slave manipulator 101, the slave manipulator 101 can be operated so as to satisfy the constraint condition, and by extension, the surgical instrument 103. The insertion part 102 does not apply an unreasonable force to the insertion hole b. Further, when the operator operates the master manipulator 111, the slave manipulator 101 follows the operation of the master manipulator 111 to operate the surgical instrument 103 inserted into the body cavity c, and the head of the operator is operated. Since the HMD 112 and the encoder 120 for the rotation axis of the HMD 112 are provided in the, the three-dimensional (stereoscopic) scope 105 fixed to the slave manipulator 101 follows the movement of the encoder 120 when the operator moves the head. The image of the field is displayed on the HMD112, and the operator
The surgical instrument 103 can be used for treatment while observing the image displayed on the screen 2. Therefore, since the treatment can be performed in the presence of being in the body cavity c, endoscopic surgery can be performed with the sensation of laparotomy.

17 to 21 show the second embodiment, and the first embodiment
The same components as those of the embodiment are designated by the same reference numerals and the description thereof will be omitted. This embodiment is a surgical manipulator in which a surgical instrument is inserted into a body cavity to observe and / or treat the inside of the body, and a slave manipulator is operated by operating a force sensor attached to the slave manipulator. The insertion part of the surgical instrument of the manipulator is made to correspond to the position and attitude of the slave manipulator with the position and attitude determined by the force sensor so that the insertion part is inserted straight to the target site to be observed and treated. It is composed.

In this manipulator for surgery, the slave manipulator 171 has a surgical instrument 172 having an insertion portion 172a for inserting its tip into the head d of the patient.
And a robot 173 having a plurality of axes having a degree of freedom of linear movement and rotation for supporting the surgical instrument 172. A three-dimensional (three-dimensional) scope 174 and a pair of treatment tools 175, 1 are provided at the tip of the insertion portion 172a.
And 76. The tip portion of the three-dimensional (three-dimensional) scope 174 and the pair of treatment tools 175 and 176 are each capable of bending with multiple degrees of freedom. Further, an HMD 177 and a three-dimensional position sensor 178 are provided on the operator's head.

On the other hand, as the operation procedure, the force sensors 179a, 17a provided on the slave manipulator 171 are used.
9b is provided. Slave manipulator 17
1, 3D position sensor 178 and force sensor 179
a and 179 b are connected to the control device 121 and operate so that the position and orientation determined by the force sensors 179 a and 179 b correspond to the position and orientation of the slave manipulator 171 and are determined by the three-dimensional position sensor 178. Position and posture are three-dimensional (three-dimensional) scope 1
It is operated so as to correspond to the bending angle of 74.

Further, the pair of treatment tools 175, 176 are mechanically operated by the operation portions 180a, 180b, 180c, 180d. In addition, the force sensor 179a is
The force sensor 179b is equipped with a strain gauge inside so as to detect two direction vectors of force and one rotation.

In FIG. 17, three-dimensional (three-dimensional)
Although the insertion portion in which the endoscope as the scope and the treatment tool are integrated is shown, the configuration may be made with only the endoscope or only the treatment tool. Further, as the endoscope, the embodiment in which the distal end portion has the bending mechanism is shown, but a rigid endoscope may be used. Further, the structure of the system for controlling the operation of the surgical manipulator of the present embodiment is the same as that shown in FIG. 2 of the first embodiment, and the explanation thereof will be omitted.

Next, the operation of this embodiment will be described.
Since the point lock position in the field outside the brain is a portion located inside the patient's head d, for example, it is necessary to previously recognize the position of the target site by an image observation device such as CT. In order to know the position of the target part, for example, by inputting position information from the standard input device of the control device 121, the position of the target part (point lock position) and the slave manipulator 101 on the control device 121 side. It is also possible to recognize the relationship.

