JPH09131351A - Medical care control device - Google Patents

Abstract

PROBLEM TO BE SOLVED: To eliminate danger of giving bad effects to normal tissue around a subject part to medical care, and largely reduce a burden of a doctor. SOLUTION: In a laser type medical care system, a hand piece 13 is moved to set a position of a laser beam output (radiation) to a subject part of a patient P, and laser beam is outputted (radiated) through the hand piece 13 in accordance with laser beam output (radiation) instruction for applying medical care to the subject part. It is provided with a CPU 5, a mouse 6, a CCD camera 3, and a TV monitor to designate a range to which the laser beam is radiated, and a controller 11 to perform a process of a step to determine if a laser beam radiation position is included in the laser beam radiation range or not. In the case where it is determined that the laser beam radiation position is not included in the laser beam radiation range as a result of determination by the controller 11, the controller 11 conducts a process of a step of constantly stopping laser beam radiation in spite of a laser beam radiation command.

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a treatment system for performing treatment such as cutting of biological tissue or coagulation hemostasis using a treatment medium such as laser light or high frequency current, and particularly, a treatment for controlling output of the treatment medium. Regarding the control device.

[0002]

2. Description of the Related Art There is a therapeutic device such as a laser scalpel or an electric scalpel that outputs (irradiates) a treatment medium such as a laser beam or a high frequency current to a living tissue, and cuts the tissue or coagulates it by a thermal action by absorption of the tissue. Also, by utilizing the fact that ruby laser light (beam) is well absorbed by the melanin pigment of living tissues, laser treatment is performed to irradiate ruby laser light on bruises such as tea bruises and black bruises for destructive treatment of the same bruises. There is a device.

In particular, since the laser light has a short wavelength and therefore has an excellent light condensing property on a microscopic portion, the laser scalpel treatment apparatus is performed by making a hole with a diameter of at most about 20 mm in the brain as shown in FIG. 6, for example. It is also used for fine surgery (microsurgery), etc. where it is difficult to perform direct manual work such as surgery or abdominal surgery under the endoscope, and its usefulness is expected to increase more and more.

As an example of the above-mentioned treatment device, the laser scalpel treatment device has a laser oscillator, a bendable light guide path for guiding a laser beam emitted from the laser oscillator, a handpiece having a condenser lens, and the like.

During treatment, the doctor visually recognizes the affected area directly with the naked eye, or after visually observing it through a monitor, for example, moves the handpiece three-dimensionally so that the irradiation position of the laser beam is the treatment area. Match. Then, the doctor irradiates the laser beam after confirming that the laser beam irradiation position is on the treatment site, and performs cutting or coagulation / hemostatic treatment of the treatment site.

[0006]

In the treatment using a treatment medium such as laser light or high-frequency current, it is important not to affect the normal tissue around the treatment site. Therefore, the treatment medium is used as the treatment medium. It is important to output accurately only to.

However, since the doctor determines whether or not the output position of the treatment medium is located on the treatment site only by visually observing it through a monitor or the like, it may happen due to the carelessness of the doctor or a sudden accident. If the output position of the treatment medium deviates from the treatment site, the treatment medium will be output to the normal tissue around the treatment site, which may adversely affect the normal tissue.

Therefore, in the treatment using a treatment medium such as laser light or high-frequency current, the doctor must constantly monitor the treatment medium output position so as not to deviate from the treatment site. Since carelessness was not allowed, the psychological burden was very high.

The present invention has been made in view of the above circumstances, and when the treatment medium output position is mistakenly deviated from the treatment site, the output of the treatment medium is always stopped regardless of the treatment medium output command. This eliminates the risk of adversely affecting normal tissues around the treatment site and significantly reduces the burden on the doctor.

[0010]

In order to achieve the above object, the invention described in claim 1 moves a treatment medium output section for outputting a treatment medium to set a treatment medium output position at a treatment site of a subject. In addition, in the system for treating the treatment site by outputting the treatment medium through the treatment medium output unit according to the treatment medium output command, output range designating means for designating a range for outputting the treatment medium, and the treatment medium. Judgment means for judging whether or not the output position is included in the treatment medium output range, and as a result of the judgment of the judgment means, the treatment medium output position is judged not to be included in the treatment medium output range. And a treatment medium output control means for constantly stopping the output of the treatment medium regardless of the treatment medium output command.

