US20070208250A1 - Apparatus and Method for Performing a Tissue Resection Procedure - Google Patents
Apparatus and Method for Performing a Tissue Resection Procedure Download PDFInfo
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- US20070208250A1 US20070208250A1 US11/734,048 US73404807A US2007208250A1 US 20070208250 A1 US20070208250 A1 US 20070208250A1 US 73404807 A US73404807 A US 73404807A US 2007208250 A1 US2007208250 A1 US 2007208250A1
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/32—Surgical cutting instruments
- A61B17/3205—Excision instruments
- A61B17/3207—Atherectomy devices working by cutting or abrading; Similar devices specially adapted for non-vascular obstructions
- A61B17/320783—Atherectomy devices working by cutting or abrading; Similar devices specially adapted for non-vascular obstructions through side-hole, e.g. sliding or rotating cutter inside catheter
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/06—Devices, other than using radiation, for detecting or locating foreign bodies ; determining position of probes within or on the body of the patient
- A61B5/061—Determining position of a probe within the body employing means separate from the probe, e.g. sensing internal probe position employing impedance electrodes on the surface of the body
- A61B5/064—Determining position of a probe within the body employing means separate from the probe, e.g. sensing internal probe position employing impedance electrodes on the surface of the body using markers
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/36—Image-producing devices or illumination devices not otherwise provided for
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
- A61B1/005—Flexible endoscopes
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B10/00—Other methods or instruments for diagnosis, e.g. instruments for taking a cell sample, for biopsy, for vaccination diagnosis; Sex determination; Ovulation-period determination; Throat striking implements
- A61B10/02—Instruments for taking cell samples or for biopsy
- A61B10/04—Endoscopic instruments
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B17/07207—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously the staples being applied sequentially
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00017—Electrical control of surgical instruments
- A61B2017/00115—Electrical control of surgical instruments with audible or visual output
- A61B2017/00119—Electrical control of surgical instruments with audible or visual output alarm; indicating an abnormal situation
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/36—Image-producing devices or illumination devices not otherwise provided for
- A61B90/37—Surgical systems with images on a monitor during operation
- A61B2090/373—Surgical systems with images on a monitor during operation using light, e.g. by using optical scanners
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/36—Image-producing devices or illumination devices not otherwise provided for
- A61B90/37—Surgical systems with images on a monitor during operation
- A61B2090/376—Surgical systems with images on a monitor during operation using X-rays, e.g. fluoroscopy
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/30—Devices for illuminating a surgical field, the devices having an interrelation with other surgical devices or with a surgical procedure
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/39—Markers, e.g. radio-opaque or breast lesions markers
Definitions
- the present invention relates generally to an apparatus and method for performing a medical procedure. More specifically, the invention provides for identifying target tissue margins and for guiding a tissue resection device to the target tissue in a tissue resection procedure.
- An endoluminal procedure is a medical procedure that takes place in one of the many tubes, or lumens, within the human body.
- the endoluminal procedures may take place in vascular, gastrointestinal, or air exchange lumens, and may involve disease diagnosis and/or treatment. Millions of endoluminal procedures are performed each year in hospitals around the world.
- a procedure that is often carried out endoluminally is the removal of “suspect” or diseased tissue.
- the purpose of such tissue removal, or resection may be to provide tissue samples for histological analysis or removal of diseased tissue as a treatment means.
- endoluminal resection of tissue is often done using only the subjective judgment of the clinician to determine where tissue should be removed.
- tissue margins are sometimes difficult to determine visually, tissue resection guided solely by visual cues can be inaccurate and even dangerous.
- a tissue resection that occurs without sufficient buffer of healthy tissue risks leaving behind cancerous tissue requiring repeated resectioning procedures, or worse, causing the cancerous lesion to “seed”, or metastasize, to other parts of the body.
- FIGS. 1 and 2 illustrate a prior art endoluminal device 100 that could be used in the harvesting of diseased tissue from within a body lumen.
- the device is comprised of a flexible catheter body 110 with a proximal end 112 and distal end 114 .
- a suction adjust knob 120 At the proximal end 112 there is a suction adjust knob 120 , a coupler 130 , a vacuum hose 140 , head-actuating handle 150 , and an electrical interconnect 160 .
- the vacuum hose 140 makes connection from a vacuum pump 142 , through the coupler 130 , to a central lumen 170 within the catheter body 110 to draw a suction on tissue-harvesting chamber 190 .
- the electrical interconnect 160 is comprised of electrical leads 161 that pass from the external electronics 162 , through the coupler 130 at the proximal end 112 of the catheter body 110 to a cavity 116 outside the central lumen 170 but within the catheter body 110 .
- Some of the electrical leads 161 supply electrical energy to a light source 163 and a vision chip 164 situated at the distal end 114 of the catheter 110 , while another group of the electrical leads 161 bring electrical signals from the vision chip 164 to a video processor and a display device 165 .
- the head-actuating handle connects to a cable (not shown) that travels the length of the catheter body 110 within the central lumen 170 to control the operation of the endoluminal device's head assembly 180 .
- FIG. 2 is a detailed view of the distal end 114 of the device 100 of FIG. 1 .
- a head assembly 180 At the distal end 114 of the catheter body 110 there is a head assembly 180 , a tissue-harvesting chamber 190 , a cutting device 192 , and the light source 163 and the vision chip 164 .
- the tissue-harvesting chamber 190 is connected to the central lumen 170 of the catheter body 110 .
- the central lumen 170 is connected to the external vacuum pump 142 .
- the head assembly 180 is movable with respect to the catheter body 110 and, thus, can be extended or retracted using the cable that is attached to the head-actuating handle 150 at the proximal end 112 of the device 100 and to the head assembly 180 at the distal end 114 of the device 100 .
- the cutting device 192 is a sharpened blade that severs the tissue 200 as the retracting head assembly 180 presses the tissue 200 against the cutting device 192 to remove the suspect tissue area 210 .