Further, when the point lock position can be confirmed from the insertion hole opened in advance for inserting the endoscope, the surgical instrument 103 is once removed from the slave manipulator 101, and instead, the laser pointer 191 shown in FIG. The point lock point indicating jig 190 including the optical distance measuring means 192 is attached to the slave manipulator. Here, as the distance measuring means, a mechanism used for focus adjustment of the autofocus mechanism of the camera can be used. An example suitable for using this point lock point indicating jig may be a case where the patient is seriously damaged when the affected part is touched carelessly in the field of brain surgery as in the present embodiment. Further, since the apparatus of this embodiment can measure the point lock point in a non-contact manner with respect to the patient, it is not necessary to clean, disinfect, and sterilize each time the point lock point indicating jig is used.

Next, how to obtain the point lock point in this embodiment will be described. As shown in FIG. 21, the jig 190 is attached to the slave manipulator 101, the force sensors 153a and 153b are operated, and the position and the posture of the slave manipulator 101 are changed.
The position pointed by the laser pointer 191 attached to 0 and the point lock point are matched. At this time, the position pointed by the laser pointer 191 and the jig 19
The distance to the tip of 0 is detected by the optical distance measuring means 192. The position pointed to by the laser pointer 191 is obtained by calculating the output of the encoder attached to each axis of the slave manipulator 101 and the distance information detected by the optical distance measuring means 192 by the control device 121, and this is calculated. It is stored as a point lock point in a storage means provided inside.

Then, the jig 190 is removed from the slave manipulator 101, and the surgical instrument 103 is attached to the slave manipulator 101. The subsequent operation and the like are the same as those in the first embodiment, and will be omitted.

Next, the specific operation will be described.
As shown in FIG. 18A, in order to move the surgical instrument 172 from the state of S1 in the horizontal direction (arrow direction), the slave manipulator 171 is operated so as to extend the A3 axis (the force sensor 179a is moved to the B3 direction). Push in the direction). When not in the point lock mode, FIG. 18 (a)
The tip of the surgical instrument 172 moves as shown by the dotted line in FIG. 18, but in the point lock mode, the point lock position A and the long axis of the surgical instrument 172 operate so as to coincide with each other. The state moves from the state of S1 shown in to the state of S2.

In order to move the surgical instrument 172 from the state of S3 in the vertical direction (in the direction of the arrow as shown in FIG. 18B), as shown in FIG.
Operation to shorten A2 axis of 1 (force sensor 179a
-Press in the B2 direction). When not in the point lock mode, the surgical instrument 172 moves to the portion shown by the dotted line in FIG. 18 (b), but in the point lock mode, moves to the state of S4 shown in FIG. 18 (b).

Although the horizontal / vertical movement method has been described, the slave manipulator 171 can also be rotated, which is shown in FIG. 18 (c).
The slave manipulator 171 from the state of S3 shown in FIG.
B5 of the force sensor 179b is operated so that the A5 axis of is rotated. When not in point lock mode, see FIG.
From the state of S5 in (c), the surgical instrument 17 is attached to the portion indicated by the dotted line.
2 moves, but in the point lock mode, the posture is moved to S6 in order to satisfy the point lock constraint condition.

The surgical instrument 172 used in the extra-cerebral field
The operating method of the slave manipulator 171 when the is attached to the slave manipulator 171 has been described.
When used in the extracranial field, the point lock position is inside the patient's head d.

Therefore, as shown in the first embodiment,
Although it does not actually pass through the point lock position, if the point lock position and the position of the distal end portion of the surgical instrument 172 coincide with each other, a singular point may occur as shown in the first embodiment. Therefore, also in this embodiment, when the dead band shown in the first embodiment is processed by the control device 121 side and the posture cannot be determined, the control device 121 side determines the posture immediately before entering the dead band. It is done.