Particularly, in the treatment control apparatus according to the second aspect, the treatment medium is laser light.

In particular, in the treatment control device according to the third aspect, the treatment medium is a high frequency current.

Further, in particular, in the treatment control apparatus according to the fourth aspect, the output range designating means displays an image pickup means for picking up an image including a treatment region of the subject, and an image picked up by the image pickup means. The display device includes a display device and a pointing device for inputting the therapeutic medium output range on the image displayed by the display device.

Further, in the treatment control apparatus according to the fifth aspect, output position designating means for designating an output position of the treatment medium, and the treatment medium output section is automatically moved based on the designated output position, And a movement control means for adjusting the treatment medium output position to the designated output position.

Furthermore, in the treatment control apparatus according to a sixth aspect of the present invention, there is provided output position designating means for designating the output position of the treatment medium, and the treatment medium output section is manually moved based on the designated output position. , The treatment medium output position is adjusted to the designated output position.

According to the present invention, for example, when the output position of the treatment medium such as the laser beam is designated by the output position designation means, the treatment medium output part is automatically moved by the movement control means to move the treatment medium output position. Matches the specified output position. In the state where the treatment medium output position matches the designated output position, the treatment medium output command is sent to the output unit or the like of the treatment device by the operation of the doctor or the like.

On the other hand, for example, an image including the treated region of the subject is picked up by the image pickup means and displayed by the display means. Then, the output range of the treatment medium is specified on the treatment region displayed in the image by operating a pointing device such as a mouse by a doctor or the like.

At this time, the judging means judges whether or not the therapeutic medium output position is included in the therapeutic medium output range, and as a result of this judgment, the therapeutic medium output position is included in the therapeutic medium output range. When it is determined that the treatment medium is not output, the treatment medium output control means always stops the output of the treatment medium regardless of the treatment medium output command. Therefore, when the treatment medium output position is set outside the treatment medium output range, that is, in the normal tissue portion around the treatment site, the output of the treatment medium is constantly stopped and controlled.

[0019]

Embodiments of the present invention will be described below with reference to the accompanying drawings. In the present embodiment, a laser scalpel treatment system will be described as an example of a treatment system using a treatment medium such as a laser beam or a high-frequency current provided with the treatment control device of the present invention.

FIG. 1 shows a schematic configuration of a laser scalpel treatment system according to this embodiment, and FIG. 2 shows a system configuration thereof. 1 and 2, the laser scalpel treatment system 1 includes a laser scalpel part 2 for irradiating a subject with a laser beam, and a microscope, a CCD camera, an ultrasonic wave for imaging a treatment site of a patient P who is the subject. Tomography device (US),
An imaging unit (which will be described as a CCD camera in the present embodiment) 3 for thermography (temperature image), a viewer 4 for observably displaying an image of a treatment region of a patient P captured by the CCD camera 3, a CPU 5, It has a pointing device (a mouse 6 in this embodiment) and a keyboard connected to the CPU 5, and a console (control console) 7 to which various control information can be input from the doctor D.

The laser knife unit 2 controls, for example, a laser oscillator 10 which oscillates CO 2 laser light, ON / OFF drive control of the laser oscillator 10 and a laser irradiation direction, and a controller 1 which performs a process shown in FIG. 5 described later.
1, and a handpiece 13 that is a laser light emitting unit that can be manually operated by being held by a doctor D.
And the handpiece 1 installed on the laser knife body 12
3 and a support arm 14 for supporting 3.