- Distal end 114 also includes staples 194 and anvil surface 196 which are utilized to staple the site.
- the vision chip 164 is connected to the external video processor and display device 165 via the electrical leads 161 within the catheter body 110 , but outside of the central lumen 170 .
- FIG. 2 also illustrates the distal end 114 of the prior art tissue-resectioning device 100 as it would appear having been inserted into a body lumen.
- the Endoscopist would guide the distal tip 114 of the device into close proximity with the tissue 200 to be resected.
- the clinician can then increase the suction at the tip 114 until the tissue 200 is drawn into the tissue harvesting chamber 190 through a distal opening 114 A and into the tissue harvesting chamber 190 .
- the clinician can then retract the head assembly 180 to perform the resection.
- the suspect tissue 210 is removed and the site is stapled with the staples contained in the head assembly 180 .
- the device 100 With the tissue sample 210 enclosed within the tissue-harvesting chamber 190 , the device 100 can be removed from the body lumen and the tissue sample 210 removed.
- a tissue-resectioning procedure such as described above would be guided by the clinician based upon whatever limited visual information could be obtained through the vision chip 164 at the distal end 114 of the catheter 110 .
- histological staining may be used to assist in tissue margin identification
- guiding the resection device 100 in the procedure in this manner is still a very subjective process and prone to error.
- the apparatus includes a positioning system and a resection device disposed within the positioning system.
- the positioning system includes an imaging device, a video processor coupled to the imaging device, a computer coupled to the video processor, and a video display coupled to the computer.
- the method includes the steps of creating an image of a lesion within a patient's body on an imaging device. Data representative of the lesion image is processed by a video processor. Tissue margins around the lesion are defined by a processor based on the processed data representative of the lesion image and a resection device is operated during a resection procedure within the patient's body based upon the defined tissue margins.
- FIG. 1 illustrates a known endoluminal device
- FIG. 2 is a detailed view of the distal end of the device of FIG. 1 ;
- FIG. 3 is an embodiment of a system for performing a medical procedure in accordance with the principles of the present invention.
- FIG. 3 illustrates an embodiment of a system for performing a medical procedure in accordance with the principles of the present invention.
- the system 30 includes a positioning system 300 and a resection device 100 .
- the positioning system 300 includes a fluoroscope 310 , an x-ray imaging sensor 320 , video processing electronics 330 , a computer 340 , a video display 350 , and an alarm 360 .
- the system 30 further includes a resection device 100 that is positionable within the positioning system 300 .
- Resection device 100 can be utilized to remove an internal lesion 420 from a tubular organ 410 within a body wall 400 of a patient and resect the tissue of the tubular body organ 410 from which lesion 420 is removed.
- fluoroscope 310 generates x-rays that are detected by the x-ray imaging sensor 320 .
- the x-rays generated by fluoroscope 310 pass through the patient and lesion 420 to be collected on x-ray imaging sensor 320 .
- a radiopaque die having selectively been absorbed by lesion 420 , creates an image of the boundaries of lesion 420 on x-ray imaging sensor 320 .
- Image information from x-ray imaging sensor 320 related to lesion 420 is communicated to video processing electronics 330 where the video processing electronics processes the image information from sensor 320 and provides digitized image data to computer 340 .
- Computer 340 utilizes the digitized image data to identify a tissue margin 420 A around lesion 420 .
- the tissue margin 420 A is provided to video display 350 where the tissue margin can be displayed relative to lesion 420 .
- computer 340 In addition to computer 340 receiving position image data for lesion 420 from x-ray imaging sensor 320 , computer 340 is also able to receive position image data for resection device 100 . Thus, computer 340 is able to provide relative positioning data for resection device 100 , lesion 420 , and the defined tissue margin 420 A.
- computer 340 is able to provide an alarm to alarm device 360 to alert the physician that is performing the procedure of the particular situation.
- the physician is able to objectively determine the amount of tissue that is to be removed when preforming the procedure.
- This provides advantages over the currently known methods and apparatuses that are utilized by surgeons who perform these procedures.
- a tissue-resectioning procedure is guided by the surgeon based on whatever limited visual information is obtainable through the vision system located at the distal end of the resection catheter. Guiding the resection procedure in this manner is a very subjective process and prone to error, with a danger of taking either too much or too little tissue from around the lesion to be removed.
- fluoroscope 310 is utilized to generate x-rays that are directed through the patient's body and, thus, through lesion 420 .
- an imaging device which consists of a fluoroscope 310 and an x-ray imaging sensor 320
- any of a variety of different imaging devices may be utilized in practicing the principles of the present invention.
- MRI magnetic resonance imaging device
- the present invention is not limited to utilizing a fluoroscope and x-ray energy in practicing the present invention.
- lesion 420 absorbs a radiopaque die which creates an image of the lesion on the x-ray imaging sensor 320 when lesion 420 is radiated by the x- rays emitted from fluoroscope 310 .
- the radiopaque die may be administered to lesion 420 through any of a variety of procedures and the present invention is not limited to any particular procedure for introducing the radiopaque die within lesion 420 .
- the die could be administered either intravenously or topically to the lesion site.
- the operating end, or distal end, of resection device 100 could also contain a radiopaque die on it. This would also allow for the position of the resection device to be detected by the x-ray imaging sensor 320 when radiated by fluoroscope 310 .
- X-ray imaging sensor 320 detects the x-rays generated by fluoroscope 310 and is thus able to create an image of lesion 420 and resection device 100 .
- Image information detected by x-ray imaging sensor 320 for both lesion 420 and resection device 100 is provided to video processing electronics 330 .
- Video processing electronics 330 processes the image information received from imaging sensor 320 and provides this processed, digitized image data to computer 340 .
- Computer 340 may be any of a variety of processing devices that are capable of processing electronic information, either in a digital or analog format.
- computer 340 could be a personal computer.