FIG. 19 shows the series of operations described above. FIG.
By 9, the operator operates the direct move. After the operation, the force sensor inputs the position and rotation at the tip of the direct move as operation commands to the control device. When the position and rotation information of the direct move is input, the position / orientation information obtained by the direct move is coordinate-converted into the position or attitude of the surgical instrument of the slave manipulator.

After the coordinate conversion, it is judged whether or not the position of the operation target site of the surgical instrument is near the position of the site to be treated or observed. If it is near the target site, As the value of the inclination of the long axis of the insertion part, the value immediately before the position of the operation target part of the surgical instrument enters a distance close to the position of the part targeted for treatment or observation is used. The rotation about the long axis is operated so as to match the rotation command of the slave manipulator.

If the position of the operation target part of the surgical instrument matches the command position determined by the master-slave manipulator, the rotation of the insertion part about the long axis matches the command of rotation of the slave manipulator. Let

Therefore, the position and posture determined by the operation of the force sensor do not satisfy the constraint condition that the insertion portion of the surgical instrument of the slave manipulator inserts the insertion portion straight into the target site to be observed and treated. Even in the case, it is possible to operate so as to satisfy the constraint condition.

When the operator operates the force sensor, the slave manipulator follows the operation of the force sensor,
The surgical instrument inserted in the body cavity can be smoothly operated.

Since the operator also has the HMD and the three-dimensional position sensor on the operator's head, when the operator moves the head, the operator follows the movement of the three-dimensional position sensor and the three-dimensional position sensor moves. Since the bending portion of the scope operates, the operator can perform treatment with the surgical instrument while observing the image displayed on the HMD. Therefore, since the treatment can be performed in the presence of being in a body cavity, endoscopic surgery can be performed with the sensation of laparotomy.

FIG. 20A shows the current positional relationship between the distal end TCP of the treatment instrument 181 and the patient's head d. If the treatment tool 181 is inserted into the patient's head d as it is,
It is dangerous to contact the patient's head d as shown in (b).

Therefore, the posture is changed so that the desired position in the patient's head d and the Z axis of the treatment tool are the same. As processing on the control device 121 side, the desired position and the current treatment tool 1
A line segment R connecting the position of the tip TCP of 81 is drawn. next,
The space posture of the line segment R is obtained, and the treatment tool 18 at the current position is obtained.
The attitude of the tip TCP of 1 is obtained.

After the above processing is completed, the slave manipulator 171 is operated so that the posture of the line segment R and the posture of the treatment instrument 181 are the same while keeping the position of the tip TCP of the treatment instrument 181 as it is. Specifically, the control device 121 is operated so that the difference between the posture value of the treatment instrument 181 and the posture value of the line segment R becomes zero. by this,
As shown in FIG. 20C, the posture change for inserting the treatment instrument 181 is performed, and the treatment instrument 181 is inserted into the patient's head d while performing point lock after the posture change.

Therefore, the slave manipulator 17
Even when the major axis of the treatment instrument 181 provided in No. 1 does not face the insertion hole of the head d, the treatment instrument 181 can be operated so that the insertion hole comes on the extension line of the major axis.
1 can be easily inserted.

When the operator operates the master manipulator, the slave manipulator 171 operates following the operation of the master manipulator, and can operate the treatment tool 181 inserted into the body cavity. Since the encoder 120 is provided on the HMD 177 and the rotation axis of the HMD 177 in the part d, when the operator moves the head, the three-dimensional (stereoscopic) scope 174 fixed to the slave manipulator 171 follows the movement of the encoder 120. H of the operative field image
The image can be displayed on the MD 177 and the operator can perform treatment with the treatment tool 181 while observing the image displayed on the HMD 177. Therefore, since the treatment can be performed in the presence of being in a body cavity, endoscopic surgery can be performed with the sensation of laparotomy.