The support arm 14 has a function as a light guide path for guiding the laser light oscillated from the laser oscillator 10 to the handpiece 13 and a function for automatically moving the handpiece 13 in three-dimensional directions. There is. That is, the support arm 14 has a light guide path 15 made of, for example, an optical fiber.
And a rotation mechanism 16 provided as joints at a plurality of positions in the light guide path 15 and rotatable about the y-axis direction.
Rotating mechanism 16b ... 1 rotatable about a and x axis directions
6b, and the rotation mechanism 16a and the rotation mechanism 16b form a laser knife support arm drive unit 17. By rotating the rotating mechanisms 16a, 16b ... 16b, the light guide path 15 can be bent to move the handpiece 13 three-dimensionally. A condenser lens is built in the emission end side of the handpiece 13, and the laser light guided in the light guide path 15 is
The light is focused at a predetermined position (laser light irradiation position) via a condenser lens. Also, the laser knife part main body 1
2 is provided with a support arm drive controller 18 capable of controlling the amount of rotation of the rotating mechanisms 16a, 16b ... 16b.
The support arm drive controller 18 is connected to the controller 11.

The controller 11 includes a joystick 20, which is a pointing device, and a laser oscillator 1.
Foot switch 2 for ON / OFF command of 0
1 is connected. The joystick 20 is installed on the console 7, for example, and a doctor or the like can specify the position and direction of the laser knife to the controller 11 by moving the joystick 20 in an arbitrary direction. Further, the foot switch 21 is arranged near the console 7 (near the foot of the doctor D), and when the doctor D steps on the foot switch 21, the foot switch 21 is connected to the laser oscillator 10 via the controller 11. For laser irradiation (oscillation) command (ON command) or laser irradiation (oscillation)
A stop command (OFF command) is sent.

The CCD camera 3 is, for example, an articulated arm 2
It is suspended from the ceiling or the like via 5. CCD camera 3
For example, a plurality of angle sensors for detecting the position and the direction of are attached to the articulated arm 25, for example, near each joint. The plurality of angle sensors form a CCD camera position / direction detector 26. The plurality of angle sensors detect the rotation angle of each joint of the multi-joint arm 25, and send the detected data to the CPU 5 of the console 7 as data (position and direction data) for specifying the position and the imaging direction of the CCD camera 3. It is like this.

The viewer 4 is attached to the head of the doctor D by a band or the like, or is suspended by an articulated arm 30 as shown in this embodiment. By rotating each joint of the multi-joint arm 30, the position and orientation of the viewer 4 can be arbitrarily moved. As shown in FIG. 3, the viewer 4 includes a box-shaped frame 31, a viewing window 32 provided on one side surface of the frame 31 for a doctor D to observe, and the viewing window 32 facing the viewing window 32. TV monitor 3 disposed at the other end of viewer 4
3 is provided. This TV monitor 33 is the console 7
The image signal is connected to the CPU 5 and is imaged by the CCD camera 3 and subjected to the required processing by the CPU 5 to be displayed. Further, the doctor D can observe the image displayed on the TV monitor 33 through the viewing window 32.

The mouse 6 provided on the console 7 can move a cursor on the TV monitor 33 by a moving operation of the mouse 6 by the doctor D to specify a desired position or a desired area on the TV monitor 33. ing.

The CPU 5 will be described later based on the position and direction data of the CCD camera 5 sent from a plurality of angle sensors which are the CCD camera position / direction detector 26, the pointing data sent from the mouse 6, and the like. The process shown in 4 is performed.

Next, the overall operation of this embodiment will be described.

At the start of laser treatment, doctor D
Sets the position and imaging direction of the CCD camera 3 in accordance with the position of the treatment site of the patient P. When the setting of the position and imaging direction of the CCD camera 3 is completed, the CCD camera 3
The image data of the treatment site is acquired by. This image data is appropriately processed through the CPU 5 and then displayed on the TV monitor 33 of the viewer 4. As a result, Doctor D
Can observe the treatment site via the TV monitor 33 of the viewer 4.

On the other hand, the CCD camera position / direction detector 26
CC during imaging of a treatment site by a plurality of angle sensors
The position and imaging direction of the D camera 4 are detected and sent to the CPU 5. Since the CPU 5 is performing the processing shown in FIG. 4, the sent position and direction data is held in the internal memory (step S1).

