MXPA00005695A - Endoscopy and three-dimensional video system. - Google Patents

Abstract

This invention is a simple an effective system of three-dimensional images display, applicable to the procedures related with chirurgical endoscopy and microscopy, which uses the endoscopes or conventional tools of current medical instruments, without modifying any of their parts. Once the images are acquired, these images are showed by means of the three-dimensional video system, depicted in this invent, and which allows the observer to make fine and precise movements, within the observed field, with an adequate volume, distance and depth perception. When displaying images in a cephalic fixing system, and placing the video screens in front of the observerÆs eyes, the relation "eyes-hand" is never lost and there can be performed procedures for long periods of time with comfort. It is applicable to the conventional microsurgery and endoscopy procedures, in all their varieties, including neuroendoscopy, stereotactic endoscopy with and without frame and all processing system and video im ages observation or printed images, independently of their purposes, by means of a reflective surface placed in a perpendicular plane to a pair of equal images, previously inverting approximately 180° one of these images.

Description

THREE-DIMENSIONAL ENDOSCOPY AND VIDEO SYSTEM TECHNICAL FIELD This invention is related to conventional endoscopy systems, instruments of Minimally Invasive Surgery (CIM), such as neuroendoscopy, endoscopy, thoracoscopy, laparoscopy, pelviscopy, arthroscopy, etc. and three-dimensional endoscopy (ESO), describing a new three-dimensional endoscopy system, which shows the real image obtained from the endoscope in real time with a simple and very efficient three-dimensional vision effect that allows the observer to perform fine and precise movements, with a Adequate perception of volume, distance and depth.

BACKGROUND OF THE INVENTION The first neurosurgical procedure using an endoscope was performed in 1910 by a urologist, V.L. Lespinasse in Chicago. A small rigid cystoscope was used in this procedure to illuminate the choroidal plexuses of two children with hydrocephalus, Walter Dandy, in 1922 describes the "ventriculoscope" and its use for the fulguration and avulsion of the choroid plexuses. In the following 30 years, little progress was reported in the endoscopy of the nervous system, which may be related to the effectiveness and simplicity of placement of ventriculo-peritoneal shunt systems (VPS). Subsequently, experimentation with neuroendoscope systems for the treatment of hydrocephalus is resumed, reporting success in up to 60% in some series, without the use of SDVP systems. Previously, therapeutic procedures had already been performed by means of endoscopy in other medical-surgical specialties.

In the surgical procedures, three main aspects intervene: 1) the action performed by the surgeon based on his skill and knowledge; 2) the help provided by the instruments; 3) what is observed during the surgical act. It is considered that any surgical procedure can be improved if one of these three aspects is improved. Regarding the surgical technological resources, the illumination, the magnification and the visual approximation of the surgical field, by means of high power light sources, surgical microscopes and endoscopy systems, have improved remarkably.

Both in the medical field and in certain industrial applications, it is convenient to obtain images through an endoscopy system. This is used to inspect and manipulate structures of interest in places that are not accessible by other means, or that their access implies the possibility of causing harm to patients in the case of their medical application. In the medical field, the main interest is to reduce trauma to patients, facilitate postoperative care and reduce the length of hospital stay with better surgical results.

This is called Minimum Invasive Surgery (CEM) and has been developed practically in all medical-surgical specialties.

Currently, different endoscopy systems are widely used in neurosurgery in the so-called "endoscopy-assisted brain surgery" and in minimally invasive techniques, because they provide better illumination of the surgical field to be able to illuminate and visualize surgical field sites where the straight light from the operating theater or surgical microscope lamps does not have access; With the current development in the design of instruments for endoscopy in all its varieties, it is possible to perform complete surgical techniques by having instruments for cutting, coagulation, tumor vaporization, washing, perforation, dissection by means of radiofrequency, laser and instruments for guidance and guidance.

In the C1M procedures, instruments are introduced into the body through small incisions or by percutaneous cannulation to perform surgical procedures, obviating the need to make the long incisions necessary in open surgical procedures. As previously described, visualization is facilitated through the use of special instruments called endoscopes, laparoscopes, neuroendoscopes, arthroscopes and other varieties related to the same function, which are conventionally rigid or flexible tubular instruments that contain a lens or fiber optic system, and in its proximal part, a piece for monocular direct vision or for the installation of a video camera. The distal portion of the instrument is introduced to the desired region and the surgeon can observe the interior of body cavities, either by direct vision in the monocular of the endoscope, or by being shown on a video monitor. Usually these instruments include a light source for illumination of the body cavity.