Next, the third embodiment will be described. FIG.
Shows a state in which the surgical instrument 103 of the surgical manipulator described in the first embodiment is removed from the slave manipulator and a point lock position determining jig 195 is attached. The point lock position determining jig 195 is a rod-shaped member having a mounting portion for mounting on the slave manipulator, and has a total length longer than that of the insertion portion 102 of the surgical instrument 103. It is preferable that the jig 195 be longer than the insertion portion 102 by 1 cm to several cm.
This is because after the point lock point is obtained by using the jig 195, even if the jig 195 is removed without changing the position and posture of the slave manipulator and the surgical instrument 103 is attached, the surgical instrument 10 is still attached during the attaching work.
This is because the tip of 3 does not go past the point lock point. When the jig 195 of this embodiment is used, a preferable condition is that a bending mechanism exists in the device at the distal end of the surgical instrument 103, the surgical instrument 103 has low rigidity, and is deformed by a slight contact pressure, resulting in an accurate point lock point. Is particularly effective when the surgical instrument 103 cannot be obtained by the distal end of the surgical instrument 103, or when a plurality of devices are attached to the distal end of the surgical instrument 103 and the exact point lock point cannot be indicated by the surgical instrument 103.

Next, how to obtain the point lock point in this embodiment will be described. As shown in FIG. 22, the jig 195 is attached to the slave manipulator 101, the force sensors 153a and 153b are operated, and the position and the posture of the slave manipulator 101 are changed.
Match the tip of point 5 with the point lock point. The tip position of the jig 195 at this time is the slave manipulator 10
1 is obtained by calculating the output of the encoder attached to each axis of the control device 121.
The storage means provided in 1 stores the point lock point.

Thereafter, the jig 195 is removed from the slave manipulator 101, and the surgical instrument 103 is attached to the slave manipulator 101. The subsequent operation and the like are the same as those in the first embodiment, and will be omitted.

As described above, according to the first to third embodiments described above with reference to FIGS. 11 to 22, the operator is attached to the manipulator when the operator previously measures the restriction point for restricting the movement of the surgical instrument. The input means is operated in the direction in which the manipulator tip is to be moved, and the position of the constraint point is easily stored in the storage means of the surgical manipulator simply by matching the designated point of the device for designating the constraint point with the constraint point. The manipulator can be caused to perform the movement constrained at the constraining point stored in the storage means. Further, this prevents the manipulator from exerting an excessive force on the patient, so that the surgery can be safely performed.

The technical idea of the following configuration is derived from the above-described specific embodiments. (1) In a medical manipulator for observing or treating a tissue part in a living body by remotely operating an insertable body that is detachable through an insertion hole formed in a living body, having a pointer for pointing the position of the insertion hole. A medical manipulator comprising a positioning means. (2) The medical manipulator according to the configuration (1), which has a fixing means that can be inserted instead of the insertion body and is detachably fixed. (3) The medical manipulator according to the configuration (1), which has a restricting unit that restricts a joint of the medical manipulator. (4) The medical manipulator according to (1), further comprising a fixing unit that is inserted in place of the insert body and is detachably fixed, and a restraining unit that restrains a joint of the medical manipulator. (5) The medical manipulator according to (4), wherein the fixing means is interlocked with the restraining means. (6) The medical manipulator according to any one of the configurations (1) to (5), including variable means for varying the positional relationship between the pointer and the mounting position of the positioning means on the medical manipulator. (7) The medical manipulator according to (1), wherein the pointer uses a light beam to indicate a position. (8) The medical manipulator according to (7), wherein two or more light rays are used and each light ray is aligned so as to have an intersection. (9) The medical manipulator according to the configuration (8), in which the position of the intersection of the two or more light rays is variable. (10) A medical manipulator having an operating means for operating the medical manipulator and the positioning means according to any one of configurations (1) to (9). (11) An operating means installed within an area that can be operated by an operator, a manipulator that moves to follow the operation of the operating means installed so as to access the operative field, and a manipulator that holds the manipulator inside the body cavity. In a surgical manipulator system, which comprises a surgical instrument having an insertion portion to be inserted into a manipulator, the surgical instrument being attached to the manipulator and instructing a movement of the manipulator. A user-operable input means, an instruction means for instructing the constraint point, a constraint point storage means for storing the position instructed by the instruction means, and the surgical instrument performing a movement constrained at the constraint point. And a control means for controlling the manipulator as described above. (12) In the configuration (11), the instruction means is detachably attached to the tip of the manipulator, and the constraint point is instructed by the instruction means by operating the input means to operate the manipulator. Surgical manipulator. (13) The surgical manipulator according to the configuration (11), in which the length of the instruction means is longer than the length of the insertion portion of the surgical instrument.