- Computer 340 contains software that is able to define a tissue margin 420 A around lesion 420 .
- tissue margin 420 A defines a sufficient area of tissue around lesion 420 such that if the surgeon removes lesion 420 and the tissue surrounding lesion 420 defined by tissue margin 420 A, enough tissue is removed from around lesion 420 to help ensure that all of the diseased tissue is removed from body organ 410 . Additionally, removal of the surrounding tissue defined by tissue margin 420 A also helps to ensure that too much healthy tissue is not removed from body organ 410 .
- computer 340 defines the tissue margin that is to be removed from a tubular body organ when removing a lesion from the tubular organ during a resection procedure.
- computer 340 is provided with digitized image data of lesion 420 within body organ 410 such that computer 340 is able to determine the position, and thus the boundaries, of lesion 420 within tubular body organ 410 .
- computer 340 is able to define tissue margin 420 A around lesion 420 .
- Any number of different methodologies may be utilized to define tissue margin 420 A around lesion 420 and the present invention is not limited to any particular methodology. All that is required is that an objectively determined tissue margin is defined around the lesion to be removed such that the surgeon performing the procedure is able to perform the procedure while considering the defined tissue margin.
- An exemplary methodology for determining tissue margin 420 A around lesion 420 is to utilize a pre-selected absolute measure of tissue.
- computer 340 could define tissue margin 420 A such that the tissue margin consists of a one-inch boundary of tissue extending from the outer boundaries of lesion 420 .
- computer 340 could define tissue margin 420 A as being a measure of tissue that is a pre-selected percentage of a physical dimension of lesion 420 .
- computer 340 could define the tissue margin 420 A such that the margin extends 100% of the thickness of lesion 420 from the outer boundaries of lesion 420 , which in this example would result in a one-inch tissue margin.
- tissue margin 420 A would be defined to encompass a boundary of one-inch of tissue that surrounded lesion 420 .
- Computer 340 may utilize any methodology for defining a tissue margin around a lesion based on the image data of the lesion received from the video processing electronics. The surgeon performing the procedure may selectively set the parameters for defining the tissue margin, based upon considerations of the particular procedure being performed, by inputting the parameters' definitions into computer 340 .
- Video display 350 displays the lesion 420 , the defined tissue margin 420 A around the lesion, and the position of resection device 100 .
- video display 350 provides a visual presentation that the surgeon can monitor while performing the resection procedure and can utilize to operate the resection device 100 such that sufficient tissue defined by tissue margin 420 A is removed when removing lesion 420 .
- video display 350 is illustrated as being a separate element from computer 340 , the video display may be integrated into the computer and, thus, separate structural elements are not required for these components.
- One methodology that the surgeon can utilize when practicing the present invention is to visually observe the defined tissue margin 420 A around lesion 420 when operating resection device 100 .
- the surgeon is able to remove the proper amount of tissue from tubular organ 410 by visually observing the lesion 420 , the defined tissue margin 420 A, and the resection device 100 when performing the resection procedure.
- the surgeon can ensure that the proper amount of tissue, as defined by tissue margin 420 A, is removed from the tubular organ.
- Computer 340 is also detecting the position of resection device 100 as resection device 100 is performing the procedure, if the resection device 100 is operated by the surgeon such that the surgeon is either taking too much tissue or not taking enough tissue, as defined by tissue margin 420 A, computer 340 can provide an alarm to alert the surgeon of the error.
- Computer 340 is coupled to alarm device 360 and may provide either an audible alarm that will sound on alarm device 360 or could provide a signal to alarm device 360 which would be visually displayed on video display 350 .
- an alarm can be provided to alert the physician of this error.
- the above embodiment describes a component for generating an alarm, i.e., alarm device 360 , that is a separate component, it is not required that the alarm function be performed by a component separate from either computer 340 or video display 350 .
- the principles of the present invention may be practiced by including the functionality of the alarm device in either computer 340 and/or video display 350 .
- the alarm function can be performed by a software module contained in any of the other components of the present invention.
- the surgeon performing the procedure may visually monitor video display 350 to control his or her operation of resection device 100 .
- computer 340 can also be directly coupled to resection device 100 .
- computer 340 can directly control resection device 100 .
- computer 340 could be programmed to disable resection device 100 in this situation.
- computer 340 can provide a signal to resection device 100 to disable resection device 100 .
- the resection device could be disabled such that its head assembly could not be opened to receive tissue within it, and/or the cutting blade could be retracted such that it could no longer cut tissue, and/or the suction could be disabled, and/or head-actuating handle 150 could be disabled.
- computer 340 could also provide the visual and/or audible alarms as previously described.
- computer 340 disables resection device 100 if too much tissue was being removed
- computer 340 could also disable resection device 100 if too little tissue was also being removed.
- computer 340 is able to control the operation of resection device 100 by monitoring the positions of the resection device 100 , the lesion 420 , and the defined tissue margin 420 A around lesion 420 .
- computer 340 can also be coupled to fluoroscope 310 .
- computer 340 may control fluoroscope 310 in order to receive a better quality of image data.
- Computer 340 can control fluoroscope 310 in order to attempt to obtain better quality image data by any of a variety of different methodologies.
- computer 340 could physically alter the positioning of fluoroscope 310 such that better quality image data is received or computer 340 could alter the x-ray dosage delivered by fluoroscope 310 .
- computer 340 is able to control fluoroscope 310 in order to provide image data of a higher quality than that possibly originally received from video processing electronics 330 .
- the apparatuses and methods of the present invention can be utilized by a surgeon to guide the surgeon in the resectioning procedure.
- the system monitors the position of the resectioning catheter relative to the tissue margins and warns the surgeon, through either audible alarms and/or visual queues on a video monitor, if either too much or too little healthy tissue is being taken.
- the system is able to control the resectioning catheter, preventing it from cutting unless proper tissue margins are being maintained.