Confoime advances the complexity of the procedures that can be performed by minimally invasive surgery techniques, it is increasingly important to have a proper perception and a precise proportion of the distance between objects under direct vision, as in the surgeries called "open sky * 'in which the surgeon performs the procedure under direct vision while preserving three-dimensional stereoscopic vision, however, in CIM procedures in which conventional endoscopy systems are used, this visual information of the distance and depth for being some of these systems for monocular vision or for two-dimensional vision when displaying the images in video monitors, liquid crystal or plasma screens despite the high image quality that these last two can show.

Due to this inconvenience, several endoscopy systems have recently been developed in an attempt to improve the quality of the image and to provide this important information about distance and depth. The main systems of conventional endoscopy are the following: The "lenscope", straight provides a better optical resolution and illumination than the rest of the endoscopes, the Hopkins model allows wide viewing angles, with a good image quality. up to 1 mm in diameter, still allowing recognition of anatomical structures.The "Fiberscope" has the advantage that pepnite can direct its tip.It has the disadvantage that when reduced its size deforms the image.It is particularly useful to be used simultaneously with the microscope Surgical to inspect the places where the straight light of the microscope does not reach to allow its adequate visualization From the "Videoscopes and Stereovideoscopes", there are commercially stereoendoscopes up to 14 mm in diameter that allow a true depth of stereoscopic field of the surgical environment by means of two photosensitive chips at the tip (Medical Dynamics, Inc. Englewood, CO), which represents an improvement in terms of safety in the realization of dissections and movements, in comparison with the monoscopic field offered by the lenscope and the fiberoscope, because this model is capable of offering a three-dimensional image sensation; however, in the particular case of neurosurgery, these stereoendoscopes currently have an unacceptable diameter to be introduced into the cranial cavity.

The main current limitations of conventional endoscopy are: 1) It has a high cost, 2) When observing the image on a monitor far from the surgical field, it interferes with the coordination "eyes-hands"; 3) It is two-dimensional and the surgeon may lose sight of the distances between the visualized objects, which sometimes makes procedures difficult and this limitation may become the cause of the complications of endoscopic procedures. 4) Currently it is limited, as a single surgical technique, for procedures. that do not demand great precision for the movements of surgical instruments (example: clipping of intracranial aneurysms).

The three-dimensional neuroendoscopes currently have the disadvantages: 1) Some models have a diameter too wide to be introduced into narrow body cavities like intracranial cavities, 2) Other recent models do not offer a real image, but an image of the type "reality virtual "very different from human anatomy, or do not transmit it in real time; 3) High cost; 4) Use of a very sophisticated technology; 5) Special training is required; 6) Low quality of the three-dimensional effect.

The Virtual Reality (VR) systems of medical-surgical application are still in experimental stage, as prototypes or projects. They can be classified as diagnostic, diagnostic-therapeutic, for rehabilitation, tutorials or research. Some can be designed and used remotely (telepresence, telerobotic surgery), for direct or simulated use. Other RV systems can be connected in networks, to be used with RV gloves or RV viewers, including the so-called "3D endoscopy", which is done through a video system that includes 3-D animation and photographs, which they have the disadvantage of not being compatible with rigid ligation systems such as stereotactic neurosurgery, whose clinical usefulness has not yet been defined, that the post-processing procedure induces a variety of significant errors in relation to the system operator and that the images received by the observer are the product of a computer-simulated animation system, being, therefore, artificial images very different from the actual appearance of the patient's anatomy despite the variable degree of accuracy they may have.

Some CIM procedures require the constant work of the surgeon for several hours, during which time he is forced to keep his eyes fixed or adopt uncomfortable positions for long periods of time, which may influence the results of the procedure. There are some devices that make it more comfortable for the surgeon to perform these procedures, such as having the image displayed on a video monitor instead of direct monocular viewing on the endoscope. Recently, a system for projecting video images of cephalic placement has been developed, in which the surgeon can observe both the endoscopy images, as well as surgical microscopy and image studies when requested orally, with comfort and with the great advantage , that preserves the "eyes-hands" relationship, achieving a more precise control of their movements. However, these systems show the images in two-dimensional form, losing the proportion of the distance and depth of the objects in the surgical field.

At present, the options for the observation of surgical images (surgical microscope and endoscope) with the previously described systems are the following: 1) Observe the images through the eyepieces of the microscope and those of the endoscope in a screen placed in front of the surgeon; 2) Observe the images of the microscope through the eyepieces of the microscope and those of the endoscope in a "Liquid Crystal Display" (LCD) screen mounted on the surgeon's head; 3) Project both images on a single screen, with "picture in picture" system; 4) Project both images in special eyepieces for microscope; 5) Project both images on an LCD screen mounted on the surgeon's head.