The operation of the configurations (1) to (13) described above is as follows. 1. The operation of the invention according to configurations (1) to (10) is that the manipulator is detachably attached to the manipulator, and the manipulator is equipped with a positioning means having a pointer for indicating the position of the insertion hole. Is operated to point the insertion hole with a pointer, and the position of the insertion hole is taken into the manipulator control device. 2. The operation of the invention according to the configurations (2) and (4) is to simplify the configuration of the manipulator by sharing the detaching mechanism of the positioning means with the detaching mechanism of the insert in the medical manipulator having the insert. is there. 3. The operation of the invention according to the configurations (3) and (4) is to uniquely determine the position of the pointer by constraining the free joint by the positioning means in the manipulator having the free joint. 4. In the case of the manipulator having the insert body and the free joint, the operation of the invention according to the configuration (5) fixes the positioning means and restrains the free joint by one operation by interlocking the attachment / detachment of the positioning means and the restraint of the free joint. Is to do. 5. The operation of the invention according to the configuration (6) is to detect the insertion hole by avoiding the interference between the peripheral device and the manipulator by changing the attachment positions of the pointer and the positioning means to the manipulator. Further, by making the positional relationship between the insert body and the positioning means the same, it becomes unnecessary to input a constant of the positional relationship of the positioning means. 6. The operation of the invention according to configuration (7) is that the position of the insertion hole can be pointed out in a non-contact manner by using the light beam as a pointer for pointing the position. 7. The operation of the invention according to the configuration (8) is to accurately point the position of the insertion hole in a non-contact manner by using the intersection of the two light rays as a pointer for pointing the position. 8. The function of the invention according to the configuration (9) is to change the position of the intersection of the two light rays to prevent the light rays from interfering with other devices and becoming invisible. 9. The operation of the invention according to the configurations (11) to (13) attaches the input means operable by the operator for instructing the movement of the manipulator to the manipulator, and instructs the constraint point by the instructing means. Then, the manipulator is controlled so that the position instructed by the instructing means is stored and the surgical instrument performs the movement constrained at the constraining point.