- the present invention is able to safely reduce the amount of healthy tissue that is resected with the diseased tissue while it increases the chances of resecting the entire lesion in a single procedure so that repeat procedures are not necessary. This reduces cost and discomfort to the patient as well as reducing the chances for metastasis of cancerous tissue by reducing the amount of damage to the lesion during its resection.
- the apparatuses and methods of the present invention can be utilized with any of a variety of different resection devices and the present invention is not limited to any particular resection device in practicing the present invention, including the embodiment described in FIGS. 1 and 2 with or without the vision chip and light source.
- a resection device as described in U.S. Pat. No. 5,868,760 which is incorporated herein by reference, may be utilized when practicing the present invention.
- the resection device described in U.S. patent application Ser. No. 09/100,393 filed on Jun. 19, 1998, now issued as U.S. Pat. No. 6,126,058, which is also incorporated herein by reference could also be utilized when practicing the present invention.
- any of a variety of known resection devices can be utilized in the present invention.
- the present invention may be utilized with a flexible endoscopic resection system including a flexible endoscope slidably received through at least a portion of a stapling mechanism comprising an anvil and a stapling head mounted to the anvil so that the anvil and the stapling head are moveable with respect to one another between a tissue receiving position and a stapling position.
- a position adjusting mechanism is provided for moving the anvil and the stapling head between the tissue receiving and stapling positions and a staple firing mechanism sequentially fires a plurality of staples from the stapling head across the gap against the anvil and through any tissue received in the gap and a knife cuts a portion of tissue received within the gap.
- a control unit which remains outside the body is coupled to the stapling mechanism for controlling operation of the position adjusting mechanism and the staple firing mechanism.
- the endoscope is inserted into a naturally-occurring body orifice to locate a lesion, for example, in a tubular organ under visual observation (usually while insufflating the organ).
- a working head assembly including a stapling mechanism and an anvil is slidably advanced along the endoscope into the tubular organ until the working head assembly is in a desired position adjacent to the lesion.
- the working head assembly may be detachably coupled to a distal end of the endoscope, and the entire arrangement may then be inserted into the body orifice under visual observation.
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Abstract
An apparatus and a method for performing a medical procedure is disclosed. The apparatus includes a positioning system and a resection device disposed within the positioning system. The positioning system includes an imaging device, a video processor coupled to the imaging device, a computer coupled to the video processor, and a video display coupled to the computer. The method includes the steps of creating an image of a lesion within a patient's body on an imaging device. Data representative of the lesion image is processed by a video processor. Tissue margins around the lesion are defined by a processor based on the processed data representative of the lesion image and a resection device is operated during a resection procedure within the patient's body based upon the defined tissue margins.
Description
- This application is a Divisional application of U.S. patent application Ser. No. 09/603,886 filed on Jun. 26, 2000 entitled “Apparatus and Method for Performing a Tissue Resectioning Procedure”. The entire disclosure of this prior application is considered as being part of the disclosure of the accompanying application and hereby expressly incorporated by reference herein.
- 1. Field of the Invention
- The present invention relates generally to an apparatus and method for performing a medical procedure. More specifically, the invention provides for identifying target tissue margins and for guiding a tissue resection device to the target tissue in a tissue resection procedure.
- 2. Description of the Related Art
- An endoluminal procedure is a medical procedure that takes place in one of the many tubes, or lumens, within the human body. The endoluminal procedures may take place in vascular, gastrointestinal, or air exchange lumens, and may involve disease diagnosis and/or treatment. Millions of endoluminal procedures are performed each year in hospitals around the world.
- A procedure that is often carried out endoluminally is the removal of “suspect” or diseased tissue. The purpose of such tissue removal, or resection, may be to provide tissue samples for histological analysis or removal of diseased tissue as a treatment means. Today, endoluminal resection of tissue is often done using only the subjective judgment of the clinician to determine where tissue should be removed. As disease tissue margins are sometimes difficult to determine visually, tissue resection guided solely by visual cues can be inaccurate and even dangerous. The danger arises when resectioning cancerous tissues that are prone to metastasize. In this case, a tissue resection that occurs without sufficient buffer of healthy tissue risks leaving behind cancerous tissue requiring repeated resectioning procedures, or worse, causing the cancerous lesion to “seed”, or metastasize, to other parts of the body.