Then, the doctor D operates the mouse 20 of the console 7 to move the cursor while visually observing the TV monitor 33 of the viewer 4, so that the image displayed on the monitor 33 as shown in FIG. On I, a laser light irradiation range R representing a part (or the whole) of the treatment site to be irradiated with the laser light is designated. This designation data (pointing data) is sent to the CPU 5. The CPU 5 holds the designated data in the internal memory and sends it to the controller 11 as irradiation possible range data (step S2). The controller 11 reads this irradiation range data into the internal memory (step S3).

Subsequently, the doctor D operates the joystick 20 while observing the image showing the treated region on the TV monitor 33, and designates the position and direction of the laser knife for specifying the laser light irradiation position of the laser knife. Enter (laser knife position / direction data). The input laser knife position / direction data is sent to the controller 11. The controller 11 reads the sent laser knife position / direction data and holds it in the internal memory (step S
4) According to the same data, the laser knife (handpiece 13 and light guide path 15) is moved to the designated position of the joystick 20 via the support arm drive control unit 18 and the support arm drive unit 17 (step S5).

In this state, the doctor D operates the foot switch 2
Step 1 and send a laser irradiation command (ON command) to the controller 11. The controller 11 reads the transmitted ON command (step S6), and the laser beam irradiation position (designated position of the joystick 20) of the laser knife in the state in which the ON command is transmitted is included in the irradiation possible range stored in the internal memory. It is determined whether or not (step S
7). If the result of the processing in step S7 is YES, the controller 11 oscillates the laser oscillator 10 to irradiate the laser light irradiation position with laser light (step S8), and ends the processing.

On the other hand, if the result of the determination in step S7 is NO, the controller 11 always controls the laser oscillation of the laser oscillator 10 to stop regardless of the ON command sent, and ends the processing (step S9).

Therefore, if the irradiation position of the laser knife is out of the laser light irradiation range of the treatment site due to unpredictable movement of the laser knife due to careless setting by the doctor or accidental accident, the laser light irradiation command is temporarily issued. Even if the laser light is sent, the laser light is never irradiated, so that the risk that the normal tissue outside the laser light irradiation range is irradiated with the laser light is completely eliminated, and the safety is improved. Also, due to the carelessness of the doctor, even if a laser light oscillation command is sent in a state outside the laser light irradiation range, the risk that the normal tissue outside the laser light irradiation range is irradiated with laser light is eliminated. As a result, the psychological burden on the doctor is greatly reduced.

In this embodiment, a marker indicating the irradiation position of the laser light is displayed on the TV monitor, and the irradiation position of the laser light is included in the irradiation range depending on whether the marker is within the irradiation range of the laser light. It may be determined whether or not to be performed.

Further, in the present embodiment, the laser knife is automatically moved by the support arm drive section and the support arm drive control section, but the present invention is not limited to this. For example, a doctor may use a laser knife handpiece. May be held and moved manually.

Further, in the present embodiment, the irradiation range data is specified by the mouse on the image of the treatment site imaged by the CCD camera, but the present invention is not limited to this, and for example, the treatment can be performed. An image including a site may be captured in advance by a medical image capturing device such as an X-ray CT device or an MRI device, and a laser light irradiation possible range may be set in advance on the image before treatment with a laser knife. .

Furthermore, the laser light irradiation range may be directly written on the patient P with a pen or the like. In this case, the laser light irradiation range can be recognized by taking an image of the treatment region including the laser light irradiation range filled in with a pen with a CCD camera or the like.

In the present embodiment, the image of the CCD camera is displayed by the viewer system, but the present invention is not limited to this, and may be displayed on, for example, an ordinary desk-type TV monitor.

On the other hand, although the present embodiment describes the laser scalpel treatment system, the present invention is not limited to this, and for example, a ruby laser oscillator is used as a laser oscillator, and a laser having a uniform output distribution in a predetermined area is used. It can also be applied to a bruise treatment laser system that irradiates a laser beam to cauterize bruise and the like. Further, the same can be applied to an electrocautery treatment system using a high frequency current as a treatment beam.