The effects of the above configurations (1) to (13) are as follows. 1. The effects of the inventions according to the configurations (1) to (10) are that the position of the insertion hole can be adjusted by attaching the detachable positioning means to the manipulator without using a separate three-dimensional position detecting means and using the manipulator operating means. Can be detected. 2. The effect of the invention according to the configurations (2) and (4) is that the configuration of the manipulator can be simplified by sharing the attachment / detachment mechanism of the positioning means with the attachment / detachment mechanism of the insert body. 3. An advantage of the inventions according to the configurations (3) and (4) is that the position of the pointer is uniquely determined by restraining the free joint of the manipulator by the positioning means. 4. The effect of the invention according to configuration (5) is that the labor of the operator at the time of detecting the insertion hole is reduced by interlocking the attachment / detachment of the positioning means and the restraint of the free joint. 5. The effect of the invention according to the configuration (6) is that even when the manipulator interferes with surrounding equipment in a state where the positioning means is attached, the interference can be avoided by changing the attachment positions of the pointer and the positioning means to the manipulator. is there.
In addition, although there are differences in the positional relationship of the insert such as the type of distal treatment instrument, the endoscope, and the length of the insertion part, the positional relationship of the positioning means can be adjusted by matching the positional relationship of the positioning means with the insert. There is no need to enter the constant of. Also,
There is an effect that one positioning means can be commonly used as a positioning means for many inserts. 6. The effect of the invention according to configuration (7) is that the position of the insertion hole can be easily taught even if there are many obstacles near the insertion hole in the peripheral device because the position can be indicated without contact. 7. The effect of the invention according to the configuration (8) is that the position of the insertion hole can be accurately indicated without contact by using the intersection of the two light rays as a pointer for indicating the position. 8. The effect of the invention according to the configuration (9) is that by varying the position of the intersection of the two light rays, it is possible to prevent the light rays from interfering with other devices and becoming invisible. 9. The effects of the inventions according to the configurations (11) to (13) are that the operator wants to move the tip of the manipulator with the input means attached to the manipulator when the operator measures in advance the constraint point that restrains the movement of the surgical instrument. The position of the constraining point can be easily stored in the storage means of the surgical manipulator simply by adjusting the pointing point of the device for indicating the constraining point to the constraining point, and the constraining point stored in the storage means is constrained. The manipulator can be caused to perform a movement. Also,
As a result, the manipulator does not apply an excessive force to the patient, so that the surgery can be safely performed.

[0099]

According to the present invention, the position of the insertion hole can be taught to the manipulator control device by a simple means when performing endoscopic surgery using the manipulator.

[Brief description of drawings]

FIG. 1 is a system configuration diagram according to a first embodiment of the present invention.

FIG. 2 is a diagram showing a configuration of a treatment manipulator of the first embodiment.

FIG. 3 is a diagram showing a state of a treatment manipulator during in-vivo operation.

FIG. 4 is a view for explaining the method of the first embodiment for knowing the position of the insertion hole.

FIG. 5 is a diagram showing a configuration of a treatment manipulator of a second embodiment.

FIG. 6 is a diagram for explaining the method of the second embodiment for knowing the position of the insertion hole.

FIG. 7 shows different types of inserts.

FIG. 8 is a view for explaining the method of the fourth embodiment for knowing the position of the insertion hole.

FIG. 9 is a diagram for explaining the method of the fourth embodiment for knowing the position of the insertion hole.

FIG. 10 is a diagram for explaining another method of the third embodiment for knowing the position of the insertion hole.

FIG. 11 is an overall configuration diagram of a surgical manipulator according to the first embodiment.

FIG. 12 is a block diagram of a control device for a surgical manipulator.

FIG. 13 is a schematic configuration diagram of a surgical manipulator.

FIG. 14 is a diagram for explaining the operation of the surgical manipulator.

FIG. 15 is a side view of a slave manipulator.

FIG. 16 is a flowchart showing the operation of the first embodiment.

FIG. 17 is a perspective view of a surgical manipulator showing a second embodiment.

FIG. 18 is a view for explaining the operation of the surgical manipulator.

FIG. 19 is a flowchart showing the operation of the second embodiment.

FIG. 20 is a diagram showing the current positional relationship between the distal end of the treatment instrument and the patient's head.

FIG. 21 is a diagram for explaining how to obtain a point lock point in the second embodiment.

FIG. 22 is a diagram for explaining the third embodiment.

[Explanation of symbols]

DESCRIPTION OF SYMBOLS 1 ... Manipulator system for treatment, 2 ... Manipulator for observation, 3 ... Endoscope, 7 ... Manipulator for treatment, 1
4 ... Observation manipulator, 15 ... Tip treatment tool, 24 ...
Position of insertion hole, 29 ... Positioning jig.

Claims (1)

[Claims] 1. A medical manipulator for observing or treating a tissue part in a living body by remote-controlling an insertable body which is detachable through an insertion hole formed in a living body, wherein a pointer for pointing the position of the insertion hole. A medical manipulator characterized by comprising a positioning means having a.