-
FIGS. 1 and 2 illustrate a prior artendoluminal device 100 that could be used in the harvesting of diseased tissue from within a body lumen. The device is comprised of aflexible catheter body 110 with aproximal end 112 anddistal end 114. At theproximal end 112 there is a suction adjustknob 120, acoupler 130, avacuum hose 140, head-actuating handle 150, and anelectrical interconnect 160. Thevacuum hose 140 makes connection from avacuum pump 142, through thecoupler 130, to acentral lumen 170 within thecatheter body 110 to draw a suction on tissue-harvesting chamber 190. Theelectrical interconnect 160 is comprised ofelectrical leads 161 that pass from theexternal electronics 162, through thecoupler 130 at theproximal end 112 of thecatheter body 110 to acavity 116 outside thecentral lumen 170 but within thecatheter body 110. Some of theelectrical leads 161 supply electrical energy to alight source 163 and avision chip 164 situated at thedistal end 114 of thecatheter 110, while another group of theelectrical leads 161 bring electrical signals from thevision chip 164 to a video processor and adisplay device 165. The head-actuating handle connects to a cable (not shown) that travels the length of thecatheter body 110 within thecentral lumen 170 to control the operation of the endoluminal device'shead assembly 180. -
FIG. 2 is a detailed view of thedistal end 114 of thedevice 100 ofFIG. 1 . At thedistal end 114 of thecatheter body 110 there is ahead assembly 180, a tissue-harvesting chamber 190, acutting device 192, and thelight source 163 and thevision chip 164. The tissue-harvesting chamber 190 is connected to thecentral lumen 170 of thecatheter body 110. Thecentral lumen 170 is connected to theexternal vacuum pump 142. Thehead assembly 180 is movable with respect to thecatheter body 110 and, thus, can be extended or retracted using the cable that is attached to the head-actuating handle 150 at theproximal end 112 of thedevice 100 and to thehead assembly 180 at thedistal end 114 of thedevice 100. Thecutting device 192 is a sharpened blade that severs thetissue 200 as the retractinghead assembly 180 presses thetissue 200 against thecutting device 192 to remove thesuspect tissue area 210.Distal end 114 also includesstaples 194 andanvil surface 196 which are utilized to staple the site. Thevision chip 164 is connected to the external video processor anddisplay device 165 via theelectrical leads 161 within thecatheter body 110, but outside of thecentral lumen 170. -
FIG. 2 also illustrates thedistal end 114 of the prior art tissue-resectioning device 100 as it would appear having been inserted into a body lumen. Extended into the body lumen, the Endoscopist would guide thedistal tip 114 of the device into close proximity with thetissue 200 to be resected. By adjusting the suction at thetip 114 with the suction adjustknob 120, the clinician can then increase the suction at thetip 114 until thetissue 200 is drawn into thetissue harvesting chamber 190 through a distal opening 114A and into thetissue harvesting chamber 190. Once the tissue is in position, the clinician can then retract thehead assembly 180 to perform the resection. Thesuspect tissue 210 is removed and the site is stapled with the staples contained in thehead assembly 180. With thetissue sample 210 enclosed within the tissue-harvesting chamber 190, thedevice 100 can be removed from the body lumen and thetissue sample 210 removed. - Today, a tissue-resectioning procedure such as described above would be guided by the clinician based upon whatever limited visual information could be obtained through the
vision chip 164 at thedistal end 114 of thecatheter 110. Whereas histological staining may be used to assist in tissue margin identification, guiding theresection device 100 in the procedure in this manner is still a very subjective process and prone to error. There is a high probability that either too much or too little tissue will be resected. Both of the outcomes are undesirable, and even dangerous. - Therefore, it would be desirable to provide an improved system and method for assisting a practitioner in accurately identifying target tissue margins and guiding the practitioner to the target tissue.
- An apparatus and a method for performing a medical procedure is provided. In an embodiment for an apparatus of the present invention, the apparatus includes a positioning system and a resection device disposed within the positioning system. The positioning system includes an imaging device, a video processor coupled to the imaging device, a computer coupled to the video processor, and a video display coupled to the computer. In an embodiment for a method of practicing the present invention, the method includes the steps of creating an image of a lesion within a patient's body on an imaging device. Data representative of the lesion image is processed by a video processor. Tissue margins around the lesion are defined by a processor based on the processed data representative of the lesion image and a resection device is operated during a resection procedure within the patient's body based upon the defined tissue margins.
- The various features of the invention will best be appreciated by simultaneous reference to the description which follows and the accompanying drawings, in which:
-
FIG. 1 illustrates a known endoluminal device; -
FIG. 2 is a detailed view of the distal end of the device ofFIG. 1 ; and -
FIG. 3 is an embodiment of a system for performing a medical procedure in accordance with the principles of the present invention. -
FIG. 3 illustrates an embodiment of a system for performing a medical procedure in accordance with the principles of the present invention. As can be seen inFIG. 3 , thesystem 30 includes apositioning system 300 and aresection device 100. In the illustrated embodiment, thepositioning system 300 includes afluoroscope 310, anx-ray imaging sensor 320,video processing electronics 330, acomputer 340, avideo display 350, and analarm 360. As can be further seen inFIG. 3 , thesystem 30 further includes aresection device 100 that is positionable within thepositioning system 300.Resection device 100, as is well-known in the art, can be utilized to remove aninternal lesion 420 from atubular organ 410 within abody wall 400 of a patient and resect the tissue of thetubular body organ 410 from whichlesion 420 is removed. As will be further explained later in this specification,fluoroscope 310 generates x-rays that are detected by thex-ray imaging sensor 320. The x-rays generated byfluoroscope 310 pass through the patient andlesion 420 to be collected onx-ray imaging sensor 320. A radiopaque die, having selectively been absorbed bylesion 420, creates an image of the boundaries oflesion 420 onx-ray imaging sensor 320. Image information fromx-ray imaging sensor 320 related tolesion 420 is communicated tovideo processing electronics 330 where the video processing electronics processes the image information fromsensor 320 and provides digitized image data tocomputer 340.Computer 340 utilizes the digitized image data to identify atissue margin 420A aroundlesion 420. Thetissue margin 420A is provided tovideo display 350 where the tissue margin can be displayed relative tolesion 420. - In addition to
computer 340 receiving position image data forlesion 420 fromx-ray imaging sensor 320,computer 340 is also able to receive position image data forresection device 100. Thus,computer 340 is able to provide relative positioning data forresection device 100,lesion 420, and the definedtissue margin 420A. - Through use of the
present system 30, if, during the resection procedure, the resection device, through operation by the surgeon, is in danger of severing tissue outside oftissue margin 420A or is in danger of not removing a sufficient amount oftissue surrounding lesion 420, as defined bytissue margin 420A,computer 340 is able to provide an alarm to alarmdevice 360 to alert the physician that is performing the procedure of the particular situation. - Thus, through utilization of