In the electric scalpel treatment system, the scalpel tip electrode at the tip of the handpiece is brought into contact with the treatment site of the subject, and a high-frequency current is passed from the scalpel tip electrode to the treatment site to treat the treatment site. Compared with the laser light treatment system described above, the laser oscillator is a high-frequency current oscillator, and is substantially the same except that the structure of the handpiece is different (a knife tip electrode is provided at the tip of the handpiece, etc.). That is, in the electric scalpel treatment system, it is judged whether or not the position (corresponding to the above-mentioned laser beam irradiation position) with which the scalpel tip electrode is abutted is included in the irradiation possible range R ′, and the result of this judgment is NO. In case of controller 1
1'is designed to always stop the oscillation of the high frequency current oscillator 10 'regardless of the ON command sent from the foot switch 21' (step S9 '), and therefore, the same effect as the laser scalpel treatment system described above can be obtained. can get.

The modifications described for the laser scalpel treatment system can be similarly implemented in the bruise treatment laser system and the electric scalpel treatment system.

[0044]

As described above, according to the present invention, even if the treatment output position is set outside the treatment medium irradiation range, that is, in the normal tissue portion around the treatment site, the output of the treatment medium is increased. Since the stop control is always performed, the risk of adversely affecting the normal tissue around the treatment site can be completely eliminated. Therefore, it is possible to significantly improve the safety of a treatment system using a treatment medium such as laser light or high-frequency current, and to significantly reduce the burden on the doctor.

[Brief description of the drawings]

FIG. 1 is a side view showing a configuration of a laser scalpel treatment system according to a first embodiment of the present invention.

FIG. 2 is a schematic block diagram of a laser scalpel treatment system according to an embodiment of the present invention.

FIG. 3 is a sectional view showing a schematic configuration of a viewer.

FIG. 4 is a schematic flowchart showing an example of processing of a CPU and a controller in the embodiment of the present invention.

FIG. 5 is a diagram showing a laser light irradiation range designated on an image displayed on a TV monitor.

FIG. 6 is a view for explaining an operation performed by making a hole with a diameter of at most 20 mm in the brain as an example of a microsurgery.

[Explanation of symbols]

 1 Laser knife treatment system 2 Laser knife section 3 CCD camera 4 Viewer 5 CPU 6 Mouse 7 Console 10 Laser oscillator 11 Controller 12 Laser knife section main body 13 Handpiece 14 Support arm 15 Light guide path 16a, 16b Rotation mechanism 17 Support arm drive section 18 Drive control Part 20 Joystick 21 Foot switch 25 Multi-joint arm 26 CCD camera position / direction detection unit 30 Multi-joint arm 31 Frame 32 Viewing window 33 TV monitor

Claims (6)

[Claims] 1. A treatment medium output unit for outputting a treatment medium is moved to align a treatment medium output position with a treatment site of a subject, and the treatment medium is output via the treatment medium output unit in response to a treatment medium output command. In the system for treating the same treatment site, output range designating means for designating a range for outputting the treatment medium, and determining means for determining whether or not the treatment medium output position is included in the treatment medium output range. As a result of the judgment of the judgment means, when it is judged that the therapeutic medium output position is not included in the therapeutic medium output range, the therapeutic medium output which always stops the output of the therapeutic medium regardless of the therapeutic medium output command. A treatment control device comprising: a control means. 2. The treatment medium is laser light.
The described treatment control device. 3. The treatment control apparatus according to claim 1, wherein the treatment medium is a high frequency current. 4. The output range designation means is an image pickup means for picking up an image including a treatment region of the subject, a display means for displaying the image picked up by the image pickup means, and a display means for displaying the image. A pointing device for inputting the therapeutic medium output range on an image.
The described treatment control device. 5. An output position designating means for designating an output position of a treatment medium, and the treatment medium output section is automatically moved based on the designated output position to designate a treatment medium output position. 5. The treatment control device according to claim 4, further comprising: movement control means for adjusting the movement. 6. An output position designating means for designating an output position of a treatment medium, wherein the treatment medium output section is manually moved based on the designated output position to designate a treatment medium output position. 5. The treatment control device according to claim 4, wherein the treatment control device is adjusted.