This invention allows obtaining high quality three-dimensional images, allowing an adequate perception of volume, distance and depth between the observed objects, using the conventional endoscopes of current medical-surgical practice, without making any modification to them, allowing the surgeon to perform movements fine and precise even in very small spaces, by modifying only the way they are shown in conventional video devices or by means of liquid crystal or plasma screens. It also conserves the "eye-hand" coordination when the images of the surgical field are shown in its different varieties or from the patient's image studies, by means of a cephalic fixation device that shows the images in front of the surgeon's eyes. It is applicable to frameless stereotactic surgery systems and to any system for processing printed images or video images, which can be both static and moving, and can be displayed on any type of screen or printed surface, both curved and flat, although a better quality effect is obtained when the surface on which the images are projected or displayed is flat. Initially the images are obtained by means of some system such as video cameras, endoscopes in their different varieties, surgical microscope, cameras or any other system for obtaining video or printed images. Then, it is duplicated to obtain two equal images and one of them is inverted; later both images are projected on video screens, in any of their varieties or on a plane in the case of the printed images and by incorporating a reflective surface interposed between the two images into the system, the observer perceives the three-dimensional effect. This system is described in detail below.

This system shows the images on a pair of high resolution, separate screens, in which the video images obtained by the endoscope are simultaneously displayed, with a high quality three-dimensional perception effect, for which it is necessary to invest approximately 180 images. ° one of the images. The other image is shown without any modification. This can also be achieved in a single screen that contains the modality called "picture in picture".

A reflecting surface, preferably flat, which can be both a mirror and a translucent reflecting surface, is placed in a plane preferably intermediate and preferably perpendicular to the images, although modifications in the position of the components can be made if required for some particular application, even without losing the three-dimensional effect. The observed images can be shown on surfaces with different degrees of inclination or on surfaces with adequate curves, in order to nullify a possible deformity of the image; the realization of any of these modifications is included in this invention. The images can also be shown in a single plane or they can be displayed simultaneously in more than one plane. This reflecting surface visually separates both images and is placed in front of the observer's eyes; this reflecting surface can be reflective on one or both sides; the gaze goes directly to the video image that has not been modified. The inverted image is captured by the observer through the reflecting surface, which again inverts it and is thus perceived by the observer's eye. In this way, a different view plane is obtained from the image that has not been modified and a high quality three-dimensional effect is obtained. This three-dimensional perception allows the observer to move the look or move significantly without losing the effect.

It is applicable to any static or moving video system and for all printed material and not only for medical or industrial purposes. Because the image that has been inverted has to travel approximately 3-5% more than the image that has not been modified to reach the eyes of the observer, it is possible to increase this same proportion the size of the image that will be reflected to obtain the effect, although it is not indispensable to make modifications in the size of the images to obtain the three-dimensional effect described in this invention.

The reflective surface preferably must lack acute angles at the ends near the observer and have a protection around its edges to give greater security, durability and protection to the observer. A surface made of an unbreakable reflective material can be used as reflective material. This reflecting surface can also be curved, beveled or both. Preferably it should be completely smooth, although it is also possible to achieve the effect with a rough reflecting surface.

The device that duplicates and inverts the video image, is composed of a translucent flat reflecting surface, which allows the passage of light through it, but also reflects light. In this way a duplicate image is obtained, with one of them inverted. Subsequently, both images are captured by different video cameras and the images are shown in the three-dimensional system. It can be used as an alternative, a video processing equipment for the duplication and / or inversion of the image.

This system can also show the images in a cephalic fixation system that is placed in front of the eyes of the observer, with the three-dimensional system that is described, which allows conserving the "eye-hands" relationship and observing the images comfortably by long periods of time, without being necessary to adopt uncomfortable positions, although it can also be placed far from the observer. This device can also be used to observe any type of images, for purposes other than medical and industrial.

FIGURES Figure 1. It is a panoramic view in perspective of the principle for three-dimensional visualization eji that the invention is based, where 1 is the reflecting surface; 2 is the inverted image that is reflected on 1 and 3 is the image that is not inverted.

Figure 2. It is a representation of how the observer is placed in front of the three-dimensional visualization system to observe the three-dimensional effect of the invention, where 1 is the reflective surface, 2 is the inverted image that is reflected in 1 and 3 is the image that it is not reversed; 4 is the right eye of the observer who perceives 3 directly and 5 is the left eye of the observer who perceives 2 when reflected on 1.