system 30, the physician is able to objectively determine the amount of tissue that is to be removed when preforming the procedure. This provides advantages over the currently known methods and apparatuses that are utilized by surgeons who perform these procedures. As discussed previously, today, a tissue-resectioning procedure is guided by the surgeon based on whatever limited visual information is obtainable through the vision system located at the distal end of the resection catheter. Guiding the resection procedure in this manner is a very subjective process and prone to error, with a danger of taking either too much or too little tissue from around the lesion to be removed. - In further describing the present invention, as described previously,
fluoroscope 310 is utilized to generate x-rays that are directed through the patient's body and, thus, throughlesion 420. Whereas the present invention is described as utilizing an imaging device which consists of afluoroscope 310 and anx-ray imaging sensor 320, any of a variety of different imaging devices may be utilized in practicing the principles of the present invention. For example, a magnetic resonance imaging device (MRI) could be utilized in the present invention to provide an image oflesion 420 andresection device 100. Thus, the present invention is not limited to utilizing a fluoroscope and x-ray energy in practicing the present invention. - As described previously,
lesion 420 absorbs a radiopaque die which creates an image of the lesion on thex-ray imaging sensor 320 whenlesion 420 is radiated by the x- rays emitted fromfluoroscope 310. The radiopaque die may be administered tolesion 420 through any of a variety of procedures and the present invention is not limited to any particular procedure for introducing the radiopaque die withinlesion 420. For example, the die could be administered either intravenously or topically to the lesion site. Similarly, the operating end, or distal end, ofresection device 100 could also contain a radiopaque die on it. This would also allow for the position of the resection device to be detected by thex-ray imaging sensor 320 when radiated byfluoroscope 310. -
X-ray imaging sensor 320 detects the x-rays generated byfluoroscope 310 and is thus able to create an image oflesion 420 andresection device 100. Image information detected byx-ray imaging sensor 320 for bothlesion 420 andresection device 100 is provided tovideo processing electronics 330.Video processing electronics 330 processes the image information received fromimaging sensor 320 and provides this processed, digitized image data tocomputer 340. -
Computer 340 may be any of a variety of processing devices that are capable of processing electronic information, either in a digital or analog format. For example,computer 340 could be a personal computer.Computer 340 contains software that is able to define atissue margin 420A aroundlesion 420. As described previously,tissue margin 420A defines a sufficient area of tissue aroundlesion 420 such that if the surgeon removeslesion 420 and thetissue surrounding lesion 420 defined bytissue margin 420A, enough tissue is removed from aroundlesion 420 to help ensure that all of the diseased tissue is removed frombody organ 410. Additionally, removal of the surrounding tissue defined bytissue margin 420A also helps to ensure that too much healthy tissue is not removed frombody organ 410. Thus,computer 340 defines the tissue margin that is to be removed from a tubular body organ when removing a lesion from the tubular organ during a resection procedure. - As described previously,
computer 340 is provided with digitized image data oflesion 420 withinbody organ 410 such thatcomputer 340 is able to determine the position, and thus the boundaries, oflesion 420 withintubular body organ 410. By knowing the position oflesion 420 withinbody organ 410,computer 340 is able to definetissue margin 420A aroundlesion 420. Any number of different methodologies may be utilized to definetissue margin 420A aroundlesion 420 and the present invention is not limited to any particular methodology. All that is required is that an objectively determined tissue margin is defined around the lesion to be removed such that the surgeon performing the procedure is able to perform the procedure while considering the defined tissue margin. - An exemplary methodology for determining
tissue margin 420A aroundlesion 420 is to utilize a pre-selected absolute measure of tissue. For example,computer 340 could definetissue margin 420A such that the tissue margin consists of a one-inch boundary of tissue extending from the outer boundaries oflesion 420. Alternatively,computer 340 could definetissue margin 420A as being a measure of tissue that is a pre-selected percentage of a physical dimension oflesion 420. For example, iflesion 420 has a thickness of one-inch,computer 340 could define thetissue margin 420A such that the margin extends 100% of the thickness oflesion 420 from the outer boundaries oflesion 420, which in this example would result in a one-inch tissue margin. Thus,tissue margin 420A would be defined to encompass a boundary of one-inch of tissue that surroundedlesion 420. - Whereas two alternative methodologies for defining
tissue margin 420A are provided above, as stated previously, any number of methodologies can be utilized for definingtissue margin 420A and the present invention is not limited to any particular methodology.Computer 340 may utilize any methodology for defining a tissue margin around a lesion based on the image data of the lesion received from the video processing electronics. The surgeon performing the procedure may selectively set the parameters for defining the tissue margin, based upon considerations of the particular procedure being performed, by inputting the parameters' definitions intocomputer 340. - Once
computer 340 has definedtissue margin 420A aroundlesion 420,computer 340 provides this definedtissue margin 420A tovideo display 350.Video display 350 displays thelesion 420, the definedtissue margin 420A around the lesion, and the position ofresection device 100. Thus,video display 350 provides a visual presentation that the surgeon can monitor while performing the resection procedure and can utilize to operate theresection device 100 such that sufficient tissue defined bytissue margin 420A is removed when removinglesion 420. Whereasvideo display 350 is illustrated as being a separate element fromcomputer 340, the video display may be integrated into the computer and, thus, separate structural elements are not required for these components. - One methodology that the surgeon can utilize when practicing the present invention is to visually observe the defined
tissue margin 420A aroundlesion 420 when operatingresection device 100. The surgeon is able to remove the proper amount of tissue fromtubular organ 410 by visually observing thelesion 420, the definedtissue margin 420A, and theresection device 100 when performing the resection procedure. By visually observing the position of theresection device 100 relative to thelesion 420 andtissue margin 420A during the procedure, the surgeon can ensure that the proper amount of tissue, as defined bytissue margin 420A, is removed from the tubular organ. - Because
computer 340 is also detecting the position ofresection device 100 asresection device 100 is performing the procedure, if theresection device 100 is operated by the surgeon such that the surgeon is either taking too much tissue or not taking enough tissue, as defined bytissue margin 420A,computer 340 can provide an alarm to alert the surgeon of the error.Computer 340 is coupled toalarm device 360 and may provide either an audible alarm that will sound onalarm device 360 or could provide a signal to alarmdevice 360 which would be visually displayed onvideo display 350. Thus, as the surgeon is watching the video presentation of the procedure onvideo display 350, if the surgeon is operatingresection device 100 such that it is not removing tissue as defined bytissue margin 420A, an alarm can be provided to alert the physician of this error. - Whereas the above embodiment describes a component for generating an alarm, i.e.,
alarm device 360, that is a separate component, it is not required that the alarm function be performed by a component separate from eithercomputer 340 orvideo display 350. The principles of the present invention may be practiced by including the functionality of the alarm device in eithercomputer 340 and/orvideo display 350. Thus, the alarm function can be performed by a software module contained in any of the other components of the present invention. - In continuing with the description of the methodologies of the present invention, as described above, the surgeon performing the procedure may visually monitor
video display 350 to control his or her operation ofresection device 100. Alternatively, as is illustrated inFIG. 3 ,computer 340 can also be directly coupled toresection device 100. Thus,computer 340 can directly controlresection device 100. For example, rather than having to rely on the surgeon visually monitoring the position ofresection device 100 with respect to the definedtissue margin 420A onvideo display 350, ifcomputer 340 detects an error in the physician's positioning ofresection device 100 outside of definedtissue margin 420A, i.e., too much tissue is being removed,computer 340 could be programmed to disableresection device 100 in this situation. Thus, ifcomputer 340 determines thatresection device 100 is being operated such that tissue outside of definedtissue margin 420A is being removed,computer 340 can provide a signal toresection device 100 to disableresection device 100. For example, the resection device could be disabled such that its head assembly could not be opened to receive tissue within it, and/or the cutting blade could be retracted such that it could no longer cut tissue, and/or the suction could be disabled, and/or head-actuating handle 150 could be disabled. These, or any of a variety of other methodologies, could be utilized to disableresection device 100. Thus, due tocomputer 340 disablingresection device 100 if the resection device is mis-positioned, the physician is not physically able to remove too much tissue from aroundlesion site 420. In addition to disablingresection device 100 in this circumstance where too much tissue is about to be removed,computer 340 could also provide the visual and/or audible alarms as previously described. - Whereas it was described above that
computer 340 disablesresection device 100 if too much tissue was being removed,computer 340 could also disableresection device 100 if too little tissue was also being removed. - As described above, in an embodiment of the present invention,
computer 340 is able to control the operation ofresection device 100 by monitoring the positions of theresection device 100, thelesion 420, and the definedtissue margin 420A aroundlesion 420. - As is further illustrated in
FIG. 3 ,computer 340 can also be coupled tofluoroscope 310. Thus, based on the quality of the image data received bycomputer 340 fromvideo processing electronics 330,computer 340 may controlfluoroscope 310 in order to receive a better quality of image data.Computer 340 can controlfluoroscope 310 in order to attempt to obtain better quality image data by any of a variety of different methodologies. For example,computer 340 could physically alter the positioning offluoroscope 310 such that better quality image data is received orcomputer 340 could alter the x-ray dosage delivered byfluoroscope 310. Thus,computer 340 is able to controlfluoroscope 310 in order to provide image data of a higher quality than that possibly originally received fromvideo processing electronics 330. - Thus, as described above, the apparatuses and methods of the present invention can be utilized by a surgeon to guide the surgeon in the resectioning procedure. With knowledge of the objectively-defined tissue margins of the lesions, the system monitors the position of the resectioning catheter relative to the tissue margins and warns the surgeon, through either audible alarms and/or visual queues on a video monitor, if either too much or too little healthy tissue is being taken. In another embodiment of the invention, as described above, the system is able to control the resectioning catheter, preventing it from cutting unless proper tissue margins are being maintained.
- Whereas fluoroscopy has been previously known in assisting surgeons to visualize a treatment site during orthopedic surgery, it is not known to use such a system with a resection procedure. The present invention is able to safely reduce the amount of healthy tissue that is resected with the diseased tissue while it increases the chances of resecting the entire lesion in a single procedure so that repeat procedures are not necessary. This reduces cost and discomfort to the patient as well as reducing the chances for metastasis of cancerous tissue by reducing the amount of damage to the lesion during its resection.
- Whereas the previously described embodiments of the present invention would possibly provide a two-dimensional image, it is also possible within the present invention to add a secondary imaging device, e.g., a second x-ray source, and combine the data of the two x-ray sources to create 3-D imagery. U.S. Pat. Nos. 5,772,594 and 5,799,055 describe fluoroscopy in medical procedures and are incorporated herein by reference.
- The apparatuses and methods of the present invention can be utilized with any of a variety of different resection devices and the present invention is not limited to any particular resection device in practicing the present invention, including the embodiment described in
FIGS. 1 and 2 with or without the vision chip and light source. For example, a resection device as described in U.S. Pat. No. 5,868,760, which is incorporated herein by reference, may be utilized when practicing the present invention. Additionally, the resection device described in U.S. patent application Ser. No. 09/100,393 filed on Jun. 19, 1998, now issued as U.S. Pat. No. 6,126,058, which is also incorporated herein by reference, could also be utilized when practicing the present invention. Again, any of a variety of known resection devices can be utilized in the present invention. - More specifically, the present invention may be utilized with a flexible endoscopic resection system including a flexible endoscope slidably received through at least a portion of a stapling mechanism comprising an anvil and a stapling head mounted to the anvil so that the anvil and the stapling head are moveable with respect to one another between a tissue receiving position and a stapling position. A position adjusting mechanism is provided for moving the anvil and the stapling head between the tissue receiving and stapling positions and a staple firing mechanism sequentially fires a plurality of staples from the stapling head across the gap against the anvil and through any tissue received in the gap and a knife cuts a portion of tissue received within the gap. A control unit which remains outside the body is coupled to the stapling mechanism for controlling operation of the position adjusting mechanism and the staple firing mechanism. The endoscope is inserted into a naturally-occurring body orifice to locate a lesion, for example, in a tubular organ under visual observation (usually while insufflating the organ). Once the lesion has been located, a working head assembly including a stapling mechanism and an anvil is slidably advanced along the endoscope into the tubular organ until the working head assembly is in a desired position adjacent to the lesion. Alternatively, the working head assembly may be detachably coupled to a distal end of the endoscope, and the entire arrangement may then be inserted into the body orifice under visual observation.