Figure 3. It is the device that duplicates and inverts one of the images, where 6 is the reflecting and translucent super-surface on which it affects 7 which is the image obtained by any imaging system, such as an endoscopy system or a Surgical microscope or other system, represented by the number 8. Subsequently, the images pass through 9 and 10, which are hermetic tunnels for image conduction, each containing a system of lenses that allow to focus and magnify the image. as required, these lenses are represented by 11 and 12. 13 is the surface on which the video cameras represented by numbers 14 and 15 are adapted. 16 is the piece that gives support to this whole system.

Claims (1)

1. Figure 4. It is a panoramic view in perspective of the cephalic fastening system that presents the observer with images close to the eyes, where 1 is the reflecting surface, 2 is the inverted image that is reflected on 1; 3 is the image that is not inverted. 18 is the system of cephalic fastening properly; 19 is the basis on which the images are held. Figure 5. It is the flow diagram by means of which the whole system is connected, representing from the obtaining of the images until reaching these in the eyes of the observer, where 8 is the system of obtaining images, whichever is the one that is use; 20 represents the system of duplication and division of images; 21 represents the (or) video cameras; 22 represents an image processing station, where by means of a video mixer it is possible to select which images will be transmitted to the three-dimensional vision system, at the request of the observer by means of a microphone represented by the number 23. 24 represents the three-dimensional vision system that includes 1,2 and 3 CLAIMS 1. A system for displaying images composed of a reflecting surface placed preferentially perpendicular to a pair of images, of which one is inverted 180 ° from right to left or vice versa, in which the observer, when looking towards the image that is find behind the reflecting surface and placed so that one eye sees the image that has not been inverted directly and that the other eye see the image inverted to reflect on the reflecting surface, observe both images three-dimensionally. A system, as claimed in claim 1, wherein the images are placed in a first and only plane, with a reflecting surface placed at an intermediate point between the two images. A system as claimed in claims 1 and 2, wherein the images can be displayed on more than one plane simultaneously. A system, as claimed in claims 2 and 3, wherein the reflecting surface is separated from the (or) planes that show the images. A system as claimed in claims 2, 3 and 4, wherein the plane (s) can be held at different inclination angles. A system as claimed in any of the previous claims, in which the reflecting surface is a mirror. A system as claimed in any of the previous claims, in which the reflecting surface is reflective on both sides. A system as claimed in any of the previous claims, in which the reflecting surface is sufficiently transparent that it allows observing the image that is behind it as well as the reflected image, both simultaneously. A system as claimed in any of the previous claims, wherein the reflective surface can be curved or beveled, or both. 10. A system as claimed in any of the previous claims, in which the reflecting surface prevents the viewer from seeing the image that is behind it. 11. A system as claimed in any of the previous claims, in which the inverted image is magnified with respect to the other image. 12. A system as claimed in any of the previous claims, in which the inverted image is brighter than the other image. 13. A system as claimed in any of the previous claims, in which there is a support means that shows the images with a correct placement. 14. A system as claimed in claim 13, wherein said support system for the invention is a cephalic fixation device. 15. A system as claimed in claims 13 and 14 where the support system is the one that arranges the position of the images. 16. A system as claimed in any of the previous claims, in which, the observed images are printed images. 17. A system as claimed in any of the previous claims, in which the observed images are static or moving video images, including medical diagnostic imaging studies. 18. A system as claimed in any of the previous claims, in which the observed images can be single or multiple. 19. A system as claimed in claim 18 in which multiple images are observed simultaneously. 20. A system composed of a transparent and reflecting surface that allows to simultaneously duplicate and invert an image, obtaining as a result two identical images, one of which is inverted approximately 180 ° and the other obtained image does not change significantly when reflected. 21. A system as claimed in claim 20, wherein the surface that duplicates and reverses the image is flat and smooth. 22. A system as claimed in claim 20, wherein the surface that duplicates and inverts the image can be curved, rough or beveled. 23. A support system for the reflective surface claimed in claims 20 to 22, which maintains the appropriate position so that the image obtained is reflected and traverses it properly. 24. A system as claimed in claim 23, which serves as support for two video cameras placed at their ends and which also serves as support to an endoscope or any other image acquisition system, simultaneously. 25. A system of lenses placed between the surface that duplicates and inverts the image and the video cameras that corrects the sharpness and focus of the images. 26. A system that displays three-dimensionally images as described in the previous claims and as shown in the accompanying figures. 27. A system that duplicates and inverts the image, as described in the previous claims and as shown in the accompanying figures. 28. An information storage system that displays images, both video and printed, using this three-dimensional system. A system, as claimed in any of the previous claims, which allows to observe the images obtained by means of the different types of conventional endoscopes, used in the different medical-surgical specialties.