- The disclosed embodiments are illustrative of the various ways in which the present invention may be practiced. Other embodiments can be implemented by those skilled in the art without departing from the spirit and scope of the present invention.
Claims (34)
1-17. (canceled)
18. A method for performing a medical procedure, comprising the steps of:
creating an image of a lesion within a patient's body on an imaging device;
processing data representative of the lesion image by a video processor from said imaging device;
defining tissue margins around the lesion by a processor based on said processed data representative of the lesion image; and
operating a resection device during a resection procedure within the patient's body based upon said defined tissue margins.
19. The method of claim 18 wherein said step of creating an image of a lesion within the patient's body on an imaging sensor includes the steps of:
applying a radiopaque die to the lesion;
absorbing the radiopaque die by the lesion;
generating x-rays with a fluoroscope; and
radiating the lesion with the x-rays.
20. The method of claim 19 wherein said step of applying a radiopaque die to the lesion includes the step of intravenously administering the radiopaque die to the lesion;
21. The method of claim 19 wherein said step of applying a radiopaque die to the lesion includes the step of topically administering the radiopaque die to the lesion.
22. The method of claim 18 further comprising the step of displaying said tissue margins on a video display.
23. The method of claim 18 wherein said step of operating the resection device during the resection procedure within the patient's body based upon said defined tissue margins includes the step of disabling said resection device if said resection device is positioned outside of said tissue margins.
24. The method of claim 18 wherein said step of operating the resection device during the resection procedure within the patient's body based upon said defined tissue margins includes the step of generating an alarm signal if said resection device is positioned outside of said tissue margins.
25. The method of claim 24 wherein said step of generating an alarm signal if said resection device is positioned outside of said tissue margins includes the step of sounding an audible alarm.
26. The method of claim 24 further comprising the step of disabling said tissue margins on a video display and wherein said step of generating an alarm signal if said resection device is positioned outside of said tissue margins includes the step of displaying a visual alarm on said visual display.
27. The method of claim 19 further comprising the step of controlling said fluoroscope based on said processed data representative of the lesion image.
28. The method of claim 27 wherein said step of controlling said fluoroscope includes the step of altering an x-ray dosage applied by said fluoroscope to improve an image quality of the lesion image.
29. The method of claim 27 wherein said step of controlling said fluoroscope includes the step of changing a physical position of said fluoroscope to improve an image quality of the lesion image.
30. The method of claim 18 wherein said step of creating an image of a lesion within the patient's body on an imaging device is performed by a magnetic resonance imager.
31. The method of claim 18 wherein said step of defining tissue margins around the lesions includes the step of utilizing an absolute measure of tissue.
32. The method of claim 18 wherein said step of defining tissue margins around the lesions includes the step of utilizing a percentage of a physical dimension of the lesion.
33. A system for imaging a tissue to be resectioned that has been marked by a marker, comprising:
an imager which remains outside a body containing the tissue, the imager generating image data of a selected region within the body including the tissue marked for resection;
an image processing unit analyzing the image data to define a region of tissue that includes the tissue to be resectioned and to locate the marker; and
a control unit capable of controlling a resection head to resect the region of tissue based on the defined region of tissue and the location of the marker.
34. The system according to claim 33 , wherein the imager includes a fluoroscope and an x-ray imaging sensor.
35. The system according to claim 33 , wherein the marker is radiopaque.
36. The system according to claim 33 , wherein the defined region of tissue and the location of the marker are displayed on a video display coupled with the control unit.
37. The system according to claim 33 , wherein the control unit is capable of disabling the resection head if the marker indicates that the resection head is oriented outside the defined region of tissue.
38. The system according to claim 33 , further comprising an alarm device, wherein the control unit transmits an alarm signal to the alarm device when the marker indicates that the resection head is oriented outside the defined region of tissue.
39. The system according to claim 38 , wherein the alarm device generates a visual alarm on the video display.
40. The system according to claim 33 , wherein the imager is a magnetic resonance imager.
41. The system according to claim 33 , wherein the control unit determines the defined region of tissue by an absolute measure of tissue.
42. The system according to claim 33 , wherein the control unit determines the defined region of tissue by a percentage of a physical dimension of a lesion.
43. A method for imaging a tissue to be resectioned that has been marked by a marker, comprising:
generating image data of a selected region within the body including the tissue marked for resection;
analyzing the image data to define a region of tissue that includes the tissue to be resectioned and to locate the marker; and
controlling a resection head to resect the region of tissue based on the defined region of tissue and the location of the marker.
44. The method according to claim 43 , further comprising displaying the defined region of tissue and the location of the marker.
45. The method according to claim 43 , further comprising disabling the resection head if the marker indicates that the resection head is oriented outside the defined region of tissue.
46. The method according to claim 43 , further comprising transmitting an alarm signal when the marker indicates that the resection head is oriented outside the defined region of tissue.
47. The method according to claim 43 , wherein the defined region of tissue is defined by an absolute measure of tissue.
48. The method according to claim 43 , wherein the defined region of tissue is defined by a percentage of a physical dimension of a lesion.
49. A system for imaging a tissue to be resectioned that has been marked by a marker,comprising:
means for generating image data of a selected region within the body including the tissue marked for resection;
means for analyzing the image data to define a region of tissue that includes the tissue to be resectioned and to locate the marker; and
means for controlling a resection head to resect the region of tissue based on the defined region of tissue and the location of the marker.
50. A computer readable medium containing a set of instructions to be executed by a processor to perform a method for imaging a tissue to be resectioned that has been marked by a marker, the method comprising:
generating image data of a selected region within the body including the tissue marked for resection;
analyzing the image data to define a region of tissue that includes the tissue to be resectioned and to locate the marker; and
controlling a resection head to resect the region of tissue based on the defined region of tissue and the location of the marker.
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